Emotional Abuse – What It Looks Like

October 14, 2019

“Did it ever get physical?”

 

This is often the first question we ask someone we know or suspect is in an unhealthy relationship. While starting a conversation about physical abuse is essential, an issue arises when it is the ONLY question we ask. Stopping short of inquiring about other forms of abuse implies that physical violence is the defining factor of an unhealthy relationship. Even worse, it conveys the message that whatever else might be going on is not that bad. This is a huge issue, because emotional abuse is as bad – and can often be worse. 

Why don’t we hear more about emotional abuse? Many people simply aren’t sure what emotional abuse actually entails. Understanding emotional abuse is complicated for many reasons. 

 

Emotional abuse is any abusive behavior that is not physical, which may include (but is not limited to) verbal aggression, intimidation, manipulation and humiliation, which most often unfolds as a pattern of behavior over time that aims to diminish another person’s sense of identity, dignity and self-worth, and which often results in anxiety, depression, suicidal thoughts/behaviors, and post-traumatic stress disorder (PTSD).

 

Breaking It Down:

1.“…any abusive behavior that isn’t physical…”

Emotional abuse is difficult to comprehend because it encompasses so much. This list delineates some, but certainly not all, behaviors that are potentially emotionally abusive:

  • Intimidation
  • Manipulation
  • Refusal to ever be pleased
  • Blaming
  • Shaming
  • Name-calling
  • Insults
  • Put-downs
  • Sarcasm
  • Infantilization
  • Silent treatment
  • Trivializing
  • Triangulation
  • Sabotage
  • Gaslighting
  • Scapegoating
  • Blame-shifting
  • Projection
  • Ranking and comparing
  • Arbitrary and unpredictable inconsistency
  • Threatening harm
  • Forced isolation

 

Some of the above can be part of a healthy relationship.  However, in the context of emotional abuse, the intent is malicious and these behaviors can be extremely cutting, especially when disguised as affection or an innocent remark.

 

2. “ …which may include verbal aggression, intimidation, manipulation, and humiliation”

The key word here is “may.” Not only is the list of emotional abuse tactics incredibly long and dependent on context, but also the particular combination of behaviors can vary greatly from relationship to relationship. As a result, we have another layer of complexity: emotional abuse doesn’t have one specific look. For example, an emotionally abusive relationship where overt aggressing behaviors like yelling, threatening and blaming are predominantly used will look very different from a relationship where only very subtle forms of abuse like gaslighting, passive-aggressive put-downs, and minimizing are used.

 

3. “a pattern of behavior over time”

Emotional abuse is rarely a single event. Instead, it occurs over time as a pattern of behavior that’s sustained & repetitive.This is one of the reasons it is so complicated and so dangerous. Even if you’re the most observant person in the world, emotional abuse can be so gradual that you don’t realize what’s happening until you’re deeply entangled in its web. As a result, the abuse can go unchecked as the relationship progresses, building for months, years, even decades, especially if the abuse is more covert. In such instances, the target’s self-esteem is steadily eroded and their self-doubt becomes so paralyzing that they often have only a vague sense that something (though unsure what) is wrong.

 

4. “aims to diminish another person’s sense of identity, dignity, and self-worth”

Regardless of how emotional abuse unfolds, the effects can be devastating. Unfortunately, these effects as well as each harmful act of abuse are largely invisible. This makes it difficult for most people to comprehend the very real risks and damage of emotional abuse. Try to picture a scene of emotional abuse, specifically someone whose self-identity has been annihilated. Can you see it? Generally, one’s mind does not know where to begin. While describing physical wounds is pretty straightforward, it is much harder to articulate emotional trauma. The parts of a person that sustained emotional abuse destroys—identity, dignity, and self-worth—are abstract and virtually impossible to picture or measure.

 

5. “results in anxiety, depression, suicidal thoughts or behaviors, and post-traumatic stress disorder (PTSD)”

Emotional abuse is essentially invisible, singling out the abuse as the culprit of its destructive effects is another kind of challenge and frustration. Even in cases of extreme emotional abuse, there are no bruises or gashes where the victim can point to as proof or validation.  Instead, what emotional abuse ends up looking like is a person suffering from painful yet not uncommon afflictions like anxiety or depression. It can therefore be heartbreakingly easy for anyone—whether the person inflicting the emotional abuse, a third-party observer, or even the target of the abuse—to misattribute its damage to some other cause or even blame the target who has escaped from a relationship.  In fact the abuser, tends to reach out to friends/acquaintances and even family of the victim, and devalue that person or make them appear ridiculous, insane or off-base.

 

The Emotional Abuser’s Typical Behavior:

Many women and men who are emotionally abused have no choice but to rescue themselves or continue to live with the abuse. Because others cannot see signs of abuse, these victims often have little or no social support.  In fact, their abuser is often quite charismatic and charming, especially to mutual friends, which is a technique often used by the abuser to further disparage their target.

 

Why would someone emotionally abusing you and think it’s okay? It may be a part of their behavior to control others by any means necessary to get what they want.  Certain personality disorders are common among those who emotionally abuse others. They may have an authoritarian personality – these people admit to no faults because they see themselves as right and others as wrong. If you are being emotionally abused by someone with an anti-social personality (a sociopath), you should seek immediate safety and remove yourself from the relationship, since those with an anti-social personality can become violent when they don’t get what they want. Another personality disorder in which emotional abuse may be evident is narcissism. The abuser makes everything about their own needs and desires. Narcissists may frame their actions as being helpful to their victim, but they all revolve around building their ego.

 

Often, abusive behavior is a direct means for the abuser to get what they want without taking responsibility for their actions. They may feel intense anxiety about losing you, so they close off your avenue of escape. Whether your abuser understands what they are doing or not, they know that they do not want you to think your own thoughts, make your own decisions, or live your own life without putting them ahead of yourself. In some way, your thoughts and behaviors are a problem for them. They do not think of you as an independent adult who can think for yourself and is entitled to your perspective. And they do not want you to think of yourself that way either. 

 

Techniques Used By An Emotional Abuser:

•Countering: telling you that you remember something incorrectly

•Trivializing: making you feel like your thoughts and feelings don’t matter

•Withholding: pretending they don’t understand what you’re saying

•Stonewalling: refusing to listen or engage with you in conversation

•Blocking: changing the subject

•Diverting: questioning the validity of your thoughts

•Forgetting: pretending to forget things that happened

•Denying: telling you something never happened

•Faking compassion: telling you they’re doing something harmful for your good

•Discrediting: convincing others, you’re insane or unstable

•Reframing: twisting your thoughts, behaviors, and experiences to favor their perspective

 

Typical Phrases Used By A Emotional Abuser:

Certain phrases come up often in relationships where someone is being emotionally abused. These phrases and others like them can convince you that your mind isn’t trustworthy. If you hear these often when you know deep inside that they’re unfair statements, it may be time to seek help:

•”I don’t want to hear that.”

•”You need to stop trying to confuse me.”

•”You’re wrong.”

•”You remember it wrong.”

•”Where did you get that crazy idea?”

•”Your imagination is getting the best of you.”

•”It didn’t happen that way.”

•”You know I’m right.”

•”You’re too sensitive.”

•”I only do it because I love you.”

•”You get angry so easily.”

•”You’re too sensitive.”

•”I have no idea what you’re talking about.”

•”You’re making that up.”

•”Calm down!”

 

Thoughts, Feelings, and Behaviors Associated with Being Emotionally Abused:

When someone emotionally abuses you, your thoughts, feelings, and actions may change dramatically. Where once you felt self-assured, you may now feel like you cannot trust your mind. Take some time to examine how these parts of you have changed since being with the person or in the situation. The National Domestic Violence Hotline describes what to watch for. Here is a quick checklist to guide you:

•Do you second-guess yourself often?

•Do you find yourself wondering whether you’re too sensitive?

•Do you feel confused a lot of the time?

•Do you feel like you’re ‘going crazy?’

•Do you notice that you apologize to someone often?

•Do you wonder why you can’t seem to be happy when you have so much?

•Do you make excuses for the abuser?

•Do you have an overwhelming sense that something’s wrong, even if you don’t know what it is?

•Do you often lie to avoid your partner’s, boss’s, or co-worker’s criticisms?

•Is it hard for you to make simple decisions?

•Do you feel hopeless?

•Do you feel like a loser who can’t do anything right?

•Do you question whether you’re good enough for your partner or job?

