A couple of healthy foods you may not be eating!

It seems that most of us know the benefits of a carrot and the tomato, and we have blogged about the walnut, red apple and red grape; but what about the pumpkin?


Fresh pumpkin is the best, when available; but even canned pumpkin (no salt added, of course, and not pumpkin pie filling) is a very good source of dietary fiber, vitamins E, A, C and K, iron, magnesium, copper and magnesium.  It is low in cholesterol, saturated fats and sodium and you can even eat it out of the can!


The next food, that you may not be eating enough or at all, is one I'm keen on: quinoa.  It is considered by some to be the perfect food from a plant, certainly for protein.  This whole grain provides all of the essential amino acids and lysine is one amino acid that is hard to find in plant sources.  Quinoa is also a good source of fiber, folate, magnesium and manganese.  It is also low in cholesterol, saturated fats and sodium.


For more on super foods check out http://www.webmd.com/diet/features/superfoods-everyone-needs.




Together we can prevent 75,000 breast cancer cases each year.  




This content is information and not personal medical advice.

Breaking News! More from yesterday's blog study.

Yesterday, we reviewed how calorie restriction and diet reduce harmful inflammatory biomarkers, but today, more from the same randomized control trial from Fred Hutchinson Cancer Research Center, lead by Dr Anne McTiernan.  Today's publication online in the Journal of Clinical Oncology includes the response of sex hormones to exercise and diet in the aforementioned group of women


The report is of one year follow-up of 438 women, mean age 58 years, mean BMI 30.9.  The groups:

1. caloric restriction
2. regular exercise
3. diet and exercise
4. control

The data are as you might expect: sex hormone levels (estrone, estradiol, testosterone) all decreased with weight loss and exercise.  They saw a modest decrease with exercise, more decrease with weight loss and the greatest decrease in the hormone levels with weight loss and exercise.

This study gives us more data on weight loss and exercise mechanisms for breast cancer risk reduction.  

In summary, the study itself through separate publications, demonstrates that weight loss and exercise favorably decrease hormones and inflammatory biomarkers that are linked to more breast cancers.

Kind of makes you want to eat less and exercise more!

Together we can prevent 75,000 breast cancer cases each year!

This content is information and not personal medical advice.

Why the link between too much weight and cancer?

We have already seen in many blogs the relationship of too much weight and cancer.  Remember the NHS results of women >50 years followed for 24 years? I invite you to review here http://drwinsett.blogspot.com/2011/04/breast-cancer-and-weight.html, but the long and short of it: for every one pound gained and kept there was 1% more breast cancer, but for every one pound lost and kept off there were 2% fewer breast cancers.  


Now we may be closing in on the reason.  A significant amount of research points toward inflammation as the mechanism causing overweight or obese and sedentary women to have more cancers, including breast cancer.


More information comes from a recent randomized controlled trial from the Fred Hutchinson Cancer Research Center http://cancerres.aacrjournals.org/content/72/9/2314.abstract?sid=3b3200b3-3ad5-4de1-81bc-7a09c30c19f8.  They randomized >400 women for a one year study and amazingly only one woman dropped out.  They measured C-reactive protein and other biomarkers of inflammation at the beginning and at one year.  The four groups were:

1. caloric restriction with a goal of losing 10% of body weight
2. moderate to vigorous aerobic exercise 225 minutes/week
3. both diet and exercise
4. control group

The results at one year were impressive for reduction in all inflammatory biomarkers in the diet and exercise groups.  They saw the greatest reduction of C-reactive protein and the other markers in the the diet (lost and kept off 5%) and exercise group.  Diet and exercise caused a 42% reduction in the inflammatory biomarkers.  Caloric restriction alone was next in benefit.

Imagine, >40% reduction in inflammatory biomarkers with only 8 pounds lost and kept off for someone who weighed 160 pounds!

Think of the potential significance for cancer reduction!

Together we can prevent 75,000 breast cancer cases each year!

Overweight and younger!

More overweight and obese teenagers is the finding in a recent US study of youths aged 12-19 years.  This study, published in the journal Pediatrics, analyzed data from over 3000 teenagers and compared 1999 to 2008.  They found that in that 10 year period that Type 2 diabetes and pre-diabetes increased from 9% to 23%.  An increase of 2.5x in just 10 years is "shockingly high" according to Dr. David Ludwig, a childhood obesity expert at Chirldren's Hospital in Boston.  The obesity epidemic has lead to an epidemic of Type 2 diabetes in teenagers.


