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Fall 2013 | Gazette Health 3

A publication of The Gazette | Fall 2013 Editors Designer Contributing Writers

Corporate Advertising Director Creative Director Prepress Manager Special Sections Coordinator

Kimberly Bamber, Anna Joyce Anna Joyce Karen Finucan Clarkson Scott Harris Arlene Karidis Archana Pyati Dennis Wilston Anna Joyce John Schmitz Ashby Rice

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Content is for informational purposes only and should not be construed as medical advice, nor as a substitute for seeing your own medical professional(s).

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The birth rates for U.S. teens and women in their 20s declined to historic lows in 2012, while birth rates for women in their 30s and early 40s rose, the U.S. Department of Health and Human Services reported.

New Findings on Drugs to

Prevent Breast Cancer

S

CANCER RIBBON: PHOTODISC/THINKSTOCK; BREAST-FEEDING: ISTOCKPHOTO/JOSEGIRARTE; BABY FEET: BANANASTOCK/THINKSTOCK; JOINT PAIN: ISTOCKPHOTO/FSTOP123; SLEEPING PILLS: ISTOCKPHOTO/ANDRESR

cientists found tiny genetic enetic differences that can help lp identify women most likely to benefit from certain drugs to help prevent breast cancer—and who ho should avoid them.

Women at high risk for breastt cancer, such as those with a previous tumor or a family history of the disease, ease, can take medications to lower wer their risk. These drugs include ude tamoxifen and raloxifene. But many women decide not to take them. The drugs don’t always prevent cancer, and in rare cases they can cause serious side effects. If doctors could better predict a patient’s response to therapy, then women could make more informed choices.

To learn more, National Institutes of Healthfunded scientists analyzed the genes of women in a breast cancer prevention study. The women had

taken tamoxifen or raloxifene for several years to reduce their risk for breast cancer.

Two Tw tiny genetic regions tended to differ between be women who did and didn’t develop develo breast cancer while taking the drugs. Women who had “helpful” versions of both bot regions were about six times less likely to t develop breast cancer than women who didn’t di have these versions.

“Our study reveals the first known genetic ge factors that can help predict di which high-risk women should be offered breast cancer prevention treatment tr and which women should be spared any unnecessary expense and risk from taking these medications,” said study leader Dr. James N. Ingle of the Mayo Clinic. “We also discovered new information about how the drugs tamoxifen and raloxifene work to prevent breast cancer.”

–NIH News in Health

Supplements Won’t Help Joint Pain Suffering from joint pain? Calcium and low doses of vitamin D probably won’t help. A study published in the Journal of the Academy of Nutrition and Dietetics found that neither provided relief of joint pain or swelling in women who had reached menopause.

“We’re wearing down over time, and there’s not much to be done about it,” said Dr. Rowan T. Chlebowski, lead author of the study. –Vitamin D Council

More Moms are Breast-feeding

B

reast-feeding rates have continued to rise over the past decade, according to recent data from the Centers for Disease Control and Prevention (CDC).

“This is great news for the health of our nation because babies who are breast-fed have lower risks of ear and gastrointestinal infections, diabetes and obesity, and mothers who breast-feed have lower risks of breast and ovarian cancers,” said CDC Director Tom Frieden, M.D. The percent of babies breastfeeding at 6 months increased from 35 percent in 2000 to 49 percent in 2010. The percent of babies breast-feeding at 1 year

also increased, from 16 to 27 percent, during that same time period, the CDC reported.

In that same 10-year span, the percent of African-American babies being breast-fed at 6 months doubled, reaching 36 percent, according to the Office on Women’s Health, part of the U.S. Department of Health and Human Services.

If recommendations, such as breast-feeding for at least the first six months, were met entirely, it would save $2.2 billion in annual medical costs, Frieden said. A family could save between $1,200 and $1,500 annually on formula, according to the Office on Women’s Health.

Women Take Sleeping Pills More Often Women use prescription sleep aids more frequently than men. Five percent have taken a prescription in the last month to get some shut-eye, compared with 3 percent of men, according to data released in late August by the Centers for Disease Control and Prevention.

Somewhere between 50 million and 70 million Americans suffer from sleep disorders like insomnia, which can not only hinder daily functioning, but also have a negative impact on overall health.

However, long-term use of drugs to help with sleep also presents its own risks, including memory impairment.

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women’sWELLNESS

BY ARCHANA PYATI

D

6 Gazette Health | Fall 2013

sion; and fibromyalgia, a chronic condition that radiates throbbing pain throughout the body. Earlier this year, she endured a bout of pneumonia.

Yet to look at Johnson, 43, is not to behold a sick person. Her skin glows, her smile is radiant and she seems to exude an inner peace. She is a motivational speaker and spoken-word poet. She has published books on selfempowerment and spirituality under the pen name Sanjo Jendayi, which she said means “one who appreciates her past and gives thanks.”

She takes a variety of medications and has been through chemotherapy,

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and credits monthly massage therapy for playing a major role in her sunny disposition. “If I wasn’t receiving massage, I’d be bedridden by now,” she said at a recent session with Nichole Ruffin, a licensed massage therapist (LMT) and owner of Caressence Therapeutic Massage in Greenbelt.

Long considered a ritual of pampering and female bonding, massage is now receiving greater recognition for its medical benefits.

According to an American Massage Therapy Association consumer survey of 1,010 adults in 2012, 50 percent said their doctors encouraged them to get a massage.

The past 15 years have seen several research studies exploring the science behind massage’s impact on specific ailments and diseases. Massage encompasses a range of techniques, from Swedish massage’s gliding strokes and kneading to the penetrative and localized manipulation of deep tissue massage.

Massage therapists receive their licenses from the states in which they choose to practice, and can pursue additional credentials from the National Certification Board for Therapeutic Massage & Bodywork.

What we do know about massage is that it boosts endorphins and

PIXLAND/JUPITERIMAGES/THINKSTOCK

eserie Johnson has suffered a battery of illnesses—some might say more than her fair share. Twelve years ago, the District Heights resident developed ankylosing spondylitis, a form of spinal arthritis possibly linked to an impaired immune system and characterized by pain and stiffness in the lower back and hips. Then came the diagnosis of sarcoidosis, another immune disorder that causes lingering inflammation in the lungs and other organs; lung cancer; hyperten-

One survey showed half of adults reporting their doctor encouraged massage.

Massage may help women trying to get pregnant. improves sleep, blood circulation and range of motion, and these benefits may alleviate symptoms associated with a range of conditions women experience—from cancer to pregnancy to chronic pain, several local massage therapists said.

“The goal is not to think you can cure a client … [but] to help a client feel as comfortable as possible” as they undergo or recover from procedures and treatments, said Ruffin.

FOR PREGNANCY AND INFERTILITY Since it adds significant weight to a woman’s body, pregnancy often leads to discomfort and even pain along the back, hips, neck and shoulders.

Pressure from the uterus on veins connecting the limbs to the heart can create swelling in the hands and feet.

In pregnant women, massage not only alleviates discomfort, but also moves excess fluids away from the limbs toward the center of the body, said Robbin Phelps, LMT and movement education therapist in Takoma Park.

