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Medicial Mistakes?
How many people each year suffer some type of preventable harm that contributes to their death after a hospital visit?
from 46,000 to 78,000
from 78,000 to 132,000
from 132,000 to 210,000
from 210,000 to 440,000

 
 
 Integrative Medicine: Osteoporosis, Heart Disease, and Breast Cancer 
 

The major type of cholesterol-protein manufactured is the low density lipoprotein, or LDL. LDL is the body's main carrier of cholesterol. When levels of LDL are elevated they remain in the body streams and injure the endothelium (the inner lining of the blood vessel wall), thereby initiating plaque formation. Thus, LDL is considered to be the "bad" type of cholesterol. Women with a total blood cholesterol above 240 mg/dl and a LDL level above 160 mg/dl are thought to be at high risk of heart disease. Ideally, the total cholesterol should be below 180 mg/dl and the LDL below 130 mg/dl for the greatest degree of protection.

Decreased HDL cholesterol.The liver also makes another type of cholesterol-protein called the high density lipoprotein or HDL. The HDL is considered to be the "good" type of cholesterol. This is because HDL picks up and carries the excess cholesterol back to the liver, where it is secreted into the bile. The bile empties the excess cholesterol into the intestinal tract, where it is excreted from our bodies through bowel movements. When her HDL is less than 35 mg/dl, a woman is considered to be at high risk of coronary artery disease. The HDL should ideally be about 55 mg/dl.

Elevated LDL to HDL ratio.The ratio between the LDL and HDL is also an important indicator of heart disease risk. Ideally, your LDL to HDL ratio should be no higher than 4:1. For example, if your HDL is 30 and your LDL is 150, then your ratio is 5:1, which puts you in the high risk category.

Hypertension. High blood pressure is a significant risk factor for developing coronary artery disease. Sixty million Americans have elevated blood pressure readings, and nearly half of these people are women. Blood pressure is considered to be elevated when readings are above 140/90. The upper number is called the systolic pressure, which is the pressure that occurs when the heart contracts and pushes blood through the arterial circulation. The bottom number is called the diastolic blood pressure. This is the pressure in the arteries when the heart relaxes between beats. Not only does hypertension increase the likelihood of heart attacks, but it also increases the risk of strokes and kidney disease.

Diabetes. The Framingham Study, an important study of cardiovascular disease risk that has been ongoing in Massachusetts since 1949, found that women with diabetes are twice as likely to have a heart attack as nondiabetic women. Diabetic women are also at higher risk of developing serious visual problems and kidney complications, as well as hypertension and higher cholesterol levels.

Lifestyle Factors
Cigarette Smoking. Because smoking narrows the diameter of the blood vessels, impairing circulation, smokers have an increased risk of heart attacks and strokes. Smokers are also more likely to have higher levels of the bad LDL and lower levels of the good HDL. Unfortunately, 27 percent of all women smoke and this percentage is not declining rapidly, despite the great amount of public information on the health perils of smoking. Women smokers also enter menopause two to three years earlier than nonsmokers.

Physical Inactivity. Women with sedentary lifestyles have three times the risk of developing heart disease than women who are physically active. The heart is a muscle that needs to be exercised. Women who engage in aerobic exercise, such as walking at least three times a week for a half hour, have lower resting heart rate, greater lung capacity, and an improved ability to handle stress.

Stress. Several studies suggest that severe stress is a risk factor in developing coronary artery disease, though this link has been researched much less in women than in men. Many studies have been done on the Type A, hard driving, aggressive male personality. However, women with multiple home and work responsibilities are often as hard driving and stressed as men. This can predispose certain women over time to an increased risk of heart attack.

Female-Related Risk Factors
Menopausal Status. The risk of coronary artery disease increases twofold to threefold once a woman enters natural menopause. Research studies, including the Framingham Study, have confirmed that premenopausal women with intact ovarian function enjoy significant protection against the development of heart attacks.

Surgical or Natural Menopause Before Age 45. Recent studies have shown that women who, during their premenopausal years, undergo a hysterectomy involving removal of their ovaries have three times the risk of coronary artery disease compared to women who cease menstruating at a later age. Similarly, a study of 122,000 nurses found that women who went through surgical menopause before the age of 35 have two to seven times the risk of heart attack. The risk is also higher in women who go through natural menopause at an early age. Estrogen appears to confer significant protection against heart attacks during the active reproductive years. The longer a woman menstruates, the more years her vascular system has estrogenic protection.

Hormonal Therapy for Heart Disease Prevention. Both estrogen alone and combined estrogen-progestin therapy have been studied for the effects on the cardiovascular system. Estrogen appears to be beneficial; it lowers the levels of LDL cholesterol, which is linked to heart attacks, and raises the level of HDL cholesterol, which appears to confer protection. The one negative factor noted on studies of estrogen users was a moderate rise in triglycerides. On the other hand, however, physicians believe the use of estrogen will confer protection against heart attacks. The addition of progesterone to an estrogen treatment program does not appear to negate estrogen's positive effects on the heart.

