Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Does weight loss surgery lower the risk of getting cancer?

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Previous studies have suggested a link between obesity and increased cancer risk, and a new one bolsters that link by showing that weight loss seems to reduce cancer risk.

The researchers at McGill University in Montreal studied nearly 6,800 very obese people and found that weight loss surgery, including gastric bypass and gastric banding, can cut the risk of some cancer by as much as 80 percent. The strongest evidence was for breast and colon cancer risk reduction, but there was also a trend toward reduction in other cancers.

The research team, led by Dr. Nicholas Christou, director of bariatric surgery and professor of surgery at McGill, looked at the medical records of 1,035 patients who had the surgery and 5,746 who did not but were otherwise similar. None of the patients, who were in their mid- to late- 40s, had been diagnosed with cancer before the study.

During a five-year follow-up period, 2 percent of the surgery group was diagnosed with cancer, compared with 8.5 percent of the nonsurgery group. Christou, whose prior studies on weight loss surgery have shown a reduction in the risk of overall mortality, cardiovascular disease, and diabetes as well as cancer, said in a telephone interview that the most likely mechanism for the reduced risk of breast cancer is hormonal.

Fat tissue produces estrogen, which drives some breast cancers. In the latest study, the incidence of breast cancer was reduced by 85 percent in the surgery group.

“This effect is so strong it surprised a lot of people,” Christou said.

The risk of colon cancer was reduced by 70 percent in the surgery group, perhaps, Christou said, because after surgery, people eat less and ingest fewer carcinogens. It’s the weight loss per se, not the surgery, that packs the punch, he added.

“The point is to get the weight loss and keep it off permanently,” he said. The study was presented at a scientific meeting in June and will be published soon.

Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the division of nutrition at Harvard Medical School, welcomed the study as further proof of the link between obesity and cancer.

Research shows that an estimated 10 percent to 40 percent of cancer cases in the United States are attributed to obesity, he said. The strongest links are between obesity and esophageal, kidney, endometrial, colon and some breast cancers, he said. But obesity also contributes to pancreatic, ovarian, and gallbladder cancers.

So, if you’re a candidate for weight loss surgery – if your body mass index is 40, or if it’s 35 and you also have another major disease – ask your doctor about the surgery, including how much it might lower your cancer risk.

How much weight should women gain while pregnant?

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Back in the Dark Ages, when I was pregnant, doctors told women to gain 2 pounds a month, or 18 to 20 pounds in all. That worked fine for me and mine, and I didn’t have tons of baby weight to lose afterward.

But in 1990, the gurus at the Institute of Medicine (part of the congressionally created National Academy of Sciences) got worried about low birth weight babies and came up with guidelines that said that skinny women (who have a BMI, or body mass index, of less than 19.8) should gain 28 to 40 pounds. Normal women (BMI of 19.8 to 26.0) should gain 25 to 35 pounds, and heavy women (BMI of more than 26.0) should gain the least, 15 to 25 pounds.

Enter the obesity epidemic. A whopping 66 percent of adult Americans are now overweight, according to the National Center for Health Statistics. “The number of obese pregnant women is rising, too,” said Dr. Laura Riley, an obstetrician who is director of labor and delivery at Massachusetts General Hospital.

Starting a pregnancy when you are already obese and then gaining too much weight during the pregnancy raises many health risks, including the risk of hypertension and diabetes, said Riley, who chairs the Clinical Document Review Panel on Obstetrics for the American College of Obstetricians and Gynecologists.

So the Institute of Medicine is at it again, working on new guidelines, due out next year, that will consider obesity as well as other factors, including the age of the mother (the risks are higher at the extremes of the childbearing years), race, ethnicity, and height, said Ann Yaktine, a biochemist and nutritionist who heads the institute’s guidelines effort.

In the meantime, said Riley of Mass. General, pregnant women should stick to the old weight gain guidelines, but aim for the lower figure in the ranges.

Does chewing ice harm teeth?

