Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Does the lycopene in tomatoes help prevent prostate cancer?

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No, according to the latest, and one of the biggest and best-designed studies published recently in the Journal Cancer Epidemiology, Biomarkers, and Prevention.

The research, led by nutritionist and epidemiologist Ulrike Peters of the Fred Hutchinson Cancer Research Center in Seattle, began with 28,000 men, from whom researchers took and froze blood samples. Researchers then followed the men for up to eight years, during which time, 692 of the participants developed prostate cancer. Then they compared blood levels of lycopene, the ingredient in tomatoes that had been thought to protect against prostate cancer.

To their disappointment, Peters said, the team found no association between blood levels of lycopene and a diagnosis of prostate cancer. The study contradicts a study in 2006 that found a hint of a protective effect for tomato consumption as well as a 2004 meta-analysis (in which data are pooled from numerous studies) that also suggested a modest protective effect for high tomato consumption.

Perhaps even more disturbing, the new study found that high blood levels of a different molecule, beta-carotene, was actually linked to a higher risk of aggressive prostate cancer, the latest in a series of worrisome studies about beta-carotene, which is found in many colorful vegetables and is a precursor to Vitamin A.

Taken all together, the lycopene studies show that “we don’t have the evidence to jump into lycopene supplements,” said Karen Collins , nutrition adviser to the American Institute for Cancer Research, a nonprofit group based in Washington that funds research on diet and cancer. “But we do still recommend eating tomatoes, cooked and raw, not because they have magical powers but because they are a great source of many nutrients and are part of a good, plant-based diet.”

Is there any way to protect against pelvic muscle damage during childbirth?

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There may be, and researchers are currently working on some possible strategies.

Doctors have suspected for years, but only just confirmed with MRI, that vaginal deliveries can severely tear the levator ani muscles in the pelvis. These tears, according to a study published in February in the journal Obstetrics & Gynecology, can lead later in life to uterine prolapse, in which the uterus bulges into and sometimes falls out of the vagina, and possibly to incontinence, or leakage of urine, as well.

The study, funded by the National Institutes of Health, suggested that the use of forceps — large tweezer-like instruments used to pull babies that are stuck from the birth canal — raises the risk of injury to pelvic muscles. Forceps stretch muscles too quickly and allow doctors to put as much as 50 pounds of force on the muscles, far more than the force from an unaided delivery.

While there are roughly 80,000 surgeries a year in women to shore up leaking bladders, there are 200,000 for uterine prolapse, said gynecologist Dr. John DeLancey, first author of the study and director of pelvic floor research at the University of Michigan Medical School.

The risk of torn pelvic floor muscles is not a reason to request a Cesarean section, warned Dr. Michael Aronson, a urogynecologist and director of women’s health services at the University of Massachusetts Medical Center. But the study does suggest that, with 3 million live vaginal births a year in this country, doctors may be able to learn to manage labor better.

One take-home lesson from the study, said DeLancey, is for women and their doctors to “limit forceps to use only when necessary.” Another option, suggested by several other studies, may be to pre-stretch pelvic floor muscles by doing special exercises in the last month of pregnancy.

If exercise is so important for good health, why don’t doctors prescribe it?

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Actually, some do, according to a report in a recent issue of the Journal of Clinical Outcomes Management which concludes that while there is little hard data, exercise prescriptions seem to help get patients moving.

Numerous studies have shown that increases in physical activity can reduce the risk for cardiovascular disease, type 2 diabetes, depression, certain cancers and other conditions. The problem has been getting people to get off the couch and exercise, even something as simple as walking.

One solution, said Drs. Caroline R. Richardson and Thomas L. Schwenk of the department of family medicine at the University of Michigan Medical School in their paper, is to literally write down exactly how much a patient should walk day by day. For instance, said Richardson, the doctor might write a prescription that said the patient should start with 3,500 steps – as counted by a pedometer – on Monday, Wednesday and Friday, then gradually increase to 5,000 steps five days a week and report back a couple of months later.

“If you write down on a prescription pad very specific exercise goals, if you make it very concrete and sign your name, that helps people get started. It’s much better than just verbal recommendations,” Richardson said.

Wendy Landman, executive director of WalkBoston, a nonprofit advocacy group working to encourage walking and make communities more walkable, said her group is developing a program to promote walking prescriptions, as well as other strategies to get people walking. WalkBoston is also trying to remove impediments to walking – like trash on the streets, and ice and snow in the winter.

Public health campaigns, like one launched by the city of Somerville and Tufts University researchers to get first, second and third graders in Somerville to eat better and exercise more, can also be highly effective, Landman noted.

Do fertility monitors help increase a woman’s likelihood of getting pregnant?

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They seem to, according to reproductive specialists.
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There are about a half-dozen fertility monitors on the market, costing $20 to $200. These urine tests measure levels of LH, or luteinizing hormone. That’s the hormone that is made by the pituitary gland and released in a “surge” roughly 24 hours before ovulation, or the release of an egg from the ovary.

By detecting this surge, the test allows a couple to time intercourse to the most fertile window of a woman’s cycle.

