EXERCISE FOR LIFE

DSCF3133Fall is an invigorating time of year for many people. Even if you are not into fitness, it is a good time to start a plan. Walking in crisp fresh air, surrounded by evolving brilliant foliage colors, can help stimulate daily activity that will generate better health in years to come.

 A recently published medical study noted advanced planning can change the course of your life. Americans are living longer, but not always better. Our current life expectancy is seventy-eight, but with longer life more people are dealing with chronic diseases. So, the goal should be to begin modifying your risk base as soon as possible. Developing fitness in middle age, even if exercise was never a priority for you, reshapes your personal health landscape and can make later years more vibrant.

 In the longitudinal study of 18,000 people beginning in 1970, most of those who were the least fit at the time of their middle-aged checkup, had developed some of the following conditions early in the aging process: dementia, diabetes, heart disease and colon or lung cancer. Those who were most fit in their forties and fifties typically did not develop chronic illnesses until the final five years of their lives, instead of 10-20 years earlier like the less physically fit individuals.

 So if you look at the big picture, exercise is beneficial in delaying illness and living well in later years. Longevity without dementia is determined by genetics, fitness and staying involved mentally and socially. Even walking half an hour a day can improve your health.

 An article reviewing 45 studies, examining physical activity in people with cancer published in the Journal of the National Cancer Institute this year, emphasized the benefits of exercise. There was a decrease in all-cause mortality, including cancer-related death. Many of the studies examined involved women with breast cancer. With exercise, there are improved insulin levels, reduced inflammation and an increase in cells known to attack tumors.

 Muscle cells strengthen with exercise. Balance improves. But another important benefit is better blood flow to organs including the brain. In an animal study published in the journal Learning and Memory, fit animals not only showed improved memory, they generated new neurons in areas of the brain involved with learning.

 We all have many excuses for not being able to exercise. However, if you evaluate your interests and abilities, usually there is something to do to remain active, even if you have physical problems that interfere. Water exercises for individuals with joint and balance problems can increase muscle strength and be relaxing, too. If you have joint or back problems, consider riding a stationary bicycle for non-weight-bearing activity. Talk with your physician. Maybe a consultation with a physical therapist could set you on a course to improve muscle conditioning and your overall health.

If you say, “I’m too tired to exercise” consider this: studies have found exercise energized people, even those undergoing cancer treatments. Remember, exercise doesn’t have to be vigorous. Just taking a slow walk outdoors in the fall sunshine can brighten your day, increase bone-density to ward off osteoporosis, strengthen your muscles and help you live a longer healthier life.

Betty Kuffel, MD

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POST-MENOPAUSAL HORMONE THERAPY IS BACK!

Low Dose Estradiol (bioidentical estrogen) and Dermal Patches Show Benefit

SunFor those who have not experienced hot flashes or flushes, as they are sometimes called, they don’t sound like much of a problem. For most women, they aren’t. For me, someone who is often cold and wears wool socks to bed the year-round, it was a comfortable experience. I was warm enough for the first time in my life, except for experiencing the 108 degree temperatures on a Nevada desert.

The actual cause of vasomotor instability resulting from low estrogen is not fully understood and the problem is highly variable between women. Some are afflicted with numerous episodes each day associated with marked flushing, drenching sweats requiring clothing changes and faintness, while others barely notice the transition of waning hormones.

Women often seek medical care for hot flashes but it is the silent problems evolving without estrogen stimulation become important over time. Hot flashes tend to disappear while related heart disease and osteoporosis evolve causing problems in years to come.

Until about ten years ago, most women with menopausal symptoms were prescribed some form of hormone replacement. But results from the 2002 Women’s Health Initiative (WHI) and the Million Women Study (MWS) changed this practice. There was controversy and confusion among the experts, but in the end, the women lost when the consensus was that hormone replacement carried too much risk. The risks primarily included increased breast cancer, uterine cancer, strokes and blood clots.

Experts decided risks outweighed the benefits and recommended discontinuing hormone therapy. — Suddenly, hot flashes around the world contributed to global warming.

Breaking from the refusal to order hormone replacement for women, in June 2013 the British Menopause Society and Women’s Health Concern updated their guidelines. New recommendations are based on findings from a panel of experts that reanalyzed data from the WHI and MWS studies related to the specific hormones used. This time, when tracking the hormone options, they found low dose bioidentical estrogen, both oral and skin patch, carried less risk.

 Supporting Information

Another article just published in the Journal of the American Medical Association, JAMA, agrees with the use of bioidentical estrogen in hormonal replacement.  A joint University of Washington/Group Health study revealed women taking the generic estradiol had fewer vascular problems than those taking the equine estrogen preparation (Premarin). This difference may be related to clotting factors levels making blood clots more likely in women taking Premarin. Also the risk of having a heart attack was slightly higher in women using Premarin. No difference in stroke risk was seen.

Which Estrogen is Preferred?

There are many forms of estrogen and progesterone, both in oral, patch and cream forms. But estradiol is the same as that produced by the human ovaries. Premarin and other preparations are similar in effect but differ in chemical structure from estradiol. This new evaluation of the 2002 data showed the skin patch delivery of hormones appears most favorable.

 What About Other Risks?

Science evolves. Study outcomes change how we treat diseases. Hormone replacement surged from high utilization to stopping its use all together. Now the transition is back toward favorable aspects of low dose preparations. This is not to say, it is safe in all cases.

  • If you have had breast cancer, even the cell type without estrogen or progesterone receptors, you are probably not a candidate for hormones.
  • If you have had a stroke or venous blood clots in your legs or elsewhere, you would not likely be prescribed either estrogen or progesterone.

 The hormone progesterone is known to increase the risk of heart disease in women. Its use is to induce hormonal withdrawal bleeding and reduce the risk of uterine cancer in association with estrogen replacement in women who have a uterus. Estrogen can be used alone, without progesterone, following hysterectomy.

 If you are troubled with disabling hot flashes or marked bone loss (osteoporosis) you may be a candidate for estrogenHip X-ray replacement. You should discuss taking an FDA–approved bioidentical form of estrogen via skin patch with your physician.

 In my book, Your Heart – Prevent & Reverse Heart Disease, there is a chapter on women’s heart disease and the impact of menopause.  Additional favorable studies are noted reporting similar findings using low dose estrogen after menopause. One such study showed a significant reduction in heart disease with bone density improvements in women who took low dose estrogen.

 Note: “Bioidentical” is not the same as pharmacy-compounded estrogen products that are not standardized and may have variable potency.

 For more information on menopause check out: http://www.womenshealth.gov and my book at http://www.yourheartbook.com.

Betty Kuffel, MD

References:

SAGE Publications. Hormone replacement therapy: British Menopause Society and Women’s Health Concern release updated guidelines. ScienceDaily, 24 May 2013. Web. 2 Oct. 2013.

Nicholas L. Smith. Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens. JAMA Internal Medicine, 2013