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It certainly can.

It’s not the fact that ice is cold that’s the problem, said Dr. Thomas Kilgore, a professor of oral and maxillofacial surgery at the Boston University School of Dental Medicine. It’s that ice cubes, like nuts, are so hard they can chip or crack teeth, especially teeth already weakened by large, old fillings.

“Nine times out of 10, you can chew ice and it won’t have any effect,” he said. But teeth can be structurally weakened by fillings, which makes them more susceptible to fracture from biting hard substances.

“If the filling has weakened the enamel, the tooth might crack.”

And once you have a cracked tooth, whether because of chewing ice or something else, you may have to have a root canal or even need a crown or lose the tooth, said Dr. Jamie Wong, an assistant clinical professor of prosthodontics and operative dentistry at the Tufts University School of Dental Medicine.

So if you, like me, enjoy “eating” ice, let it melt in your mouth. But don’t bite down.

Does coenzyme Q10 help combat problems like hypertension or cancer?

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Coenzyme Q{-1}{-0} is a fat-soluble, vitamin-like substance that works with other enzymes, particularly in the mitochondria, the “powerhouse” of the cell, to make energy. It also acts as an antioxidant, mopping up “free radicals” that can damage cells, said Douglas Wallace, a geneticist who directs the Center for Molecular and Mitochondrial Medicine and Genetics at the University of California, Irvine.

Scientists are increasingly interested in coenzyme Q{-1}{-0} because there’s growing recognition of the importance of malfunctioning mitochondria in many diseases, including diabetes, obesity, heart problems, and autism, said Wallace.

CoenzymeQ{-1}{-0} is plentiful in foods including beef, soy oil, oily fish such as sardines, mackerel, and salmon, as well as nuts, whole grains, and vegetables such as spinach, broccoli, carrots, and cabbage, said Paula Quatromoni, a nutritionist and epidemiologist at Boston University. It’s always better to get your vitamins from whole foods, she said, not supplements, “to be sure you’re getting the balance of nutrients and phytochemicals that promote good health.”

So, be cautious about the hype for supplements, said Quatromoni. “The websites that sell it make it sound like the scientific evidence is there, but those claims are not substantiated.”

Like all dietary supplements, coenzyme Q{-1}{-0} is not regulated by the US Food and Drug Administration prior to marketing, so products can vary widely in their formulations.

The supplement can also interact with other drugs, including cholesterol-lowering statins, insulin, beta-blockers, and blood thinners such as warfarin (Coumadin). In its role as a free-radical reducing antioxidant, coenzyme Q{-1}{-0} may actually interfere with cancer chemotherapy drugs that work by increasing free radicals to kill cancer cells.

Do the new asthma inhalers work as well as the old ones?

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Yes, but they may take some getting used to.

For years, the propellant in inhalers was chlorofluorocarbon. The CFC helped push the active drug, such as albuterol, out of the canister and into the airways, making breathing easier for people with asthma. But CFCs damage the earth’s ozone layer and have therefore been eliminated from many products.

Now that good alternative inhalers are available, the US Food and Drug Administration has ruled that CFC inhalers may not be sold after Dec. 31.

The CFC-free inhalers use a different propellant, called HFAs, or hydrofluoroalkanes, which do not damage the ozone layer. But the new inhalers taste and feel different.

“And the blast may feel softer, so patients may think they are not getting enough,” said Dr. Frederic Little, a pulmonologist, allergist, and critical care specialist at Boston Medical Center.

The smaller albuterol particles in the HFA inhalers may actually allow more of the drug to get into tight airways, Little said.

“Patients should absolutely not worry” about the new inhalers, said Dr. Aaron Waxman, a pulmonologist and critical care specialists who directs the pulmonary vascular disease program at Massachusetts General Hospital. “The delivery system is more accurate – it deliver the medicine right to the area of the airway where it is needed.”

