New study sounds warning on hormone replacement therapy
An analysis by a federal task force finds that hormone replacement therapy’s risks may outweigh the benefits for women who are past menopause and healthy but hoping to ward off dementia, bone fractures or heart disease.
By Melissa Healy, Los Angeles TimesWomen who are past menopause
and healthy should not use hormone replacement therapy
in hopes of warding off dementia
, bone fractures or heart disease
, says a new analysis by the government task force that weighs the risks and benefits of screening and other therapies aimed at preventing illness.
The recommendation by the U.S. Preventive Services Task Force does not necessarily apply to women who use hormone replacement therapy to reduce menopausal symptoms such as hot flashes, night sweats and vaginal dryness. The balance of harm and benefits for that use is expected to be addressed soon in a report by the federal Agency for Healthcare Research and Quality.
The latest recommendation, published Monday in the Annals of Internal Medicine, comes from an organization accustomed to controversy. In recent months, the task force has recommended against routine breast cancer screenings for most women younger than 50. It has also urged abandonment of the prostate-specific antigen, or PSA, test that has become a standard part of older men’s yearly physicals.
Its latest recommendation could be a bit less controversial but is likely to have detractors among physicians who believe that the dangers of hormone replacement therapy for menopausal women have been overblown.
The recommendation is largely based on revised analyses of the landmark Women’s Health Initiative, a 15-year study involving more than 160,000 women. It comes a decade after the study first linked hormone replacement therapy with higher rates of invasive breast cancer. Those initial findings prompted droves of women to abandon or avoid hormone therapy.
But a decade of subsequent research tempered much of the fear, and preliminary but conflicting studies had suggested that some postmenopausal women taking hormones might benefit from lower rates of bone fractures, dementia and heart disease.
The task force found limited evidence that hormones protect against bone fractures, and no evidence that they reduce the most probable threat — heart disease. It also found that for most menopausal women using hormone therapy, the risk of developing dementia later in life actually rose a bit.
Against such sparse benefits, the panel weighed relatively new evidence of the risks, including a significantly higher rate of life-threatening blood clots in the legs and lungs, a greater probability of gallbladder disease and increased risk of urinary incontinence that persisted in studies for at least three years.
Dr. Kirsten Bibbins-Domingo, chairwoman of the panel, said members took pains to put the possible benefits of hormone replacement therapy in context. One form of the therapy — estrogen alone — did appear to slightly reduce the incidence of breast cancer. Invasive breast cancer looms large as a concern to many women but affects just 11% of them after menopause.
That possible protective effect became less consequential when weighed against hormone therapy’s effects on far more likely risks to women’s health, said Bibbins-Domingo, professor of medicine and of epidemiology and biostatistics at UC San Francisco: It fails to reduce the risk of heart disease, which will affect 30% of women who live past menopause.
It slightly increased the likelihood of dementia, which will affect 22% of all postmenopausal women. It was linked to a higher likelihood of stroke, affecting 21% of these women. And although it slightly reduced the rate of hip fractures, which affect 15% of women past menopause, other medications can do that more effectively.
Today, 1 in 5 postmenopausal American women uses hormone replacement therapy, mostly to treat symptoms such as hot flashes, night sweats and vaginal dryness. That is about half the rate in 2002, when 40% took hormones. But as revisions to the Women’s Health Initiative have relaxed widespread reticence about the medications among women and their physicians, hormone use appears to be creeping back up.
“You would think there wasn’t much room for concern,” said Dr. Rowan Chlebowski, the principal investigator for the Women’s Health Initiative and a professor of medicine at UCLA‘s Harbor campus. “That’s not exactly correct.”
In the last year, the North American Menopause Society, healthcare professionals active in promoting the health of women as they make the transition out of childbearing years, has issued guidance on hormone therapy that has reopened the door to its widespread use, Chlebowski said.
“This [Preventive Services Task Force] recommendation kind of says, ‘Not so fast.’ … It’s a pretty sophisticated argument to make,” Chlebowski said.
The task force said its decision to recommend against hormone therapy for prevention of chronic diseases was based on “at least fair” evidence that the harm outweighed the benefits, or that its use was ineffective. But Bibbins-Domingo, lead author of the report, said the panel struggled with two slightly different mixes of potential harm and benefits: those linked to standard hormone therapy, which includes estrogen and progestin and is used by most women; and those linked to estrogen alone, which is prescribed for women who have undergone uterus removal.