Not only do we need to work on this from the standpoint of diabetes-related risks, like kidney failure, heart attacks, strokes and blindness, but as we have seen in this blog, cancer.


For more information http://www.cdc.gov/diabetes/projects/cda2.htm.


The American Diabetes Association http://www.diabetes.org/diabetes-basics/prevention/?loc=DropDownDB-prevention recommends:

• choose a variety of lean meats, fresh vegetables and fruits, whole grains and non-fat dairy products
• limit portion size
• avoid too much of the same food type
• eat meals regularly throughout the day
• don't skip meals

And, of course, DAILY EXERCISE!!!

We can set an example for these teenagers and have fewer cancers by doing all these things.

Together we can prevent 75,000 breast cancer cases each year!

This medical content is information and not personal medical advice.

Lifting heavier weights is not the only way to build muscle.

According to research from McMaster University, the amount of weight is not the only factor in the building of muscles.  Light weights with more repetitions may be just as good as heavy weights with fewer repetitions.  In a series of papers, they have demonstrated that exercising until you can not lift the weight again or what they call volitional fatigue is what is important.  See  http://www.researchgate.net/profile/Cameron_Mitchell2.


They found that muscle growth and strength were increased equally effectively by heavy and light weights.  


They tested people for the maximum weight lifted, then backed off some.  One group of 8-12 repetitions lifted 80% of maximum and another group lifted 30% of maximum but did it 25-30 times in each of three sets.  They studied muscle volume by MRI and muscle protein synthesis by biopsy and found equal increases.


Their conclusion, "lower load lifted to failure resulted in similar hypertrophy as a heavy load lifted to failure".


What does this mean for all of us?  We can all get benefits form lifting what our joints allow.  One doesn't have to lift the biggest weight on the rack, but a lighter load, lifted to when it becomes difficult to maintain good form, works just as well!




Together we can prevent 75,000 breast cancer cases each year!




This content is informational and not personal medical advice.

Want to save money? Try being fit!

That's right.  A recent study showed that men and women that were fit in middle age had significantly lower health care costs later.  Imagine saving almost $2000.00 every year! 


That is what a study presented at the American Heart Association's Quality of Care and Outcomes Reasearch meeting last week showed http://newsroom.heart.org/pr/aha/midlife-fitness-means-lower-healthcare-233183.aspx.  The lead author, Dr. Justin Bachman, from UT Southwestern in Dallas collaborating with the Cooper Clinic reported that "physically fit, healthy middle-aged adults have significantly lower health care costs as they age, compared to their less physically fit counterparts.


The study followed 20,489 healthy people from 1999-2009.  They controlled for smoking, diabetes, high blood pressure, high cholesterol and body-mass index (BMI).  Fitness was determined by measuring metabolic equivalents (METs) on a treadmill.  The higher the METs, the more fit.


When they compared the least fit group of men to the most fit, they found a savings of $1857.00 in medical costs per year ($5134 vs $3277 spent per year!). A savings of 36%


For women the savings were 40% (they do most things better!) from $4565 per year for the least fit to $2755 per year for the most fit.


To quote Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital NYC, "exercise is the best medicine we have!"


Need I say more?




Together we can prevent 75,000 breast cancer cases each year!




This blog is informational and not personal medical advice.  Check with your doctor to assure that you are healthy enough to exercise.  Then do it!

Please pass the piperine; I'm on a diet!

Black pepper comes from the Piper nigrum vine (Piperaceae family) that is native to southern Asia.  Usually, the peppercorns are harvested green and dried in the sun until black.  They may be used in pepper mills or ground into various grades of what we use as a seasoning.  


Piperine is the pungent tasting alkaloid in the black pepper that gives it the characteristic taste.  Alkaloids are basic organic compounds, containing nitrogen, most often of plant origin, that may have profound human physiologic effects.  Other examples are nicotine and opium.