The pain in pregnancy is caused by tightness of the fascia, a connective tissue that wraps around muscles, enabling them to contract and expand and glide against each other.

Phelps said massage softens the fascia, making it stronger and more pliable to support a woman’s expanding belly.

Most therapists recommend positioning pregnant clients on their side after the second trimester, using pillows and bolsters for support.

Additionally, massage reduces the emotional stress that can accompany pregnancy, Phelps said. “It’s very soothing for the pregnant mom to be quiet, to be tended to, and to have some peace and relaxation.”

Massage can also benefit women who are trying to get pregnant. At Pulling Down the Moon, a Chicagobased holistic health center with a branch in Rockville, women receiving fertility treatments can participate in a four-step massage regimen.

Various techniques—some of which are intended to increase blood flow to the pelvic organs—may help clients conceive, said Phelps, who practices at the center three days a week.

Infertility treatment can be hit or miss, so massage helps clients contend with the anxiety and uncertainty. “Pretty much all the women coming there don’t know why they’re not getting pregnant,” and are, therefore, open to alternatives like massage, said Phelps.

FOR CANCER PATIENTS For years, massage was contraindicated for cancer patients due to an erroneous belief that increased blood circulation caused cancer cells to spread.

This view was disputed by studies demonstrating the process by which cancer cells metastasized is too complex to be dictated by increased circulation alone.

Still, the American Cancer Society, which endorses massage as an adjunct therapy for cancer patients, cautions against direct pressure on tumors or lumps until the question of how cancer spreads from these areas “is clearly answered,” according to the society’s website.

Now, massage for cancer patients and survivors has become a growing subspecialty among massage therapists, who in 2007 formed the Society for Oncology Massage (S4OM) to offer special training to peers and education on how massage can relieve pain, side effects of chemotherapy and radiation and irritation of postsurgical scar tissue.

Oncology massage is no different than regular massage, but usually employs lighter strokes, said Lee Anne Blank, LMT, owner of Massuage Associates in Rockville and a charter member of S4OM. Blank said oncology massage varies from client to client, depending on the diagnosis. For example, sessions may be shorter than the standard 50 minutes, positions are modified to accommodate chemotherapy ports or radiation burns and aromatic oils and lotions are never used on patients experiencing nausea.

Cancer patients are at risk for developing blood clots, which therapists avoid touching since it could cause the clot to detach and move, a potentially fatal condition called an embolus, Blank said. At the continued on 21

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women’sWELLNESS

Instead of snacking on a chocolate bar, make a trail mix of dark chocolate chips and nuts.

what & how

Women Should Eat

BY ARLENE KARIDIS

G

DIET AND WOMEN’S DI HEAL ISSUES HEALTH Mood, premenstrual syndrome (PMS), bone h health and gut health are all affected by d diet.

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WOMAN: ISTOCKPHOTO/PONYWANG; TRAIL MIX: ISTOCKPHOTO/IMO. OPPOSITE PAGE: ISTOCKPHOTO/ KARANDAEV

ood nutrition is not only about what we eat, but about h how and when we eat.

Wendy Martens, a certified health Mar and wellness coach and president of c New Pathway to Health in i Glen Echo, promotes a method called eating rhythm to help boost metabolism. With women, weight loss is often the ultimate goal.

“Eating rhythm is about having healthy foods at Marte who also has a mashealthy times,” said Martens, ter’s in counseling from T The George Washington metabol University. “Your metabolism is most efficient in the morning to early afternoon, so you want to afte eat larger meals then, an and smaller meals in the evening, before 7 p.m.,” sshe said, explaining that if you adopt this routin routine and exercise as well, you’ll be more likely to feel satisfied and thus less likely to binge eat.

Anot Another component of eating rrhythm is to consume food slowly and to relax.

This boosts digestion, Th nutrient absorption and nu u ultimately helps with w weight management. Convversely, if you don’t rrelax, you release cortisol and insulin, and ongoing, elevated levels can work against you, she said. “Cortisol adds w weight around the midd dle, and insulin [surge] signals the body to not burn calories or build muscle. And muscle is important; it burns food more efficiently.”

For instance, mood is often related to blood sugar levels, said Fortunato Greenberg, a dietitian at Rebecca Bitzer & Associates in Greenbelt.

“Ways to regulate sugar and improve mood are to limit refined sugar and include more complex carbohydrates [nonstarch] in your diet,” she said.

Fortunato Greenberg also suggested two supplements: vitamin D and omega-3 fats. Many people require supplements for sufficient vitamin D, according to the Vitamin D Council, but you can get plenty of omega-3 fat from foods. She steers clients toward ground flax, salmon, sardines, olive oil and walnuts for this essential fatty acid.

With PMS, Fortunato Greenberg sees cravings as one of women’s greatest issues.

“You should give into them in a healthy way.

Rather than eat a chocolate bar, maybe make a trail mix of dark chocolate chips and nuts so you’re getting protein and healthy fats. And focus on whole foods rather than processed foods high in salt, which can cause bloating,” she said.

For bone health, Fortunato Greenberg recommends calcium and vitamin D. While women may need to supplement calcium, there are plenty of calcium-rich foods, such as dairy, fortified soy milk, fortified cereals, sardines and salmon, tofu and collard greens, she said.

Gut health is related to estrogen. Heather Gunn, a licensed clinical nutritionist and herbalist at Village Green Apothecary in Bethesda, encourages women to learn what foods promote gut function, which is about how the liver works, and about digestion and excretion.

“Estrogen goes through the liver to be broken down and excreted. But typically our modern-day diet doesn’t provide enough nutrients for proper bowel movement, so estrogen is recirculated in the blood.

“A way to improve overall gut health is through a plant-based diet high in magnesium and calcium, including kale, collards and other vegetables.

Good essential fatty acids help too, like nuts, seeds and flaxseed oil,” said Gunn.

She recommends bitter foods—such as artichoke, radish, chicory and endive—stressing nutrients these provide should come from food, not supplements.

women’sWELLNESS

Avoid sugar and cream with tea and coffee. Add a little skim milk instead.

“When you chew the bitters, you activate salivary glands and liver enzymes to start the digestive process.” A few fermented foods, such as tempeh, kimchi and sauerkraut, can also be helpful.

WHAT DOES A HEALTHY PLATE LOOK LIKE? For meals, fill half the plate with fruits and/or vegetables. The remainder of the meal should be mostly lean protein, said Paulette Thompson, a dietitian and owner of Nutrition Education and Counseling Services in Cheverly.

“For snacks, I suggest a handful of nuts, a piece of fruit, popcorn, or some raw baby carrots, sugar snap peas and minipeppers. You can pair this with hummus or low-fat dip.”

With beverages, Thompson recommends going low on sugar, which means watching one’s intake of fruit juices—not just sodas.

“Ideally with tea or coffee you should have no sugar or cream—maybe a little skim milk. You can use artificial sugar if you need this for it to work for you,” she said.

TRACKING CALORIES Michael Berard M.D., who owns a practice in College Park, sees issues where women gain

weight while eating approximately the same diet as men.

