3/6/2019 Newsletter—A Host of Hot Topics

To my Patients and Friends,

Here are some of the recent medical news highlights… enjoy!

Birth control vs bone health - Larry Leibowitz, MD newsletter

Birth control vs. bone health

A study recently published in the journal Clinical Endocrinology has revealed that the use of combined hormonal contraceptive pills (OCPs) by adolescent girls is associated with reduced spinal bone density (osteoporosis) in later years. Based on these findings—at least until they are confirmed with further study—it would be wise for young women in this age group to consider long-acting reversible contraceptives such as hormonal injections (example: Depo-Provera), intrauterine devices (IUDs) or hormone-secreting skin implants (example: Nexplanon). Be sure to stay in touch with your gynecologists regarding this emerging issue.

And it’s important to remind young women that none of these forms of contraception prevent sexually transmitted diseases, such that barrier protection (i.e., condoms) should be used on every occasion (until they are involved in exclusive, safe, long-term relationships).

Colon Cancer Health - Larry Leibowitz, MD Newsletter
Keeping our colons FIT

According to a recent meta-analysis (an analysis of multiple studies on a particular topic), annual home-based fecal immunochemical tests (FIT tests) may be adequate for colon cancer screening purposes as an alternative to periodic colonoscopies for average-risk individuals.  FIT is a very simple screening method which involves sending a small stool specimen to a laboratory that assesses it for signs of trace amounts of blood in the colon. Although the test may miss a small percentage of colon cancers or precancerous polyps and may not be able to distinguish between cancer and other causes for bleeding (such as hemorrhoids), the overall statistics are favorable. According to an editorialist, this method “should not be considered a ‘second-best’ approach or less than a ‘gold standard’ strategy for average-risk patients” who either can’t or prefer not to undergo colonoscopy.

There is one group in particular who I believe may benefit from this screening method: patients aged 45 through 49 years who are at average risk for colon cancer. Although the standard recommended age for the first colonoscopy remains 50 years for those at average risk, the American Cancer Society has advised that this starting age should be reduced 45 years, as we have been seeing more colon cancer in younger people.  Thus far (and not surprisingly), insurers have not adjusted their reimbursement policies accordingly, such that coverage for a colonoscopy for an average-risk person under age 50 is often elusive.

Importantly, patients who are at above-average risk for colon cancer (for instance, those with a personal or family history of colon cancer or precancerous colon polyps) are not ideal candidates for this testing method.

Respect your kidneys
Kidney health and medication - larry leibowitz, md newsletter

Using high doses of over-the-counter or prescription nonsteroidal anti-inflammatory medications (NSAIDS)—such as ibuprofen (brands include Motrin and Advil), naproxen (brands include Aleve and Midol), diclofenac (brands include Cataflam and Voltaren), indomethacin (brands include Indocin) and others—increases our risk for kidney disease, particularly among active younger and middle-aged adults, and when taken more than seven times per month, according to a study just published in Jama Open Network. These medications are used daily by millions of Americans, and yet very few take into consideration (or are informed about) the risks. We’ve known about the associations between NSAIDs and kidney damage, cardiovascular disease, abnormal bleeding from the G.I. tract and blood pressure elevations for some time; this study adds to the already-ample evidence. I encourage everyone to use NSAIDs at the lowest effective doses and as infrequently as possible.

ROUNDing up carcinogens
Roundup and cancer - Larry Leibowitz, MD newsletter

Researchers at the University of Washington have recently reconfirmed that Monsanto’s popular weedkiller Roundup (which contains the notorious herbicide glyphosate) increases our risk of non-Hodgkin’s lymphoma…by a whopping 41%. Although the US Environmental Protection Agency (EPA) indicated in 2017 that the herbicide “is not likely to be carcinogenic to humans,” much of the developed world disagrees. For instance, in 2015, the World Health Organization’s International Agency for Research on Cancer classified the herbicide as “probably carcinogenic to humans.” And Monsanto’s influence over EPA policy has been well documented.

Unfortunately, glyphosate is literally everywhere: it has been detected in beer and wine, meat and poultry, fruits and vegetables and popular snack foods. It has even been found in the urine of those who go out of their way to avoid glyphosate via measures such as eating only organic and non-GMO foods. That said, as the scientific (and legal) glyphosate battles rage on, I do believe that less is more, and it would be prudent for us all to do what we can to minimize our exposure to this nasty chemicals by focusing on non-GMO, organic and unprocessed foods whenever possible.

artificial sweeteners - larry leibowitz, md newsletter

Souring on artificial sweeteners

The Women’s Health Initiative (WHI) is a highly-regarded long-term national health study, launched in 1993, that focuses on strategies for preventing heart disease, breast and colon cancer and osteoporotic fractures in postmenopausal women. This ongoing study has been invaluable and helping us to better understand how to prevent disease in women. Most recently, WHI researchers have determined that higher intake of artificially-sweetened beverages is associated with increased risk for stroke, coronary artery disease, and all-cause mortality. Concerns about the negative health impacts of artificial sweeteners are not new, and this recent analysis adds to the mounting evidence that these chemicals simply do not belong in our bodies.

breast cancer update - larry leibowitz, md newsletter

Breast cancer update

Traditionally, increasing chronological age has been viewed as an important risk factor for the development of breast cancer in postmenopausal women. However, new research from the National Institutes of Health (NIH) recently published in the Journal of the National Cancer Institute suggests that biological age may be a more reliable measure of breast cancer risk than chronological age. In this very interesting study, the researchers looked at a specific chemical change in DNA known to be associated with aging (called methylation) as a means of gauging the subjects’ biological age. The researchers found that, in those subjects whose biological age was deemed to be higher than their chronological age, breast cancer risk was increased. Conversely, those with lower biological age relative to their chronological age were found to be at decreased risk.

Although the researchers did not delineate precisely what factors may influence breast cancer risk via the curtailing of DNA methylation, we do know that lifestyle factors such as regular exercise, a healthy diet and maintaining a healthy weight can favorably impact the methylation process in general. And we also know from previous research that a healthy lifestyle reduces breast cancer risk. So while we await further research, there’s no harm in extrapolating…I believe this fascinating study provides strong support for a healthy lifestyle as a means of reducing the risk of developing breast cancer (and, as we all know, of other chronic diseases).

 

and speaking of

FDA alert - larry leibowitz, md newsletterThe FDA recently issued an alert advising women regarding the use of thermography for breast cancer screening. This notoriously imprecise technology involves the use of an infrared camera to produce images that show patterns of heat and blood flow at or near the surface of the body, the underlying assumptions being that cancerous tissues emit more heat than do noncancerous tissues (which in reality is often not the case). The big selling point is that thermography provides a radiation-free alternative to mammography. And it’s a cash cow for practitioners who use it since it’s not covered by insurers. The FDA has not gone so far as to forbid the use of thermography but did make clear that it is not a suitable alternative to mammography or other recommended imaging techniques. Although I am not a detractor of alternative approaches when implemented appropriately (and have incorporated integrative modalities in my own practice), I discourage women from pursuing thermography in lieu of evidence-based modalities for breast cancer screening such as mammography with or without ultrasound or MRI imaging (as recommended by their physicians).

And in closing, please keep an open mind!

staying active with age - larry leibowitz, md newsletterNumerous studies have shown that increased physical activity when we’re young can help to ward off dementia as we age. But a new study recently published in the journal Neurology has shown that even in later years, physical activity can confer meaningful cognitive health benefits. So don’t the cold weather keep you on the couch…let’s get up and move!

That’s all for now… be well!

 

 

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