Breast Cancer Awareness Month

October is Breast Cancer Awareness Month. This is an annual event aimed at raising awareness about the impact of breast cancer. Although October is almost over, you still have the opportunity to help raise awareness in your family or community. Breast cancer that is detected early, when it is still small and has not spread, can be treated more easily and more effectively. Getting regular screening tests is the most reliable way to find breast cancer in its earliest, most treatable stages.

Let’s talk about some background first.

Breast cancer remains the leading cancer among women and the primary cause of mortality. According to The National Breast Cancer Foundation, every ten minutes a woman is diagnosed with breast cancer across the globe.

Breast cancers that are identified by screening tests are more likely to be smaller and limited to the breast. The size of a breast cancer, and how much it has spread outside the breast are some of the most vital factors in determining a woman’s response to treatment and ultimate survival odds.

What is a screening test?

A screening test in the medical sense is defined as a test or exam that is used to detect or rule out disease in a person who has no symptoms. If you have a symptom that prompts a test, such as a lump in your breast, any test done to evaluate that symptom is considered a diagnostic test, not a screening test. Screening tests are designed and recommended to find diseases when they are still too small to cause any symptoms that you would notice with the aim of improving survival and decreasing the burden of disease.

What are the screening tests used for breast cancer?

Mammogram

A mammogram is a special X-ray of the breast done with a low amount of radiation compared to other X-rays. Mammograms can often find breast changes due to cancer years before they would cause symptoms. Women who have regular mammograms are more likely to have breast cancer found early, are less likely to need aggressive treatment, and are more likely to be cured.

Studies have shown that regular annual mammogram screening of women with no symptoms of breast cancer has lowered the number of women who die from breast cancer by about 30 percent.

Mammograms are not perfect though; they do miss some cancers and they sometimes find things that look suspicious but turn out not to be cancer. They can result in additional tests to determine if something is or is not cancer.

There is a new type of mammogram called a 3D mammogram. It is more expensive than the standard (2D) mammogram, and it is not available at all breast imaging centers. It is now becoming more commonly available. This type of mammogram appears to lower the chance of needing to go back for additional tests and appears to find more cancers. It also appears to do a better job of screening on women with dense breast tissue.

Clinical breast exam and self-exam of the breast

Although this used to be routinely recommended, research has not shown clear benefit from regular breast exams, either by a health care provider or being done by women on themselves. However, women should be familiar with how their breasts normally look and feel and they should report any changes to a health care provider right away.

Although the research does not support a recommendation for routine breast exams in all women, that does not mean that they should never be done. For instance, if a woman is at high risk for breast cancer, after discussion with their doctor, they may decide that regular breast exams by their doctor is warranted. Some women prefer to do regular breast exams at home to keep track of how their breasts look and feel.

Next week we will talk more specifically about the recommended guidelines for breast cancer screening in women.

If you have any questions about breast cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Am I Getting Enough Fiber in My Diet?

Fiber is an important part of the diet that is sometimes forgotten. The standard American diet tends to be low in fiber due to high amounts of processed foods and refined grains which leads to fiber deficiencies. It is recommended that women eat 21-25 grams of fiber per day and men consume 30-38 grams per day. Slowly increase fiber to goal while also adding more water to avoid unwanted GI distress.

Sources of Fiber

Fresh, frozen, and lower processed foods tend to be higher in fiber. To maintain the most fiber, limit overcooking. Removing peels and seeds can also change the fiber content.

Navigating the Food Label

Fiber content of foods is listed on the food label under carbohydrates and broken down into soluble and insoluble. To improve cholesterol, choose foods with soluble fiber. 

Fiber does not raise blood sugar the same way other carbohydrates will. When counting carbohydrates to manage diabetes, if the food has 5 or more grams of fiber per serving, subtract half of the fiber from the total carbohydrates. Meals high in fiber will improve blood sugar after mealtime. 

Look for foods that have been fortified with fiber or consider taking a fiber supplement that can easily be added to foods or beverages. 

Slowly increasing fiber can result in great improvements to your overall health.

High Fiber Overnight Oats (6.2 grams fiber)

1/3 cup skim milk

1/3 cup vanilla Greek yogurt

1/3 cup old fashion oats

1/3 cup berries

1/2 tablespoon chia seeds

1 teaspoon honey

Combine all ingredients in a jar and store in refrigerator overnight. 