“Many times this is based on the science of metabolism,” he said, so he advises women to not just watch what they eat, but also to calculate their consumption.

“I suggest women focus on a balanced diet with appropriate portions of fruit and vegetables. But most important is calorie counting and to be aware of what you are consuming versus what you are burning daily,” said Berard, emphasizing the importance of restricting calories from fat, sugar and starch.

He suggests tools to keep track. “The Internet provides a lot of helpful information on weight management and nutrition,” he said, citing three sources: Weight Watchers (www.weightwatchers.com) for information on nutrition and caloric intake, though there may be a fee; American Diabetes Association (www.diabetes.org) for information on low-sugar diets, as high sugar intake contributes to weight gain whether you have diabetes or not; and CalorieKing (www. calorieking.com), which has a tool that calculates ideal caloric intake.

WHAT TO DRINK Ideally, drink about 2 to 2-and-a-half quarts of mineral water a day. Add a tiny sprinkle or two of sea salt to your water, as the sodium in sea salt holds water and drives it into your cells, said Alan Vinitsky, M.D., an internist in Gaithersburg. n Avoid sugary drinks and those with artificial flavors. Read labels carefully, because even sports drinks, thought by many to be healthy, are often high in both of these ingredients, Vinitsky said. n

COUNTING CALORIES Eat about 300 calories for breakfast, 400 for lunch and 500 for dinner, said dietitian tian Paulette Thompson. Keep snackss to about 100 calories each and havee two or three a day. n Have 0-calorie beverages like water er or naturally flavored waters. Consider der unsweetened tea, unsweetened coffee, or lightly sweetened tea or coffee, said Michael Berard, M.D. n

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women’sPREVENTION

The likelihood of a woman having the genetic mutations is usually 1 in 400.

ISTOCKPHOTO/FTWITTY; OPPOSITE PAGE: COURTESY OF MIRIAM COHEN

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PRE-EMPTIVE

STRIKE Women with Faulty Genes Choose Preventive Mastectomies

BY KAREN FINUCAN CLARKSON

M

iriam Cohen’s 47th birthday was bittersweet. “That’s the age my mother was when she died of breast cancer,” said Cohen, who underwent a preventive mastectomy in 2009. “Nothing is foolproof.

There’s always a chance that something might manifest itself. But I reduced my risk of breast cancer significantly.”

By about 95 percent, according to Nancy Markus, M.D., a breast surgeon at Shady Grove Adventist Hospital in Rockville. “When you look at risk reduction, a prophylactic mastectomy is as close to 100 percent as you can get,” she said.

Of Ashkenazi Jewish descent, Cohen inherited a mutated version of the BRCA1 gene that makes its carriers about five times more likely to get breast cancer than women without the mutation, according to statistics from the National Cancer Institute (NCI). About 60 percent of women with the faulty gene develop breast cancer.

“I always knew I was at high risk,” said the Rockville resident. “I didn’t live in fear of dying from breast cancer, but it was always in the back of my mind.”

BRCA1 and another gene, BRCA2, are part of a class of genes known as tumor suppressors. Certain mutations to these genes strip them of their ability to suppress abnormal cell growth, so cancer is more likely to develop. The likelihood of a woman having the mutation is 1 in 400 unless, like Cohen, she is of Ashkenazi Jewish heritage, in which case it is 1 in 40, according to NCI.

COHEN IS AMONG A NUMBER OF WOMEN WITH the mutation who, after evaluating the odds, believe that the removal of their breasts may add years to their lives. This pre-emptive strike involves major surgery and, usually, breast reconstruction. That translates into hours in the operating room—often on more than one occasion—and weeks of recuperation, not to mention a risk of complications.

It’s not something to be entered into lightly, said Sonya Kella, M.D., a breast radiologist at Shady Grove Adventist Hospital in Rockville and medical director of the Shady Grove Breast Center. A woman’s age, circumstances and life plans all come into play. “Having a double mastectomy may affect sexuality and alter your life,” she said. “A patient in her early 30s who wants to have children and breast-feed may opt for surveillance, whereas a woman who has completed childbearing may have a prophylactic mastectomy.”

Aware of what the surgery involved, Cohen did not initially pursue the option after she tested positive for the gene mutation in 2002. Instead, the mother of two decided to undergo a prophylactic oophorectomy to remove her ovaries. Up to 40 percent of women with a BRCA gene mutation get ovarian cancer, according to NCI. The surgery has the added benefit of cutting breast cancer risk in half for premenopausal women with a BRCA mutation. That’s because the ovaries are the main source of estrogen in a woman’s body and excess estrogen is thought to contribute to certain breast cancers.

For years, Cohen opted for increased surveillance rather than a mastectomy. The recommendations are “a physical exam every six months and an annual mammography,” said Markus. continued on 20

‘‘

I didn’t live in fear of dying from breast cancer,

but it was always in the back of my mind.”

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-Miriam Cohen

Fall 2013 | Gazette Health 11

women’sPREVENTION

BY KAREN FINUCAN CLARKSON

I

12 Gazette Gazette Health Health || Fall Fall 2013 2013 12

dence of two types of cancer in women. A level of protection was noted by researchers at Stanford School of Medicine investigating aspirin’s effect on melanoma, a type of skin cancer. After analyzing data from 60,000 Caucasian women ages 50 to 79, researchers found that those who took aspirin lowered their risk of developing melanoma by 11 percent at one year, 22 percent between one and four years and 30 percent at five years and beyond.

The American Cancer Society (ACS) estimates that this year more than 31,000 women will be diagnosed with melanoma and 3,200 will die from it.

Unlike the melanoma study where aspirin’s benefit was read-

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ily apparent, a study focused on colon cancer showed no risk reduction until after 10 years of taking the drug. Researchers at Brigham and Women’s Hospital and Harvard Medical School, who reviewed data from nearly 40,000 women 45 and older, found the incidence of colorectal cancer was 20 percent lower among those taking aspirin every other day. This year, more than 102,000 colon and 40,000 rectal cancers will be diagnosed and nearly 51,000 people will die from colorectal cancer—the third leading cause of cancer death in women, according to ACS estimates.

THESE STUDIES, WHICH SHOW AN association between a woman’s

aspirin intake and reduction in disease risk, raise a number of questions. Chief among them is how does aspirin prevent certain cancers.

There are theories but no answers, said Stephanie Trifoglio, M.D., an internist and geriatrician with Maryland Geriatric Medicine in Greenbelt. “Aspirin is both a platelet inhibitor and an anti-inflammatory.

Either or both may be a mediator in cancer development,” she said.

Another theory, put forward in a study of esophageal cancer released in June, suggests that aspirin’s effectiveness in fighting cancer comes from its ability to lower rates of DNA mutation.

Aspirin’s anti-inflammatory properties may explain why the drug is

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t is relatively cheap, available over the counter and potentially able to reduce a woman’s risk of cancer, stroke and cognitive decline. But aspirin is not without its own risks.

