PMS: You are what you eat - or something like that

Periods are bad enough without adding premenstrual agonies to the front end. You know what I'm talking about - the bloating, breast tenderness, irritability, fatigue, acne, crying spells, anxiety, and food cravings (chocolate, salt, both - do I hear chocolate covered pretzels anyone?) that occur a week or so before your period arrives.

There has been a lot written in the popular media about easing PMS symptoms through changes in diet, such as consuming less caffeine and sodium and increasing vitamin B intake. But a study published in the Journal of Women's Health actually looked at what proportion of the participants' diets consisted of what kinds of foods (e.g., fats, carbs, fiber) and how these proportions related to their premenstrual symptoms. The study consisted of 3,302 ethnically diverse women who participated in SWAN (Study of Women's Health Across the Nation). They did find some relationships between what women ate and how they felt. But you may be surprised by the results (I sure was).

Fat intake was associated with fewer premenstrual cravings and less bloating (potato chips okay). Caffeine was associated with more anxiety and mood changes (pumpkin spice latte from Starbuck's not okay). Alcohol consumption was associated with less anxiety and mood changes (glass of red wine okay), but more headaches (or maybe not okay). Fiber was associated with more breast pain (bran muffin maybe not okay, I'm still not sure about this one - see below).

Perhaps more important than the dietary findings, they found certain subgroups of women experienced PMS differently. Perimenopausal women reported significantly more premenstrual symptoms than premenopausal women. Additionally, women with depression reported more PMS symptoms, especially anxiety and mood changes. Conversely, 0lder women reported less anxiety, mood changes, and back pain. Finally, overweight and obese women reported more cravings and bloating than normal weight women.

Is there a dietary moral here? The authors of the study say no. With the exception of caffeine, most of the dietary relationships were in the opposite direction - that is, fat and alcohol were actually associated with fewer symptoms, not more. Additionally, I would add there are other benefits of fiber intake that may outweigh the monthly nuisance of breast pain (although I'm not someone who experiences breast pain, so I might be convinced otherwise). They also didn't time their study to measure food intake and then track subsequent symptoms in the same 2-week period. Had they done this, they might have identified some different relationships between food and symptoms. Perhaps the more important part of this study is the identification of subgroups of women who are at higher risk for PMS symptoms, namely perimenopausal women, overweight women, and women with depression. If you are in one of these subgroups and you experience PMS, talk to your health care provider about ways to alleviate your symptoms.

Facebook breastfeeding debate driving you to drink? Not so fast...

If you've been keeping up with the discussions about Facebook letting pro-anorexia members freely mingle (despite research that says "pro-ana" websites are bad for women) while they ban breastfeeding moms for posting pictures of their children eating (despite research that shows breastfeeding is good for women AND their children), you'll know it's enough to drive anyone to drink.

Not so fast. While research does suggest women may receive some benefits from alcohol consumption, new research published yesterday in the online version of the International Journal of Cancer shows caution is in order.

Researchers followed over 41,000 postmenopausal women of diverse ethnic backgrounds, including African-American, Japanese-American, Latina, Native-Hawaiian and White women. They tracked the women for an average of 8 years and recorded their dietary intake (including alcohol consumption), lifestyle decisions, genetic risk factors, and health outcomes. The investigators found women who drank 2 or more alcoholic beverages of any kind (wine, liquor, or beer) daily had twice the risk of contracting endometrial cancer (cancer of the lining of the uterus) as women who did not drink. They did not find an increased risk for endometrial cancer among women who consumed less than 2 alcoholic drinks daily.

When they separated women according to their preferred/most often consumed beverage, there were differences in rates of endometrial cancer. Women who drank 2 or more servings of wine daily were 3 times as likely to develop endometrial cancer as non-drinkers. Women who drank just 1 or more servings of hard liquor were on average twice as likely to develop endometrial cancer as those who abstained. The investigators did not find any differences among women who preferred beer, mostly because few women identified beer as their primary drink of choice.

The investigators also studied alcohol consumption in relation to other risk factors for endometrial cancer, such as body mass index, history of pregnancy, use of hormone replacement therapy, and smoking. They found lean women (women with a BMI less than 25) who consumed at least two drinks daily had greater risk for endometrial cancer than overweight and obese women. Women who never gave birth also were at greater risk for endometrial cancer if they consumed 2 or more drinks daily. Smokers and women who used hormone replacement therapy did not show increased risk for endometrial cancer based on their alcohol consumption.

So while you may derive some health benefits from enjoying your favorite libation, there also are some risks if you get too carried away too often. In addition to "how many" drinks you have, be mindful of how much you pour into a glass. (Do you ever notice a bottle of wine lasts longer in a restaurant - when someone else is pouring - than it does at home?). Here's a guide to standard serving sizes (yes, that reads 5 ounces for a glass of wine). Bottom line: moderation is key.

Avandia - the next Vioxx?

