Menopause management complex but possible!
Posted by on October 7, 2011 - 6:10am

Recently, I attended the meeting of the North American Menopause Society (NAMS) in Washington DC along with 1500 other health professionals.    The bottom line:    Estrogen is not the devil, but it is not the panacea for all things female!

When the large Women's Health Initiative was halted in 2002 due to some unexpected findings in women on hormone treatment, the use of hormones significantly dropped.   However, many women found that their most bothersome symptoms returned and some went back on HT with a bit more concern.

The conference focused on new data, much of it refined to look at subsets of women.   It has become significantly clearer that all women are NOT alike when it comes to their health status at the time menopause begins, their age at onset, and the intensity of symptoms. Thus, generalizing outcomes to all women makes little sense.

Here are a few key points that were discussed at the meeting and are currently being studied by researchers:

  • Ill effects in the WHI  participants were more predominant in women who were 10 years post menopause when it came to heart disease.    The latest research suggests that estrogen can make atherosclerosis (one cause of heart disease) worse in women who already have it, but it may delay or prevent it in women who still have healthy arteries.
  • There is an increased risk of breast cancer in hormone users but the absolute numbers were small and were more prevalent among those who took HR that contained both estrogen and progesterone.   Women on estrogen alone had risks similar to placebo.   There is growing interest in the role certain types of progesterone  used in combination therapy play in breast cancer risk.
  • There is a major concern about osteoporosis and bone fractures among aging women whose estrogen levels are dropping.   As one researcher put it, "breaking a hip (in older women) can  kill you faster than breast cancer".   Approximately 50% of women over age 50 will have at least one fracture and we know that hormone therapy significantly reduces that risk. Understanding personal risk profiles for these two conditions should be part of the decision process.
  • While there are more drugs on the market to help maintain bone health, there is more long term data available  on their use that is indicating some alarming side effects with prolonged use. Some of these side effects may be worse than those related to hormone therapy.
  • Researchers are finding that the stages of the menopause transition are quite complex and there may be several levels of the transition that may need different interventions.
  • Vaginal atrophy in women including breast cancer survivors  can be devastating and reasonable treatment options are sorely needed.
  • Since the WHI, there are new treatment options available today for menopause symptoms using different drug formulas and different means of applications (pills, patches, creams, gels and sprays) that may have reduced risk profiles.

That's just a sampling of the many topics discussed at this conference.    Our Institute has been awarded a grant from the Evergreen Initiative at Northwestern Memorial Hospital Foundation to create a decision making tool for women who are menopausal and having bothersome symptoms.    As a result, we will be focusing on all aspects of menopause this year through our educational and fact finding events and I encourage you to follow our blog for our latest findings.

Saw Palmetto Ineffective for Prostate Symptoms
Posted by on October 4, 2011 - 4:16pm

Ladies, share this blog with the men in your life.     Long-term adminstration of the dietary supplement saw palmetto, even at three times the usual dose, did not reduce symptoms of prostate enlargement significantly better than placebo in a large group of middle-aged men, according to the most rigorous study of the popular herb.

"The bottom line is don't waste your money on saw palmetto supplements for an enlarged prostate," said senior study author Kevin McVary, M.D., a professor of urology at Northwestern University Feinberg School of Medicine. "It doesn't work any better than a placebo.”  McVary suggested men with enlarged prostate talk to their doctors about medications that shrink or relax the prostate or laser surgery, the most common surgical approach.

The study from researchers at 14 institutions across the United States and Canada appears in the Sept. 28 Journal of the American Medical Association. The lead author is Michael Barry, M.D., of the Massachusetts General Hospital.

Benign prostatic hyperplasia (BPH), commonly referred to as an enlarged prostate, affects around half of men at age 50 and three-quarters by age 80. The condition can be mild, but for many men symptoms such as frequent urination – including the need to visit the bathroom several times at night –- difficulty urinating and weak or intermittent urinary flow interfere with their quality of life. Several conventional medications are available to treat BPH, but their side effects can be unpleasant.

Saw palmetto extract is a common alternative treatment for BPH. Some early studies indicated that saw palmetto could reduce symptoms of BPH, but recent, more rigorous trials had less promising results. The largest previous trial, enrolling 225 men over age 50, found that a standard dose of 160 milligrams twice a day for one year was no better than placebo at relieving symptoms. The current study was designed to see whether longer treatment with higher doses would give better results.