In the February issue of Fertility and Sterility, researchers who were funded by Unipath Ltd, makers of the Clearblue Easy Fertility Monitor, found that the monitor, when used for two menstrual cycles, increased the likelihood of getting pregnant, especially in women who had been trying to conceive for six months or less.

While not endorsing any particular monitor, Dr. Mark. D. Hornstein , director of the center for reproductive medicine at Brigham and Women’s Hospital, said that fertility monitors are “highly reliable” and can be useful for women who are trying to get pregnant, including women trying insemination with donor sperm.

With intra-uterine insemination, said Hornstein, “the supply of sperm might be limited, so getting the timing right becomes very important.”

“The kits are a big improvement over the old method of having a woman take her temperature to detect ovulation,” said Dr. John Petrozza , chief of the division of reproductive medicine and in vitro fertilization at Massachusetts General Hospital. For many couples, the kits represent “a great tool. There is no downside except the price.”

Do fingernails reveal any information about a person’s health?

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To the extent that nails provide clues to health, these clues are usually too little, too late.

Years ago, when sophisticated diagnostic tests were not available, doctors sometimes looked to the appearance of nails for clues to a patient’s health, said Dr. Howard Baden , a dermatologist at Massachusetts General Hospital. “And the nails do change with some diseases. But by the time the nails are involved, the patient is pretty sick,” he said.

Although not good for diagnostic purposes, fluctuations in health can show up as changes in nails. Many people, for instance, have longitudinal lines on the nails. But these occur with normal aging and “don’t mean anything is wrong systemically,” said Dr. Rebecca Kazin , associate professor of dermatology at Johns Hopkins University.

On the other hand, ridges that cross the nail often occur with acute illness or other severe bodily stress such as chemotherapy. The nail stops growing, then starts again, creating grooves that grow out when the person recovers.

“Club nails,” which become very convex, or domed, can be a sign of chronic low blood-oxygen levels, which can occur with chronic lung or heart disease. Spoon nails, which often run in families, don’t mean anything medically, although doctors used to think they were a sign of iron deficiency.

Nails can also change color with certain diseases. So-called yellow nail syndrome is sometimes associated with cancer, immunodeficiency syndromes, and some other conditions.

Very pale nails, sometimes called half-and-half nails, may be associated with liver or kidney disease. Pitted nails can be a sign of psoriasis.

The only warning signal that you might pick up early by looking at your nails is melanonychia, a longitudinal line of brown. If this doesn’t grow out, it could be a sign of skin cancer in the nail matrix, from which the nail grows.

Are people having surgery to increase the size of their derrieres?

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It’s not only true, the practice is booming! According to the American Society of Plastic Surgeons, the number of “buttock lifts” increased 283 percent nationwide between 2000 and 2005, from 1,356 to 5,193.

An American pioneer of the so-called “Brazilian Butt-Lift,” Dr. Anthony Griffin , a Beverly Hills plastic surgeon, said the most popular form of buttock enhancement, or gluteal augmentation, involves taking fat from the abdomen via liposuction, then injecting it into the muscles of the rear end.

And it’s not just West Coast women, or women from South American or African cultures that value curvy bottoms, who are embracing the trend.

“We are getting more and more demand for fat injections,” said Dr. Richard Ehrlichman , a consultant in plastic surgery at Massachusetts General Hospital and a plastic surgeon in private practice in Wellesley.

Over the first year, in 10 percent to 30 percent of cases, the transplanted fat tissue can get reabsorbed by the body instead of staying where it was put, which means the procedure may have to be repeated, said Ehrlichman. But Griffin said his transplants last on average 10 years. Making sure to inject fat into muscles, which have a good blood supply, boosts survival of fat tissue, he said.

It’s not cheap to get that curvy look, though. Depending on how long the surgery takes, it can cost $12,000 to $18,000 for the fat transfer procedure, which is not covered by insurance.

In addition to creating more curvy behinds with fat, plastic surgeons can put in silicone implants, though these tend to shift around and may become quite hard.

Further boosting the demand for plastic surgery on the derriere is the boom in gastric bypass surgery; when a person loses massive amounts of weight, the skin on the derriere sags. Plastic surgeons can correct this by pulling up the skin and cutting off the excess; some surgeons combine this with a tummy tuck.

But before you leap, remember that plastic surgery is real surgery — with all the risks that accompany other surgical procedures.

Is it OK to suppress menstruation for a year?

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There are several birth control pills on the market that allow women to have short, infrequent bleeding. The newest of these pills, Lybrel — approved last week by the US Food and Drug Administration — stops periods entirely as long as a woman takes it.

In clinical studies, women have taken Lybrel for one to two years, according to Dr. Amy Marren, director of clinical affairs for the manufacturer, Wyeth Pharmaceuticals. As soon as a woman stops taking Lybrel, a combination of estrogen and progestin, she gets a “withdrawal bleed,” which is not a true period because no ovulation has occurred.

While advocates of menstrual suppression claim that birth control pills that reduce periods to once every three months or once a year are a welcome lifestyle choice, critics worry about safety. In particular, said Judy Norsigian , executive director of Our Bodies, Ourselves, the Boston-based health advocacy group, is the fact that “there are no longterm safety data.”