“Aspirin is an interesting drug, but it’s not for everyone,” said Reed M. Shnider, M.D., a cardiologist with Cardiology Associates, LLC in Olney. “And while some of the recent studies are interesting and show there may be some beneficial effects for women, they are not conclusive.”

Since March, studies have linked aspirin to a reduction in the inci-

Studies have linked the drug to a reduced risk of two types of cancer in women.

don’t really know,” said Trifoglio. widely believed to guard against “Prevention is a relatively young Alzheimer’s disease. Increased brain field … and actually being able to inflammation is thought to be both prevent disease is somewhat new. a cause and result of that disease.

People want answers, but we don’t How aspirin may protect women have them. We’re still figuring it from cognitive decline is unclear, out.” but a Swedish study out of the What they have figured out is University of Gothenburg, pubthat aspirin increases the risk of gaslished last October, suggested that trointestinal bleeding. A meta-analit does. Researchers followed 681 ysis, published in 2012 in JAMA women between 70 and 92 who Internal Medicine, put the risk at were at high risk for heart disease 70 percent for total bleeding events and stroke. At the beginning of the and 30 percent for “nontrivial” study, the women took a series of bleeding events. memory and cogAnother downnitive tests. When Aspirin increases side to aspirin use the tests were the risk of is that it may repeated five years raise the risk of a later, the average hemorrhagic—or score fell. But, the bleeding—stroke, women who had said Shnider. The U.S. Food and consistently taken low-dose aspiDrug Administration has warned rin during the study increased their that the antiplatelet effect of lowscores. The researchers, acknowldose aspirin can be negated by the edging that the mechanism behind concomitant use of ibuprofen. And, aspirin’s protective effect is not when aspirin and ibuprofen are fully understood, suggested that regularly taken together, there’s a the drug “might influence cogfourfold increase in the risk of gasnitive decline by enhancing the trointestinal bleeding, according to cerebral blood flow.” the Harvard Medical School.

Stroke is known to lead to cognitive decline and aspirin lowers the risk of stroke by 17 percent GIVEN ALL THE UNCERTAINTY AND in women over 65, said Shnider. possible side effects, should “Under that age, there’s virtually no women take aspirin? For the vast benefit. And, while aspirin reduces majority under 65, the answer is the incidence of stroke, there’s no no, said Trifoglio, noting that aspiperceived benefit when it comes to rin should be considered only if a heart attack” in women. woman is in a high-risk group—be it for stroke or cancer. “The benefit clearly must outweigh the risk,” OTHER QUESTIONS THAT ARISE include how much aspirin should a she said. That could be the case, for woman take and how often. When example, if a woman has already it comes to stroke prevention, suffered a stroke or has a strong “women benefit from low doses family history of colon cancer. of aspirin, 80 to 100 milligrams “My advice is not to worry too every day or every other day,” said much about aspirin,” said Shnider, Shnider. The typical baby aspirin is “and focus on lifestyle changes and 81 milligrams, regular strength is surveillance—colonoscopies and 325 milligrams and extra-strength blood pressure checks—to reduce is 500 milligrams. your risk.”

Low-dose—75 to 160 milliLifestyle changes and routine grams daily—is what the Swedish screenings are the safest risk women were taking in the study reducers for most women, said that noted the drug’s effect on Trifoglio. “I’ve lived through so cognitive decline. Women in the many studies that were misintercolorectal cancer study took 100 preted … where people jumped milligrams. Of the women in the on the bandwagon” prematuremelanoma study, 75 percent took ly. “These studies are interestregular or extra-strength aspiing and food for discussion with rin. What is most effective? “We your internist.”

gastrointestinal bleeding.

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Fall 2013 | Gazette Health 13

women’sPREVENTION

African-Americans have the highest vitamin D deficiency rate: 88 percent.

Vitamin D

Benefits Become Clearer, But Ideal Dosage Debated The sun’s ultraviolet B rays

BY KAREN FINUCAN CLARKSON

trigger the skin to convert a

L

14 Gazette Health | Fall 2013

type of cholesterol into vitamin D.

Only a few foods—cod liver oil, swordfish, salmon and tuna fish—are good sources of vitamin D, which is why many beverages, such as milk and orange juice, are fortified, said Allen. It is nearly impossible to get adequate vitamin D from food alone, she added.

FOR MOST PEOPLE, VITAMIN D supplements are in order, said Lord.

The question is how much. Over the past 16 years, the recommended dietary allowance has gone from 200

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international units (IU) to 400 IU to the current 600 IU, adopted in 2010, for women up to age 70, including those who are pregnant. At 71, the suggested intake rises to 800 IU. But many studies purporting benefits used higher levels of vitamin D, according to a Mayo Clinic report.

Some physicians and institutions— including Allen, Lord and the Harvard School of Public Health—believe the new recommendations do not give enough weight to recent science. Lord called the guidelines “outrageously

OVER THE PAST YEAR, A NUMBER OF studies have been released indicating widespread health benefits for both the general public and females in particular. Cells and tissues throughout the body have vitamin D receptors, noted Lord, as vitamin D is both a nutrient and steroidal hormone.

Its hormonal status may be linked to vitamin D’s reported ability to help delay the early onset of puberty in girls, said Lord. “The data presented at The Endocrine Society meeting showed that 44 percent of girls with precocious puberty had severe vitamin D deficiency,” he said. That’s more than double the rate for girls with ageappropriate physical development.

Early menarche is a risk factor for breast cancer.

Best known for aiding in the body’s absorption of calcium, vitamin D has long been touted as an essential element in bone health. Insufficient levels of vitamin D lead to low bone-calcium stores, increasing the risk of fractures.

In February, a study in Osteoporosis International confirmed previous find-

ISTOCKPHOTO/DIGITALSKILLET

ong associated with bone health, vitamin D may protect women against a host of ailments—cancer, dementia, depression, diabetes, uterine fibroids and heart disease, to name a few. It may also influence the onset of puberty, effectiveness of in vitro fertilization (IVF) treatment and success of a pregnancy. But with the studies touting these myriad benefits often suggesting dosages exceeding current recommendations, women may well find themselves confused.

At a minimum, vitamin D is important to maintaining good health. Yet 56 percent of women don’t have optimal blood levels of this important nutrient, according to researchers at Massachusetts General Hospital in Boston. Among both men and women, African-Americans have the highest deficiency/insufficiency rate at 88 percent. That’s because the darker skin pigmentation reduces the body’s ability to make vitamin D, according to C. Douglas Lord, M.D., a holistic gynecologist with Women First OB/ GYN Associates in Silver Spring and privileges at MedStar Montgomery Medical Center in Olney.

The sun is a major source of vitamin D. Ultraviolet B rays trigger the skin to convert a type of cholesterol into the vitamin. The increasing use of sunscreen, which blocks the skin’s absorption of UV rays, is thought to contribute to declining vitamin D levels. “For most women, 20 minutes a day outside without sunscreen is probably fine,” said Vanessa Allen, M.D., a family practitioner with Natural Family Wellness in Glenn Dale.

conservative.” Both he and Allen agreed that 5,000 IU daily could be beneficial for the average woman. The current recommended upper limit is 4,000 IU. Overdosing on vitamin D, while unlikely, is possible, said Allen. Unlike water-soluble vitamins, which are excreted from the body when not used, vitamin D is stored in the body’s fat tissue. At extreme levels, vitamin D can raise blood calcium to levels that can cause grogginess, constipation and even death. But, noted the Harvard Medical School, it takes massive overdosing to produce toxicity.