Conducted at 11 North American hospitals, the current trial enrolled men over 45 with moderate symptoms of BPH. Participants took daily doses of identical gelcaps that contained either saw palmetto extract or a placebo. The dosage was doubled 28 weeks into the study and then tripled at 48 weeks. Those receiving saw palmetto started at a standard daily dose of 320 milligrams, increased to 640 and ended at 960. Of the more than 300 participants who completed the study, all reached the triple dose with no significant side effects. At the end of the 72-week study period, participants receiving saw palmetto showed less improvement in a standard index of BPH symptoms than did those taking the placebo.

Support for the study – which was conducted by the Complementary and Alternative Medicine for Urologic Symptoms Study Group – included grants from the National Institutes of Health.

By Marla Paul is the health sciences editor at Northwestern.

Your genes at work
Posted by on October 2, 2011 - 1:16pm

In one of the largest genomic studies ever, an international research consortium identified 29 genetic variations that influence blood pressure. More than half of these variants were previously unknown. The findings provide insights into the biology of blood pressure and may lead to new therapeutic strategies.

High blood pressure, or hypertension, affects over 1 billion people worldwide. It can damage the body in many ways over time, leading to heart disease, stroke, kidney failure and other health problems.

More than 230 researchers across 6 continents scanned the genomes of over 200,000 European people to identify genetic variants that influence systolic and diastolic blood pressure. They followed up by analyzing the genomes of 70,000 people of East Indian, South Asian and African ancestry. The study was funded by the National Institutes of Health. The results appeared in the September 11, 2011, issue of Nature.

The researchers discovered 16 previously unknown variations. Six were found in genes already suspected of regulating blood pressure. The remaining 10 were found in unexpected locations and provide new clues into how blood pressure is controlled. Individually, the genetic variations increased the risk of hypertension by only a tiny amount. However, for people with multiple variants, the effects were significant.

The researchers developed a blood pressure genetic risk score based on the 29 variants they found. Among people with the top 10% of genetic risk score, 29% had hypertension, compared with 16% of those in the lowest risk group. Higher genetic risk scores were associated with increased blood pressure across ethnic groups. The risk score was also a good indicator of hypertension complications, such as increased thickness of the heart chambers, heart failure, stroke and coronary artery disease.

“This is one of the most important studies of the genetics of high blood pressure to date and a significant step toward finding better therapies for it,” says NHLBI Acting Director Dr. Susan B. Shurin.

A related study by the research group, the International Consortium of Blood Pressure Genome-Wide Association Studies, appeared on the same day in Nature Genetics. This other genome-wide association study identified 4 new genetic regions associated with pulse pressure and 2 linked to mean arterial pressure. The influence of these variants on systolic and diastolic blood pressure turned out to be more complex than expected.

Taken together, these findings suggest new genetic pathways underlying blood pressure regulation. They will also likely open new doors to research into treating high blood pressure.

RELATED LINKS:

What is High Blood Pressure?:
http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/

Safety concerns raised on birth control pills containing drospirenone
Posted by on September 30, 2011 - 6:02am

[09-26-2011] The U.S. Food and Drug Administration (FDA) is informing the public that it has not yet reached a conclusion, but remains concerned, about the potential increased risk of blood clots with the use of drospirenone-containing birth control pills. FDA has completed its review of the two 2011 studies that evaluated the risk of blood clots for women who use drospirenone-containing birth control pills, previously mentioned in FDA's Drug Safety Communication issued on May 31, 2011. FDA is continuing its review of a separate FDA-funded study that evaluated the risk of blood clots in users of several different hormonal birth control products (contraceptives). Preliminary results of the FDA-funded study suggest an approximately 1.5-fold increase in the risk of blood clots for women who use drospirenone-containing birth control pills compared to users of other hormonal contraceptives.

"It is unknown at this time whether the reported VTE risk applies to all drospirenone-containing products," the FDA indicated.    Drospirenone-containing products with the higher estrogen dose include Yasmin, Zarah, Syeda, Safyral, and Ocella.   Those with the lower amount of estrogen include Yaz, Loryna, Gianvi, and Beyaz.

Given the conflicting nature of the findings from six published studies evaluating this risk, as well as the preliminary data from the FDA-funded study, FDA has scheduled a joint meeting of the Reproductive Health Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee on December 8, 2011 to discuss the risks and benefits and specifically the risk of blood clots of drospirenone-containing birth control pills.