Piperine has been isolated from the black pepper and studied for its effects in humans from reducing inflammation to promoting healthy digestion and from preventing cancer to interfering with normal reproduction.  The mechanisms of action are not well understood, but a recent paper in the Journal of Agriculture and Food Chemistry http://onlinelibrary.wiley.com/doi/10.1111/j.1750-3841.2010.01542.x/abstract, suggests a potential benefit as treatment for obesity.


The formation of the mature fat cell or adipocyte has been the subject of many studies and is a very complex process.  Researchers in Korea have shown that piperine decreases the activity of transcription factors necessary to from the mature adipocyte from its precursor cells.  In their in vitro or laboratory study, piperine down-regulates the activity of genes that control the formation of fat.  They suggest that this finding might lead to potential treatments for obesity-related diseases. 


Maybe they are on to something, but for now, we just need to eat less, exercise more and be active.




Together we can prevent 75,000 breast cancer cases each year!




This content is intended as information and not personal medical advise.

Proximity and Visibility work for healthy foods, too!

Studies have repeatedly demonstrated that "foods" that are closer to you, easier to get, more convenient to prepare and more visible are consumed in greater quantities.  BUT these studies have been done with ready-to-eat fast foods and candies, not healthy foods.


If you have apples and carrots visible and close will they be eaten?


The answer seems to be yes!


In research done with 96 college students at St Bonaventure University in NY summarized at http://www.nlm.nih.gov/medlineplus/news/fullstory_124913.html they ate more carrots and apple slices if closer and more apples if more visible (clear bowls).


So just imagine, having apples, red grapes or walnuts where you can get them (walk by) and see them (clear bowls) and we would all eat more healthy foods!  Put away the potato chips and candy!  Note; I included those foods that are good sources of polyphenols that help prevent breast cancer as mentioned in prior blogs.






Together we can prevent 75,000 breast cancer cases each year!






This blog is general information and not personal medical advice.

Another potential candidate for breast cancer blood test.

                                          Happy Mother's Day!

Recently, I was asked to comment on a new potential blood test for breast cancer risk.  This test is different from the one I noted in a recent blog http://drwinsett.blogspot.com/2012/04/detecting-breast-cancer-in-blood-test.html.

This new finding (http://apps.facebook.com/theguardian/science/2012/apr/30/blood-test-breast-cancer-risk?post_gdp=true) may help detect breast cancer risk.  The research, lead by Dr. James Flanagan, found that the ATM gene was more likely to show the epigenetic change of methylation (see my blog for more about how the environment can change our genes http://drwinsett.blogspot.com/2012/03/and-you-thought-you-couldnt-change-your.html) in patients who subsequently developed breast cancer.  Those with the highest methylation level on the ATM gene found in white blood cells were twice as likely to get breast cancer.  We don't know what environmental factors cause the change in the white blood cell gene or why it is associated with more breast cancers.  Their hope is that with the confirmation of the finding from this simple blood test we can then find those at high risk and offer "pre-emptive" strategies.


At present the most accurate breast cancer risk assessment tool is the BREVAGen test, a cheek swab with clinical data about you.  For more information read http://drwinsett.blogspot.com/2011/09/easier-way-to-learn-your-risk.html and call 512-451-5788 or email www.thedoctor@owenwinsettmd.com to come get one.


Together we can prevent 75,000 breast cancer cases each year!

Why shouldn't I get a breast ultrasound?

"Although use of ultrasound rather than MRI as a supplement to mammographic screening in intermediate-risk women with dense breasts might seem appealing, the authors point out that low reimbursement rates and the shortage of qualified breast sonographers could make this strategy difficult to implement."

— Andrew M. Kaunitz, MD

This quote from the April 4 JAMA http://jama.ama-assn.org/content/307/13.toc was recently sent to me.  

Numerous studies (see  http://drwinsett.blogspot.com/2012/01/more-about-whole-breast-ultrasound-and.html) have demonstrated that supplemental whole breast ultrasound finds breast cancers that mammograms miss, including the study in this same journal where women had supplemental whole breast ultrasound if they had dense breast tissue and one other risk factor.  But that was the comment published in the journal.


So, if you find a willing and experienced doctor who is qualified to do the breast ultrasound, wouldn't you get one if you were at increased risk?  


Together we can prevent 75,000 breast cancer cases each year.

So, You DON'T want a hot flash!