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The vitamin can help treat mood disorders.

A WOMAN’S COGNITIVE HEALTH appears to be tied to sufficient levels of vitamin D, according to several recent studies. Last fall, The Journals of Gerontology published papers linking severe deficiency in older females with a higher risk of developing Alzheimer’s disease and experiencing cognitive impairment and decline.

“Vitamin D can be used for mood disorders,” said Allen. “If you have depression, we might start you on a vitamin D supplement.” Women with type 2 diabetes who showed signs of depression significantly improved their moods and blood pressure, according to the results of a pilot study that was presented in June at the American Diabetes Association’s annual Scientific Sessions in Chicago. The researchers have secured a $1.5 million grant from the National Institutes of Health to do an additional study.

A number of studies over the years have associated low vitamin D levels with a higher risk of prediabetes and type 2 diabetes.

WOMEN LOOKING TO BECOME pregnant through IVF need sufficient levels of vitamin D, according to a June study in CMAJ Open. Of the 173 women undergoing IVF at Toronto’s Mount Sinai Hospital, those with sufficient levels of the vitamin had a significantly higher rate of pregnancy than those who were deficient: 52.5 percent compared with 34.7 percent.

The March of Dimes encourages pregnant women to maintain sufficient levels of vitamin D to reduce the risk of preterm birth. The recommendation is particularly important to African-American women, who give birth prematurely and suffer from low levels of vitamin D more often than white women. Preterm babies tend to have more health complications and are at an increased risk of lasting disabilities. Babies born between 34 and 36 weeks are three times more likely to die in their first year of life than fullterm infants, according to the March of Dimes.

A link between vitamin D and the development of uterine fibroids was reported earlier this year. The National Institute of Environmental Health Sciences Uterine Fibroid Study indicated that women with sufficient levels of vitamin D were 32 percent less likely to have the tumors.

When it comes to cancer, the strongest association is between vitamin D and colorectal cancer, according to the Harvard School of Public Health.

There may be some beneficial effects on cervical and breast cancers, but the jury is still out. A Mayo Clinic report noted a “lack of consistent evidence to support claims that vitamin D reduces the risk of ovarian or pancreatic cancer occurrence.”

Given all the scientific interest in vitamin D, it may not be too much longer before more links between the supplement and specific diseases are cemented and optimal doses identified. “With so many studies going on around the world, the next five years is certain to provide much more detailed information,” said Lord.

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ings that the long-term use of 400 IU of vitamin D and of 1,000 milligrams (mg) of calcium substantially reduces the risk of hip fracture in postmenopausal women. A study accepted for publication in the journal Menopause gave the same dosage to hormone therapy replacement patients and found that postmenopausal women at standard risk for hip fracture who took vitamin D and calcium supplements had a significantly reduced incidence of hip fractures. The U.S. Preventive Services Task Force, meanwhile, came out with recommendations supporting the dosage found in the studies, while noting “that current evidence is insufficient to make a recommendation on daily supplements greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium,” for fractures.

If vitamin D did nothing more than protect bones, it would still be important. But other organs and systems benefit from sufficient levels. “Vitamin D is cardioprotective and can prevent further heart disease,” said Allen.

There is no shortage of studies linking the vitamin to cardiovascular health, and a January study in The Journal of Clinical Endocrinology & Metabolism noted that vitamin D’s ability to reduce the risk of coronary heart disease “is more pronounced in women than in men.”

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commonCONDITIONS

The good news is that for many women, hair loss can be a short-term condition.

Women’s Hair Loss Common.

Complex.

Treatable.

BY SCOTT HARRIS

H

16 Gazette Health | Fall 2013

A GAZETTE PUBLICATION

Women comprise 40 percent of those women as well as men, is androgenetic alopecia, known struggling with some form of hair loss. as male (or female) pattern baldness. As with most cases of women’s hair loss, the condition is characterized by thinning hair across the result, unable to grow hair. Though there is speculascalp, especially on the top or sides, while the front tion about the causes of CCCA, a definitive cause hairline remains intact. A change in the levels of remains elusive. the hormone dihydrotestosterone or DHT can “CCCA occurs more in women of color, postrigger the hair loss, according to the AHLA. sibly because of grooming habits,” Callender said.

“Usually we see this condition during or after “Things like the chemical relaxers or tight menopause, when the hormone starts to decrease,” braids might be behind it, but we really don’t said Valerie Callender, M.D., a dermatologist with know for sure.”

Callender Dermatology & Cosmetic Center in Glenn Another cause of women’s hair loss is telogen Dale. “But it can also happen after puberty or when effluvium. According to the AHLA, telogen effluwomen are in their 20s.” vium is usually triggered by a traumatic event African-American women, Callender said, are like child birth, surgery, a major infection or even particularly susceptible to another condition known extreme stress. For those with this condition, a as central centrifugal cicatricial alopecia (CCCA). In chemical change in the body switches hair from the CCCA sufferers, hair follicles are scarred and, as a growing or resting phase to the telogen—or shed-

ISTOCKPHOTO/WAKILA

air loss is more common in men, but far more complex in women. A range of conditions can cause the problem, which, in turn, makes it fairly difficult to find a solution. Fortunately, doctors say a variety of treatment options are available.

“Hair loss in men is well-known and far more prevalent, but it’s a problem for a lot of women as well,” said Brenda Pellicane, M.D., a dermatologist with The Dermatology Center, which has offices in Bethesda and Germantown. “Up to 50 percent of women in their 50s and 60s will have thinning hair.

It’s just not talked about as much for women as it is for men.”

According to the American Hair Loss Association (AHLA), women comprise 40 percent of all Americans struggling with some form of hair loss.

For women, there are several possible causes of temporary or long-lasting alopecia, the medical term meaning excessive or abnormal hair loss, according to the AHLA. The good news for many women is that hair loss can be a short-term condition. Pregnancy and excessive stress are often the catalysts. Commonly prescribed medications, such as Zoloft and other antidepressants, the acne-fighting drug Accutane, painkillers including naproxen, and birth control pills, all can cause hair loss as a side effect, according to the AHLA. In these cases, simply reducing stress or changing medications can treat the problem.

However, there are some instances where hair loss signals a deeper issue, requiring a deeper solution.

One of these more prevalent causes, which affects

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It’s normal to lose 100 strands of hair a day.

ding—phase, causing hair to fall out en masse.

Because various other indirectly related circumstances can lead to this sort of hair loss, extensive tests are often needed. As a last resort, doctors can perform a scalp biopsy for further testing.

“Effluvium is a systemic condition, so we need to work those patients up,” Callender said. “Anemia can cause it, so we do blood work to check your iron stores. If iron is low, that can cause effluvium.”