In the meantime, the agency advised health professionals to inform women taking drospirenone-containing products of the potential clotting risk.  Smoking, being overweight, and having a family history of clotting disorders are all risk factors for VTE that should be discussed with patients, the agency noted.

To read full report click HERE .

 

 

Cancer Drug May Also Work for Scleroderma
Posted by on September 28, 2011 - 2:52pm

A drug used to treat cancer may also be effective in diseases that cause scarring of the internal organs or skin, such as pulmonary fibrosis or scleroderma.

The drug, with the generic name bortezomib, stopped the production of fibrotic proteins in human cells and the development of fibrous scarring in a mouse model of fibrotic disease, according to a new Northwestern Medicine study published in the journal Thorax.  Studies have not yet been done in humans.

“This drug appears to put the brakes on abnormal development of scar tissue in the lungs and skin and may also work in other organs,” said lead author Manu Jain, M.D., associate professor of medicine and of pediatrics at Northwestern University Feinberg School of Medicine. “These diseases have a high fatality rate, and there is no truly effective treatment for them right now.”

Scleroderma is an autoimmune disease that causes progressive thickening and tightening of the skin and can lead to serious internal organ damage and, in some cases, death. Scleroderma affects an estimated 300,000 people in the United States, most frequently young to middle-aged women.

Idiopathic pulmonary fibrosis is a scarring or thickening of the lungs without any known cause that makes it increasingly difficult to breathe. It may affect up to 200,000 people in the U.S. between 50 and 70 years old.

Jain said the drug appears to inhibit a protein called transforming growth factor beta, which is essential for the growth of the scar tissue. Patients with fibrosis have increased levels and activity of the growth factor. Bortezomib is currently used to treat multiple myeloma and lymphoma.

In the study, when researchers gave bortezomib to mice, it prevented the development of a fibrotic-like disease. “The mice that normally get this disease didn’t get it,” Jain said.

Researchers also took fibroblast cells from scleroderma and pulmonary fibrosis patients and incubated those cells with the drug. Fibroblast cells are believed to be important in the development of scarring in humans. The drug prevented the expression of proteins that are necessary for scarring.

Source:  Northwestern Newcenter

Vitamin D for Men, One Size Does Not Fit All
Posted by on September 26, 2011 - 10:21am

African-American men living in areas with low sunlight are up to 3 ½ times more likely to have Vitamin D deficiency than Caucasian men and should take high levels of Vitamin D supplements, according to a new study from Northwestern University Feinberg School of Medicine.

“This study shows that the current one-size fits all recommendations for 600 International Units (IU) of Vitamin D don’t work,” said Adam Murphy, M.D., a clinical instructor in urology at Northwestern’s Feinberg School. “Skin color and sunlight exposure need to be considered for recommended daily allowances of Vitamin D.”

Vitamin D deficiency causes brittle bones and has been linked to such diseases as prostate cancer, diabetes, rheumatoid arthritis and multiple sclerosis.

African-American men have lower levels of Vitamin D because the increased melanin in darker skin blocks the ultraviolet rays necessary for the body to produce the vitamin, Murphy said. Thus, African-American men require up to six times more sun exposure than Caucasian men to make adequate Vitamin D levels.

“It takes a dark-skinned male like myself 90 minutes three times a week to absorb enough sunlight to produce the recommended amount of Vitamin D compared to just 15 minutes three times a week for a Caucasian male,“ said the Chicago-based Murphy, who also is a physician at Jesse Brown VA Medical Center.

African-American men living in Chicago would need to take nearly 2,500 IU’s of Vitamin D daily to reach normal, healthy levels, Murphy said.

The Institute of Medicine recommends adults and children take 600 International IUs of Vitamin D daily, but Murphy says that’s way too low.

All men living in the northern third of the country “from Northern California all the way to Virginia” need to increase their Vitamin D supplementation, Murphy said. But the amount likely varies by region because Chicago residents, for example, aren’t outdoors as much as those who live in Washington or California.

For the study, blood samples were collected from 492 men ages 40 to 79 from three Chicago urology clinics along with demographic and medical information such as body mass index, skin melanin content, sunlight exposure and Vitamin D intake. In the study, 63 percent of African-American men were Vitamin D deficient compared to 18 percent of Caucasian men using the Institute of Medicine minimum recommendation of 20 nanograms per milliliter (ng/ml) of Vitamin D. African-American heritage, a high body mass index and lack of Vitamin D supplementation all were associated with Vitamin D deficiency.