Goes without saying, doesn't it?


Despite the fact that 80% of menopausal women experience them, we really don't know what causes hot flashes.  We know that typically they are like a blast furnace door that suddenly opened (so you could be engulfed in intense heat) and then two minutes later closed so you could be cold, but I don't have to tell you that.  They may happen once a day or once an hour, but I don't have to tell you that.  They may go on for several months or in a few, for years, but I don't have to tell you that.  In the Study of Women's Health Across the Nation (SWAN) 20% of premenopausal women reported hot flashes.


Physiologic studies point to thermoregulatory dysfunction.  Well, yes.  Note that we use big words to restate the issue when we don't know much about it.  What we do know is that core body temperature is normal at the beginning of a hot flash and falls below normal afterwards.  We know there is abnormal peripheral vasodilatation and increased blood flow in the skin.  We also know that the thermoneutral zone (range of temperatures that you "feel" ok) narrows at menopause.  We know about physiological changes, but not what causes them.


We also know that hot flashes are associated with:

• decreased endogenous estrogen levels
• a pulse of luteinizing hormone
• increased follicle stimulating hormone (FSH)
• different sleep stage (REM suppresses hot flashes)
• decrease in normal heart rate variability 
• decreased endogenous brain opioid activity

We know that vasomotor symptoms (hot flashes) are worse for:

• obese women (despite higher endogenous estrone)
• smokers
• sedentary women
• women who are hyperthyroid

And may be triggered by:

• hot drinks
• alcohol
• anxiety
• many drugs, particularly SSRIs
• rare diseases, such as carcinoid

So many observations, but no true cause and effect found, but we can help.

Studies have shown decrease in number, duration or magnitude of hot flashes in women treated with everything from estrogen replacement to breathing "right".

Studies of women with hot flashes show that estrogen replacement is the most effective treatment, orally or transdermal.  Find out more at http://www.endo-society.org/journals/scientificstatements/upload/jc-2009-2509v1.pdf from the Endocrine Society Scientific Statement.  We have previously blogged about the risks of estrogen replacement from deep vein thrombosis to increased breast cancer.  There are almost too many studies for other attempted hot flash treatments to mention (from SSRIs and SNRIs to Vitamin E); almost as many options as those with hot flashes!  No drug or supplement has been shown to be overwhelmingly effective, but there is help.

Imagine the medicine that could treat hot flashes, increase bone density and not cause any bad side effects like breast cancer or maybe even prevent cancer.

Yes, you are right, that medicine is already available: 

• BE LEAN
• BE ACTIVE
• REGULARLY EXERCISE
• LIMIT ALCOHOL

Together we can prevent 75,000 cases of breast cancer each year!

Can my husband get breast cancer?

I am sorry to say, "yes".


Breast cancer is far less common in men, but does happen at the rate of 1:1000 men.  That means about 1 man with breast cancer for each 10 women with breast cancer.  That translates to around 2000 men affected this year.  Just like in women the incidence has been increasing, but is still <1% of cancers affecting males.


More are inherited: 4% BRCA 1 and 15% BRCA 2 (total BRCA 1 & 2 for women only 7%).  Some argue that every male with breast cancer should have the BRCA 1 & 2 test.


90% are estrogen receptor positive (women 75%) and the average age is 66 years (older than for women).


The presentation is most often a painless firm or hard mass, with workup including mammogram, sonogram and needle biopsy.  In most studies there are more advanced cases at presentation than for women.


Treatment parallels that for women, but in most series is treated by total mastectomy and sentinel lymph node biopsy.  In many cases anti estrogen treatment is then offered.


Risk factors are similar to those in women such as higher estrogen exposure and prevention measures are the similar, such as, weight control, activity, exercise, etc.  Remember men should have all breast lumps checked out!






Together we can prevent 75,000 breast cancer cases each year.

You can come to see me even if you don't have a breast lump!

Recently, I was told "I wanted to come see you, but I didn't think I could get in to see you without a breast lump".


As part of "reader question week" I am responding to concerned comments.


I do many things for patients besides reacting to the breast lump or abnormal mammogram.  Indeed, that is a great part of what I have to offer, but we can have an impact even before the lump!  I now spend the majority of my time discussing how to reduce your personal risk for breast cancer, which tests to do (and when) to learn all about personal risk for breast cancer and then what to do about it.  We continue to do many whole breast ultrasounds for those with dense breast tissue even without a known lump.


