The Skinny on Low-fat Diets
According to the most recent findings from a key clinical trial, women need more than a low-fat diet to reduce the risk of heart disease, stroke, breast cancer and colorectal cancer. The National Institutes of Health’s Women’s Health Initiative (WHI’s) discovered a low-fat eating pattern might not significantly reduce the risks of these health risks for postmenopausal women. Experts cannot completely abandon the notion of a low-fat diet since it’s still an effective way to maintain a healthy body weight and prevent obesity. Understanding the differences between “good fats” and “bad fats” is still essential to a healthy lifestyle as is exercise.
The WHI Dietary Modification (DM) trial was based on the hypothesis that a low-fat dietary pattern can reduce the risk of breast cancer, colorectal cancer and heart disease. According to the National Institutes of Health, it was the largest investigative clinical trial on the subject. The $415 million federal study commenced in 1993 and included 48,835 women of multiple races and ethnicities, ages 50-79. The women followed strict health guidelines for 8 years. They frequently congregated in small groups of 8-15 in order for dieticians and nutritionists to monitor them.
The trial was a randomized controlled clinical trial with a “non-intervention” group used to compare the frequency of cases of breast cancer, colorectal cancer and heart disease to those of the “intervention” group. Sixty percent of participants didn’t change their regular eating habits (non-intervention group) while 40% were included in the dietary change group. The low-fat diet was based on fat consumption of 20% of calories consumed per day, high fruit/vegetable (5 or more servings daily), and high grain (6 or more servings daily).
The conclusions state that the low-fat diet does not have a large influence on breast cancer, colorectal cancer or heart disease. The diet did not reduce the incidence of these health problems as many experts once hypothesized. Although the risk of colorectal cancer was unaffected by the dietary change, the National Institutes of Health (NIH) reports a possible benefit for women who were taking aspirin or combined hormone therapy (estrogen plus progestin). NIH qualifies this statement by claiming the results could have been a coincidence but additional benefits were still found from the study.
Although the initial hypothesis was disproved due to the lack of statistical significance in the results, benefits of a low-fat diet do exist. The low-fat diet reduced the risk for breast tumors for the estrogen and progesterone receptor. Also, women who began the study with diets that were very high in fat significantly reduced their risk for invasive breast cancer incidence when they switched to a low fat diet.
Results surprised the professional community as many doctors promoted a low-fat diet to prevent these cancers and diseases. For years, professionals suspected the foods people eat, directly reflect their ability to conflict chronic diseases. Some experts heavily criticize the results of the WIH study for many reasons. Some believe the study was not conducted for a long enough time period. Others consider the fat percentage of calories consumed (20%) was not low enough.
Even with the unpromising results from the WHI study, it is still difficult to dismiss the opinion that a low-fat diet is a good thing. Besides, the study was not designed to investigate the benefits of a low-fat diet. It merely provides a lack of evidence for particular health risk preventions. WHI concludes, “It seems unlikely that changes in any one single food group or source of energy will improve overall health; rather, the total dietary pattern and lifestyle (including exercise) may be the key to better health.” So, we should still resort to the old advice of “get plenty of exercise and eat healthy”.
Eating healthy involves choosing the right fats in your diet. The main types of fats include saturated, polyunsaturated, monounsaturated and trans fatty acids. The good fats are polyunsaturated fats including Omega-6 and Omega-3 (essential fatty acids) and monounsaturated fats. These fats are critical to good health and are in foods such as flax seeds, pumpkin seeds, sunflower seeds, nuts, walnuts, cold-water fish (wild salmon, tuna, sardines, anchovies, shellfish, etc.), or fish-oil supplements, tofu and other types of soy, and many more. Although there is no recommended daily intake of the “good fats”, they are essential to a balanced diet.
All other fats are unhealthy, “bad fats”. They should be cut back in your diet or completely avoided. Trans fatty acids are thought to contribute to the development of cancer and cardiovascular disease. Trans fatty acids are hydrogenised fats and oils that aren’t found anywhere in nature and may be more unhealthy than saturated fats..
Webmd compiled a list of the top 10 “trans fat” foods.