Using the commonly used 30 ng/ml deficiency cutoff, 93 percent of African-American men were deficient in Vitamin D compared to 69.7 percent of Caucasian men.

Researchers found African-American men had an average of 17.2 ng/ml of Vitamin D in their blood serum, which is below the Institute of Medicine minimum recommendation. “When Vitamin D levels in the bloodstream are less than 20 ng/ml the bone starts to become brittle in adults and in kids it causes rickets,” Murphy said.

Caucasian men had an average level of 24.2 units of Vitamin D in their blood.   A future study will look at Vitamin D levels in Hispanic and Asian men.

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

What do you do for your health that takes less than 5 minutes???
Posted by on September 23, 2011 - 6:00am

SEND US YOUR IDEAS!  Being healthy and safe takes commitment, but it doesn't have to be time-consuming, painful, or boring. Most things are simple and take so little time that you'll wonder why you've been avoiding them. Even small steps can mean big rewards in preventing illness and injury.

Find out what you can do in five minutes or less to make a difference to your health and safety. Some things even take less than one minute. Here is a sample of activities you can do to help protect yourself and your family in five minutes or less (SEND US YOUR IDEAS--we'll post the best ones!):

Wash hands (20 seconds)
Buckle up (4 seconds)
Test smoke alarms (10 seconds per alarm)
Eat healthy (2 minutes to make a salad)
Take the stairs (2 minutes to walk two flights)
Make a doctor’s appointment (2 minutes)
Put on a condom (less than a minute)

Remember that maintaining and improving your health is a lifetime journey. So don't get discouraged if you don't "see" those preventive rewards, like the extra pounds you didn't gain, the high blood pressure you didn't get, or the emergency room visit you avoided.

Got headaches? You're not alone!
Posted by on September 22, 2011 - 6:59am

Factoids on headaches!
Headaches account for more than 3 million emergency department visits annually in the U.S., and of those, about 81,000 result in hospital stays.

In 2008, the highest rate of emergency department visits for headaches involved people ages 18 to 44. Migraines accounted for 63 percent of all headache-related hospital stays and women were nearly five times more likely than men to be admitted to the hospital for migraines.  At least, ER doctors aren't telling these women "it's all in your head" like they sometimes do for chest pain! (Click HERE to see our blog on this!)    And, while emergency visits for headaches were higher among rural and low income residents, there was little difference in hospitalization rates by location and income.

 

Source:   U.S. Agency for Healthcare Research and Quality

Uterine stem cells used to treat diabetes in mice
Posted by on September 21, 2011 - 6:02am

Researchers have converted stem cells from the human endometrium into insulin-producing cells and transplanted them into mice to control the animals’ diabetes.  The endometrium, or uterine lining, is a source of adult stem cells. Normally, these cells generate uterine tissue each month as part of the menstrual cycle. Like other stem cells, however, they can divide to form other kinds of cells.

The study’s findings suggest the possibility that endometrial stem cells could be used to develop insulin-producing islet cells. These islet cells could then be used to advance the study of islet cells transplantation as a treatment for people with diabetes. If the transplantation of islet cells derived from endometrial cells is perfected, the study authors write that women with diabetes could provide their own endometrial tissue for such a transplant, sidestepping the chance of rejection posed by tissue from another person. Endometrial stem cells are readily available and can be collected easily during a simple outpatient procedure. Endometrial tissue could also be collected after hysterectomy, the surgical removal of the uterus.

“The study findings are encouraging,” said Louis V. DePaolo, Ph.D., chief of the Reproductive Sciences Branch at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Research to transplant insulin-producing cells into patients with diabetes could proceed at a much faster pace with a relatively accessible source of donor tissue.”

The study authors note that such a treatment would be more useful for people with Type 1 diabetes, in which no insulin is produced. The treatment would be less useful for Type 2 diabetes, in which insulin is usually produced, but in which cells have difficulty using the insulin that is available.

The findings appear in Molecular Therapy. The study was conducted by researchers at Yale University, New Haven, Conn.

The study authors write that endometrial tissue samples could be warehoused in a tissue bank. A large number of samples would make it comparatively easy to find compatible tissue for transplant to women who no longer have a uterus and to men. According to the Centers for Disease Control and Prevention, roughly 600,000 hysterectomies are performed each year in the United States as treatment for a number of disorders and conditions.