In two studies published in JAMA today, it appears that a popular class of drug for diabetes, known as thiazolidinedione (popular brand names = Avandia [rosiglitazone] and Actos [pioglitazone]) is causing some heart problems. Avandia was found to increase risk for heart attack by 42% and double the risk of heart failure. Actos also was found to increase the risk of heart failure, although it reduced risk of heart attack, stroke and death.

Actos and Avandia are used most often in the treatment of type 2 diabetes. The drugs act on similar mechanisms to lower glucose (blood sugar) levels in the body. They can be prescribed alone, or in conjunction with other therapies, such as insulin.

This is not the first time research has suggested these drugs may cause serious cardiac events. This past May, the New England Journal of Medicine published two studies that also revealed Avandia caused some heart problems. In response, a federal advisory panel met to discuss the drug and voted to keep it on the market. The FDA also placed stricter warnings on both Avandia and Actos in June.

Does this sound familiar? Drs. Solomon and Winkelmayer seem to think so. They wrote a great piece on common threads between the Vioxx case and the current findings on Avandia. It seems the jury is still out, because at present GlaxoSmithKline is keeping Avandia on the market. However, if this does become another Vioxx, let's hope GSK doesn't wait too long to do the right thing.

Meantime, if you're taking Avandia or Actos, you may want to discuss this new research with your health care provider. You also want to remember that good nutrition, exercise, and maintaining a healthy weight are also important for managing your type 2 diabetes.

Metabolic Syndrome: you can decrease your risk

Most people have heard about common diseases like high blood pressure, diabetes, and arthritis. However, few people know about the metabolic syndrome, which is a disorder that affects an estimated 25% of Americans (and growing), and is associated with serious disease.

The metabolic syndrome is a group of conditions related to your metabolism that occur at the same time. These conditions include: (a) obesity, especially around your belly/mid-section; (b) high blood pressure; (c) abnormal cholesterol levels, including low levels of the "good cholesterol" (HDL) and high levels of triglycerides, or fat in your blood; and (d) insulin resistance, where the normal process your body uses to get sugar (glucose) into your cells does not work, resulting in increased levels of both insulin and glucose in your blood. Having any one of these conditions increases your likelihood of heart disease, heart attack, type 2 diabetes, and stroke. However, having them in combination can double and even triple your risk.

The good news is that lifestyle changes are key to preventing and treating the metabolic syndrome. In a study published in this month's International Journal of Obesity, researchers followed 224 people (80% of whom were women) for one year after assigning them to one of four groups: (1) use of an appetite suppressant alone, (2) a lifestyle modification program to lose weight, (3) the appetite suppressant plus the group lifestyle modification, and (4) the appetite suppressant plus brief meetings with their primary care physicians on weight loss, food diaries, healthy food choices, etc.

All weight loss treatments were successful in helping participants lose weight. Further, they found that weight loss decreased risk for metabolic syndrome: for every 2.2 pounds lost, there was an 8% reduction in the risk for the disorder. Additionally, participants who lost at least 5% of their starting body weight were 59.2% less likely to have the metabolic syndrome, and those who lost at least 10% of their starting body weight were 83.2% less likely to have the metabolic syndrome. Essentially, lose weight - even just a couple of pounds - and you can reduce your risk for the metabolic syndrome and related diseases.

Other ways to prevent and treat the metabolic syndrome? Stop smoking, exercise most days, and eat fiber-rich foods. Sounds like just healthy living to me. Couldn't we all use a little more of that?

Red, red wine - go to my heart?

I was reading the newest issue of Food & Wine magazine this weekend when I came across an article touting all the health benefits of wine (yeah! for my love of red wine). I was pleased to see they were citing premier medical journals as the sources of their information. However, as I read the fine print, I was dismayed they were making broad claims about wine promoting longevity and reducing heart attack risk "for all" based on studies conducted on men.

So, I did what any good researcher of women's health would do - I went to Pubmed and searched both for the articles they cited and to see whether there were similar findings about women available. I found a couple of things.

The blanket statement that drinking wine "promotes longevity" may be misleading. While the authors of the study cited in F&W indeed found that men who preferred to drink wine had a 34% reduction in mortality because fewer died cardiovascular-related deaths, it is important to note some key limitations of this research, acknowledged by the investigators themselves. For one, this study is of a fairly homogeneous sample of older men. Second, the wine drinkers were healthier to start, including fewer smokers, lower triglycerides, and lower BMIs (all of which are associated with cardiovascular disease). Thirdly, the authors explicitly state that caution must be used when trying to extend these findings to the general population and especially to women. Finally, the authors note the relationship between wine and lower mortality rate may reflect other research that has shown wine drinkers tend to make healthier food choices than drinkers of other alcoholic beverages, rather than reflect the benefits of wine itself. Future research is most definitely needed before making claims about longevity.

Although F&W's claim that wine reduces heart attack risk referred to (yet another) study of men, there is research out there on women, heart attacks, and alcohol. Investigators studied 1,885 women's drinking patterns and history of non-fatal heart attacks. They found that women who drank alcohol were consistently less likely to have had a heart attack than women who abstained, and this trend was related to how much women drank. Women who drank less than 1 drink per day cut their risk by 4%, whereas women who drank 3 drinks per day cut their risk nearly in half. This is not a license to down a bottle of wine a day, however. The researchers also found that women who drank enough to become drunk at least once a month were three times as likely to have a heart attack as those who did not drink and six times as likely to have a heart attack as those who did drink without becoming intoxicated. Finally, they found that women who drank wine were less likely to have a heart attack than women who drank liquor.