The wise thing to do is “to transition now while both kinds of inhalers are still available,” said Little. In other words, give yourself time to get used to the new inhalers.

My children wake me at night; how good is interrupted sleep?

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In general, interrupted sleep is not as good as continuous sleep, but it can be quite adequate if you’re not awakened too many times, if you can fall back asleep quickly, and if you get enough sleep in total.

In the “siesta cultures,” people typically sleep six hours at night and two hours after lunch, and they do fine, said Dr. Gregory Belenky, director of the Sleep and Performance Research Center at Washington State University.

You can also feel and function just fine if you are wakened two or three times a night and get back to sleep easily. But if you need eight hours’ sleep and you actually get only five because of all the time you lose being awake in the wee hours, you may not feel restored and may feel irritable the next day, he said.

Worse than small children or prostate problems is obstructive sleep apnea, which awakens some sleepers every few minutes, making restorative sleep virtually impossible. Aging also can make people wake up several times at night, noted Belenky, who is 63 and copes with his awakenings by spending nine hours in bed to get eight hours of sleep.

But for people with genuine insomnia – those who have trouble falling asleep and get anxious if they wake up and can’t get back to sleep – spending extra time in bed is the wrong approach, said Cynthia Dorsey, an associate psychologist at McLean Hospital in Belmont and director of behavioral sleep medicine at the SleepHealth Centers, a chain of for-profit sleep labs affiliated with the Harvard teaching hospitals.

For them, she said, what often works best is to restrict time in bed to reduce the time you spend awake and fretting. It’s better, she said, to read or do some other quiet activity until you are genuinely sleepy, and get out of bed and read again if you can’t sleep. If kids do wake you up at night, she said, you can practice some cognitive-behavioral therapy techniques such as not telling yourself you will never get back to sleep but instead say, “That’s not a foregone conclusion. That may not be true tonight.” Above all, she said, don’t try too hard to sleep: that is counterproductive.

Is there any way to prevent ear infections after swimming?

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Swimming in a pool, lake, or ocean and letting the water stay in the ear can change the acidity in the ear canal, making it more prone to infection from whatever bacteria are lurking in the water.

One way to prevent “swimmer’s ear,” an infection of the external ear canal from the eardrum to the outside world, is to use earplugs to keep water out. You can also rinse your ears after swimming with white vinegar, alcohol, or a half-and-half solution you can make at home. And you can also buy over-the-counter products such as Swim Ear (mostly alcohol) or prescription acetic acid drops for use after swimming.

You can also learn to leave your ear wax alone. One of the biggest reasons people get swimmer’s ear is overzealous attempts to remove ear wax. “Earwax waterproofs the ear canal. It should not be cleaned out,” said Dr. Jennifer Smullen, an otolaryngologist at the Massachusetts Eye and Ear Infirmary.

Attempting to remove ear wax with Q-tips, bobby pins, safety pins, or even fingernails can also traumatize the canal enough to allow bacteria to penetrate the skin of the canal, causing infection, said Dr. Eli Grunstein, an associate professor of otolaryngology and head and neck surgery at Columbia University Medical Center and an attending physician at Morgan Stanley Children’s Hospital in New York.

If you do get swimmer’s ear, which can become quite painful, see your doctor, who will likely prescribe antibiotic drops. If your ear canal is very swollen, making it impossible for drops to get in, the doctor may insert a small “wick” that acts like a sponge to help get the drops into the canal. If the pain is severe, the doctor may also prescribe pain medication.

Are sunscreens made with parabens safe?

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The answer depends on whom you talk to.
The US Food and Drug Administration classifies sunscreens as over-the-counter drugs, which means they must be approved before they are marketed. In March, 2006, the agency released a statement saying that there is “no reason to be concerned about the use of cosmetics containing parabens.”

The key issue is whether parabens, which are chemical preservatives, can seep through the top layer of skin, the dead cells that comprise the thick stratum corneum.