To help determine whether hair loss is a cause for concern, Callender recommends a hair pull test. If 15 to 20 strands come out of the scalp after a gentle hair pull, a doctor’s appointment may be in order. However, it is normal, noted Callender, for women to naturally lose up to 100 strands of hair over the course of a given day.

One symptom that is particularly worrisome is soreness or inflammation in the scalp. According to Callender, swelling in the scalp can cause scarring in the hair follicles, which exacerbates hair loss and may caused permanent problems.

“For scarring conditions, the scalp can be tender and inflamed,” Callender said. “Inflammation in the scalp causes destruction of the hair follicle and permanent hair loss and scarring.”

Though the causes can be complex and multifaceted, the condition is treatable. For those with female pattern hair loss, 2 percent minoxidil solutions, which are available over the counter as Rogaine, can help, though users must apply the solution three times a week indefinitely, according to both Pellicane and Callender, which can be an expensive and burdensome proposition.

“It slows the hair loss, and can even help regrow a little of the hair sometimes,” Pellicane said. “But if you stop the treatment, the thinning starts again.”

According to Pellicane, androgenblocking drugs like Aldactone can help in cases of androgenetic alopecia, though it is not recommended for women who are trying to get pregnant. Another treatment uses a

If 15 to 20 strands come out of the scalp after a gentle hair pull, a doctor’s appointment may be in order. laser comb with low-dose light beams to stimulate hair growth, Callender said. In addition, hair transplants are becoming increasingly more available for women.

“Hair transplant technique is evolving and improving,” Callender said.

“It’s easier with male hair loss because the area [where hair loss has occurred] is usually very open, but women have diffuse thinning, so the grafts have to be inserted between the healthy hair areas without damaging them.”

Because of the complexities involved, experts recommend women who suspect they have a problem see a doctor, and the sooner, the better.

“Even less-serious types can become more serious and cause permanent damage,” Pellicane said. “With any kind of hair loss, the sooner you get the diagnosis and start the treatment, the better your chances are.”

An internist or other primary care doctor is a good first step, but eventually a patient may need to visit a dermatologist, depending on the nature of the condition.

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commonCONDITIONS

Uterine fibroids account for 4 out of 10 hysterectomies in the U.S. each year.

THE SILENT TUMOR Many Women Unaware They Have Uterine Fibroids

BY KAREN FINUCAN CLARKSON

T

hey afflict up to threequarters of women, yet most who have them experience no symptoms.

Still, they account for 40 percent of the 600,000 hysterectomies performed each year in the U.S., according to the American Congress of Obstetricians and Gynecologists.

They are uterine fibroids, noncancerous tumors that grow within the wall of the uterus. The term fibroid is a bit of “a misnomer,” said Elliece S. Smith, M.D., a gynecologist and cosmetic surgeon in Lanham with privileges at Doctors Community Hospital, in that the tumors “are actually made of smooth muscle, tightly bound.”

The benign tumor is “distinct from the surrounding muscle of the uterus,” said James S. Powers, M.D., a Chevy Chase gynecologist and former chief of the division of gynecology at Suburban Hospital in Bethesda. “It tends to grow in very discrete spots.”

Those spots—of which there are three—dictate what type of symptoms a woman may experience. Uterine fibroids cause symptoms in a quarter of reproductive-age women, according to the Center for Uterine Fibroids at Boston’s Brigham and Women’s Hospital. While pain is uncommon, according to Powers, other symptoms can detract from a woman’s quality of life.

18 Gazette Health | Fall 2013

want to get pregnant. “Fibroids can sometimes interfere with the implantation of a fertilized egg,” said Powers.

The rate of spontaneous miscarriage may be as much as 85 percent higher in women with fibroids than those without, according to a 2010 study in Reviews in Obstetrics & Gynecology.

Fibroids that grow within the muscular wall of the uterus, known as intramural fibroids, can distort the shape of the uterus and also may cause longer periods with heavier bleeding.

When these tumors get large enough, “they can cause the abdomen to poke out and the woman to look pregnant,” said Smith.

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Subserosal fibroids, which project to the outside of the uterus, may press on the rectum or bladder. “If the fibroid is posterior, it can cause constipation. If anterior, the result can be frequent urination,” Smith said.

The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Whereas normal menstrual periods typically last four or five days, seven or more days is not unusual among symptomatic women.

“Women with fibroids also can have such heavy bleeding that they need to change sanitary protection frequently (perhaps every hour) or hesitate to participate in their normal activities for

FIBROIDS OFTEN ARE DISCOVERED by a gynecologist during an internal exam. A sonogram may be used to confirm the finding. In most cases, the patient is unaware of the fibroids’ existence, said Powers. Fibroids aren’t

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THE LEAST COMMON FIBROIDS ARE those that grow into the inner cavity of the uterus, noted the Center for Uterine Fibroids. Submucosal fibroids, which represent 5 percent of these tumors, are more likely to cause prolonged, heavy menstrual bleeding and can be a problem for women who

Submucosal fibroids, which represent 5 percent of these tumors, are more likely to cause prolonged, heavy menstrual bleeding.

fear of socially embarrassing bleeding,” noted the Center for Uterine Fibroids’ website. Such bleeding can cause anemia, which can be a problem when treating fibroid patients, said Smith.

Fibroids come in a variety of shapes and sizes, and where there is one, there probably are more. The average affected uterus contains six to seven fibroids, according to the Center for Uterine Fibroids. They can be as small as an apple seed or as large as a soccer ball, said Smith, and “neither pain nor bleeding is correlated with the size of the fibroid.”

Fibroids, which occur primarily between the ages of 30 and 40, are about three times more prevalent in black women than in white women, according to the Center for Uterine Fibroids. The tumors tend to develop in African-American women at a younger age, grow more rapidly and be more likely to cause symptoms. The reason for the discrepancy between races is not understood, said Smith.

Overweight and obese women are two to three times more likely to get fibroids, according to the National Women’s Health Information Center.

That may be due to the fact that fat cells raise estrogen levels in the body and estrogen is known to promote fibroid growth. Diet, too, is a risk factor. Eating a lot of red meat and ham has been linked to fibroid development. Family history is also thought to play a role. The risk of fibroids is about three times higher for a woman whose mother had them.

Fibroids primarily occur between ages 30 and 40.

cancerous, but they can grow, albeit slowly. For that reason, physicians often follow a practice of watchful waiting. Fibroids shrink—disappearing completely or at least 50 percent, according to Powers—after menopause, when estrogen levels drop.

Symptomatic women do not need to wait until menopause to shrink or eliminate fibroids. Treatment plans are tailored to the individual, said Smith, depending on the severity of symptoms, age, lifestyle and future plans. “Not everyone has the same symptoms; not everyone has the same plans for her uterus,” she said. “A 23-year-old who has not yet started her family will want more conservative treatment, whereas a 49-year-old has other options.”

For women who wish to preserve their ability to bear children, there are a few options. “If the main complaint is heavy bleeding, birth control pills can make periods lighter and shorter,” said Smith. Although the low-dose pills contain estrogen, they do not appear to make the fibroids grow, Smith noted.