 

How to Deal with Emotional Abuse:

People who have endured emotional abuse (no matter how long a person was exposed to it) always find it challenging to leave the relationship, have any self-confidence at all after leaving the relationship and can often struggle to have a healthy relationship with another person in the future. The real question is how to deal with emotional abuse before it reaches that point. Here are a few suggestions for dealing with emotional abuse in relationships:

  1. Study intuition and develop a strong belief in your intuition.
  2. Realize that the abuser’s manipulations have nothing to do with who you are.
  3. Understand that you can’t change someone who is abusive; you can only change yourself.

October is Domestic Violence Awareness Month

September 29, 2019

DOMESTIC VIOLENCE FACTS

 

Did you know . . . .

 

Domestic violence is the #1 cause of injury ages 14 – 55 — more than car accidents, muggings & rapes combined  

 

Domestic violence is a pattern of controlling behaviors that one partner uses to get power over the other.  It includes: physical violence or threat of physical violence to get control, emotional or mental abuse and sexual abuse

 

Domestic violence occurs in all races, socio-economic classes, religious affiliations, occupations & educational backgrounds

 

 

Domestic violence is rarely an isolated event — tends to increase & become more violent over time

 

Someone is beaten by their spouse/partner every 9 seconds

 

On average, 24 people per minute are victims of rape, physical violence or stalking by an intimate partner in the United States

 

More than 12 million women and men are victims of domestic violence over the course of a year

 

3-4 million people are beaten in their homes each year by partners or ex-partners

 

85% of domestic violence victims are women

 

1 : 4 women and 1 : 7 men over the age of 18 will experience domestic violence in their lifetime

 

Women between the ages of 20 – 24 are at greatest risk of becoming victims of domestic violence

 

25 – 45% of all women battered are battered during pregnancy

 

Half of all homeless women and children in the U.S. are fleeing from domestic violence

 

1 : 12 women and 1 : 45 men have been stalked in their lifetime

 

Witnessing violence is the strongest risk factor of transmitting violence from one generation to the next

 

Boys who witness domestic violence are 2 times as likely to abuse their own partners and children when they become adults

 

In 60% to 80% of intimate partner homicides, no matter which partner was killed, the man physically abused the woman before the murder

 

The costs of domestic violence amount to more than $37 billion a year in law enforcement involvement, legal work, medical and mental health treatment, and lost productivity at companies

 

Children who witness violence are twice as likely to abuse their own partners & children as adults

 

30 – 60% of perpetrators of intimate partner violence also abuse children

 

Children of violent homes display emotional and behavioral disturbances like withdrawal, low self-esteem, nightmares, self-blame and aggression against peers, family, animals & property

 

 

Are you concerned that someone you care about is experiencing abuse?

 

If someone you love is being abused, it can be so difficult to know what to do. There are many reasons why people stay in abusive relationships, and leaving can be a very dangerous time for a victim.

Abuse is about power and control, so one of the most important ways you can help a person in an abusive relationship is to consider how you might empower them to make their own decisions. Offer support :

 

  • Acknowledge That They Are In A Very Difficulty and Scary Situation – Be Supportive and Listen
  • Be Non-Judgemental
  • If They End The Relationship, Continue To Be Supportive of Them
  • Encourage Them To Participate In Activities Outside of The Relationship with Friends & Family
  • Help Them Develop A Safety Plan
  • Encourage Them To Talk To People Who Can Provide Help & Guidance 
  • Offer To Go with Them If They Have to Go To Police, Court, Attorney, Etc.

 

If you need help, find a local domestic violence agency or contact the National Domestic Violence Hotline at 1-800-799-SAFE (7233) to get help.

Struggling with Thinning Scalp Hair?

December 23, 2018

Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone can experience hair loss.

Baldness is excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some people prefer to let their hair loss run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. Others choose one of the treatments available to prevent further hair loss and to restore growth.

Before pursuing any hair loss treatment, talk with your doctor about the cause of your hair loss and treatment options.

 

Types of Hair Loss

 

  • Male-pattern baldness

  • Female-pattern baldness

 

  • Patchy hair loss (alopecia areata)

 

  • Traction alopecia

 

Hair loss can appear in many different ways, depending on what’s causing it.  It can come on suddenly or gradually.  It can affect just your scalp or your whole body.  Some types of hair loss are temporary, and others are permanent.

 

Signs and symptoms of hair loss may include:

 

  • Gradual thinning on top of head.

    The most common type of hair loss, affecting both men and women as they age.  In men, hair begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.

 

  • Circular or patchy bald spots.

    Generally smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it also can occur in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.

 

  • Sudden loosening of hair.

    Physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing – or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.

 

  • Full-body hair loss.

    Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.

 

  • Patches of scaling that spread over the scalp.

    Often a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

 

When to see a doctor

See your doctor if  you are distressed by hair loss and want to pursue treatment. Also talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair. Sudden hair loss can signal an underlying medical condition that requires treatment.

 

Causes

People typically lose about 100 hairs a day. This usually doesn’t cause noticeable thinning of scalp hair because new hair grows in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

 

Hair loss is typically related to one or more of the following factors:

 

  • Family history (heredity).

    The most common cause of hair loss is hereditary – referred to as male-pattern baldness or female-pattern baldness. It usually occurs gradually with aging and in predictable patterns — a receding hairline and bald spots in men and thinning hair in women.

 

  • Hormonal changes and medical conditions.

    A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems. Medical conditions include alopecia areata, which causes patchy hair loss, scalp infections such as ringworm and a hair-pulling disorder called trichotillomania.

 

  • Medications and supplements.

    Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout and high blood pressure.

 

  • Radiation therapy to the head.

    The hair may not grow back the same as it was before.

 

  • A very stressful event.

    Many people experience a general thinning of hair several months after physical or emotional stress. This type of hair loss is temporary.

 

  • Certain hairstyles and treatments.

    Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent.

 

Risk factors

A number of factors can increase your risk of hair loss, including:

  • Family history of balding, in either of your parent’s families
  • Age
  • Significant weight loss
  • Medical conditions, such as diabetes and lupus
  • Stress

Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.

 

A variety of tips may help you avoid preventable types of hair loss:

 

  • Avoid tight hairstyles, such as braids, buns or ponytails.
  • Avoid compulsively twisting, rubbing or pulling your hair.
  • Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
  • Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.
  • Avoid medications and supplements that could cause hair loss.
  • Protect your hair from sunlight and other sources of ultraviolet light.
  • Stop smoking. Some studies show an association between smoking and baldness in men.
  • If you are being treated with chemotherapy, ask your doctor about a cooling cap. This cap can reduce your risk of losing hair during chemotherapy.

 

Diagnosis

Before a diagnosis can be made, you will often need a physical exam.  You may also be asked about your medical history and family history. Additional tests may also be needed:

 

  • Blood test. This may help uncover medical conditions related to hair loss.
  • Pull test. Your provider will gently puls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
  • Scalp biopsy. Taking samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
  • Light microscopy. A special instrument  may be used to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.

Treatment

Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow further thinning. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment.

Treatments for hair loss include medications, surgery to promote hair growth and slow hair loss.

 

Medications

If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone.

If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.

Medications are available to treat pattern (hereditary) baldness. Options include:

 

  • Minoxidil (Rogaine).

    This is an over-the-counter medication approved for men and women. It comes as a liquid or foam that you rub into your scalp daily.  At first it may cause you to shed hair as hair follicles. New hair may be shorter and thinner than previous hair. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).

 

  • Finasteride (Propecia).

    This is a prescription drug. Many patients using finasteride experience a slowing of hair loss, and some may show some new hair growth. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer.

 

  • Other medications.

    For men, the oral medication dutasteride is an option. For women, treatment may include oral contraceptives and spironolactone.  There are also a variety of over-the-counter supplements that both men and women can try.

 

Hair Transplant Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left.

During a hair transplant procedure, a dermatologist or cosmetic surgeon removes tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include bleeding and scarring.

 

Laser Therapy

The Food and Drug Administration (FDA) has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density. The long-term benefits are not yet known.

 

Lifestyle and home remedies

You may want to try shaving, other styling techniques and products, scarves, a wig, or a hairpiece. Talk with a hair stylist for ideas. These nonmedical solutions can be used to cover permanent or temporary hair loss.

If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance.

 

Schedule an Appointment Today to Learn More About Your Options

Boost Your Mood With Vitamin D

October 2, 2018

Do you get enough vitamin D?

 

There could be many warning signs or symptoms of vitamin D deficiency in your life or of someone you know.

 

It is essential to understand the importance of getting enough of this crucial vitamin.

 

 

Vitamin D Basics

Vitamin D is best known for building bones. However, this highly-potent vitamin is essential for overall brain and body health. Optimal vitamin D levels can help improve your mood, boost your overall brain function, and generally improve your wellbeing. Vitamin D may be involved in the healthy regulation of as many as 900 human genes.

 

Vitamin D is converted by the liver and kidney into a hormone that is so important to brain function its receptors can be found throughout the brain. Vitamin D plays a critical role in the brain’s early development, its ongoing maintenance, and in its functions to maintain healthy mood and many of the most basic cognitive functions including learning and making memories. 

 

Avoid Vitamin D Deficiency

Unfortunately, vitamin D deficiency is becoming more and more common, in part because we are spending more time indoors and using more sunscreen when having fun outdoors. Research suggests that 70% of all adults and 67% of children, aged 1-11, do not have adequate levels of vitamin D. Low levels of vitamin D have been associated with low mood, behavioral difficulties in children, and psychological difficulties in adults. Vitamin D supplementation is consistently linked to higher quality of life and better wellbeing with the passing of the years.

 

Recommended Daily Vitamin D

In the United States, the current recommended daily dose of vitamin D is 400 IU. However, most experts agree that this is well below the physiological needs of most individuals. Instead, it is suggested that all adults take at least 2000 IU of vitamin D daily – unless directed to take a higher dose by their healthcare provider. We all should get our blood vitamin D levels tested every 4-6 months and if necessary increase our daily intake to as much as 5000-10000 IU per day to ensure we achieve blood levels of at least 60 ng/mL.

Avoid taking vitamin D2 supplements since D2 can interfere with the actions of vitamin D3 which is the body’s natural vitamin D.

 

The Vitamin D Challenge

Getting necessary amounts of vitamin D can be challenging during the winter season in some parts of the country —typically from November to March—when there are fewer hours of sunlight and when the sun itself is less intense. This is particularly true if you live in the northern half of the United States. Due to colder temperatures and inclement weather, the tendency for many people is to stay inside where it is warm and hunker down for the winter. However, failure to get enough vitamin D, as well as exercise, can lead to health problems and other mental and physical difficulties. For individuals who struggle with low mood during the winter, the colder months can produce feelings of melancholy and desperation.

 

5 Tips for How to Get More Vitamin D In Your Life

1.  Alternate Light Source

Daily exposure to appropriate levels (even just 10-30 minutes per day) of direct sunlight can boost vitamin D3 levels which can help improve your mood. If you have a hard time getting enough natural light during the winter, consider buying a vitamin D lamp for your home or work desk. Though many artificial light boxes claim to do the job, make sure to purchase one that is as close as possible to the natural sunlight spectrum and proven to increase vitamin D levels.

2.  Go Somewhere Sunny

If getting sufficient levels of UVA (ultraviolet A) rays from the sun proves difficult during the winter months, especially if you live anywhere near the Great White North, consider saving up some money during the summer for a vacation to a sunny destination (the Caribbean, for instance) during the winter. This will make enduring the cold, dark months more bearable.

3.  Get Quality Sleep

Insufficient and inconsistent sleep can increase irritability, moodiness and poor judgment. To remain at the top of your game, it is recommended that you get between 7-9 hours of sleep each night. Getting appropriate levels of sunlight during the day, or adequate amounts of vitamin D from foods or supplements can also help maintain your body’s natural production of serotonin. In the evening, the brain naturally converts serotonin into melatonin, our main sleep hormone that improves our chance of getting a good night’s sleep.

4. Vitamin D-Rich Diet

Foods can be an important source of vitamin D. Examples of vitamin D-rich foods are fortified milk, eggs, mushrooms and fish (especially wild salmon, tuna, and mackerel). A 4-ounce portion of salmon can provide over 250% of your daily recommended allowance of vitamin D. Wild salmon contains about 988 IU of vitamin D per serving, while farmed salmon contains 250 IU, on average.

5.  Take Sunshine Supplements

When it comes to mood, the scientific evidence is clear – the higher your vitamin D levels, the more likely you are to feel happy rather than blue. A 2014 study showed that the positive effect of vitamin D3 on mood was clinically very substantial as compared to other options. Since it promotes healthy mood, vitamin D3, which is often referred to as the sunshine vitamin, can help you get through the doldrums of the winter season.

Iodine Deficiency on the Rise

June 25, 2018

Iodine is an essential mineral.  Your thyroid gland uses it to make thyroid hormones, which help control growth, repair damaged cells and support a healthy metabolism.  Unfortunately, up to a third of people worldwide are at risk of an iodine deficiency. Those at the highest risk include:

 

  • Pregnant women.
  • People who live in countries where there is very little iodine in the soil: South Asia, Southeast Asia, New Zealand and European countries.
  • People who don’t use iodized salt.
  • People who follow a vegetarian or vegan diet.

 

Iodine deficiencies had been rare in the United States, where there are sufficient levels of iodine in the food supply.  However, changes in lifestyle have increased the prevalence across the United States in recent years.  Symptoms can include swelling in the neck, pregnancy-related issues, weight gain and learning difficulties.  Its symptoms are very similar to those of suboptimal thyroid function. Since iodine is used to make thyroid hormones, an iodine deficiency means your body cannot make enough of them, leading to hypothyroidism.

 

Signs that you may have an iodine deficiency:

 

Swelling in the Neck

Swelling in the neck is the most common symptom of an iodine deficiency. This is called a goiter and occurs when the thyroid gland grows too big. The thyroid gland is a small, butterfly-shaped gland in the front of your neck. The thyroid gland uses iodine to make thyroid hormones. However, when your body is low in iodine, it cannot make enough of them. To compensate, the thyroid gland works harder to try to make more. This causes the cells to grow and multiply, leading to a goiter. Most cases can be treated by increasing iodine intake. However, if a goiter has not been treated for many years, it might cause permanent thyroid damage.

 

Unexpected Weight Gain

Unexpected weight gain may occur if the body does not have enough iodine to make thyroid hormones. This is because thyroid hormones help control the speed of your metabolism, which is the process by which your body converts food into energy and heat. When your thyroid hormone levels are low, your body burns fewer calories at rest. Unfortunately, this means more calories from the foods you eat are stored as fat. Adding more iodine to your diet may help reverse the effects of a slow metabolism, as it can help your body make more thyroid hormones.

 

Fatigue and Weakness

Fatigue and weakness are also common symptoms of an iodine deficiency. Studies have found that nearly 80% of people with low thyroid hormone levels, which occur in cases of iodine deficiency, feel tired, sluggish and weak. These symptoms occur because thyroid hormones help the body make energy. When thyroid hormone levels are low, the body cannot make as much energy as it usually does. This may cause your energy levels to plummet and leave you feeling weak.

 

Hair loss

Thyroid hormones help control the growth of hair follicles. When thyroid hormone levels are low, your hair follicles may stop regenerating. Over time, this may result in hair loss. For this reason, people with an iodine deficiency may also suffer from hair loss.  Approximately 30% of those with low thyroid hormone levels experienced hair loss. If you experience hair loss because of an iodine deficiency, getting enough of this mineral may help correct your thyroid hormone levels and stop hair loss.

 

Dry, Flaky Skin

Dry, flaky skin may affect many people with an iodine deficiency. Studies show that up to 77% of people with low thyroid hormone levels may experience dry, flaky skin. Thyroid hormones, which contain iodine, help your skin cells regenerate. When thyroid hormone levels are low, this regeneration does not occur as often, possibly leading to dry, flaky skin. Additionally, thyroid hormones help the body regulate sweat. People with lower thyroid hormone levels, such as those with an iodine deficiency, tend to sweat less than people with normal thyroid hormone levels. Given that sweat helps keep your skin moist and hydrated, a lack of sweat may be another reason why dry, flaky skin is a common symptom of iodine deficiency.

 

Feeling Colder Than Usual

Feeling cold is a common symptom of an iodine deficiency. Over 80% of people with low thyroid hormone levels may feel more sensitive to cold temperatures than usual. Since iodine is used to make thyroid hormones, an iodine deficiency can cause your thyroid hormone levels to plummet. Because thyroid hormones help control the speed of your metabolism, low thyroid hormone levels may cause it to slow down. A slower metabolism generates less heat, which may cause you to feel colder than usual. Also, thyroid hormones help boost the activity of brown fat, a type of fat that specializes in generating heat. This means that low thyroid hormone levels, which may be caused by an iodine deficiency, could prevent brown fat from doing its job.

 

Changes in Heart Rate

Your heart rate is a measure of how many times your heart beats per minute. It may be affected by your iodine levels. Too little of this mineral could cause your heart to beat slower than usual, while too much of it could cause your heart to beat faster than usual. A severe iodine deficiency may cause an abnormally slow heart rate making you feel weak, fatigued, dizzy and possibly cause you to faint.

 

Trouble Learning and Remembering

An iodine deficiency may affect your ability to learn and remember. Thyroid hormones help your brain grow and develop. An iodine deficiency, which is required to make thyroid hormones, can reduce brain development. Studies have found that the hippocampus, the part of the brain that controls long-term memory, appears to be smaller in people with low thyroid hormone levels.

 

Problems During Pregnancy

Pregnant women are at a high risk of iodine deficiency – they need to consume enough to meet their own daily needs, as well as the needs of their growing baby. The increased demand for iodine continues throughout lactation, as babies receive iodine through breast milk. Not consuming enough iodine throughout pregnancy and lactation may cause side effects for both the mother and baby. Mothers may experience symptoms of an under-active thyroid, such as a goiter, weakness, fatigue and feeling cold. Meanwhile, an iodine deficiency in infants may stunt physical growth and brain development. Furthermore, a severe iodine deficiency may increase the risk of stillbirth.

 

Heavy or Irregular Periods

Heavy and irregular menstrual bleeding may occur as a result of an iodine deficiency. Like most symptoms of iodine deficiency, this is also related to low levels of thyroid hormones. In one study, 68% of women with low thyroid hormone levels experienced irregular menstrual cycles, compared to only 12% of healthy women. Research also shows that women with low thyroid hormone levels experience more frequent menstrual cycles with heavy bleeding. This is because low thyroid hormone levels disrupt the signals of hormones that are involved in the menstrual cycle.

 

Role of Iodine in Breast Health

Iodine deficiency is rapidly emerging as a major risk factor for breast cancer. Human breast tissue and breast milk contain higher concentrations of iodine than the thyroid gland itself, which contains just 30% of the body’s iodine stores. Breast tissue is rich in the same iodine-transporting proteins used by the thyroid gland to take up iodine from the blood. Iodine plays an important role in the health of women’s breast tissue. Iodine has been shown to exert a powerful antioxidant effect equivalent to vitamin C. Iodine-deficient breast tissue exhibits chemical markers of elevated lipid peroxidation, one of the earliest factors in cancer development. Iodine-deficient breast tissue also shows alterations in DNA and increases in estrogen receptor proteins. Coupled with iodine deficiency-induced increases in circulating estrogen levels, these changes can substantially increase the risk of breast cancer in women with low iodine levels.

 

Iodine also helps regulate levels of the stress hormone cortisol and contributes to normal immune function. Abnormal cortisol levels and deficient immune function are significant contributors to the risks of breast cancer; women with fibrocystic breast disease may also suffer from elevated cortisol levels. Taken together, these biological factors explain the well-known link between iodine deficiency and thyroid disease, thyroid cancer, and breast cancer, all of which predominate in postmenopausal women. The link between iodine consumption and breast cancer is most evident when you compare the Japanese and Western diets against cancer incidence. Japanese women consume a diet high in iodine-rich seaweed, which provides them with an iodine intake 25 times higher than the average American woman’s. Japanese women also have breast cancer rates roughly one-third of those found in American women, a difference that disappears in Japanese women who immigrate to the US, where they consume considerably less seaweed.

 

Studies of iodine therapy for breast cancer prevention are encouraging. Breast cancer cells avidly absorb iodine, which in turn suppresses tumor growth and causes cancer cell death. Added dietary iodine reduces the size of both benign and malignant breast tumors. Further benefits may be obtained by supplementing with selenium in addition to iodine; selenium is an essential cofactor in the enzymes used in thyroid and breast tissue to make optimal use of dietary iodine. In addition to its obvious role in preventing breast cancer, increased iodine intake may be important in mitigating another common, if less lethal, breast disorder—fibrocystic breast disease. Fibrocystic breast disease is extremely common – found in at least 9% of all women who undergo biopsies, though the actual rate is probably much higher. Fibrocystic breast changes can be reversed and women with fibrocystic breast disease can obtain substantial relief.

 

It is becoming increasingly clear that iodine deficiency interferes with optimum breast health, and intake of levels far higher than the recommended dietary allowance of 150-290 mcg is required to achieve benefits. Daily amounts of 3,000-6,000 mcg may help relieve the symptoms of fibrocystic breast disease.

 

The Role of Iodine in Cardiovascular Health

Iodine and iodine-rich foods enjoy a long history as natural therapies for hypertension and cardiovascular disease. Even when no overt symptoms are evident, hypothyroidism can contribute to heart disease and stroke, and it increases the risk of death from these conditions. Thyroid dysfunction creates unfavorable disturbances in lipid profiles, elevating low-density lipoprotein (LDL) and total cholesterol levels and raising the risk of atherosclerosis. Hypothyroidism also weakens the heart muscle, causing it to ‘squeeze’ less firmly with each contraction; it can cause cardiac arrhythmias as well. These effects may not be evident at rest, but become important during moderate exercise. Low thyroid function is also associated with higher waist-to-hip ratios, an obesity-related risk factor for cardiovascular disease. Restoring normal thyroid function helps reverse multiple cardiovascular risk factors, most notably adverse lipid profiles. Iodine therapy shows promise in safely and effectively modulating these health concerns.

 

Sources of Iodine

As with many diseases, it is better to prevent the problem rather than have to treat it. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Elimination of iodine deficiency has been a major goal of the World Health Organization. Iodized salt has been the mainstay of treatment for iodine deficiency worldwide, including in the United States. Injections of iodized oil are occasionally used in regions of the world where widespread iodized salt use is not possible. Iodination of water supplies also has been effective in some places.

 

There are very few good sources of iodine in the diet. This is one reason why iodine deficiency is common worldwide. The recommended daily intake (RDI) is 150 mcg per day. This amount should meet the needs of 97–98% of all healthy adults. One teaspoon of iodized salt contains approximately 400 μg iodine. Most iodine-containing multivitamins have at least 150 μg iodine, but only about half of the types of multivitamins in the United States contain iodine.  Pregnant or breastfeeding women need more iron. Pregnant women need 220 mcg daily, while lactating women need 290 mcg daily. Because the effects of iodine deficiency are most severe in pregnant women and their babies, the American Thyroid Association has recommended that all pregnant and breastfeeding women in the United States and Canada take a prenatal multivitamin containing 150 μg iodine per day. 

 

The foods below are excellent sources of iodine:

  • Seaweed, one whole sheet dried: 11–1,989% of the RDI
  • Cod, 3 ounces (85 grams): 66% of the RDI
  • Yogurt, plain, 1 cup: 50% of the RDI
  • Iodized salt, 1/4 teaspoon (1.5 grams): 47% of the RDI
  • Shrimp, 3 ounces (85 grams): 23% of the RDI
  • Egg, 1 large: 16% of the RDI
  • Tuna, canned, 3 ounces (85 grams): 11% of the RDI
  • Dried prunes, 5 prunes: 9% of the RDI

 

 

Seaweed is usually a great source of iodine, but this depends on where it came from. Seaweed from some countries, such as Japan, are rich in iodine. Smaller amounts of iodine are also found in a variety of foods like fish, shellfish, beef, chicken, lima and pinto beans, milk and other dairy products. The best way to get enough iodine is to add iodized salt to your meals. Half a teaspoon (3 grams) over the course of the day is enough to avoid a deficiency.

 

If you think you have an iodine deficiency, it’s best to consult your doctor. They will check for signs of swelling (a goiter) or take a urine sample to check your iodine levels.

 

Too Much Iodine

Taking too much iodine can also cause problems. This is especially true in individuals that already have thyroid problems, such as nodules, hyperthyroidism and autoimmune thyroid disease. Administration of large amounts of iodine through medications (i.e.: Amiodarone), radiology procedures (iodinated intravenous dye) and dietary excess (Dulce, kelp) can cause or worsen hyperthyroidism and hypothyroidism. In addition, individuals who move from an iodine-deficient region (for example, parts of Europe) to a region with adequate iodine intake (for example, the United States) may also develop thyroid problems since their thyroids have become very good at taking up and using small amounts of iodine. In particular, these patients may develop iodine-induced hyperthyroidism.

 

Talk to your heal care provider before starting an iodine regimen.

The IUD – What You Need to Know

May 1, 2018

An IUD is a tiny device that is placed in the uterus to prevent pregnancy. It is long-term, reversible, and one of the most effective birth control methods available.  IUD stands for intrauterine device. It is a small piece of flexible plastic shaped like a T.

 

Types of IUDs

There are 5 different brands of IUDs that are FDA approved in the United States: ParaGard, Mirena, Kyleena, Liletta, and Skyla. These IUDs are divided into 2 types: copper-containing IUDs (ParaGard) and hormone-containing IUDs (Mirena, Kyleena, Liletta, and Skyla).

 

The ParaGard IUD does not have hormones. It is wrapped in copper, and it is effective for up to 12 years.  The Mirena, Kyleena, Liletta, and Skyla IUDs use the hormone progestin to prevent pregnancy. Progestin is very similar to the progesterone. Mirena and Kyleena are effective for up to 5 years. Liletta works for up to 4 years. Skyla works for up to 3 years.

 

How Does the IUD Work?

Both copper IUDs and hormonal IUDs prevent pregnancy by changing the way sperm moves so they can’t get to an egg. If sperm can’t make it to an egg, pregnancy can’t happen.

 

 

The ParaGard IUD uses copper to prevent pregnancy. Sperm is adversely affected by copper, so the ParaGard IUD makes it almost impossible for sperm to get to that egg.

 

 

The hormones in the Mirena, Kyleena, Liletta, and Skyla IUDs prevent pregnancy in two ways.  First, hormones thicken the cervical mucus, which blocks and traps the sperm.  Second, the hormones sometimes stop ovulation, which means there is no egg for a sperm to fertilize. No egg, no pregnancy.

 

 

One of the advantages of IUDs is that they last for years — but they are not permanent. If you decide to get pregnant or you just do not want to have your IUD anymore, it can quickly and easily be removed. You are able to get pregnant immediately after the IUD is removed.

 

IUDs For Emergency Contraception?

The ParaGard (copper) IUD works well as emergency contraception. If you have it placed within 120 hours (5 days) of unprotected sex, it is more than 99.9% effective. It is the most effective way to prevent pregnancy after sex.

 

IUD Effectiveness

IUDs are more than 99% effective. That means fewer than 1 out of 100 women who use an IUD will get pregnant each year. IUDs are effective because there is no chance for you to make a mistake. You cannot forget to take it (like the pill), or use it incorrectly (like condoms). And you are protected for 3-12 years, depending on which kind you get. Once your IUD is in place, you can pretty much forget about it until it expires – just keep track of your insertion and removal date.

 

Do IUDs protect against STDs?

No, IUDs do NOT protect against STDs.

 

Where Do I Get an IUD?

An IUD has to be put in by a healthcare provider.

 

The IUD Insertion

People usually feel slight cramping or pain when the IUD is placed. The pain can be worse for some, but it only lasts for a minute or two.  Some people feel dizzy during or right after the IUD is inserted. You might want to ask someone to come with you to the appointment so you don’t have to drive or go home alone, and to give yourself some time to relax afterward.

 

What To Expect After an IUD Insertion

Most people feel perfectly fine right after an IUD insertion – although some people need to take it easy for a while after the insertion. Heating pads and over-the-counter pain meds can help ease cramps.

 

You may have cramping and spotting after getting an IUD, but this almost always goes away within 6-8 weeks. Hormonal IUDs eventually make periods lighter and less crampy, and periods mights stop completely. Copper IUDs may make periods heavier and cramps worse. For some people, this goes away over time. There is a very small chance that your IUD could slip out of place. It can happen any time, but it is more common during the first 3 months. If your IUD falls out, you are NOT protected from pregnancy, so make sure to go see your doctor, and use condoms or another kind of birth control in the meantime.

 

How soon after getting an IUD can I have sex?

You can have sex as soon as you want after getting an IUD.

 

Who SHOULDN’T Get an IUD?

Most people can use IUDs safely, but there are some conditions that make side effects or complications more likely. You may not be able to get an IUD if you:

  • have certain STD’s or pelvic infection
  • think you might be pregnant
  • have cervical cancer that has not been treated
  • have cancer of the uterus
  • have vaginal bleeding that is not your period
  • have had a pelvic infection after either childbirth or an abortion in the past 3 months

 

 

Additionally, you should not get a ParaGard IUD if you have a copper allergy or a bleeding disorder that makes it hard for your blood to clot.  Very rarely, the size or shape of someone’s uterus makes it hard to place an IUD correctly.

 

Risks of IUD

There are possible risks with an IUD, but serious problems are really rare.

 

The IUD can sometimes slip out of the uterus — it can come all the way out or just a little bit. If this happens, you can get pregnant. If the IUD only comes out part of the way, it has to be removed. It is possible — though extremely unlikely — to get pregnant even if the IUD is in the correct location. If you get pregnant with an IUD in place, there is an increased risk of ectopic pregnancy and other serious health problems.

 

It is possible to get an infection if bacteria get into the uterus when the IUD is inserted. If the infection is not treated, it may affect your chances of getting pregnant in the future.

 

When the IUD is inserted, it could push through the wall of the uterus. If this happens, you could need surgery to remove the IUD. This is very rare.

 

What Warning Signs Should I Know About?

Chances are that you will NOT have problems with your IUD. But it is important to pay attention to your body and how you feel after you get your IUD. Here are the warning signs to watch out for:

  • the length of your IUD string feels shorter or longer than previously
  • you can feel the hard plastic bottom of the IUD coming out through your cervix
  • you think you might be pregnant
  • you have bad cramping, pain, or soreness in your lower abdomen
  • there is recurrent pain or bleeding during sex
  • you get unexplained fever, chills, or have trouble breathing
  • your vaginal discharge is different than normal
  • you have vaginal bleeding that is heavier than usual

 

IUD and Breastfeeding?

Yes, it is safe to use the IUD while you’re breastfeeding.  It should not have any effect on how much milk you produce, and it will not hurt your baby. In fact, the IUD is a great method to use if yo a’re breastfeeding and you do not want to get pregnant.

 

IUD Side Effects

Some people have side effects after getting an IUD. They usually go away in about 3–6 months.  Side effects can include:

  • pain when the IUD is put in
  • cramping or backaches for a few days after the IUD is put in
  • spotting between periods
  • irregular periods
  • heavier periods and worse menstrual cramps (ParaGard)

 

 

Pain medicine can usually help with cramping. If the bleeding or cramping gets worse or does not get better, tell your healthcare provider immediately.

 

IUD Removal

Getting an IUD removed is quick and easy. A healthcare provider gently pulls on the string, and the IUD slips out. You may feel cramping for a minute as it comes out.  There is a small chance that your IUD will not come out easily. If this happens, your healthcare provider may use special instruments to remove it. Very rarely, surgery may be needed.

 

 

You can get your IUD taken out whenever you want. ParaGard should be replaced after 12 years.  Mirena and Kyleena should be replaced after 5 years.  Liletta should be replaced after 4 years.  Skyla should be replaced after 3 years.

 

You should feel completely normal after getting your IUD removed. You may have some spotting. Your period will go back to how it was before you got your IUD.

 

Your fertility goes back to normal right after your IUD is removed.  It is possible to get pregnant right away. If you get your IUD removed and you don’t want to get pregnant, use another method of birth control.

Food Intolerance & Food Sensitivity Testing

February 28, 2018

The terms ‘food intolerance’ and ‘food allergy’ are often confused – although the two are completely different.

 

A true food allergy is rare: only about 2% of adults are affected by a food allergy.  With a food allergy the body’s immune system mistakes a food for a ‘foreign invader’ which results in a rapid allergic reaction often within minutes (and generally within a maximum of two hours).

 

Food intolerances are much more common than food allergies. Researchers estimate that at least 60% of the U.S. population suffers from unsuspected food reactions that can cause or complicate health problems. When foods and drinks are digested the proteins within them are broken down into smaller fragments for easy absorption.  Sometimes the body reacts to the fragments by attacking them using antibodies called immunoglobulins. The symptoms can greatly impact a person’s quality of life, but symptoms are not life threatening.  Symptoms of food intolerance can take up to 72 hours to appear after eating the trigger food.  On average people who suffer from food intolerances usually have between 4 and 8 trigger foods. Many people suffer for years, having formed a coping mechanism to deal with the symptoms but being unable to enjoy a normal work and home life.  Many people don’t realize that there are easy steps to take that could resolve their condition. Studies show that those who eliminate trigger foods based on food-specific immunoglobulin tests have: reductions in weight, body mass index, waist and hip circumference and improvements in all indicators of quality of life that were measured. The quality of life indicators included physical and emotional wellbeing, mental health, social life, pain levels and vitality.

