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Thursday, January 3, 2019

Healthy eating through the holidays

Right now the world is experiencing an epidemic that is projected to get much, much worse. It’s an epidemic of dementia, affecting 40 million people — and millions more of their caregivers — staggering numbers that will likely triple by 2050.

Dementia is a progressive deterioration of brain functioning associated with aging. While there are different causes, the most common — Alzheimer’s and vascular dementias — are now thought to be closely related.
How is heart health related to cognitive health?

We have long known that the diseases and conditions that clog the arteries of the heart also clog the arteries of the rest of the body, including the brain. It all boils down to damage of the arteries, the blood vessels that are critical for blood flow and oxygen delivery to the organs. Arterial damage leads to arterial blockages, which leads to heart disease and heart attacks, strokes, peripheral vascular disease, and vascular dementia.

Meanwhile, Alzheimer’s disease used to be thought of as a different process, because the brains of people with Alzheimer’s seemed to be full of tangled tube-shaped proteins (neurofibrillary tangles). However, more and more research is linking Alzheimer’s dementia to the same risk factors that cause heart disease, strokes, peripheral vascular disease, and vascular dementias: these risk factors are obesity, high blood pressure, high cholesterol, and diabetes.

The evidence is substantial: studies show that people with these conditions are significantly more likely to develop Alzheimer’s disease. Meanwhile, studies also show that people with Alzheimer’s disease have significantly reduced brain blood flow, and autopsy studies show that brains affected by Alzheimer’s can also have significant vascular damage.

Researchers are now focusing on why this is — what is the connection? It appears that good brain blood flow is key for clearing those tubular proteins that can accumulate and become tangled in the brains of Alzheimer’s patients, and so one solid hypothesis is that anything that reduces that blood flow can increase the risk for Alzheimer’s, and conversely, anything that increases blood flow can reduce the risk for Alzheimer’s.
Healthy heart behaviors can lower your risk of dementia

And it is true that exercise lowers the risk of dementia, even Alzheimer’s. Studies show that people who exercise more are less likely to develop dementia of any kind, and this stands even for adults with mild cognitive impairment. There is also substantial research evidence showing that eating a Mediterranean-style diet high in fruits, vegetables, whole grains, healthy fats, and seafood is associated with a significantly lower risk of cognitive decline and dementia.

The take-home message here is, even if someone has a family history of dementia, particularly Alzheimer’s dementia, and even if they already have mild cognitive impairment (forgetfulness, confusion), they can still reduce their risk of developing dementia by simply living a heart-healthy lifestyle. That means a Mediterranean-style diet with 4 or 5 servings of fruits and veggies daily, and 150 minutes per week of activity. Lifestyle factors that help to reduce stress can also help: enough hours of good sleep, positive relationships, and social engagement have been shown to protect cognition.
Holiday time is here again! So are the joys and challenges of holiday eating. The big challenge is to have fun at special occasions without jeopardizing some of the healthy practices you have worked on throughout the year.

Here are some tips to help you survive the holiday season.

Do not arrive hungry to the party! Skipping meals before a holiday party in an effort to save calories for the big party will only make you overeat. Eat a light meal or snack before arriving to the party. A snack or meal that is high in fiber and contains lean protein is ideal because it can help control your appetite and help you avoid overeating.

Choose the right plate. You are more likely to eat food that ends up on your plate. Thus, choosing a smaller plate will not only prevent you from filling your plate with more items then you really need, but it will also make the amount of food on your plate seem larger.

Be merry. Spread holiday cheer by spending time enjoying the company of others at the party. The more you talk, the less time you will spend eating.

Balance your plate. Aim to fill half your plate with vegetables, a quarter with lean protein, and a quarter with starch.

Bring something to the party. Offer to bring an appetizer, side, or dessert to the party. Not only will the host or hostess appreciate the help, but you’ll also have control over what goes into the dish.

Fill up on vegetables and fruits. Not only do these foods have plenty of vitamins and minerals, but they also contain fiber, which helps keep you full longer and may leave less room for other high-calorie foods.

Watch the liquid calories. For some, a holiday party is not complete without traditional drinks and cocktails. Beware that these drinks often contain a large number of calories. One cup of eggnog can set you back around 360 calories, while hot chocolate can contain around 200 calories. Alcoholic mixed drinks and punches can easily contain over 200 calories. Opt instead for a glass of sparkling water with a splash of your favorite juice or wine.

Be choosy. If you are at a buffet, scan the table before you enter the line. Choose small servings of the foods you want, but try not to return for seconds.

Food gifts. With the holidays come tins full of cookies and sweets. If you know that these will be trouble once you bring them home, open them up at work and pass them around for all to enjoy. If you are in the position of giving a gift to someone that is trying to eat healthy or lose weight, why not give them a non-food gift like a plant, balloons, or a healthy cookbook.

Be active. A short trip over the holidays doesn’t have to mean taking a vacation from your workout. Pack your sneakers or walking shoes and make a plan to fit in some activity each day.
When you think of menopause, you might think of hot flashes and night sweats. But many women also experience symptoms of depression. The risk of depression doubles or even quadruples during the menopausal transition, which has researchers looking for ways to address — or even prevent — the problem.

One study published in JAMA Psychiatry found that hormone therapy may help ward off symptoms of peri- and postmenopausal depression in some women. Researchers found that perimenopausal and early postmenopausal women who were treated with hormones were less likely to experience symptoms of depression than women in the study who were given a placebo.

But unfortunately, the findings present a far-from-perfect solution. Hormone therapy brings its own set of risks, and for this reason it likely shouldn’t be widely used for preventing depression in women at this stage of life, says Dr. Hadine Joffe, the Paula A. Johnson Associate Professor of Psychiatry in Women’s Health at Harvard Medical School, who wrote an editorial accompanying the study. “It’s not a ‘never,’ but it shouldn’t be a standard approach; in general, all of medicine has moved away from using hormones for prevention,” she says.
About the study

The study included 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who were experiencing low-level symptoms of depression. Roughly half used a skin patch containing the hormone estradiol for 12 months, as well as intermittent oral progesterone pills. The rest received a fake skin patch and placebo pills.

The women were evaluated at the beginning of the trial and throughout for symptoms of depression, using the Center for Epidemiologic Studies Depression Scale. Researchers found that only 17% of women in the hormone group developed clinically significant depression, compared with 32% of those in the placebo group.

Untreated depression can cause physical symptoms, such as headaches and fatigue, in addition to emotional symptoms, including persistent sadness and even suicidal thoughts. It can interfere with daily function and reduce quality of life. However, hormone use brings its own health risks, such as a greater chance of blood clots and stroke. “It would be irresponsible to recommend this as a blanket prevention treatment for women,” says Dr. Joffe, who is also executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.
Lessons learned

Despite the caveat about hormone therapy, the findings should not be ignored. Rather, the key message for women is that depression during perimenopause and early postmenopause should be taken seriously, and women at this stage of life should be more closely monitored for depressive symptoms. In addition, study authors identified at least one risk factor for depression that stood out among women in this group — recent life stress. “A lot of people have stress, so I think it’s an important message that stress contributes to depression,” says Dr. Joffe.

Depression symptoms are not a sign of someone’s failure to cope. “This really is a brain phenomenon,” says Dr. Joffe. So here are some action points based on the findings.

    Be aware of depression risk. Knowing that depression is more common during perimenopause and early postmenopause can help you identify worrisome symptoms and act quickly. If you are perimenopausal or in early postmenopause, your doctor should ideally be screening you for mood symptoms at your regular visits. If not, bring up the topic yourself. If symptoms do develop, ask your doctor for a referral to a mental health specialist.
    Weigh hormone therapy’s pros and cons. Hormone therapy may be the right choice for some women. Talk to your doctor about the potential benefits and risks. Consider how long to use hormone therapy and whether there are other medical reasons to consider taking it. Keep in mind that more research is needed to fully understand the potential benefits and drawbacks of using this therapy to prevent depression, says Dr. Joffe. Talk with your doctor about whether behavioral strategies or antidepressant drugs might be a good alternative choice for you.
    Consider lifestyle changes and treatment. Regardless of whether you opt for hormone therapy or not, nondrug strategies can also be used to reduce the likelihood of depressive symptoms, including managing stress and boosting physical activity.
For generations, midwives and doctors have looked for ways to imitate human physiology and nudge women’s bodies into giving birth. Synthetic hormones can be used to start and speed up labor. Soft balloons and seaweed sticks placed alongside the cervix can shape a pathway through the birth canal. Self-stimulation can spontaneously spark natural labor transmitters.

But the start of labor remains a complex and mysterious process. And part of this mystery is figuring out which women to induce, when to induce labor, and how. Now, a landmark study known as ARRIVE has brought a bit of clarity.
What does the study tell us about inducing labor?

This multicenter, randomized, controlled trial involving thousands of women compared outcomes of induced labor versus “expectant management” — just waiting for labor to begin. All participants in the study were expecting their first baby, and all were within one week of their due date. For most of the women, their cervix wasn’t really open yet. No special methods were used to induce labor, just what was standard at each institution.

The results were interesting. For the baby, similar numbers of complications and need for intensive care occurred in both groups. However, when compared with waiting for labor, induction decreased the likelihood that the baby would need help with breathing. Breastfeeding success was no different between the two groups.

The big news? Inducing labor was associated with a lower rate of cesarean delivery (approximately 19% versus 22%).
What else is important to know?

It’s worth pointing out that the overall rate of cesarean birth among women in the study is quite a bit lower than the national average. The study participants were also younger, more likely to be black or Hispanic, and more likely to have public insurance than the general population of women having their first baby. So these results would not apply to all women equally. Also, of all the patients who were initially eligible and asked to join the study, only about one-third chose to participate. It could be that women opting to participate in a study of induction of labor had a particular leaning that could skew the results. It also tells us that many women may not want to have labor induced. And, while the chance of cesarean was lower in the induced patients, labor took longer than it did for those women who waited for labor to kick in on its own.

Doctors sometimes recommend inducing labor and birth for the benefit of the baby, mother, or both. Hypertensive diseases, including chronic high blood pressure and preeclampsia, are dangerous conditions that may require accelerated delivery. Over time, the health of the placenta that nourishes the fetus can deteriorate, leading to lack of growth and low amniotic fluid levels. When problems like these occur, inducing birth is appropriate. Other conditions — such as diabetes requiring insulin and, at times, the age of the mother — may be good reasons to induce. But even without a medical reason, the ARRIVE trial tells us it may actually be safer to induce labor in some women than to wait for labor to happen.
Should a woman choose to have labor induced?

So, should a woman choose to be induced? The answer may be yes if she is having her first baby, is not opposed to the idea of inducing labor, and is within one week of her due date. However, the benefits become less clear if her characteristics differ from those of the study participants in the ARRIVE trial. It’s best for a woman to discuss the options with her health care team.

We also don’t yet know how the longer labor and length of hospital stay associated with induction affect the cost of care. And most labor and delivery units are not built or staffed appropriately to accommodate the increase in occupancy that would result if many more first-time mothers were induced at full term. So, while the ARRIVE trial has answered some critical questions about inducing labor, some of the mystery remains.

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