Enjoy for breakfast or a sweet snack!
 

If you have any questions about dietary fiber, please log into your account and send us your question. We are here to help.

Elizabeth Calloway MS, RD, COWMS, LD

Dietary Fiber is Essential for a Healthy Diet

You have probably been told at some point that you should eat more fiber.  Most people know fiber for its ability to prevent or relieve constipation, but it doesn't just keep your bowel habits regular!  Foods containing fiber can provide several health benefits, from maintaining a healthy weight to lowering your risk of some cancers.  

What is dietary fiber?

Dietary fiber includes the parts of plant foods that your body can't digest or absorb.  Other food components, such as fats, carbohydrates, and proteins, are broken down and absorbed by your body.  But fiber is not digested by your body; human cells just don't have the enzymes to digest fiber.  Instead, it passes through the stomach and small intestine relatively intact.  However, it can be digested to some degree by the good bacteria that live in your gut, primarily in the large intestine.  These bacteria are commonly referred to as your microbiome.  

What are the different types of fiber?

• Soluble fiber - This type of fiber will dissolve in water to form a kind of gel.  This type can help to lower blood cholesterol and glucose levels.  It is found in oats, apples, citrus fruits, carrots, peas, beans, and psyllium.
• Insoluble fiber - As the name implies, this type of fiber does not dissolve in water.  It promotes the movement of material through your digestive system and increases stool bulk.  It can be very beneficial in preventing constipation or irregular stools.  It can also help with people who suffer from diarrhea, by adding bulk to the stool.

Let's talk more about your microbiome, the good or friendly bacteria that live in your gut.

Your body works as well as it does in large part due to a mutually beneficial relationship between you and what we think of as "good" bacteria.  Good bacteria live on the skin, in the mouth, in the nose, and in your gut.  The great majority of those are living in the gut, primarily in the large intestine.  

Up to a thousand different species of bacteria live in the intestine.  They are also known as the gut flora, or the gut microbiome.  They can do things that your body cannot do on its own.  Some of these bacteria are crucial for many aspects of your health, including weight control, blood sugar control, immune function, and even brain function.

Here's where fiber comes in.  Your body is breaking down and absorbing all the fats, carbohydrates, and proteins before they get to the large intestine.  This leaves none of those for the bacteria to eat.  Since you can't digest fiber, it reaches the large intestine essentially intact.  Intestinal bacteria do have the enzymes to digest many of these fibers.  

Dietary fiber is feeding these good bacteria.  In return for you providing this food for the bacteria, they produce certain nutrients for your body.  These nutrients can decrease inflammation in your colon and provide benefits throughout your body.

What are the health benefits of a high-fiber diet?

• Normalizes bowel movements - Fiber increases the weight and size of the stool and softens it.  This decreases the risk of constipation.  If you have loose or watery stools, fiber can help to solidify the stool, because it absorbs water and adds bulk to the stool.
• Lower cholesterol levels - Soluble fiber can lower cholesterol levels, particularly "bad" cholesterol levels.  
• Helps control and prevent diabetes - Fiber, particularly soluble fiber, can slow the absorption of sugar, making blood sugar levels more steady, with fewer highs and lows.  This is particularly important for people who already have diabetes.  Studies also indicate that a healthy diet that includes insoluble fiber may reduce the risk of developing type 2 diabetes.
• Lowers inflammation levels - The nutrients produced by the gut bacteria can lower the level of inflammation in the intestine and throughout your body as well.  This includes inflammation in blood vessels, which helps lower your risk of heart attack and stroke.
• Healthy weight - High-fiber foods are more filling than low-fiber foods.  They are less dense in energy, meaning that they have fewer calories for the same volume of food.  They also keep your appetite satisfied longer, so you don't get hungry as quickly.
• Maintain overall bowel health - Higher fiber intake lowers your risk of developing hemorrhoids as well as the small pouches in your colon called diverticuli.  Diverticular disease can lead to recurrent infections of the colon and can even rupture like your appendix.
• Lower risk of colon cancer - Studies have found that a high-fiber diet lowers the risk of colorectal cancer.
• Longer life - Studies suggest that increasing your fiber intake is associated with a reduced risk of dying from cardiovascular disease and all cancers.