- Butter substitutes- including butter, margarine and shortening
- Packaged foods- including cake mixes, Bisquick and others
- Soups- Ramen noodles, soup cups
- Fast food- Fries, chicken and anything else deep fried in partially hydrogenated oil, pancakes and grilled sandwiches (from the margarine on the grill)
- Frozen food- pies, pot pies, waffles, pizza
- Baked goods- doughnuts (contain shortening in dough, cooked in trans fat), pound cake, cream-filled cookies
- Chips and crackers- potato chips, corn chips, Wheat Thins, Cheez-Its
- Breakfast food- cereals, granola bars, energy bars
- Cookies and candy
- Toppings and dips- nondairy creamers, flavored coffee, gravy mixes, salad dressing
Alternatives to the common items listed above are:
- Soft-tub margarine
- Homemade baking
- Make your own soup or try fat-free or reduced-fat cans
- Skip the fries
- Choose the baked types over breaded ones
- Homemade baking and fat-free baking products
- Pretzels, toast, pita bread are good alternatives
- Whole wheat toast, bagels, many cereals
- Gummy bears, jelly beans
- Skim milk, soy milk or powdered, nonfat dry milk in coffee, fat-free salad dressings
Saturated fats should also be avoided. These fats are usually solid or waxy at room temperature and found in animal products (red meat, poultry, butter, whole milk). Coconut, palm and other tropical oils are also high in saturated fat. The USDA and HHS recommend saturated fats should constitute less than 10% of your total daily calories.
Another important component to lowering health risks during menopausal and post-menopausal years includes exercise. A low-fat diet and a suitable amount of regular exercise is the combination to unlocking a healthy lifestyle. Exercise can reduce your risk of heart disease, breast cancer and osteoporosis. Women who exercise regularly have less ovarian, uterine and colon cancer than sedentary women. The benefits are innumerable. Start today.
Educate yourself on eating right and exercising regularly to prevent major health risks we often see transpire during the menopausal years. Use this knowledge in order to work towards a healthy lifestyle can begin with your next trip to the grocery store. Don’t disregard the low-fat diet as it may be effective in preventing diseases with a different combination of factors which were out of the realms of the WHI study. Alter your lifestyle accordingly and take the right steps to decreasing your health risks as you travel on the menopause path.
Citations:
Kolata, G., “Low-Fat Diet Does Not Cut Health Risks, Study Finds”, New York Times, Feb. 8, 2006.
Seibel, MM. The Soy Solution for Menopause: The Estrogen Alternative. Simon & Schuster, New York, 2003.
“Low-Fat Dietary Pattern and Risk of Invasive Breast Cancer: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial.” Published in the Feb. 8, 2006 Journal of the American Medical Association (Vol. 295, No. 6: 629-642). First author: Ross L. Prentice, PhD, Fred Hutchinson Cancer Research Center.
“Low-Fat Dietary Pattern and Risk of Breast Cancer, Colorectal Cancer, and Cardiovascular Disease: The Women’s Health Initiative (WHI) Randomized Controlled Dietary Modification Trial.” The Women’s Health Initiative Summary of Findings: http://www.whi.org/findings/dm/dm.php.
“National Women’s Health Network’s Perspective on ‘Large Clinical Trial Finds Low-Fat Diet Does Not Reduce Incidence of Breast Cancer, Heart Disease or Stroke’.” National Women’s Health Network, Feb. 8, 2006: http://www.susanlovemd.com/community/flashes/news020806.htm
“News from the Women’s Health Initiative: Reducing Total Fat Intake May Have Small Effect on Risk of Breast Cancer, No Effect on Risk of Colorectal Cancer, Heart Disease, or Stroke.” National Institutes of Health News Release, Feb. 7, 2006.
“Studies Find Little Cancer Benefit in Low-Fat Diet for Older Women.” American Cancer Society, Feb. 7, 2006: http://news.yahoo.com/s/acs/20060208/hl_acs/studies_find_little_cancer_benefit_in_low_fat_diet_for_older_women.
Davis, J.L., “Top 10 Foods With Trans Fats”, WebMD Feature article: http://www.webmd.com/content/Article/70/81100.htm?pagenumber=1.
A Commonly Overlooked Thyroid Disorder: Hashimoto’s Disease
Last month’s thyroid disease article was greatly received among our fellow Red Hot Mamas members. Many women were relieved to hear they are not alone in battling the difficulties associated with the thyroid. Grave’s Disease is the most common type of hyperthyroidism (overactive thyroid). This article is about another notable disorder associated with hypothyroidism (an underactive thyroid): Hashimoto’s Thyroiditis. Like Grave’s Disease, Hashimoto’s Thyroiditis is an autoimmune disease. Hashimoto’s is the most common cause of hypothyroidism and is very common in older women.