Moreover, some women are ambivalent about losing periods. Two studies by nurse-researcher Linda C. Andrist , an associate professor at the MGH Institute of Health Professions, suggest that slightly more than half of women would choose not to menstruate every month. But many others see their monthly periods as symbols of fertility, normalcy, and health, Andrist said in an e-mail.

The package insert cautions that “because regular monthly bleeding does not occur on Lybrel, an unexpected pregnancy may be difficult to recognize.” Lybrel is comparable to other low dose contraceptives at preventing pregnancy.

As with all birth control pills, the period-stopping pills may lower levels of available testosterone, thus diminishing libido. The long-term pills can also trigger considerable breakthrough bleeding, said Dr. Alan Altman , a Brookline menopause specialist. “This pill doesn’t add much to existing birth control options,” Altman said.

Does hair relaxer cause breast cancer in black women?

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No, according to a new study by epidemiologist Lynn Rosenberg of Boston University’s Slone Epidemiology Center. Rosenberg and her team studied 48, 167 black women from all over the country who replied to questionnaires mailed out every two years. The women in the Black Women’s Health Study were aged 21 to 69 when the study began in 1995. Rosenberg tracked what happened to women who used hair relaxers containing lye (sodium hydroxide) or calcium hydroxide, guanidine carbonate or thioglycolic acid between 1997 and 2003.

“These substances are not known carcinogens, but because the US Food and Drug Administration does not monitor all ingredients in cosmetics, there is no way to tell for certain that hair relaxers are safe. These products are so widely used by black women that we felt it was important to do our study,” she said. “We found absolutely no increased risk of breast cancer with hair relaxers,” she added.

There’s a caveat in all this, however, noted Judy Norsigian, executive director of Our Bodies, Ourselves, the Boston-based feminist health group. “The study does not answer questions about much longer term use of hair relaxants, nor does it look at particular brands of hair relaxants, some of which might contain especially toxic ingredients.”

The Environmental Working Group, a Washington, D.C.-based research group, rates 101 hair relaxers on one segment of its website, www.cosmeticdatabase.com. Many received unfavorable scores because they contain ingredients whose breakdown products have, in some cases, been linked to cancer, but no specific hair relaxer has been shown to cancer, said Kristan Markey, a chemist and research analyst for the group. “The FDA needs the power to make the cosmetics industry prove its products are safe.”

Are human beings genetically programmed to seek the sunshine?

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Personally, I’ve always thought so. And now a new study suggests that there may really be a genetic impulse to seek the sun, though there’s plenty of evidence that excess exposure to sunlight can cause skin cancer.

In the study, published in the March 9 issue of Cell, Dr. David E. Fisher , director of the melanoma program at the Dana-Farber Cancer Institute, reported that the same biochemical process that leads to skin tanning also raises levels of a natural opiate, the “feel good” chemical, beta-endorphin.

Evolution might have favored this because, by making sunning pleasurable, the body increases production of melanin, the pigment that makes the skin tan. People who can tan have a much lower risk of skin cancer, including melanoma, than non tanners.

The link between sun exposure and release of beta-endorphins “is an intriguing hypothesis worthy of pursuit,” said Dr. Hensin Tsao , director of the Massachusetts General Hospital melanoma and pigmented lesion center. He said he’d like to see follow-up research examine whether enough beta-endorphins are released during tanning to make people want to spend more time in the sun.

There’s another interesting tidbit in all this: The body makes vitamin D in response to sunlight. As our ancestors migrated away from the equator, their skins got lighter.

Gene mutations that triggered lighter skin would have allowed people to make sufficient vitamin D, even as sunlight became weaker.

But the cautious take: You should protect your skin most of the time with sunscreen and clothing, especially if you have fair skin and do not tan.

Is virtual colonography – a screen for colon cancer – ready for prime time?

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Almost. In fact, by the end of the year, the American Cancer Society, which is now working on new guidelines, may include virtual colonography as one of the recommended ways to screen Americans over 50 for colon cancer.

In a virtual colonography, the colon is examined by a CT scan — a less invasive screening method than conventional colonscopy, in which patients often have to be sedated so a viewing tube can be inserted into the rectum.

So far most insurers do not pay for virtual colonography, which costs about $650. But data expected to be published later this year, as well as a study published in the journal CANCER late last month, are building momentum for greater acceptance.

With virtual colonography polyps greater than 5 millimeters are found, the patient must go on to have a regular colonoscopy so that a doctor can snip the polyps out.

A growing body of evidence suggests that polyps of less than 5 millimeters are not dangerous so long as you get a repeat scan in 10 years, said Dr. Michael Zalis, director of CT colonography at Massachusetts General Hospital. Since most polyps ARE this tiny, virtual colonography means that roughly 85 percent of the time, people need no further testing.

Though some gastroenterologists have feared that if everybody switches to virtual exams, their incomes could go down, Dr. Perry Pickhardt, the lead author of the CANCER study and a radiologist at the University of Wisconsin, said this has not happened in his program. Because the virtual exam is less anxiety-provoking, more people actually get screened, he said. And there are enough people who do need further testing that gastroenterologists’ business has actually increased, he said.