Estrogen alone appears to offer some benefits that estrogen-progestin does not. The task force found that for women past menopause, estrogen offers a small measure of protection against breast cancer, for reasons that are not yet well understood. Only women who have had hysterectomies can take estrogen alone because it has been linked to uterine cancer.
New York Plans to Ban Sale of Big Sizes of Sugary Drinks
Chang W. Lee/The New York Times
Mr. Bloomberg on Wednesday with Linda Gibbs, deputy mayor for health. By each soda is the amount of sugar in it.
By MICHAEL M. GRYNBAUM
New York City plans to enact a far-reaching ban on the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts, in the most ambitious effort yet by the Bloomberg administration to combat rising obesity.
The proposed ban would affect virtually the entire menu of popular sugary drinks found in delis, fast-food franchises and even sports arenas, from energy drinks to pre-sweetened iced teas. The sale of any cup or bottle of sweetened drink larger than 16 fluid ounces — about the size of a medium coffee, and smaller than a common soda bottle — would be prohibited under the first-in-the-nation plan, which could take effect as soon as next March.
The measure would not apply to diet sodas, fruit juices, dairy-based drinks like milkshakes, or alcoholic beverages; it would not extend to beverages sold in grocery or convenience stores.
“Obesity is a nationwide problem, and all over the United States, public health officials are wringing their hands saying, ‘Oh, this is terrible,’ ” Mr. Bloomberg said in an interview on Wednesday in City Hall’s sprawling Governor’s Room.
“New York City is not about wringing your hands; it’s about doing something,” he said. “I think that’s what the public wants the mayor to do.”
A spokesman for the New York City Beverage Association, an arm of the soda industry’s national trade group, criticized the city’s proposal on Wednesday. The beverage industry has clashed repeatedly with the city’s health department, saying it has unfairly singled out soda; industry groups have bought subway ads promoting their cause.
“The New York City health department’s unhealthy obsession with attacking soft drinks is again pushing them over the top,” the industry spokesman, Stefan Friedman, said. “It’s time for serious health professionals to move on and seek solutions that are going to actually curb obesity. These zealous proposals just distract from the hard work that needs to be done on this front.”
Mr. Bloomberg’s proposal requires the approval of the Board of Health, a step that is considered likely because the members are all appointed by him, and the board’s chairman is the city’s health commissioner, who joined the mayor in supporting the measure on Wednesday.
Mr. Bloomberg has made public health one of the top priorities of his lengthy tenure, and has championed a series of aggressive regulations, including bans on smokingin restaurants and parks, a prohibition against artificialtrans fat in restaurant food and a requirement for health inspection grades to be posted in restaurant windows.
The measures have led to occasional derision of the mayor as Nanny Bloomberg, by those who view the restrictions as infringements on personal freedom. But many of the measures adopted in New York have become models for other cities, including restrictions on smoking and trans fats, as well as the use of graphic advertising to combat smoking and soda consumption, and the demand that chain restaurants post calorie contents next to prices.
In recent years, soda has become a battleground in efforts to counter obesity. Across the nation, some school districts have banned the sale of soda in schools; some cities have banned the sales in public buildings.
In New York City, where more than half of adults are obese or overweight, Dr. Thomas Farley, the health commissioner, blames sweetened drinks for up to half the increase in city obesity rates in the last 30 years. About a third of New Yorkers drink one or more sugary drinks a day, the city says. Dr. Farley said there were higher obesity rates in neighborhoods where soda consumption was more common.
The ban would not apply to drinks with fewer than 25 calories per 8-ounce serving, like zero-calorie Vitamin Waters and unsweetened iced teas, as well as diet sodas.
Restaurants, delis, movie theater and ballpark concessions would be affected, because they are regulated by the health department. Carts on sidewalks and in Central Park would also be included, but not vending machines or newsstands that serve only a smattering of fresh food items.
At fast-food chains, where sodas are often dispensed at self-serve fountains, restaurants would be required to hand out cup sizes of 16 ounces or less, even if a customer opts for a diet drink. But free refills — and additional drink purchases — would be allowed
Corner stores and bodegas would be affected if they are defined by the city as “food service establishments.” Those stores can most easily be identified by the health department letter grades they are required to display in their windows.