In their study, the researchers bathed endometrial stem cells in cultures containing special nutrients and growth factors. Responding to these substances, the endometrial stem cells adopted the characteristics of beta cells, cells of the pancreas that produce insulin.

The incubation process took about three weeks. During this time, the endometrial stem cells took on the shape of beta cells and began making proteins typically made by beta cells. The researchers found that some of these cells also produced insulin.

After a meal, the body breaks food down into components like the sugar, glucose. Glucose then circulates in the blood. In response, beta cells release insulin, which allows the body’s cells to take in the circulating glucose. In their study, the researchers exposed the mature stem cells to glucose and found that, like typical beta cells, the cultured cells responded by producing insulin.

Next, the researchers injected the mature, insulin-making cells into the kidney capsule (membrane surrounding the kidney) of mice having a laboratory-induced form of diabetes. The mice had few working beta cells and very high levels of blood glucose. In mice that did not receive the stem cell therapy, blood sugar levels remained high. Additionally, the mice became lethargic and developed cataracts—both signs of untreated diabetes.

In contrast, mice receiving the cell therapy were active and did not develop cataracts. However, the treatment was not entirely effective, as the animals’ blood sugar remained higher than normal. Still, the animals continued to produce some insulin for six weeks, until the researchers ended the study.

“Verifying how long this treatment stays effective is one of our next research priorities,” said Dr. Taylor, the study’s senior author. “We also will investigate how changing the nutrient bath or increasing the dose of injected cells could make this treatment more effective.”

Dr. Taylor explained that culture and transplantation of endometrial stem cells might prove useful principally for Type 1 diabetes. In this form of the disorder, the immune system destroys the body’s own insulin-producing cells. As a result, insulin is not available to bring blood glucose levels under control. Although a diabetic woman’s immune system would be unlikely to reject islet cells developed from her own endometrial stem cells, it is still possible that her immune system would eventually target the new islet cells in the same way it targeted her original islet cells in the pancreas. For this reason, studies using endometrial stem cells to treat diabetes might first need to find ways to quell the immune attack against the islet cells.

Dr. Taylor added that endometrial stem cell therapy also might one day prove most useful for patients with Type 2 diabetes. In this form of diabetes, islet cells still produce insulin, but cells have trouble using insulin. In some patients with Type 2 diabetes, beta cells eventually die off. Dr. Taylor suggested that the stem cell approach might be helpful for patients at this later stage of the disease.

In 2010, the researchers published a study  which showed that endometrial stem cells could replace brain cells lost in mice having a laboratory-induced form of Parkinson’s disease. See our earlier blog on this.

Should politics drive health information?
Posted by on September 20, 2011 - 10:42am

Where do you get your health information?   Doctors are often too busy to spend much time on preventive care.   The internet is alive with personal and commercial  blogs on the latest health fads. And most recently, politicians are getting into the act.

The latest bruhaha about the HPV vaccine has been front and center in the presidential debate and has hit the airwaves.   In case you are not following this case, one presidential candidate has raised concerns about the safety of the HPV vaccine given to teenage girls to prevent cervical cancer.  And her source:   a woman she met on the campaign trail who said her daughter is mentally retarded due to the vaccine.   Even though this presidential candidate admits that she personally is not a "doctor" or a "scientist",  she still cites this mother's concern in the media as evidence that this HPV vaccine is dangerous!  There was no followup to see if there was any truth to the mother's assertion.   In my mind, what this candidate is doing IS  dangerous because she is using her celebrity status to spread unsubstantiated information about a serious women's health issue!

The Institute for Women's Health Research at Northwestern U. has created this blog site as an authoritative resource for women (and men) around the globe to learn about the latest (evidence-based) research in women's health.   Our sources include the leading scientific institutions around the world.   We also try to put risks and benefits into perspective based on the LATEST EVIDENCE so that you can decide what is best for you.  We acknowledge that science constantly evolves making it even more important the we continue to monitor the latest findings.  And the internet is certainly a good way to keep up.....if you use it wisely.

The good news about this latest political gaffe, is that even the talk shows are pointing out how absurd this candidate's assumptions are.  Maybe it will shed light on how important it is to find credible source for your health information.     By the way, please check out our recent blog on the HPV vaccine by clicking HERE.

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