Dr. Barbara Gilchrest, chair of the department of dermatology at Boston University School of Medicine, says it can’t. The skin “is an excellent barrier,” said Gilchrest, who is also a scientific advisor to Coppertone, a sunscreen manufacturer.

But some people are concerned. Parabens, are “endocrine disrupters,” which means if they do reach the inner layers of skin, they could potentially damage the reproductive system, said Jane Houlihan, an environmental engineer and also vice president for research for the Environmental Working Group, a not-for-profit environmental advocacy organization.

Her group has studied ingredients in 1,200 sunscreens and found that 64 percent contain one or more parabens.

In a study published in March, chemist Antonia M. Calafat at the Centers for Disease Control and Prevention found that a different ingredient in sunscreen, oxybenzone, does show up in the urine of 97 percent of the 2,517 people she studied. But her study was not designed to determine how this chemical got into the body, via the skin or some other route.

Asked by phone if sunscreens are safe, she said, “I don’t think we can tell. Additional research is needed.”

It’s theoretically possible, said Gilchrest, that minute amounts of sunscreen could pass through the stratum corneum in children because that layer is a less effective barrier than in adults.

Will diet help combat inflammatory woes such as arthritis?

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Possibly, but hard data are sketchy.

Nutritionists certainly agree that eating lots of fruits and vegetables and omega-3 fatty acids – from walnuts, flax seed, and oily fish, such as salmon – is a good idea.

But, “there’s been nothing proved” about an anti-inflammatory diet reducing arthritis pain, said Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the Division of Nutrition at Harvard Medical School. “So we really shouldn’t suggest that you can improve arthritis this way. The best diet is an overall healthy one, in which you get most of your nutrients, including omega-3 fatty acids, from foods, not supplements.”

Karen Collins, a nutrition adviser for the American Institute for Cancer Research, a not-for-profit group that studies diet and cancer, said there is tentative evidence that “a Mediterranean diet rich in fruits and vegetables may reduce levels of CRP, or C-reactive protein, but more evidence is needed,” she said. CRP is a marker of inflammation that is used as a key test for heart disease.

And, of course, weight control is key. Excess body fat, particularly in the abdomen, pumps out inflammatory proteins called cytokines that make inflammation worse.

Does eating ‘local honey’ help prevent allergies?

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It’s an intriguing idea, but even a staunch advocate of honey for this use acknowledges that there’s virtually no published, scientific evidence to support his view.

Tom Ogren, a California horticulturalist and botanist (tloallergyfree@earthlink.net) who advocates local honey (meaning honey harvested within a few miles of where you live), said that bees in any given area “will visit all the flowers that produce pollen” in that area and that this honey will therefore contain pollen from the plants you frequently encounter and may be allergic to.

“If you take small amounts daily, it’s like getting allergy shots” because you may become desensitized to the pollens, he said. “I hear from people who are crazy about the results they get” from this, he added.

But as for real data? Zilch. “You can’t get a big bee company to do research because it [the honey] has to be local,” he said. Ogren acknowledged that any pollen in local honey could also trigger the very allergies a person is hoping to ward off.

Dr. Leonard Bielory, an allergist and immunologist at UMDNJ-New Jersey Medical School, said that while “there are no controlled studies of a clinical effect” of local honey to combat allergies, “I do believe there is something to it.” There have been reports in the medical literature of people who have gotten contact dermatitis from eating honey that came from bees that had pollinated nearby poison ivy plants. “This is exactly the point. You can get positive and negative effects.

“However, the plural of anecdote is anecdotes – not evidence,” he said.

All of which is not to say that honey is without potential medical benefits. It does have small antimicrobial effects when put on the skin, said Bielory, as well as natural substances that prevent mold growth. After all, sugar and water left out on the counter will eventually get moldy, but honey won’t.

And it’s great for coughs. Honey has been shown to be “safer and more effective than cough medicines for calming cough in young children,” said Dr. Frank Twarog, an allergist and clinical professor at Harvard Medical School.