The mayor, who said he occasionally drank a diet soda “on a hot day,” disputed the idea that the plan would limit choices, saying the option to buy more soda would always be available.
“Your argument, I guess, could be that it’s a little less convenient to have to carry two 16-ounce drinks to your seat in the movie theater rather than one 32 ounce,” Mr. Bloomberg said in a sarcastic tone. “I don’t think you can make the case that we’re taking things away.”
He also said he foresaw no adverse effect on local businesses, and he suggested that restaurants could simply charge more for smaller drinks if their sales were to drop.
The Bloomberg administration had made previous, unsuccessful efforts to make drinking soda less appealing. The mayor supported a state tax on sodas, but it died in Albany, and he tried to restrict the use of food stamps to buy sodas, but the idea was rejected by federal regulators.
With the new proposal, City Hall is now trying to see how much it can accomplish without requiring outside approval. Mayoral aides say they are confident that they have the legal authority to restrict soda sales, based on the city’s jurisdiction over local eating establishments, the same oversight that allows for the health department’s letter-grade cleanliness rating system for restaurants.
In interviews at the AMC Loews Village, in the East Village in Manhattan, some filmgoers said restricting large soda sales made sense to them.
“I think it’s a good idea,” said Sara Gochenauer, 21, a personal assistant from the Upper West Side. Soda, she said, “rots your teeth.”
But others said consumers should be free to choose.
“If people want to drink 24 ounces, it’s their decision,” said Zara Atal, 20, a college student from the Upper East Side.
Lawrence Goins, 50, a postal worker who lives in Newark, took a more pragmatic approach.
“Some of those movies are three, three and a half hours long,” Mr. Goins said. “You got to quench your thirst.”
My Favorite Quinoa Recipe!
3 cups cooked quinoa
1 cup diced cucumber
1 cup diced tomatoes
1 cup grated carrots
1 cup minced green onions
1 cup minced green peppers
1/4 cup minced parsley
1/4 cup minced mint
1 Tbsp lemon juice
1 Tbsp Dijon mustard
1/2 tsp Tabasco
1/4 cup Pritikin Italian Dressing
Mix all ingredients and refrigerate.
Nutrition Values: 120 calories, 3g fiber, 4g protein, 70mg sodium, 1.5g total fat, 0g saturated fat and 0mg cholesterol.
Nutrition notes: Don’t base your diet on these nutrition myths
Elaine Hastings, Nutritionist, Fitness & Healthy Lifestyles Expert
Separate food fact from fiction
We’ve all heard certain “facts” about nutrition so many times that we take them at face value, no longer questioning their validity. I’m going to knock a hole in a few of the things we “know” to be true about food.
Let’s start with the food that’s hardest to avoid: sugar. Those who’ve ever attempted the Atkins Diet or simply tried to avoid sugar probably got a rude
awakening when they started reading labels. Sugar is hiding everywhere: lunch meat, ketchup, salad dressings. The average person in the U.S. consumes about “128 pounds” a year, or 34 teaspoons a day.
Super-size fountain drink, anyone?
But what about sugar causing hyperactivity in kids? Controlled studies prove that’s false. And doesn’t eating sugar put a person at risk for diabetes? No.
What causes diabetes is lack of inactivity, being overweight and a high-calorie diet. Diabetes patients have to cut way down on sugar, but just don’t go there.
Perhaps you’ve heard that brown sugar is healthier than white sugar. Sorry to disappoint, but brown sugar is white granulated sugar with molasses added. The mineral content between the two is insignificant at the end of the day.
Sugar is a refined food that’s been stripped of fiber, water, vitamins and minerals. Avoid foods that list a variant of it as its first three ingredients. This
includes dextrose, lactose, sucrose and maltose. Sugar is calories without nutrients, so picture that 128-pound pile and try to make a dent in it. The “brown vs. white” myth has carried over into the egg department as well. While they may look more natural, brown eggs have no additional nutritional benefits over white. Nor are they higher quality or more flavorful. Hen color determines the eggshell color. White feather hens lay white eggs; red feather
hens lay brown eggs.