Next week, one of our dieticians will be giving you more information about how much fiber you need and some tips for adding fiber to your diet.

If you have any questions about dietary fiber, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Nighttime Leg Cramps

Nighttime leg cramps, also called nocturnal leg cramps, are quite common.  Up to 60% of adults report that they have had leg cramps at night.  Up to 20% of people who experience leg cramps at night will have daily symptoms that are bothersome enough for them to see a doctor.  These leg cramps can be quite painful and can interrupt sleep.  There are a number of possible causes of these painful cramps.  You might be surprised to hear the things that do not cause these cramps.

What is a nocturnal leg cramp?

Nocturnal leg cramps are painful, involuntary contractions or spasms of muscles in your legs, usually occurring when you are in bed.  They usually involve the calf muscles but will commonly involve your feet or your thighs as well.  They can be incapacitating and last an average of nine minutes per episode.  The acute cramping may sometimes be followed by hours of recurrent cramping and residual pain.  They can cause involuntary movement of your leg, such as extreme pointing of your toe.

What causes nighttime leg cramps?

Unfortunately, we don't know the precise cause of nocturnal leg cramps.  Several possible causes have been suggested over the years, but most cases of nocturnal leg cramps turn out to have no known cause, even after a thorough investigation.  Here are a few possible causes:

• Muscle fatigue - Recent research suggests that muscle fatigue is the primary cause of leg cramps.  Research done with endurance athletes shows that a higher-than-normal intensity of exercise is associated with leg cramps.  
• Abnormal nerve function - Due to certain types of nerve damage.
• Metabolic problems - Abnormal levels of phosphate in the blood seen in patients with end-stage kidney disease on dialysis.  
• Certain medications - Including intravenous iron treatments, certain estrogens, raloxifene (Evista), naproxen, and teriparatide (Forteo), although, the overall incidence of leg cramps with these medications is relatively low.
• Pregnancy - Can be associated with leg cramps with certain activities or positions as well as nighttime leg cramps.
• Restless Legs Syndrome (RLS) - Usually causes an irresistible urge to move or shake the legs and does not cause pain or tight muscles, but studies show patients have difficulty distinguishing typical RLS symptoms from nocturnal leg cramps.

There are several medical conditions that can be associated with leg cramps in general, although they usually also cause leg cramps during the day or with activity.  Your doctor might want to rule out these conditions, depending on your medical history and symptoms.  These conditions include:

• Vascular disease such as peripheral artery disease or venous insufficiency
• Degenerative Disc Disease of the lumbar spine with spinal stenosis
• Kidney disease
• Cirrhosis of the liver
• Thyroid disease
• Neurologic conditions such as neuropathy or Parkinson's disease

What does NOT cause typical nighttime leg cramps?

Although people commonly think about the following things as being a cause of leg cramps, the clinical research has shown that these things are NOT associated with typical nighttime leg cramps:

• Dehydration
• Abnormal levels or changes in the levels of potassium, magnesium, sodium, calcium, zinc, glucose, bilirubin, or albumin (a measure of protein stores).
• Diuretics (water pills)

What can you do about nighttime leg cramps?

No current treatments for leg cramps have been proven to be both safe and effective.  However, there are a few things that you can do that might help.

For prevention you can try:

• Gentle stretching of your calf muscles before bed (slow gentle stretching, not bouncy stretching)
• Mild exercise shortly before bed such as riding a stationary bike or walking on a treadmill at a slow pace
• If muscle fatigue is an issue, changing your daily exercise routine might help
• Untucking the bed covers at the foot of your bed
• If none of these work, a mild muscle relaxer at bedtime might be helpful

For treating an acute leg cramp, you can try:

• Forceful stretching of the calf muscle by pulling the foot up toward your head
• Massaging the cramped muscle with your hands or with ice
• Walking or shaking out the leg
• Taking a hot shower or warm bath  

What should not be used to prevent or treat nighttime leg cramps?

Quinine was once used for nocturnal leg cramps, but research shows that it is only slightly beneficial.  It also has multiple dangerous drug interactions and potential serious adverse reactions.  For these reasons, it is no longer recommended.  In 2010, the US FDA issued a warning about the use of quinine, noting that the potential for serious adverse effects outweighs the modest benefit of the drug.

If you have any questions about leg cramps, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor