a few of my favorite things"
Green Tea and its Effects on Breast Cancer Metastasis and Recurrence
Abstract/summary: 472 women were studied who had invasive breast carcinoma.
117 had stage I, 273 stage II, and 82 stage III and all had undergone
a partial or total mastectomy. This epidemiological survey was carried
on for 9 years from 1984 to 1993. The questionnaire included intake
of green tea, coffee, black tea, various food groups such as soy
and seaweed and fish and vegetable, cigarettes, alcohol as well as
breast tumor characteristics, tumor markers, adjunct treatments,
medical history and various physical parameters.
The researchers determined that in stage I and II breast cancer, increased
consumption of green tea was associated with less metastasized axillary
lymph nodes in premenopausal women and an increased progesterone and
estrogen status in postmenopausal women. No such associations were
seen in stage III breast cancer patients. The consumption of green
tea among the 349 women without a recurrence of breast cancer was significantly
higher than among the 123 women with a breast cancer recurrence. In
stage I and II patients, there was a 16.7% recurrence rate for those
consuming 5 cups or more of green tea (average 8 cups) per day. For
those who consumed 4 or less cups per day (average of 2), there was
a 24.3% recurrence rate. Disease-free survival was also significantly
improved in stage I and stage II breast cancer patients with a greater
consumption of green tea. Of all the predictors, green tea was the
most statistically significant predictor for a decreased rate of recurrence
in the stage I and II patients. No improvement in prognosis was seen
in stage III patients.
Commentary: The estimated risk of developing breast cancer in one's
lifetime for Western women is at least one in nine and dropping. In
Japan, it is estimated to be 1 in 40. This paper points to the discrepancy
being due to green tea although there is also a significant body of
data to suggest that the difference in rates of breast cancer is due
to soybean product consumption as well as fish consumption.
Green tea (Camellia sinensis) contains several polyphenols including
epigallocatechin gallate (EGCG). EGCG enhances glutathione peroxidase
and catalase as well as being a potent free-radical scavenger. It has
also been shown to inhibit the growth of several breast cancer cell
lines in vitro, inhibit urokinase that is involved in tumor invasion
and metastasis and induces apoptosis. The suggestion is that EGCG found
in green tea has multiple anticancer properties.
A possible bias influencing this survey study is that perhaps those
individuals who drink so much green tea are also those who are more
health conscious. It is also my experience that getting a Western woman
to drink an average of 8 cups of anything per day besides coffee or
soft drinks is very difficult. However, once these results are shared
with new breast cancer patients, advising something as benign and potentially
significant as merely drinking tea, may inspire greater compliance.
One option might be to use green tea extract in tablet form. It is
estimated that one cup of green tea contains 30 to 40 mg of EGCG.
In the spirit of common sense, it would seem that your average non-breast
cancer patient and women at higher risk for breast cancer, should extrapolate
this data to the point of drinking green tea as a preventive measure.
Green tea has not been associated with any significant side effects
or toxicity. Due to the caffeine, it may produce a stimulant effect,
although for some reason the caffeine in green tea does not often produce
the symptoms of anxiety and irritability and insomnia that other sources
of caffeine may induce.
Nakachi K, Suemasu K, Suga K, et al. Influence of drinking green
tea on breast cancer malignancy among Japanese patients. Japan
Ginger for Nausea and Vomiting in Pregnancy
Seventy pregnant women at or before 17 weeks' gestation were
randomized in a double-blind design to receive either ginger 1gm per
day (250 mg four times daily) or placebo for 4 days. The women graded
the severity of their nausea and recorded the number of vomiting episodes
in the previous 24 hours before treatment, and again during 4 consecutive
days while taking the ginger or placebo. The median change in nausea
scores in the ginger group was significantly greater (P=0.14) than
that in the placebo group. All 32 women in the ginger group and 33
of 35 women in the placebo group had one or more vomiting episodes
during the 24 hours before treatment. After 4 days of treatment, the
proportion of women who had vomiting in the ginger group(12 of 32)
was significantly less than that in the placebo group (23 of 35). Patients
also reported their subjective response to treatment. 28 of 32 (87.5%)
ginger-treated women reported that their symptoms improved, compared
with only 10 of 35 (28.6%) in the placebo group.
Commentary: Only one previous randomized cross-over trial of ginger
for hyperemesis gravidarum (severe nausea and vomiting) has been published
in the English literature. In that study, 70.4% women preferred the
ginger treatment compared with 14.8% of women receiving placebo. There
was also a significant reduction in the number of vomiting episodes
in the ginger group. It's a testimonial to the desire of women
to utilize safe effective natural substances that ginger has gained
as much popularity as it has with only one previous clinical trial
on pregnant women with nausea and vomiting. Side effects were minimal
in this study with five women experiencing headaches in the placebo
group and six in the ginger group. One ginger patient had abdominal
discomfort, one heartburn and one had diarrhea for one day. There were
three spontaneous abortions in the placebo group and one in the ginger
group. There were no differences in term delivery and no infant congenital
Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting
in pregnancy: randomized, double-masked, placebo-controlled trial.
Obstetrics and Gynecology 2001;97(4):577–582.
Walking and the Prevention of Hip Fractures after Menopause
In this analysis to determine the effect of just walking on risk of
hip fractures, researchers studied the relation between hip fracture
and walking and leisure-time activities in 61,200 postmenopausal
women from the Nurses Health Study. (ages 40 to 77; 98% were Caucasian).
Study participants did not have histories of osteoporosis, cancer,
or cardiovascular disease upon entry. The intent was to more clearly
understand the intensity of exercise activity required to increase
bone mineral density and reduce hip fractures.
During a follow-up of 12 years, 415 hip fractures were reported. After
an analysis that controlled for age, BMI, hormone therapy use, smoking
and diet, it was determined that the risk for hip fracture declined
by 6% for every increase of 3 metabolic equivalent (MET) hours per
week (equivalent to 1 hour of waling at average pace). Women with at
least 24 MET-hours per week had a 55% reduction in risk compared with
women with less than 3 MET-hours per week. Women who were heavier in
body weight were at lower risk for hip fracture and their risk reduced
further by increasing exercise. For the women who walked as their only
activity, 4 hours per week had a 41% lower risk for hip fracture than
those who walked less than 1 hour per week.
Commentary: We have known for some time that exercise will increase
muscle mass, improve muscle strength, improve balance, increase bone
mineral density, and reduce falls that can cause a hip fracture but
it has not always been clear as to what intensity of activity is required
to achieve these benefits. Observational studies have short comings,
but the message for postmenopausal women is still strong: Walking as
few as 4 hours per week reduces hip-fracture risk and more exercise
yields further reductions in risk. For clinicians, we should use this
information to further encourage our patients to engage in regular
exercise, even though it may be as simple as walking. It's easy,
without expense, accessible, convenient, and does not require complex
skills. For those postmenopausal women with health problems that limit
their ability to walk, we must continue to be creative in searching
for a regular physical activity that they can perform.
Feskanich D, et al. Walking and leisure-time activity and risk of
hip fracture in postmenopausal women. JAMA 2002; Nov 13; 288:2300–2306.
Estriol and Pelvic Floor Muscle Exercise for Stress Incontinence
Sixty-six postmenopausal women with stress incontinence (SI) were randomized
to a group treated with estriol 1 mg per day and pelvic floor muscle
exercise (PFME) and a group treated with PFME alone. Patients were
evaluated every 3 months and efficacy of treatment was evaluated
in patients who had been treated for two years.
A significant decrease in urinary incontinence (UI) scores was observed
in mild and moderate UI women in both groups at the first three month
follow-up. The improvement was greater in the estriol plus PFME group
for up to 18 months in mild UI and for up to 12 months in moderate
Commentary: It can take a long time for PFME alone to bring about desired
results in women with SI. Estriol is an appropriate and appealing tandem
treatment because the carcinogenic effects of estriol seem to be lower
than with other estrogens with both the breast and uterus, and the
effects on the urinary tract are considered to be stronger. Estrogen
receptors are present in the urethra and vagina. Estrogen stimulates
the smooth muscle, epithelial cells, connective tissue around the urethral
tract and the blood vessel floor by binding to the receptors in the
urethra and bladder trigone. This then increases the concentration
of alpha-adrenergic receptors that leads to improvement of the urine-collecting
The findings of this study demonstrate that oral estriol and PFME was
significantly more effective even after only three months than PFME
alone. It is also encouraging that even moderate cases were able to
benefit significantly. It is important to use estriol with PFME for
at least one year in women with SI.
Once again, researchers and practitioners outside of the U.S. take
the lead in estriol research.
Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S. Hormone replacement
therapy plus pelvic floor muscle exercise for postmenopausal stress
incontinence. J Reprod Med 2001;46:213–220.
Calcium and PMS
Reports have suggested that problems in calcium regulation may underlie
some of the symptoms of PMS and that calcium may have a therapeutic
benefit. A recent randomized, double-blind, placebo-controlled, multicenter
clinical trial was conducted to test this hypothesis.
Four hundred ninety-seven women were enrolled and given either 1,200
mg of calcium carbonate or placebo for three menstrual cycles. During
the luteal phase of the treatment cycle, a significantly lower symptom
complex score was observed in the calcium group for both the second
and third months. By the third month, calcium effectively resulted
in a 48% reduction in total symptom scores from baseline compared with
a 30% reduction in the placebo group. All four symptom factors (i.e.
negative mood affect, water retention, food cravings, and pain) were
significantly reduced by the third treatment cycle.
Thys-Jacobs et al. Calcium carbonate and the premenstrual syndrome:
effects on premenstrual and menstrual symptoms. Am
J Obstet Gynecol 1998; Aug: 444–452.
Osteoporosis and Essential Fatty Acids
Osteoporosis is a growing concern with postmenopausal women due to
its prevalence in 75 year-olds and older and the disability and
even mortality it can cause. Although EFAs have not been talked
much in relationship to this disease, there is a growing body of
evidence and research to warrant our attention. EFAs have been
shown to increase calcium absorption from the gut, in part by enhancing
the effects of vitamin D, to reduce urinary excretion of calcium,
to increase calcium that is deposited in the bone and improve the
bone strength and to stimulate the synthesis of bone collagen.(1)
findings have demonstrated that patients with osteoporosis who
are given fish oil show an increase in serum calcium levels, and
given a fish oil/evening primrose oil combination had increased
osteocalcin as well as an increased procollagen, all suggestions
that these supplements
may enhance bone formation.(2) In this study, serum and urinary
markers of bone turnover were monitored in 40 women eighty years
with osteoporosis. Patients were divided into four groups, each
group receiving one of the following:
1) 4g EPO
2) 4 g fish oil
3) 4 g
of a mixture of EPO and fish oil and
4) olive oil.
supplemented for 16 weeks. A number of meaningful parameters in the
fish oil and combined groups changed as a result of the treatment.
In the fish oil group alkaline phosphatase fell significantly, procollagen
rose and calcium clearance rose significantly. The observations were
similar in the combination group except that the osteocalcin also
rose significantly. EPO alone had no significant effects. Even though
this study was short term, and it only measured markers of bone turnover
and not bone density, the findings do suggest that supplementation
with fish oil or a combination of fish oil and EPO may improve bone
In animal studies, EFA deficiency leads to the development of severe
osteoporosis along with increased calcifications in the kidney and
the walls of the arteries. This is similar to what we see in elderly
patients with osteoporosis, i.e. loss of bone calcium and increased
calcifications in soft tissues, particularly the arteries and the kidneys.
These calcifications outside the bone may be more dangerous than the
osteoporosis itself, since the great majority of osteoporosis related
deaths is due to a vascular problem such as a blood clot formation.
Supplementing our diet with oils high in GLA may improve absorption
of calcium and enhance the calcium content in the bone. Supplementing
with fish oils may improve the blood levels of calcium and help to
correct a deficient calcium effect in the bone.
Kruger M, Horrobin D. Calcium metabolism, osteoporosis and essential
fatty acids: a review. Prog Lipid Res 1997; 36(2–3):131–151.
Van Papendorp D, Coetzer B, Kruger M. Biochemical profile of osteoporotic
patients of essential fatty acid supplementation. Nutrition
Research 1995; 15(3):325–334.
Speculum Lubrication Does Not Adversely Affect Pap Smear Results
Most all medical students and residents are trained to avoid using
lubricants on vaginal speculums when doing a Pap smear. Two studies
investigated this presumptive practice.
One study randomly assigned 182 patients who were to receive Pap smears
to speculum insertion with either warm water or 2 to 3 cc of water-soluble
lubricant. Cytopathologists were blinded to which slides were from
which group. No significant difference in Pap smear results was found.
In a similar study, clinicians were randomized in 5 family planning
clinics to use either a water soluble gel or no lubrication or water
on the speculum prior to insertion. There were no significant differences
or abnormal cells detected.
I recall that in one of my early preceptorships 20 years ago, the Ob/Gyn
I studied with was my first exposure in dispelling the myth that lubricants
should not be used on the speculum because it would interfere with
the accuracy of the pap smear. I've been using a thin film of
lubricant applied to the superior blade of the speculum ever since.
The findings of these two studies should clearly dispel this long-held
belief. The use of a thin layer of a water soluble lubricant on the
blade of the speculum provides a more comfortable exam and may improve
compliance of pap smears in those who avoid exams for fear of pain.
Harer W, et al. Lubrication of the vaginal introitus and speculum
does not affect Papanicolaou smears. Obstet
Gynecol 2002; Nov; 100:887–888.
Amies A-M, et al. The effect of vaginal speculum lubrication on the
rate of unsatisfactory cervical cytology diagnosis. Obstet
Gynecol 2002; Nov; 100: 889–92.
Boric Acid and Yeast Vaginitis
Ninety-two women with chronic yeast vaginal infections were followed
during prolonged therapy using anti-fungal agents and boric acid
for a period of six months. Microscopic examination of the discharge
and symptomatic evaluation tools were used to assess response. In
women who had failed conventional mycotic treatment for chronic yeast
vulvovaginitis, boric acid suppsitories given once in the morning
and once in the evening for 2 weeks and in some cases 4 weeks, was
effective in curing 98% of the patients. It was also clearly indicated
as the treatment of choice for prophylaxis.
Commentary: The criteria for cure in this remarkable study was determined
with microscopic examination and a resulting normal vaginal discharge.
Forty-eight (52%) of the 92 study patients experienced an initial disappearance
of symptoms after conventional antifungal therapy but had abnormal
microscopic findings. All of these women suffered a recurrence of their
symptoms within a few days, weeks or months.
Of the 92 patients who failed the usual antifungal therapy, 78 (85%)
were cured with boric acid during the six-month study period. An additional
12 (13%) required periodic prophylactic treatment to control their
infections. In total, the boric acid suppositories in the form of a
gelatin capsule, was successful in 90 (98%) of the study patients.
Of the two patients who were not cured, one felt worse on the boric
acid and discontinued the treatment after three days. The other refused
to continue the treatment after not responding to the first course
I find the results of this study remarkable in that basically, 100%
of the women who completed the study, were cured with something as
inexpensive and easy as boric acid vaginal suppositories. That the
pharmaceutical and natural products industry has found it necessary
to develop dozens of yeast vaginal treatments for women when we seem
to have little or no need for any of them.
Boric acid therapy appears to be a far more effective medication for
chronic yeast vulvovaginits than any of the available agents, although
this study was done prior to the use of diflucan.
The regimen used is as follows: Insert one 600mg boric acid gelatin
capsule in the vagina twice a day for two weeks. Repeat treatment for
2 weeks if not completely symptom free. For prophylactic use, insert
one suppository daily during the menstrual period only, for 4 months.
Continue prophylactic therapy if required to sustain cure. Having used
this therapy with patients for some time now, I have found that some
women will need to apply vitamin E oil to the external genital area.
For some individuals, the tissue has become so irritated and raw due
to the infection, that when the capsule dissolves, and the boric acid
disperses, some of it can leak out onto the vaginal tissue and cause
a burning sensation. The vitamin E will protect the tissue.
Jovanovic R, Congema E, Nguyen H. Antifungal against versus boric
acid for treating chronic mycotic vulvovaginitis. Journal
of Reproductive Medicine 1991;36(8):593–597.