Provera, a synthetic derivative of the hormone progesterone, can help reduce bleeding, according to Powers.

The drug, taken 10 to 12 days per month, should be reserved for cases where periods are exceptionally heavy.

Another medication, known as a gonadotropin-releasing hormone, may be prescribed to block the production of estrogen and progesterone. “It fools the body into thinking it is going through menopause so that fibroids shrink,” said Smith. The drug has significant side effects—“hot flashes, a dry vagina, all the things you associate with menopause,” she said. “It shouldn’t be taken for more than six months and should be used only as an adjunctive therapy to stop bleeding, get the blood count up, and deal with anemia so that the patient is in better shape for surgery.”

A myomectomy surgically removes fibroids while leaving the healthy uterine tissue. The surgery does not prevent fibroids from recurring.

Women whose fibroids were deeply imbedded in the uterus and become

pregnant sometimes need a cesarean section when delivering, according to the National Women’s Health Information Center.

For women who are done bearing children, endometrial ablation can destroy the lining of the uterus. This can be done using heat, microwave energy, hot water or electrical current, according to the Mayo Clinic. “The result is no period or a scanty period,” said Smith. The procedure is done on an outpatient basis.

During uterine artery embolization, “an interventional radiologist threads a catheter into the vessels supplying blood to the fibroid and blocks the supply,” said Smith. “It’s like your fibroid is having a heart attack, then dies and shrinks. It doesn’t go away, but it does get smaller.”

The only way to cure fibroids is with a hysterectomy, which involves the surgical removal of the uterus.

Most women with uterine fibroids can choose to keep their ovaries in order to avoid surgically induced menopause, noted the Mayo Clinic.

If fibroids are small, the surgeon may be able to access the uterus through the vagina as opposed to cutting into the abdomen. Both are major surgeries involving several weeks of recuperation. Occasionally, the surgery can be done less invasively through the use of a laparoscope, according to the National Women’s Health Information Center.

Research continues into less invasive and more effective ways to treat uterine fibroids, said Smith, pointing to studies exploring the use of ultrasound to shrink tumors.

According to the National Institutes of Health, a recent finding suggests fibroid tissue is actually made of tangles of collagen and that certain drugs may be able to break apart the strands of protein or prevent them from forming.

Such research will expand the options available to physicians so that they can “further refine and tailor treatment plans for patients,” said Smith. But, even today, some tailoring is possible. With uterine fibroids, “there’s no one size fits all.”

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women’sPREVENTION

A more natural breast reconstruction was actress Angelina Jolie’s goal.

BRCA, continued from 11

Should You Get Tested?

“These women are also eligible for an annual breast MRI.” The MRI detects cancer earlier by pinpointing areas in the breast with increased blood flow, which is necessary to support growing cells.

Some women may be treated with tamoxifen, an infertility drug that stops or slows the growth of hormone-positive cancers by preventing estrogen from attaching to receptors on the cell. “You could treat a BRCA carrier with tamoxifen until she’s ready to have a mastectomy and give her a 50-percent risk reduction until she makes the leap,” said Markus.

Generally, this drug may be as a preventive measure for up to 10 years, although there is a little data on how well it works long term because studies indicating its effectiveness are relatively recent.

Deciding whether to find out if you have BRCA1 and 2 genes with mutations that increase cancer risk is complex.

The U.S. Preventive Services Task Force recommends that only women who meet very specific risk criteria be tested, which it says amounts to only 2 out of 100. That’s in part because results may be inconclusive.

Many insurance companies require women to undergo genetic counseling prior to being tested, and sometimes insurance won’t cover the cost of the procedure.

As you begin the conversation about whether to be tested with your doctor, your family and yourself, these websites may be good resources for information gathering: n www.cancer.gov/cancertopics/factsheet/ Risk/BRCA n www.mayoclinic.com/health/brca-gene-test/ MY00322 n ww5.komen.org/breastcancer/ genemutationsampgenetictesting.html

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20 Gazette Health | Fall 2013

A GAZETTE PUBLICATION

There have been many advances in this procedure in the last few years, and

the results can be beautiful.”

-Actress Angelina Jolie, who elected to have a preventive mastectomy earlier this year

Hampton points to some recent techniques that allow for the preservation of breast skin, as well as the nipple and areola. “The result is much closer to what we have normally.”

A more natural breast reconstruction was actress Angelina Jolie’s goal. Prior to her February preventive mastectomy, she underwent a nipple delay, which, as she wrote in The New York Times, “rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area” to maintain the nipple’s viability. “There have been many advances in this procedure in the last few years, and the results can be beautiful.”

WHILE THE NUMBER OF CANCER-FREE WOMEN with a BRCA gene mutation who undergo a prophylactic bilateral mastectomy has not been documented, there have been several studies showing an increase—by some accounts more than triple in the last 15 years—in the number of women who, after getting cancer in one breast, choose to have both removed. In a 2008 study published in the International Journal of Cancer, U.S. women had the highest rate—36.3 percent—of prophylactic mastectomies among carriers of the faulty BRCA1 and BRCA2 genes.

“Some doctors are concerned that too many women are choosing the very aggressive step of … prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer,” according to Breastcancer.org.

But while the decision to have a preventive mastectomy can be difficult, many women appear content with their decision to undergo surgery. In a 2011 presentation at the annual meeting of The American Society of Breast Surgeons, Mayo Clinic researchers said they found 90 percent of women with cancer in one breast who chose to have both breasts removed were satisfied with their decision 20 years later.

Studies reported in the Journal of Clinical Oncology in 2005 and 2006 showed satisfaction rates of 83 and 86.5 percent, respectively.

“I have zero regrets,” said Cohen. “Now that I’ve lived longer than my mom, I realize just how young she was when she died. I want to be here for my grandchildren.”

ISTOCKPHOTO/EDSTOCK

IT WAS A CHANCE MEETING WITH A FRIEND FROM college, now a breast surgeon outside of Philadelphia, that convinced Cohen to have a bilateral mastectomy.

“Her basic message to me was that it wasn’t just that I could get breast cancer but that, if I got it, the outcome might not be good .... Cancer in women with the BRCA1 gene often manifests itself as triple negative.”

“Triple negative is a more aggressive cancer,” said Regina Hampton, M.D., a breast surgeon with Signature Breast Care in Lanham and privileges at Doctors Community Hospital. Compared with other breast cancers, triple negative tends to grow faster, be less visible on a mammogram, spread to other parts of the body earlier and recur more often.

Tamoxifen does not protect against this estrogennegative cancer. BRCA1 mutations are a risk factor for this type of cancer. “About 10 percent of triple negative cancers are found in BRCA women,” Hampton said.

The day after lunch with her friend, Cohen decided to have a mastectomy. “I didn’t make an emotional decision. It was informed by my situation and knowledge. It was a factual, scientificbased decision.”

In July 2009, at 46, Cohen had both breasts removed. “I’d read a lot about mastectomies, but nothing really prepares you for everything you have to deal with—pain, draining tubes, expanders,” she said. Four months later, Cohen had implant surgery to reconstruct her breasts. “You always know the implants are there; they’re not really part of your body …. But that’s OK. My breasts have never been a big part of who I am.”