Now I won't argue with F&W about their finding that red wine has tannins, and tannins do protect against heart disease. I also won't argue too much with them about evidence that suggests wine MAY protect against type 2 diabetes, stroke, cataracts, colon cancer, and brain decline, except to say that many of these benefits probably reflect healthier lifestyles rather than properties of wine. What I will say is that you should consume your research as you would a fine wine - pay attention to its complexity and character, gauge its potential, be clear about its possible faults, and know know how to compare it to recognized standards.

Cod Liver Oil for Depression

Omega-3 fatty acids have been shown to protect against disease, including coronary heart disease and cancer. A new study shows that omega-3s also may be useful for depression.

Researchers examined a community-based sample of nearly 22,000 people in Norway. They found that people who took daily cod liver oil, which is rich in omega-3s, were significantly less likely to have high depression symptoms than people who did not consume daily cod liver oil. These calculations were adjusted for other factors associated with depression, including age, smoking habits, alcohol use, exercise habits and use of antidepressants and lithium. Additionally, these researchers found that the longer individuals used cod liver oil, the lower their risk for depressive symptoms.

The dose of cod liver oil that was studied was 0.7 - 1.2 grams of omega-3 fatty acids. Of this, 0.3-0.6 was DHA, which can reduce blood triglycerides, and 0.3-0.6 was EPA., which is thought to lower inflammation. Additionally, the cod liver oil supplements contained vitamins A, D, and E.

Based on this study, cod liver oil or another omega-3 fatty acid supplement might be a useful addition to your diet, especially if you have a family or personal history of depression. In addition to supplements, fish such as wild salmon, herring, mackerel, anchovies, and sardines are great sources of omega-3s. Do be mindful, however, that omega-3 supplementation isn't for everyone. There are some risks, including increased bleeding in patients taking aspirin or coumadin, reduced glycemic control in diabetics, and increased susceptibility to bacterial infection due to a suppressed immune system. Be sure to talk to your doctor to weigh the risks and benefits before you add supplements. Meantime, a little extra fish in the diet never hurt anyone.

Eat Better, Breathe Easier

Most everyone knows that eating a diet high in fruits, vegetables, whole grains, and lean meats reduces the risk of a number of diseases, including cancer and obesity. A study published this month shows that a healthy diet also reduces the risk of chronic obstructive pulmonary disease, or COPD. COPD occurs when the tubes that carry air in and out of the lungs are partially blocked, making it difficult to breathe. This finding is especially significant for women, because the COPD death rate for women nearly tripled between 1980 and 2000.

Smoking and second-hand smoke exposure are the main culprits of COPD, but not all smokers contract COPD. Additionally, this new study shows that even exsmokers had a lower risk of contracting COPD if they primarily consumed healthy foods. Also interesting: lean women (those with a body mass index less than 21) who consumed a higher fat diet with more refined sugars were more likely to contract COPD whether or not they exercised regularly.

Often smoking and poor eating habits go hand-in-hand, so it's clear that women who smoke are at an even greater risk for developing COPD than previously thought. However, these new findings also suggest that even women who used to smoke can help reduce their future risk for COPD by improving their diets. There are a number of resources available to improve eating habits. Here's a sample. Also visit with your doctor, who may be able to tell you about local resources in your community.

As for smoking...let's all breathe easier.

Weight Matters in Pregnancy

Ask the average woman how much weight she should gain during pregnancy, and she'll probably respond 25-35 pounds. This Institute of Medicine guideline has been the practice for nearly 20 years. However, this recommendation is for normal weight women (i.e., body mass index [BMI] 18.5-24.9). The IOM also recommends that overweight and obese women limit their gestational weight gain according to their prepregnancy BMI.

A recent study, however, shows that many overweight and obese women are not limiting their weight gain during pregnancy, and this can have serious consequences for both the mother and newborn. In their study of over 7,500 women, researchers found that 64.3% of overweight and 52.9% of obese women gained more weight during pregnancy than recommended by the IOM for their BMI. Further, overweight and obese women were more likely to deliver by C-section and give birth to infants who were large for gestational age, with associated complications including the infant’s anterior shoulder becoming stuck above the pubic bones during delivery, birth canal lacerations, and fetal hypoglycemia (low blood sugar). Overweight/obese women also were less likely to initiate or continue breastfeeding beyond 10 weeks.

So if you are planning to become pregnant in the next year, take a look at your BMI. If you're above 25, talk to your doctor about steps to lose weight. Further, once you become pregnant, keep an eye on your diet and the scale. Pregnant women need only an additional 300 calories per day. By watching your weight before and during pregnancy, you'll not only improve your own health, but you'll also improve the health of your baby.