Thyroid function and menopause are very closely related and can often be problematic. The hormonal balance becomes offset during menopause and quite often, there is an insufficient production of thyroid hormones. Women with thyroid problems should recognize symptoms early. They should frequently screen their hormones (women age 50 and over should be tested for hypothyroidism every few years) and treat the problem to control proper thyroid function.
Seventy-nine percent of all autoimmune disease patients in the US are women. Hashimoto’s is four times more common among women than men. It is a disorder where the body’s own immune system fights off the thyroid cells causing gradual destruction of the thyroid gland. White blood cells (specifically T-lymphocytes) overrun the thyroid tissue and further damage the organ.
The thyroid is a complex part of the body. It is ultimately controlled by the hypothalamus of the brain that produces the Thyrotropin Releasing Hormone (TRH) and releases it to the pituitary gland. Then the pituitary gland manufactures Thyroid Stimulating Hormone (TSH) which stimulates your thyroid gland to produce and secrete thyroid hormones. In very simplified terms, the thyroid absorbs iodine from foods and combines it with the amino acid tyrosine converting it to the thyroid hormones T3 and T4. T3 is the most active thyroid hormone although T4 is more abundantly secreted. These hormones then regulate metabolism. When levels of thyroid hormone are high enough, the thyroid hormones cause the hypothalamus and pituitary gland to slow down, much like a thermostat turns off when the house temperature reaches a set point. Schematically, the process looks something like this:
Hypothalamus (TRH) -> Pituitary Gland (TSH) <--> Thyroid Gland (T4 and T3) -> Metabolic Activity
Although some Hashimoto’s patients may not have symptoms, they are similar to those of hypothyroidism. Hashimoto’s is a “disease” while hypothyroidism is a “condition”. The effect on you is the same. The thyroid’s decreased ability to produce hormones results in the hypothyroid condition and subsequent symptoms. Fatigue, depression, sensitivity to cold, weight gain, muscle weakness, coarsening of the skin, dry or brittle hair, constipation, muscle cramps, increased menstrual flow and goiter (enlargement of the thyroid gland) are common.
An endocrinologist can recognize thyroid abnormalities and conduct wide array of tests to confirm Hashimoto’s Disease. Blood tests can be conducted to measure levels of T3, T4 and TSH. High levels of antibodies fighting thyroglubin (TG) and thyroid peroxidasae (TPO) may also be verified by blood tests if the patient is suffering from hypothyroidism.
Mild cases exist where these levels can appear normal in blood tests but the condition of hypothyroidism still exists. Other tests may be necessary. Physical examination of the gland can also be used to detect abnormalities. Lymphocytes and macrophages can be found by conducting a needle biopsy on the thyroid. Also, an enlarged thyroid can be seen in a radioactive uptake scan or ultrasound. Often your doctor can feel the enlargement which feels like a swollen butterfly or bowtie on the front of your neck.
Proper diagnosis may be a frustrating experience. The condition cannot always be detected right away. For some people, multiple of tests may be necessary. An endocrinologist can assist you in assessing the symptoms, choosing the tests, diagnosis and treatment options.
Specific treatments for Hashimoto’s Disease do not exist yet but patients are regularly treated for hypothyroidism. Hypothyroidism and Hashimoto’s Disease can be treated safely and effectively but require a life-long therapy. Hormone levels can be brought back to a “normal” state with thyroid hormone pills. Different dosages are available. Finding the proper amount for your specific condition is an individualized experience as with any hormone therapy.
Most prescribed therapies involve replacement of the T4 hormone. Even though the T3 hormone is the most active, T4 is more stable. T3 is a much shorter-acting therapy that has to be taken multiple times a day. Most patients have no problems converting the synthetic T4 hormone to T3 naturally in the bloodstream so most doctors treat patients with some type of synthetic T4 therapy.
Depending on your hormone levels and severity of hypothyroidism, other therapies are available. Some people cannot sufficiently convert T4 to T3 and need some replacement to maintain levels of T3. Low doses of T3 can be given if symptoms of hypothyroidism do not improve. Combining T4 and T3 hormones can benefit some patients but it is a controversial topic among many doctors.