 

Food Intolerance verses Food Allergy

 

Food Intolerance Food Allergy
Reactions up to 72 hours after eating Immediate reactions (2 hours or less)
Multiple foods can be involved Rarely more than 1-2 foods
Any organ system can be affected Primary skin, airways and digestive system
Very common Trace amounts of foods can cause reactions
Difficult to self-diagnose Caused by raised IgE antibody
Symptoms can clear after avoidance (3-6 months) Lifelong

 

Symptoms of food intolerance:

 

  • Abdominal Cramps/Pain
  • Muscle and Joint Aches
  • Acne
  • Bloating
  • Constipation and/or diarrhea
  • Fatigue
  • Dizziness
  • Eczema/Rashes
  • Itching
  • Fluid Retention
  • Headaches
  • Hyperactivity
  • Migraine
  • Nausea
  • Rhinitis/Sinusitis
  • Anxiety/Tension
  • Weight loss/Weight Gain
  • Wheezing

 

In considering food sensitivities, the role of ‘leaky gut’ must be discussed. Leaky gut, or ‘intestinal permeability’, is a condition in which the lining of the small intestine becomes damaged, causing undigested food particles, toxic waste products and bacteria to ‘leak’ through the intestines and flood the bloodstream. The foreign substances entering the bloodstream cause inflammation throughout the body, stirring up trouble everywhere. A vicious cycle of worsening inflammation and worsening leaky gut occurs, which leads to a variety of health issues. This cycle of inflammation triggers an antibody immune response and a whole cascade of inflammatory signals travel to anywhere and everywhere in the body.

 

Inflammation and leaky gut are tied to a variety of conditions, from autoimmunity – like Hashimoto’s, lupus, rheumatoid arthritis, and psoriasis – to depression, anxiety, migraines, irritable bowel, eczema, chronic fatigue, fibromyalgia, PMS, PCOS, infertility, cervical dysplasia and more.  In many cases, leaky gut is caused by your diet. Leaky gut can also be caused by medications including antibiotics, steroids or over-the-counter pain relievers like aspirin and acetaminophen, which can irritate the intestinal lining and damage protective mucus layers.

 

The best way to resolve health issues is to heal leaky gut – the best way to heal leaky gut is to avoid foods that cause it.
To do that, we need to start by doing a food sensitivity panel, so we can determine where we are starting and which foods to avoid.

Transgender Health Issues

February 11, 2018

“Transgender” is an umbrella term used to capture the spectrum of gender identity and gender-expression diversity. Gender identity is the internal sense of being male, female, neither or both. Gender expression — often an extension of gender identity — involves the expression of a person’s gender identity through social roles, appearance and behaviors.

 

Transgender persons are at increased risk for certain types of chronic diseases, cancers, and mental health problems.

If you’re a transgender person, don’t avoid seeing a doctor out of fear of a negative encounter. Instead, look for a doctor who is empathetic and respectful of your specific needs. By doing so, your doctor can help identify ways to reduce your risk of health concerns, as well as identify medical conditions and refer you to specialists when necessary.

 

Health Issues to Consider:

#1: Access to Health Care

Transgender persons may avoid medical care for fear of being rejected. Many have been turned away by healthcare providers or had other negative experiences. Not all providers know how to deal with specialized transgender issues. Often, transgender health services are not covered by insurance. For these reasons, transgender persons may not be able to access the care they need.

Transgender persons should find a personal doctor who understands transgender health issues.

#2: Hormones

Hormone therapy is often used to make a transgender person more masculine or feminine. But the use of hormones has risks. Testosterone can damage the liver, especially if taken in high doses or by mouth. Estrogen can increase blood pressure, blood glucose (sugar), and blood clotting. Anti-androgens, such as spironolactone, can lower blood pressure, disturb electrolytes, and dehydrate the body. Hormone use should always be supervised by a doctor.

Transgender persons wishing to use hormones should only do so under the supervision of a doctor who can prescribe an appropriate dose and monitor its effects.

#3: Cancer

Trans men who still have a uterus, ovaries, or breasts are at risk for cancer in these organs. Trans women are at risk for prostate cancer, though this risk is low. Cancers related to use of hormones are rare, but counseling is still needed.

Transgender persons should be screened for cancers of the reproductive organs.

#4: Injectable Silicone

Many transgender persons use silicone injections to enhance their appearance. The injection of silicon by non-medical persons is a dangerous practice that can lead to serious health problems. Silicone, when administered by someone who is not a doctor, can move through the body and disfigure it. Also, silicone injected outside of a healthcare setting is typically not medical grade, may be contaminated, and is often injected using shared needles, which can transmit hepatitis.

Transgender persons need to be counseled about the risks of injecting silicone.

#5: Substance Use

Transgender persons use substances at higher rates compared to others. Substances used include amphetamines including crystal meth, marijuana, ecstasy, and cocaine. Use of these drugs has been linked to higher rates of HIV transmission through impaired decision making during sex. Although the long-term effects of these substances are unknown, evidence suggests that their prolonged use is likely to have serious negative health consequences.

Transgender persons should be screened for substance use and get appropriate education and risk-based counseling.

#6: Depression and Anxiety

Transgender persons have higher rates of depression and anxiety compared to others. These problems are often worse for those who do not have adequate social support or who are unable to express their gender identity. As a result, teenagers and young adults have an increased risk of suicide. However, culturally sensitive mental health services can help prevent and treat these problems.

Transgender persons should be screened for signs and symptoms of depression and anxiety and should seek appropriate mental health services provided as needed.

#7: Sexually Transmitted Diseases (STDs)

Transgender persons are at risk for sexually transmitted diseases. These include infections for which there are effective cures (gonorrhea, chlamydia, syphilis, pubic lice or crabs), as well as those for which treatments are more limited (HIV, hepatitis A, B, or C, human papilloma virus). Safe sex, including the use of barriers, is key to preventing STDs.

Transgender persons who are sexually active should be routinely screened for sexually transmitted diseases.

#8: Alcohol

Studies have shown that transgender persons have higher rates of alcohol abuse and dependence. Although limited alcohol use, such as one drink a day, may not be unhealthy, any use can be a problem for a transgender person with an alcohol related disorder. Alcohol abuse is a common problem among transgender persons and can increase the risk for being injured or becoming the victim of a crime.

All transgender persons should be screened for alcohol dependence and abuse, and alcohol use should be limited.

#9: Tobacco

Transgender persons smoke and use tobacco products at much higher rates than others. This can lead to a number of serious health problems, including heart disease, high blood pressure, lung disease, and lung cancer.

Transgender persons should be screened for tobacco use and offered tobacco cessation programs.

#10: Heart Disease

Transgender persons are often at higher risk for heart disease because of hormone use, smoking, and obesity. All transgender persons should have their blood pressure and cholesterol checked as generally recommended. Also, transgender persons should learn about the signs and symptoms of heart disease and stroke.

Transgender persons should have their blood pressure checked at least once a year and their cholesterol screened at least every five years.

 

Experts recommend that you take steps to protect your health based on your anatomy, regardless of your gender identity or expression. This might include:

 

  • Age-appropriate screening for cervical and breast cancers
  • Age-appropriate screening for prostate cancer
  • Age-appropriate screening for colon cancer
  • Age-appropriate vaccinations
  • Screening for mental health conditions
  • Screening for substance abuse
  • Screening for HIV
  • Screening for hepatitis

 

Additional issues might need to be considered if you have had feminizing or masculinizing hormone therapy or surgery.

Your health is important — regardless of your gender identity or gender expression. If you’re due for a screening or you have health concerns, don’t put off seeing a doctor. Early diagnosis and treatment help promote long-term health.

 

More About Transgender Hormone Health:

Hormone replacement is also often part of the transition process . Many transgender persons experience dysphoria, or psychological distress experienced in relation to the discrepancy between the sex they were assigned at birth and their gender identity. There is a high prevalence of depression, anxiety and suicidal thoughts.

Hormones help align physical characteristics with gender identity. Many individuals find hormone therapy extremely beneficial because it enables them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria and distress. Research shows that hormone therapy significantly reduces depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, hormone therapy often has the effect of increasing self-esteem and feelings of attractiveness. During gender transition, people who receive hormones typically experience a second puberty, during which secondary sex characteristics change to align with gender identity.  These hormones help to produce characteristics that align with their identity or eliminate characteristics causing distress/dysphoria.

It is essential to remember that it is not possible to choose which characteristics result from hormone therapy, and hormone therapy will affect people in different ways. Because of this, the initiation of hormone therapy can also increase feelings of dysphoria and distress.  Many transgender patients don’t quite know what to expect.  Often the changes experienced as a result of hormones therapy are not the results that patients anticipated or have side effects that were not considered.  For the reason, it is essential to counsel these patients thoroughly before initiating a regimen.

Cervical Cancer Awareness

January 1, 2018

January is Cervical Cancer Awareness Month!!

Cervical cancer was once one of the most common causes of cancer death for American women. Over the last 30 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change is the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it’s small, has not spread, and is easiest to cure. Another way to help prevent cervical cancer in the future is to have children vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer.

What Is Cervical Cancer?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. Cervical cancer starts in the cells lining the cervix — the lower part of the uterus (womb). This is sometimes called the uterine cervix. The fetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal). The cervix has two different parts and is covered with two different types of cells.

  • The part of the cervix closest to the body of the uterus is called the endocervix and is covered with glandular cells.
  •  The part next to the vagina is the exocervix (or ectocervix) and is covered in squamous cells.

 

These two cell types meet at a place called the transformation zone. The exact location of the transformation zone changes as you get older and if you give birth.  Most cervical cancers begin in the cells in the transformation zone. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.

 

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. It usually takes several years for cervical pre-cancer to change to cervical cancer, but it also can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all cervical pre-cancers can prevent almost all cervical cancers.

 

What Are the Types of Cervical Cancer?

Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.

  • Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the exocervix and the cancer cells have features of squamous cells under the microscope. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
  • Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years.
  • Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

 

Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma and lymphoma occur more commonly in other parts of the body.

 

What Are the Risk Factors for Cervical Cancer?

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

 

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it might not be possible to say that a particular risk factor was the cause.

 

In thinking about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it’s even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

 

Cervical Cancer Risk Factors Include:

Human Papillomavirus (HPV) Infection

Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papillomas, which are more commonly known as warts .

  • HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
  • HPV can spread from one person to another during skin-to-skin contact. One way HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.
  • Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.

Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are called high-risk types because they are strongly linked to cancers, including cancer of the cervix, vulva and vagina in women, penile cancer in men, and cancers of the anus, mouth and throat in both men and women.

Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.

Smoking

When someone smokes, they and those around them are exposed to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body.

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections.

Having a Weakened Immune System

Human immunodeficiency virus (HIV), the virus that causes AIDS, damages a woman’s immune system and puts them at higher risk for HPV infections.
The immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.

Another group of women at risk for cervical cancer are those taking drugs to suppress their immune response, such as those being treated for an autoimmune disease (in which the immune system sees the body’s own tissues as foreign and attacks them, as it would a germ) or those who have had an organ transplant .

Chlamydia Infection

Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility.

Some studies have seen a higher risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection.  Women who are infected with chlamydia often have no symptoms. In fact, they may not know that they are infected at all unless they are tested for chlamydia during a pelvic exam.

A Diet Low in Fruits and Vegetables

Women whose diets don’t include enough fruits and vegetables may be at increased risk for cervical cancer.

Being Overweight

Overweight women are more likely to develop adenocarcinoma of the cervix.

Long-Term Use of Oral Contraceptives Pills

There is evidence that taking oral contraceptives (OCPs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCPs, but the risk goes back down again after the OCPs are stopped, and returns to normal about 10 years after stopping.

Intrauterine Device (IUD) Use

Some research suggests that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer. The effect on risk was seen even in women who had an IUD for less than a year, and the protective effect remained after the IUDs were removed.

Using an IUD might also lower the risk of endometrial (uterine) cancer. However, IUDs do have some risks. A woman interested in using an IUD should first discuss the possible risks and benefits with her doctor. Also, a woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.

Having Multiple Full-Term Pregnancies

Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that pregnant women might have weaker immune systems, allowing for HPV infection and cancer growth.

Being Younger than 17 at Your First Full-Term Pregnancy

Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

Economic Status

Many low-income women do not have easy access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.

Diethylstilbestrol (DES)

DES is a hormonal drug that was given to some women between 1940 and 1971 to prevent miscarriage. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. These types of cancer are extremely rare in women who haven’t been exposed to DES. There is about 1 case of vaginal or cervical clear-cell adenocarcinoma in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of “DES daughters” do not develop these cancers.

DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 40 − past the age of highest risk. Still, there is no age cut-off when these women are felt to be safe from DES-related cancer. Doctors do not know exactly how long these women will remain at risk.
DES daughters may also be at increased risk of developing squamous cell cancers and pre-cancers of the cervix linked to HPV.

Having a Family History of Cervical Cancer

Cervical cancer may run in some families . If your mother or sister had cervical cancer, your chances of developing the disease are higher than if no one in the family had it. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women in the same family as a patient already diagnosed could be more likely to have one or more of the other non-genetic risk factors previously described in this section.

Do We Know What Causes Cervical Cancer?

In recent years, there has been a lot of progress in understanding what happens in cells of the cervix when cancer develops. The development of normal human cells mostly depends on the information contained in the cells’ DNA. DNA is the chemical in our cells that makes up our genes, which control how our cells work. We look like our parents because they are the source of our DNA. But DNA affects more than just how we look.

 

Some genes control when cells grow, divide, and die:·

  • Genes that help cells grow, divide, and stay alive are called oncogenes.
  • Genes that help keep cell growth under control or make cells die at the right time are called tumor suppressor genes.

 

Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes.

 

HPV cause the production of two proteins known as E6 and E7 which turn off some tumor suppressor genes. This may allow the cervical lining cells to grow too much and to develop changes in additional genes, which in some cases will lead to cancer.

 

But HPV is not the only cause of cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.

Can Cervical Cancer Be Prevented?

The most common form of cervical cancer starts with pre-cancerous changes and there are ways to stop this disease from developing. The first way is to find and treat pre-cancers before they become true cancers, and the second is to prevent the pre-cancers.

 

Finding cervical pre-cancers

A well-proven way to prevent cervical cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (or Pap smear) and the HPV test are used for this. If a pre-cancer is found it can be treated, stopping cervical cancer before it really starts. Most invasive cervical cancers are found in women who have not had regular Pap tests.

 

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under a microscope to find cancer and pre-cancer. These cells can also be used for HPV testing. A Pap test can be done during a pelvic exam, but not all pelvic exams include a Pap test.

 

An HPV test can be done on the same sample of cells collected from the Pap test.

 

Things to do to prevent pre-cancers:

  • Get an HPV vaccine
  • Test for HPV
  • Do not smoke
  • Use condoms

 

For more information visit the American College of Obstetricians and Gynecologists website.

 

 

Cancer Risk in Women

September 15, 2017

Cancers that most affect women are breast, colon, endometrial, lung, cervical, skin, & ovarian.

Doing what you can day to day to prevent cancer is your best defense. Knowing about cancer & what you can do to reduce your risk can help save your life.  Another key is early detection. Finding cancer early, before it has spread, gives you the best chance to do something about it.  You can take control of your health & reduce your cancer risk by doing the following:

  • Stay away from tobacco.
  • Get to and stay at a healthy weight.
  • Get moving with regular physical activity.
  • Eat healthy with plenty of fruits and vegetables.
  • Limit how much alcohol you drink (if you drink at all).
  • Protect your skin.
  • Know yourself, your family history, and your risks.
  • Get regular check-ups and cancer screening tests.

 

Breast cancer is the most common cancer that women face in their lifetime (except for skin cancer). It can occur at any age, but risk goes up as you age. Because of certain factors, some women may have a greater chance of having breast cancer than others. Every woman should know about breast cancer, their personal an&d family risks, and what can be done about it.

The best defense is to find breast cancer early: called ‘early detection’.  All women should perform routine self-breast exam and should be familiar with the benefits, limitations, and potential harms linked to breast cancer screening. Women should be familiar with how their breasts normally look & feel and report any changes to a healthcare provider immediately. Women ages 40-54 should have a yearly clinical breast exam, and a mammogram every 1-2 years.  The frequency of mammograms should depend on careful discussion with your doctor. Women 55 and older can switch to mammograms every 2 years, along with yearly clinical breast exam. Screening should continue as long as a woman is in good health and is expected to live at least 10 or more years. Women at high risk for breast cancer should be screened with MRIs along with mammograms. Talk with your doctor about your risk for breast cancer and the best screening plan for you.

 

Colon Cancer.  Most colon cancer (cancers of the colon or rectum) are found in people age 50 or older. People with a personal or family history, or who have polyps in their colon or rectum, or those with inflammatory bowel disease are more likely to have colon cancer. Also, being overweight, eating a diet mostly of high-fat foods, smoking & being inactive can increase risk.

Colon cancer almost always starts with a polyp – a small growth on the lining of the colon or rectum. Screening can help save lives by finding polyps before they become cancer. If pre-cancerous polyps are removed, cancer can be prevented. People should have one of the following tests, starting at age 50:

  • Colonoscopy every 10 years, or
  • CT colonography (virtual colonoscopy) every 5 years (if positive, a colonoscopy should be done)
  • Flexible sigmoidoscopy every 5 years (if positive, a colonoscopy should be done)
  • Double-contrast barium enema every 5 years (if positive, a colonoscopy should be done)

If you are at high risk of colon cancer based on family history or other factors, you may need to start testing at a younger age. Talk to your doctor about your risk for colon cancer to know when you should start testing.

 

Endometrial cancer (cancer of the lining of the uterus) occurs most often in women age 55 and older. Taking estrogen without progesterone and taking tamoxifen for breast cancer treatment or to lower breast cancer risk can increase risk. Having an early onset of menstrual periods, late menopause, a history of infertility, or not having children can increase risk, too. Women with a personal or family history of hereditary non-polyposis colon cancer (HNPCC) or polycystic ovary syndrome (PCOS), or those who are obese are also more likely to have endometrial cancer.

Women should watch for symptoms, such as unusual spotting or bleeding not related to menstrual periods, and report these to your doctor. It is also recommended that women who have or are likely to have HNPCC be offered yearly testing with an endometrial biopsy by age 35.

 

Lung cancer:  Eight out of 10 lung cancer deaths result from smoking. But people who don’t smoke can also have lung cancer.

Lung cancer is one of the few cancers that can often be prevented by not smoking.  If you are a smoker, ask your doctor to help you quit. If you don’t smoke, don’t start, and avoid breathing in other people’s smoke. Certain women at high risk for lung cancer may want to talk to a healthcare provider about whether getting yearly low-dose CT scans to test for early lung cancer is right for them. Testing may benefit adults who are current or former smokers ages 55-74 who are in good health and who have a 30 pack-year or more smoking history (A pack-year is 1 pack of cigarettes per day per year). You should discuss the benefits, limitations, and risks of lung cancer testing with your doctor.

 

Cervical cancer can affect any woman who is or has been sexually active. It results from the human papilloma virus (HPV). This virus is acquired during sex. Cervical cancer is also more likely in women who smoke, have HIV or AIDS, have poor nutrition, and who do not get regular Paps. A Pap smear can find changes in the cervix that can be treated before they become cancer. The following is recommended:

  • Cervical cancer screening starting at age 21. Women under age 21 should not be tested.
  • Women ages 21-29 should have a Pap every 3 years. HPV testing should not be used unless it’s needed after an abnormal Pap.
  • Women ages 30-65should have a Pap plus HPV testing (co-testing) every 5 years. This is the preferred approach, but it’s OK to have a Pap alone every 3 years.
  • Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Women with a history of a cervical pre-cancer should continue testing for 20 years after the diagnosis, even if testing continues past age 65.
  • A woman who has had a hysterectomy (removal of uterus and cervix) for reasons not related to cervical cancer & who has no history of cervical cancer or pre-cancer should not be tested.
  • If vaccinated against HPV, you should still follow screening recommendations for your age group.

Some women (because of their history) may need testing more often. You should talk to your doctor about your history.

 

Skin cancer.  Anyone who spends time in the sun can get skin cancer. People with fair skin, especially those with blond or red hair, are more likely to get skin cancer than people with darker coloring. People who have had a close family member with melanoma & those who had bad sunburns as children are more likely to get skin cancer.

Most skin cancers can be prevented by limiting exposure to ultraviolet (UV) rays. When outside, try to stay in the shade, especially midday. If you are going to be in the sun, wear hats with brims, long-sleeve shirts, sunglasses, and use broad-spectrum sunscreen with SPF 30 or higher. If you have children, protect them from the sun and don’t let them get sunburned. Do not use tanning beds or lamps.  Be aware of moles and spots on your skin, and report any changes to your doctor immediately. Have a skin exam done during routine wellness check.

 

Ovarian cancer is more likely to occur as women age. Women who have never had children, who have unexplained infertility, or who had their first child after age 30 are at increased risk. Women with a personal or family history of HNPCC, ovarian cancer, or breast cancer are more likely to have this disease. Women who don’t have any of these conditions can still get ovarian cancer.

There are no good tests for finding ovarian cancer early. A pelvic exam should be part of a woman’s regular health exam. Also, talk to a healthcare provider about your risk for ovarian cancer and whether there are tests that may be right for you. You should talk to your doctor right away if you have any of these symptoms for more than a few weeks:

  • Abdominal (belly) swelling
  • Digestive problems (including gas, loss of appetite, and bloating)
  • Abdominal or pelvic pain
  • Feeling like you need to urinate (pee) all the time

 

Research shows poor diet and not being active are two key factors that increase cancer risk. Twenty percent of cancers are related to obesity, physical inactivity, excess alcohol, and/or poor nutrition. Besides quitting smoking, you can help reduce your cancer risk by: (1) get to and stay at a healthy weight, (2) be physically active and (3) make healthy food choices.

Getting to and staying at a healthy weight reduces risk of cancer and other chronic diseases, such as heart disease and diabetes. Excess weight causes the body to produce and circulate more estrogen and insulin, hormones that can stimulate cancer growth. When trying to control weight, watch portion size, especially of foods high in calories, fat, and added sugars. Also, limit intake of high-calorie foods and drinks. Try writing down what and how much you eat & drink to see where you can cut down on portion sizes and cut back on unhealthy foods and drinks.  Losing even a small amount of weight has health benefits.

Next, increase your physically activity. Being active helps improve weight, and it can help improve hormone levels and the way your immune system works. The recommendation for adults is at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week. This is over and above usual daily activities like using the stairs instead of the elevator at your office or doing housework. For kids, the recommendation is at least 60 minutes of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week. Moderate activities are those that make you breathe as hard as you would during a brisk walk. Vigorous activities make you use large muscle groups and make your heart beat faster, make you breathe faster and deeper, and also make you sweat. It’s also important to limit sedentary behavior such as sitting, lying down, watching television, or other forms of screen-based entertainment.

Eating well is an important part of improving your health and reducing cancer risk. Read food labels to become more aware of portion sizes and calories. Low-fat or non-fat does not necessarily mean low-calorie. Eat smaller portions when eating high-calorie foods. Choose vegetables, whole fruit, legumes such as peas and beans, and other low-calorie foods instead of calorie-dense foods such as French fries, potato and other chips, ice cream, donuts, and other sweets. Limit your intake of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks. When you eat away from home, choose food low in calories, fat, and added sugar, and avoid eating large portion sizes. Limit how much processed meat and red meat you eat. Eat at least 2½ cups of vegetables and fruits each day. Choose whole grains instead of refined grain products. If you drink alcohol, limit intake to 2 drinks per day for men and 1 drink per day for women. The recommended limit is lower for women because of their smaller body size and slower breakdown of alcohol. A drink of alcohol is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of 80-proof distilled spirits (hard liquor).

It has been shown that people who experience high levels of psychological stress or who experience stress repeatedly over a long time may develop health problems (mental and/or physical).

The body responds to physical, mental, or emotional pressure by releasing stress that increase blood pressure, speed heart rate & raise blood sugar levels. Research shows that people who experience intense and chronic stress can have digestive problems, fertility problems, urinary problems, and a weakened immune system. Chronic stress makes people more prone to viral infections such as the flu or common cold and to have headaches, sleep trouble, depression, and anxiety. Although stress can cause a number of physical health problems, the evidence that it causes cancer is weak. Apparent links between psychological stress and cancer could arise in several ways. For example, people under stress may develop certain behaviors, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer. People who have cancer may find the physical, emotional, and social effects of the disease to be stressful. Those who attempt to manage their stress with risky behaviors such as smoking or drinking alcohol or who become more sedentary may have a poorer quality of life after cancer treatment. In contrast, people who are able to use effective coping strategies to deal with stress, such as relaxation and stress management techniques, have been shown to have lower levels of depression, anxiety, and symptoms related to the cancer and its treatment. People who have cancer who are under increased stress have poorer outcomes. Patients can develop a sense of helplessness or hopelessness when stress becomes overwhelming. This response is associated with higher rates of death, although the mechanism for this outcome is unclear. It may be that people who feel helpless or hopeless do not seek treatment when they become ill, give up prematurely on or fail to adhere to potentially helpful therapy, engage in risky behaviors such as drug use, or do not maintain a healthy lifestyle, resulting in premature death. Despite this, there is no evidence that successful stress management improves cancer survival.

Emotional & social support can help patients cope with psychological stress. Support can reduce depression, anxiety, and disease- and treatment-related symptoms. Approaches can include:

  • Training in relaxation,meditation or stress management
  • Counseling or talk therapy
  • Cancer education sessions
  • Social support in a group setting
  • Medications for depression or anxiety
  • Exercise