While we’re on the subject of protein, I’ll dispel a few other myths. Low-carb diets will cause temporary weight loss but are not a good long-term idea. You may end up ingesting too much cholesterol, which ups the risk of heart disease. Too few fruits and whole grains can lead to a lack of fiber and constipation. Too few carbs can also make a person feel tired, weak or nauseous. Being wobbly at a party can really detract from a girl’s beautiful size 6 cocktail dress.
Another risk of too few carbs is the buildup of ketones in your blood. The kickoff of the Atkins diet is designed to put your body “in ketosis” … but over
time, these ketones cause the body to produce a lot of uric acid, a risk factor for joint swelling (gout) and kidney stones. You’ll also notice your new bad
breath, and your friends may too.
Ketosis makes the body use fat instead of carbs as an energy source. The weight you lose may well be lean muscle and water. So much better to reduce
calories, fat and exercise.
Final myth: cabbage soup and grapefruit burn fat. Nope, sorry, reread the last few paragraphs. You’ll just lose water weight, lean muscle and feel tired
and queasy. And that’s the truth!
make sunday dinner a family affair
There’s good news on the family meal front! Seventy-three percent of families reported eating at home daily in 2010, up from 52 percent in 2003. If you’re not already onboard, start now by making a commitment to eating at least one meal together each week. Sunday night dinner is a loved tradition by many families. Make it one in your home too by turning it into a family affair.
Family meals are especially important for kids, says child nutrition consultant Connie Evers, MS, RD, LD, author of How to Teach Nutrition to Kids. “The statistics are powerful,” she adds. Kids who eat with their families have healthier eating habits, tend to be at a healthier weight and do better in school. And there’s more. “Eating together improves family bonding and improves young children’s verbal skills. And teens and tweens who eat three or more family meals per week exhibit less depression, substance abuse, disordered eating and other risky behaviors.”
Get Everyone Involved
So how can you make the family meal fit into your family’s busy schedule? Start with a good plan and some organization, suggests Vandana Sheth, RD, CDE, spokesperson for the Academy of Nutrition and Dietetics. Plan your menu and shop for your groceries in advance, so cooking is the only thing left to do Sunday evening. Make sure each family member knows that everyone is to be home for dinner at a certain time. And get everyone involved to share the work and feel good about making a contribution. No matter the age, kids can help plan the meal, set the table, prepare the food and clean up, Sheth says.
Little kids can practice counting skills by getting the right number of forks and napkins for the table. Teens love the independence they have when shopping for groceries. Hand them some money and a grocery list and allow them to pick out an extra vegetable or some bread for dinner. Get all hands in the kitchen for food prep too. Making salad? Bring a stool to the sink for younger children to wash the vegetables. Older kids can chop them. When preparing mashed potatoes, you or an older child can cut and cook the potatoes. Little ones will love the mashing. Ask someone to pick out and prepare a fruit dessert too.
Add some fun and excitement with food themes, suggests Sheth. Cover the table with a checkered cloth for an Italian meal. Or cook up some Chinese food and eat with chopsticks. Throw a blanket out and sit on the floor for a family picnic. Let everyone choose a theme and you’ll see that your choices are endless. Now that you’re enjoying the meal, keep everyone involved in conversations by asking each person to share something that happened that day or week that was funny, weird, scary, good or bad.
Before you know it, family dinner will be a time that everyone looks forward to.
Summer Tomatoes, Roasted Corn, Crab and Avocado Salad
== Ingredients ==
12 (ounce) lump crab meat
1 (pint) grape tomatoes, cut in half 1 (whole) avocado, diced
1 1/2 (cup) frozen corn kernels, defrosted and roasted
1/3 (cup) red onion, chopped
2 (whole) limes, juiced
2 (teaspoon) olive oil, divided Pinch (ounce) salt and fresh pepper to taste
== Directions ==
1. Preheat oven to 400 degrees F. In a small bowl combine red onion, lime juice, olive oil, pinch of salt and pepper. Let them marinate at least 5 minutes to mellow the flavor of the onion.
2. Toss corn in 1 tsp. olive oil and spread corn on a cookie sheet and roast in oven for 5 minutes.
3. Mix all ingredients together. Adjust lime juice and salt and pepper. Serve.
–Food on the Table http://foodonthetable.com/recipes/353823