Although some patients need the combination, there are disadvantages. Since T3 is faster-acting than T4, patients usually take it two or three times a day. Compounding pharmacists can mix both hormones. Caution should be used and keep in mind FDA’s position on compounding pharmaceuticals, “Whenever possible, the FDA would recommend that patients use an approved drug. We have more data and reporting requirements on those to assure us of their safety and effectiveness.”
If you suspect a thyroid problem, the first step is to ask your primary doctor. Often they will be able to diagnose the problem. If they are not certain or don’t take care of this problem, ask them for help acquiring an endocrinologist. These specialty doctors can assist in the diagnosis and treatment of common conditions including diabetes, thyroid diseases, metabolic disorders, hormone production, menopause, osteoporosis, hypertension, cholesterol disorders, infertility and cancers of the endocrine glands. One word of caution. If you take HT and your dosage changes, it can effect the amount of thyroid hormone your body needs. Generally, the more HT, the more thyroid hormone you need and visa versa. So be sure to ask your doctor about this adjustment if your HT dosages is adjusted.
Citations:
Wikipedia Online Encyclopedia: http://en.wikipedia.org/wiki/Hashimoto_Disease
Endocrine Disorders and Surgery Information: http://www.endocrineweb.com/thyroiditis.html
Rackowski, P., “Thyroid Disease and Menopause”, Thryoid-Info: http://www.thyroid-info.com/articles/thyroid-and-menopause.htm
Thyroiditis Health Center: http://www.medicinenet.com/thyroiditis/index.htm
Red Hot Mamas and Orange Park Medical Center Draw Tremendous Crowd for February 9th Event: “Making Midlife Magic: Menopause and Beyond”
On the evening of February 9th, Red Hot Mamas founder, Karen Giblin and women’s health expert, Dr. Bruce Bekkar, spoke to an excited audience of over 375 Red Hot Mamas (and Papas!) at the Thrasher-Horne Arts Center in Orange Park, FL. The local Red Hot Mamas group at Orange Park Medical Center was in attendance for a special free event called, “Making Midlife Magic: Menopause and Beyond”.
The event was an educational workshop focusing on teaching couples about what to expect from perimenopause, menopause, and how to maintain a positive attitude during the transition. Women and their partners were encouraged to attend for information and practical advice with topics ranging from hormone therapy to prescriptions for good sex. One main focus of the event was about communicating and opening lines of communication with partners so they can become the supportive significant others they strive to be.
The room glowed with a bright “Red Hot”color. Attendees were greeted by a large number of giant, bright red balloons that were tied around the room. Many women who were already Red Hot Mamas members proudly sported their radiant, red t-shirts. Couples flowed through the door at a steady rate until a whopping 375 people were assembled in the auditorium.
Before the program started, the attendees helped themselves to a buffet dinner and mingled about the variety of complimentary health information and screenings made available for this event. Handouts and health literature were provided by the American Stroke Association, the American Diabetes Association, the American Cancer Society and more. Couples made their rounds gathering information and talking to representatives from these various organizations. They asked questions and collected helpful resources to further their understanding of many health topics associated with menopause.
About ten enthusiastic hospital volunteers escorted people to their seats for the commencement of the speakers’ presentations. The couples were welcomed to their seats by bright red goody bags filled to the brim with handouts to accompany the presentation, “Questions to ask your doctor”, event flyers, learning objectives, pens, and much more. Fervent guests poked through their bags awaiting the beginning of the presentation.
During the program, Karen Giblin and Dr. Bekkar offered an abundance of information to attendees. Both speakers were energized by the welcoming crowd. Dr. Bekkar was relaxed and didn’t skip a beat as he gave the group a taste of his stand-up comedy. His comic relief eased everyone’s tension as he introduced topics that are usually tip-toed around by couples. Men can become uncomfortable talking about a woman’s anatomy but Dr. Bekkar’s straightforward, comedic manner offered a different approach.
For one of Dr. Bekkar’s very amusing activities, he asked the attendees to sketch a woman’s reproductive anatomy, ovaries and all. After all drawings were submitted, Dr. Bekkar revealed the winners. To avoid embarrassing anyone, he showed the winners from a previous event. The group burst out in laughter at the lack of detail most displayed. From two lines on a piece of paper to bunny rabbit drawings, the couples were amazed to see other people lacked the same knowledge of a woman’s anatomy as themselves!