Improved reconstructive techniques may make the surgery “more palatable” for some women, said Hampton. “We now have more pleasing cosmetic procedures that offer great results, especially when compared to where we were 20 years ago. Then, the options we had to offer women in their 30s and 40s were horrible.”

MASSAGE, continued from 7 same time, massage on the hands and feet can help with the neuropathy— a tingling/numbness—brought on by chemotherapy.

“What we’re trying to do is support someone’s immune system,” which is typically compromised by cancer treatment, Blank said.

Chemotherapy, for example, depletes the number of infection-fighting white blood cells in bone marrow.

Massage doesn’t replenish white blood cells, but increasing blood flow boosts a patient’s overall well-being, Blank said.

A carrier of disease-fighting white blood cells, the lymphatic system is also a critical element of our immune response that can be damaged by cancer treatment.

Not technically massage, lymphatic drainage is a popular technique therapists use on breast cancer patients whose lymph nodes have been removed during a mastectomy.

These patients run a 50-percent chance of developing lymphedema, a

‘‘

It doesn’t make the pain go away … but by the time the session is over, the pain may be in the 3 to 4 range,” on a scale of 1 to 10.

-Nichole Ruffin, massage therapist

condition where a blockage prevents lymph fluid from draining, causing swelling and potentially infection, said Jill Nelson, LMT, certified lymphedema therapist and owner of Integrative Therapies in Bethesda.

Lymphatic drainage, which involves gentle stretching of the skin, is designed to reverse the flow of lymph fluid so it’s redistributed through the body, said Nelson. “Lymphedema isn’t curable, but it’s manageable,” she said.

FOR CHRONIC PAIN Of her many illnesses, Johnson describes fibromyalgia as her “biggest challenge.” The pain is “deeply ingrained,” “constant,” and “feels like walking around with weights .... There are times when a hug hurts, when brushing my teeth hurts,” she said.

Women make up almost 90 percent of the 5 million Americans who suffer from fibromyalgia, and their symptoms include fatigue, insomnia, widespread but diffuse pain, a tingling

sensation in their fingers, and “tender points” along the body that are painful when touched, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

With Johnson and other clients with fibromyalgia, Ruffin doesn’t “go to the center” of a tender point, but will massage around it to release some of the pain. Clients, including Johnson, have reported better sleep, greater range of motion and an uplifted mood, Ruffin said.

“It doesn’t make the pain go away … but by the time the session is over, the pain may be in the 3 to 4 range,” on a scale of 1 to 10, Ruffin said.

Clients with multiple sclerosis (MS) also benefit from massage as it relieves tightness and muscle spasms, the results of a disease that attacks the central nervous system and disrupts communication between nerves and muscles.

“What I do is a lot of stretching [since] she feels scrunched in,” said Ruffin of a client with MS. “She’s continued to do the things she wants to do, and she believes massage has helped her do it.”

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Experts’ Advice

Just because a supplement is promoted as being natural doesn’t mean it’s safe.

Should You Take Supplements?

W

22 Gazette Health | Fall 2013

A GAZETTE PUBLICATION

comes from meat, fish and dairy foods, so vegans may consider taking a supplement to be sure to get enough of it,” Haggans said.

Research suggests that fish oil can promote heart health. Of the supplements not derived from vitamins and minerals, “fish oil probably has the most scientific evidence to support its use,” Hopp said.

The health effects of some other common supplements need more study.

These include glucosamine (for joint pain) and herbal supplements such as echinacea (immune health) and flaxseed oil (digestion).

Many supplements have mild effects with few risks. But use caution. Vitamin K, for example, will reduce the ability of blood thinners to work. Ginkgo can increase blood thinning. The herb St. John’s wort is sometimes used to ease depression, anxiety or nerve pain, but it can also speed the breakdown of many drugs—such as antidepressants and birth control pills—and make them less effective.

Just because a supplement is promoted as being natural doesn’t necessarily mean it’s safe. Comfrey and kava, for example, can seriously damage the liver.

“It’s important to know the chemical makeup, how it’s prepared and how it works in the body—especially for herbs, but also for nutrients,” said Haggans.

“Talk to a health care provider for advice on whether you need a supplement in the first place, the dose and possible interactions with medicine you’re already taking.”

For vitamins and minerals, check the Percent Daily Value (DV) for each nutrient to make sure you’re not getting too much. “It’s important to consider the DV and upper limit,” said Haggans. Too much of certain supplements can be harmful.

Because supplements are regulated as foods, not as drugs, the FDA doesn’t evaluate the quality of supplements or assess their effects on the body. If a product is found to be unsafe after it reaches the market, the FDA can restrict or ban its use.

“Products sold nationally in the stores and online where you usually shop should be fine,” said Dr. Paul M. Coates, director of NIH’s Office of Dietary Supplements. “According to the FDA, supplement products most likely to be contaminated with pharmaceutical ingredients are herbal remedies promoted for weight loss and for sexual or athletic performance enhancement.”

NIH recently launched an online Dietary Supplement Label Database at dsld.nlm.nih.gov. –NIH News in Health

LIQUID LIBRARY/GETTY IMAGES/THINKSTOCK

hen you reach for that bottle of vitamin C or fish oil pills, you might wonder how well they’ll work and if they’re safe. The first thing to ask yourself is whether you need them in the first place.

More than half of all Americans take at least one dietary supplement daily or on occasion. Supplements are available without a prescription and usually come in pill, powder or liquid form. Common supplements include vitamins, minerals and herbal products, also known as botanicals.

People take these supplements to make sure they get enough essential nutrients and to maintain or improve their health. But not everyone needs them. “It’s possible to get all of the nutrients you need by eating a variety of healthy foods, so you don’t have to take one,” said Carol Haggans, a registered dietitian and consultant to the National Institutes of Health (NIH). “But supplements can be useful for filling in gaps in your diet.”

Some supplements may have side effects, especially if taken before surgery or with other medicines, and can also cause problems if you have certain health conditions. The effects of some haven’t been tested in children, pregnant women and other groups.

“You should discuss with your doctor what supplements you’re taking so your care can be integrated and managed,” said Dr. D. Craig Hopp, an expert in botanicals research at NIH. Dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods, not as drugs. The label may claim certain health benefits, but unlike medicines, supplements can’t claim to cure, treat or prevent a disease.

“There’s little evidence that any supplement can reverse the course of any chronic disease,” said Hopp. “Don’t take supplements with that expectation.”

Evidence does suggest that some supplements can enhance health in different ways. The most popular nutrient supplements are multivitamins, calcium and vitamins B, C and D. Calcium supports bone health, and vitamin D helps the body absorb calcium. Vitamins C and E are antioxidants—molecules that prevent cell damage and help to maintain health.

Women need iron during pregnancy, and breast-fed infants need vitamin D. Folic acid—400 micrograms daily, whether from supplements or fortified food—is important for all women of childbearing age.

Vitamin B12 keeps nerve and blood cells healthy. “Vitamin B12 mostly

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