Early detection is key, but prevention is even better!


There are also many breast concerns, like infection, or other breast-related concerns like hormone replacement that we help with every day.


Please, don't hesitate to call with any concern or question.




Together we can prevent 75,000 breast cancer cases each year!

Three more informative food websites.

In addition to the two sites noted in the last blog, there are three others that I would mention.


The first, http://www.choosemyplate.gov/food-groups/ gives information about food groups and much more.  This takes the place of "my pyramid" type food teaching that you may remember from that "mention" of healthy eating in school.


Next, I recommend http://nutritiondata.self.com/ for detailed nutrition information for just about any food you can imagine.  Type in banana, raw, select medium (7") and get at least 100 nutrition facts from vitamins to omega fatty acids.  Our medium banana contains 105 calories with 27g carbohydrates and 422mg potassium.  There is also a summary, called "the good":  low in saturated fats, cholesterol and sodium, high in dietary fiber, manganese, potassium, Vitamin C and B6.  And the "bad": almost all calories are sugars.  These "good" and "bad" ratings may help you personalize your diet.  For instance, a diabetic might want to know which foods have sugar calories or hypertensives might want to know how much sodium.


Lastly, I recommend for your perusal http://www.webmd.com/diet/ for healthy eating and dieting ideas.


These may be useful sources of nutritional and dietary information and may help you achieve your goal of heathy eating.  Each offers its own authority and validation for your review, but is intended as information and not personal medical advice.  Remember, ask your doctor questions.




Together we can prevent 75,000 breast cancer cases each year!

Who knows about foods that prevent breast cancer?

There are two websites everyone interested in findings about how food, nutrition and physical activity can prevent breast cancer should view regularly.


The first is Sponsored by the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR) found at http://www.dietandcancerreport.org/.  


On this site, one can find who is reviewing the research, why and what is recommended and even preventable estimates for breast cancer and many others.  It is an easy to navigate site with a wealth of cancer preventive data and information.


The second site is http://www.aicr.org/foods-that-fight-cancer/ and provides specific information about which food, how much, how to cook it, best recipes and even more.  Can you name all the cruciforms?  


Each site is updated continuously and even allows you to sign-up for email notifications.  Just click on each link above to find out more.




Together we can prevent 75,000 breast cancer cases each year!




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Does Vitamin E prevent or cause cancer?

Interesting question.  Some reports demonstrate cancer prevention, but some show a lack of cancer prevention.  Many human and animal studies have demonstrated an association with dietary Vitamin E and fewer cancers.  BUT, a recent report from the SELECT Trial (Selenium and Vitamin E Cancer Prevention Trial) showed an increase in prostate cancers in men supplementing their diet with Vitamin E, and which one, alpha-Tocopherol.  


Therein may lie the answer.  Vitamin E is a group of essential fat soluble vitamins: 4 tocopherols and several tocotrienols.  The tocopherols are the major source of Vitamin E in the US diet, they are all antioxidants but they are not all the same.  Recent research from Rutgers University http://news.rutgers.edu/medrel/news-releases/2012/04/rutgers-study-vitami-20120420 may have the answer.  


The simple answer to quote Dr. Chung S Yang, "Our message is that Vitamin E in the form of gamma-tocopherols...and delta-tocopherols...are beneficial in preventing cancers while the form of Vitamin E, alpha-tocopherol...has no such benefit".


Why is this important and how do we make this work for us?  The gamma and delta forms we get from our diet: plant seeds, avocados, nuts and oils (sunflower, sesame, cottonseed and canola), whole grains.  The supplement Vitamin E you buy at the health food store is almost always alpha-tocopherol.  So, if you buy a Vitamin E supplement make sure it provides a mixture of gamma and delta tocopherols similar to our diet.  The gamma and delta forms are cancer preventers in animal models of lung, colon, breast and prostate cancers.  Hopefully more research will show that they are cancer preventers in humans.  




Together we can prevent 75,000 breast cancer cases each year!




This content is informational and not personal medical advice.


Comments and questions at www.thedoctor@owenwinsettmd.com.