Holding back her laughter as she approached the podium, Karen Giblin introduced her topics, personal experiences and a woman’s approach to menopause. In a composed fashion that is characteristic of most of her presentations, Karen’s topics discussed the many symptoms of menopause. Her encouraging remarks helped many members of the audience as they did not previously know how to deal with the emotional, hormonal upheaval associated with the menopausal experience. Karen’s presentation was light, amusing and optimistic as she approached every topic (including the typically difficult subject of sex) with a gracious smile.
 Attendees also had a chance to talk. For half an hour, the audience participated in a breakout session. This time was specifically designed for the men to separate from the women and ask any questions or thoughts they had on their minds. Dr. Bekkar congregated with the men in a different room than where Karen hosted the ladies. The remarks were kept confidential and never shared among the two groups. The questions and comments that most refrained from asking in the presence of their loved ones were shared. The feedback from both groups was overwhelmingly positive. Everyone enjoyed the time they had to ask and participate in personal discussions.
At the closing ceremony, the men participated in a graduation ceremony. The men’s names were called as they proudly walked to the stage. They accepted their diplomas that read they were now “supportive squeezes”. The commencement officially ended as each one of them shook hands with their instructors, Dr. Bekkar and Karen Giblin.
The feedback from the event attendees has been overwhelmingly enthusiastic and positive. Jill Buie, the Red Hot Mamas program director at Orange Park Medical Center comments, “We definitely reached our target audience. The turnout and exposure for our program was tremendous.” Although the men primarily stayed by their partners most of the time during the event, Ms. Buie states, “It can be awkward for men to discuss these topics but it would be great if they attended all of our programs. The split apart (breakout session) was good. Questions can get personal and this time gave the men a chance to speak out.”
Many thanks are due to Jill Buie, the Red Hot Mamas Program Director at Orange Park Medical Center, who did an outstanding job of coordinating the logistics and helping to get the word out about this event. Many thanks also go out to Noven Pharmaceuticals who was sponsored the program through an unrestricted educational grant. In addition, much appreciation is extended to the staff at Orange Park Medical Center for their continued support of the Red Hot Mamas Program.
If you are interested in attending or hosting an event like “Making Midlife Magic: Menopause and Beyond”, please contact us: info@redhotmamas.org
The crowd mingles and enjoys some of the many activities and information booths available
Dr. Bruce Bekkar presenting for the large gathering
In the Spotlight: Calcium and Vitamin D
In the past two weeks, major research findings have left women even more confused and baffled about some major health topics. Results from some significant studies were released just last week. Calcium and vitamin D may not prevent broken bones and colorectal cancer as we once thought.
Calcium and Vitamin D supplements made headlines on February 16, 2006 when “The New England Journal of Medicine” published the latest Women’s Health Initiative study. The seven years of research included 36,282 women ages 50 to 79. Women were randomly assigned to take either one daily pill of 1,000 milligrams elemental calcium and 400 international units of vitamin D3 or daily placebo pills. The study revealed a 1% higher hip bone density and a 12% lower chance of having a hip fracture for the group taking supplements. No statistically significant difference in the incidence of colorectal cancer was found between the supplement group and the placebo group. The National Institutes of Health statement was released February 15, 2006: http://www.nhlbi.nih.gov/new/press/06-02-15.htm
Women are being bombarded with information from the media. We hear various interpretations of the data that was released “a moment ago”, but who and what should we believe? Throughout all the hype, we cannot abandon the notion that a healthy lifestyle is within our reach. You may be able to get enough calcium and vitamin D from the foods you eat, so make friends with a cow and get a sufficient amount of exposure to sunlight each day (15 minutes). But given the fact of the release of this recent information in the New England Journal of Medicine, we can’t assume a low-fat diet or calcium/vitamin D supplements do not make a difference. These regimens provide many other good benefits.
Health decisions regarding these topics should be treated individually for every woman. The studies are merely one piece of a larger puzzle. Sorting out the facts and making sense of the news is difficult and confusing for a great many of us. If you have concerns about these new findings, discuss them with your doctor- an expert who understands your health and someone you trust and who stays up- to-date on the latest studies.
The evolution of menopause is a mystery that researchers have yet to unfold. We are an extraordinary species of the animal kingdom. Homo sapiens have tremendous psychological capacities. The nature of our behavior is complex as is our ability to rationalize it. We are the most intelligent of all living beings on Earth although we share many similar biological characteristics to our evolutionary primate cousins, the gorilla.
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