Breast Cancer
The incidence of breast cancer has increased dramatically over the past two decades. During the 1950s, it was estimated that one out of every twenty Americans would develop this disease. These estimates have been revised many times over the past forty years as the incidence of breast cancer has skyrocketed. It is currently estimated that one out of eight women, or 12 percent of all women in this country, will develop breast cancer during her lifetime. This is a staggering number, placing breast cancer as the most common cancer of American women today. It is the second most common cause of cancer deaths in women, behind only lung cancer in its mortality rate. In absolute numbers, 180,000 new cases of breast cancer were projected for 1993, as well as 46,000 deaths from this disease.

Breast cancer cells, like other malignancies, invade and destroy normal tissue (unlike benign tumors, which remain confined within a specific area). Breast cancer cells first grow within the breast tissue itself. In the later stages of the disease, the cancerous cells spread to other parts of the body near or adjacent to the breast (as with invasion to the lymph nodes). The cancerous cells can also invade distant sites, like the liver and the bones.

How high a woman's chance of survival is depends on how early the cancer is detected. The earlier the detection and the more localized a tumor is to the breast tissue itself, the more likely a woman is to have a long term recovery from this disease (five years or more). For example, women with localized tumors are eight times more likely to survive the disease long term than a woman with an advanced case that has spread throughout her body.

Risk Factors for Breast Cancer
Not all women have the same risk of developing breast cancer. While any woman can develop the disease, certain factors do put some women statistically at greater risk:

  • Previous history of breast cancer.

  • Family history of breast cancer. This is particularly pertinent if a woman's mother or sisters had the disease.

  • Early onset of menstrual periods.

  • Late menopause - Women who menstruate for more than 40 years seem to be at particular risk of breast cancer.

  • Postmenopausal age. Most breast cancers occur after age 50.

  • Childlessness or having a first child after age 30.

  • Bottle feeding. Women who nurse their children appear to be at lower risk.

  • Certain types of "atypical" cell patterns with benign (noncancerous) breast disease.

  • High fat diet - This seems to be a risk factor for some cases of breast cancer.

  • Obesity - A high-fat and too-rich diet causes women to be overweight, which is a risk factor for the development of this disease.

  • Alcohol use — more than nine drinks per week significantly increases the risk.

  • Height or tallness is a risk factor.

  • Affluence or degree of wealth.

  • Radiation exposure.

  • Prolonged estrogen and progesterone use (this is still a controversial area in medicine, with some studies supporting this view and other studies contradicting it).

  • Urban lifestyle.
Diagnosis of Breast Cancer
Breast cancer is often discovered by the woman herself on breast examination or by her physician during a medical visit. A woman can usually feel a hard, nontender mass that is not particularly movable within her breast tissue. Other signs of breast cancer can include swelling, dimpling, or redness of the breast tissue. If the cancer has spread to the lymph nodes under the armpit or above the collarbone, they may feel enlarged and hard.

Mammography, or an X ray of the breast, is a tremendously helpful diagnostic tool to pinpoint breast cancer. In fact, many early stage cancers, too small to be felt manually, can be detected by mammography. As a matter of fact, it can detect 90 percent of all breast cancers. Undoubtedly, the use of mammography has saved many women's lives through early detection. Other techniques such as thermography, which detects heat changes in the breast tissue, and ultrasound, which uses highfrequency sound waves, are diagnostic tools used less often.

Despite the usefulness of all of these techniques, the definitive diagnosis of breast cancer can only be made by doing a surgical biopsy. This allows the tissue sample removed from the breast to be looked at under the microscope and examined for cancerous cells.

Once breast cancer is diagnosed, many treatment options are available. These include surgery and removal of the breast and lymph nodes, if indicated. Less radical surgery, which leaves the breast intact, is being used more for localized cancer. Radiation therapy and chemotherapy are also used with various treatment regimens. What regimen is finally selected depends on how localized or disseminated the tumor is, as well as the preference of the patient and physician. Women interested in prevention should follow a diet low in saturated fat and limit their alcohol intake.

Vitamins and Minerals for Prevention of Osteoporosis

These are nutrients that can be of help in promoting prevention:
Calcium. There are dozens of studies that reinforce the importance of calcium for the prevention of osteoporosis. Calcium is the most abundant mineral in the body, and 99 percent of it is deposited in the bones and teeth. (The other 1 percent of calcium is involved in blood clotting, nerve and muscle stimulation, and other important functions.) As a result, calcium is the most important structural mineral in bone. Along with phosphorus, calcium helps to build and maintain strong and healthy bones. However, calcium absorption becomes much less efficient by the time women reach their postmenopausal years due to the aging of the digestive tract. Calcium needs an acid environment in the stomach for proper digestion. As many as 40 percent of postmenopausal women lack sufficient stomach acid for proper calcium absorption.

Unfortunately, most women have too little calcium intake in their diets. The average American woman takes in 400 to 500 mg per day. This is far less than the recommended daily allowance (RDA) of 800 mg per day for women during their active reproductive years and the 1200 to 1500 mg per day needed by postmenopausal women.

(Excerpted from The Women's Health Companion ISBN: 0890877335)
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 About The Author
Susan Lark MDDr. Susan M. Lark is one of the foremost authorities on women's health issues and is the author of nine books. She has served on the faculty of Stanford University Medical School...more
 
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