Practicing medicine in the current era is an infinite stream of research studies to keep up with, dealing with complex patients, seeing patients with complex and challenging medical issues, embracing patients with elusive conditions that have yet no diagnosis, and we haven’t even arrived at the economic obstacles of running a clinical practice.
For those of us who practice modern naturopathic medicine or integrative medicine, all of these issues are escalated…. and no more so than the challenge of trying to keep up with the natural medicine research as well the conventional medicine research.
That is why I am compelled to vigilantly remind myself, and my patients, what I consider to be the basics: Nutrition, Exercise, Water, Sunshine, Air, Rest, Nature, Avoid harmful substances, Mental/Emotional health and support, and Trust in a greater power than our own. Employing the use of our increasingly sophisticated and more successful clinical utilization of botanicals and nutraceuticals, in the context of the basic essential lifestyle changes, makes for even more positive outcomes, in my experience.
The following few select studies are good examples of just how powerful some of these basics can be.
Reducing Recurring Urinary Tract Infections – The Power of Water
This study in premenopausal women prone to urinary tract infections demonstrates the point that simple lifestyle changes can make a big difference.
Researchers assessed 140 premenopausal women who had at last 3 urinary tract infections in the previous year, and who reported a daily fluid intake of less than 1.5 liters (about 6.25 cups) of water per day. The 70 women in the treatment group were instructed to drink an additional 1.5 liters of water each day, and the 70 in the control group were instructed not to change their typical intake.
Over the course of the 1 year study, the average daily increase was 1.15 liters (about 5 cups) in the treatment group, for a daily total of 2.8 liters (12 cups). The average daily intake was 1.2 liters (5 cups) in the control group. After one year, there were 48% fewer urinary tract infections in the treatment group than in the control group. In addition to that, the number of days from the last infection to the first recurrent infection of acute uncomplicated cystitis was 55 days longer in the intervention group than in the control group (148 vs 93). The average number of days between episodes (143 vs. 85) was also better in the treatment group.
With fewer infections, this also led to 47% fewer courses of antibiotics in the intervention group than in the control group (1.8 vs 3.5).
Commentary: Approximately 60% of women will develop a urinary tract infection in their lifetime, and one in four will have a repeat infection. Urinary tract infections lead to more than 10 million doctor visits a year, and more antibiotics. While this simple approach will not work for everyone, it is an important strategy to at least incorporate. One caution is that in women with overactive bladder, this increased fluid intake could worsen the urgency to urinate and increase urinary incontinence. Why does increased water intake work?? What we think is that this increases frequency of flushing bacteria from the urinary tract, which means the bacteria don’t have time to attach to the bladder wall and thus the overall concentration of bacteria is reduced. I would also predict that these same results would be acquired in postmenopausal women.1
Greater Cardiovascular Fitness in Midlife Women leads to Lower Dementia Risk Later
This study was done looking at 200 Swedish women aged 38-60 who underwent cycling testing that measured cardiovascular fitness. They were followed for an average of 29 years. Using objective assessments and repeat neuropsychiatric evaluations, 23% were diagnosed with dementia at a mean age of 80. Researchers compared women who had medium cardiovascular fitness at baseline to those who had a high fitness level, and found that those with a higher fitness level had an 88% lower risk for dementia over the course of the follow-up years. Of those that were in the high fitness category who were diagnosed with dementia, it developed about 11 years later compared to those with medium fitness.
Commentary: While fitness level cannot be asserted to be a causal effect, it is worth emphasizing the possibility that improved cardiovascular fitness in midlife could modify a woman’s risk and delay or prevent dementia. There are several herbs and nutrients that have shown some suggestive influence in providing neurocognitive protection, but all research should be multifactorial in this area, given the growing numbers of individuals affected. Causation, prevention and treatments, all deserve assertive research and across the spectrum of issues related to causation: environmental exposures, stressors, diet, brief and long term medication exposures and genetics. Prevention: stress, nutrition, optimal sleep habits, herbal/nutrient supplements and medications. Treatments: Lifestyle, natural and pharmaceutical interventions.2
Weight Training May Reduce Hot flashes
There are several reasons to recommend strength training to women, including postmenopausal women – weight management, prevent decline in muscle mass, bone density, and now hot flashes!!
This clinical trial suggests that it is effective for the hot flashes of perimenopause/menopause.
When it comes to exercise, some studies suggest that exercise may help reduce hot flashes but others show no effect. The researchers of the current study randomly assigned 58 women experiencing at least four moderate-to-severe hot flashes or night sweats daily to 15 weeks of resistance training or to a control group in which the women did not change their physical activity routine. None of the women in either group were regular exercisers or had used hormone therapy for the two months prior.
The strength training workout group had a regimen of 45 minutes sessions, three times per week which included six exercises on resistance machines and two using body weight. Women started with lighter weights for the first three weeks, then progressively increased their weights and loads. Prior to the workout regimen, the exercise group averaged 7.5 hot flashes or night sweats a day and after 15 weeks were having an average of 4-5 per day. There were no changes in the control group.
Commentary: I always like to see studies on hot flashes and night sweats that offer women more lifestyle options, that can actually work. If one is not already engaged in regular exercise including some kind of strength training, starting with lighter loads for the first 1-2 weeks is important in order to avoid injury. There are many non-hormonal and hormonal options to relieve hot flashes and night sweats… including dietary influences, botanicals, nutraceuticals, hormones and non-hormone prescription medications. In the case of strength training, as I said, there are other meaningful benefits as well. Other forms of exercise are also full of benefits including a decreased incidence of heart disease, type 2 diabetes, bone loss and cancer.3
How Many Steps it Takes to Live Longer
Most all of us are familiar with the concept that we need 10,000 steps per day to achieve health benefits. A recent study was done to investigate further the optimal number of steps daily, as well as intensity required for health benefits. This observational study was conducted in 16,700 women with a mean age of 72, who used accelerometers for at least 10 hours daily for several days at the entry into the study. Women were assessed annually over a follow-up period of 4.3 years. Lower mortality was associated with more daily steps with a median of 5,500 steps daily. Compared with the women who were the least active, about 2,700 steps per day, women in the range of 4,400 steps daily had a 46% lower all-cause mortality and women who recorded about 5,900 steps per day had a 53% lower mortality. The women in the highest step group, about 8,400 steps per day, had a 66% lower mortality. More than 7,500 steps per day had not added mortality benefit and there was no association between mortality and speed of steps/walking.
Commentary: While I don’t really want to be an advocate of lowering the amount of daily steps/exercise I do think it is important to realize that even about half the customary 10,000 steps per day has mortality benefits, and 7,500 steps per day has optimal mortality benefits. We walk more or less on any given day, due to the demands or our lives, or the excuses we concoct, but these current results are comforting and provide a good basic guideline for how to help ourselves improve our longevity. And don’t forget, walking is a therapeutic tool for depression, osteoarthritis, high blood pressure, high cholesterol, pre-diabetes, diabetes, history of cardiac disease and PMS. Plus… good for the soul, good for the planet.4
Exercise and All-Cause Mortality
Current physical activity guidelines recommend moderate intensity exercise for 30 minutes most days of the week for a total of 150 minutes/week, or vigorous exercise for 75 minutes per week, spread out over at least 3 sessions per week. In a report published in January, 2017, researchers evaluated more than 63,000 men and women over age 40, inquiring about their moderate to vigorous physical activity. The research participants were classified into four groups: 1) individuals who did no moderate or vigorous physical activity 2) those who met the 150 minutes/week of moderate intensity or 75 minutes/week guidelines for of vigorous intensity and divided over at least 3 times weekly 3) those who met the total number of minutes per week but did so within 1-2 sessions/week and 4) and those who did some moderate to vigorous exercise but less than the guidelines.
The results demonstrated that all the active groups compared with those having no moderate to vigorous activity, had substantial reductions in cardiovascular disease and all-cause mortality. Those individuals who met the guidelines and exercised at least 3 sessions per week had a 35% reduction in all-cause mortality. All three active groups had approximately a 40% reduction in cardiovascular mortality compared with those who did not report any moderate to vigorous activity.5
Coffee Reduces Breast Cancer Risk
The purpose of this meta-analysis was to try to get some clarity and to summarize the evidence, from prospective cohort studies regarding the association between coffee intake and breast cancer risk.
The design was established to assess associations between amounts of decaffeinated and caffeinated coffee (from 0 to 7 cups of coffee per day) and breast cancer risks, including categories of body mass index, hormone receptor status and menopause status.
The analysis included 13 prospective studies totaling over 1 million participants, and concluded in showing no significant association between coffee consumption and breast cancer risk. However, when the analysis was specific to postmenopausal women, there was an inverse relationship to the tune of consumption of 4 cups of coffee per day was associated with a 10% reduction in postmenopausal cancer risk, no matter body mass index or hormone receptor status, or caffeinated or decaffeinated coffee.
Conclusion: coffee consumption is associated with a decreased risk of postmenopausal breast cancer.
Commentary: The last few years of coffee research have shown multiple potential benefits, suggesting reducing cardiovascular disease and cardiovascular mortality, Parkinson’s disease, type 2 diabetes, and cancers including breast/colon/endometrium and prostate.6 Overall, observational prospective cohort studies suggest that moderate-to-high coffee intake is associated with lower risk of mortality from any cause, and cardiovascular, and cancer mortality compared to lower consumption.7
Prior meta-analyses have not shown any clear results with coffee consumption and female cancers.8 In a 2013 meta-analysis of 16 cohort and 10 case-control studies, there was only a borderline association when comparing highest vs lowest coffee consumption although they did find a significant inverse association between coffee consumption and cancer risk in estrogen receptor-negative women and in BRCA1-positive women.9
In the study, since there was no difference between caffeinated or decaffeinated coffee, there must be other compounds in the coffee that are responsible. Women and practitioners should not reduce coffee intake based on concerns regarding breast cancer, and if anything, perhaps we should consider encouraging coffee drinking in postmenopausal women, (although 4 cups per day may have other problems such as anxiety, insomnia, agitation, palpitations, breast tenderness) and perhaps even more so if there are other breast cancer risk factors (first degree family history, obesity, excess alcohol).10
References:
- Hooten, M.T., et al, Presentation at Infectious Disease Society of America, IDWeek 2017, 2017.
- Horder, H., et al. Neurology 2018.
- Berin, E., et al. Maturitas. 2019 Aug;126:55-60.
- Lee I-M, et al. JAMA Intern Med 2019.
- O Donovan, G., et al. JAMA Intern Med 2017.
- Grosso G, Godos J, Galvano F, Giovannucci EL. Coffee, caffeine and health outcomes: an umbrella review. Annu Rev Nutr. 2017;37:131-156.
- Grosso G, Micek A, Godos J, et al. Coffee consumption and risk of all-cause, cardiovascular and cancer mortality in smokers and non-smokers: a dose-response meta-analysis. Eur J Epidemiol. 2016;31:1191-1205.
- Malerba S, Turati F, Galeone C, et al. A meta-analysis of prospective studies of coffee consumption and mortality for all causes, cancers and cardiovascular diseases. Eur J Epidemiol. 2013;28(7):527-539.
- Li XJ, Ren ZJ, Qin JW, et al. Coffee consumption and risk of breast cancer: an up-to-date meta-analysis. PLoS One. 2013;8(1):e52681.
- Lafranconi A, Micek A, De Paoli P, et al. Coffee intake decreases risk of postmenopausal breast cancer: a dose-response meta-analysis on prospective cohort studies. Nutrients. 2018;10(2). pii:E112.
