Is Breast Cancer Preventable?

By Dr. Madelyn Fernstrom

October is National Breast Cancer Awareness Month. While there are no specific instructions for breast cancer prevention, there are many things you can do to reduce your risk. Here are six lifestyle steps that research shows contribute to reducing breast cancer risk. 

Manage Your Weight. Overweight and obesity increase the occurrence of breast cancer, especially after menopause (when breast cancer occurs most often). Healthy eating and physical activity likely contribute most to risk reduction by promoting weight loss.

Limit Your Alcohol Intake. As alcohol intake rises, so does breast cancer risk. If you do consume alcohol, limit intake to one drink daily from all sources (a 12-ounce beer, 5 ounces of wine, or 1.5 ounces spirits).  

Breastfeed. The longer you breastfeed, the greater the protective effect. Breastfeeding for one year appears to provide the greatest effect.

Avoid Hormone Replacement Therapy. Using hormone replacement therapy for menopausal symptoms can raise your risk. Avoid progesterone containing therapy (stick with estrogen), and limit use to less than three years. Talk to your doctor about non-hormonal ways to manage menopausal symptoms. And “bio-identical” hormones have the same risks as any others.

Conduct a Monthly Self-Exam. Get to know your own breasts. A monthly self-exam (one week after your period) can detect changes like lumps, skin changes, or nipple discharge. With any changes, schedule an appointment with your doctor.

Schedule a Yearly Medical Exam. Combine your lifestyle plan with a yearly visit to your gynecologist or primary care doctor to discuss a personalized plan for additional breast cancer screening. In addition to a physical exam, you can discuss the timing of mammograms and other screenings that support optimal risk reduction.

All About Caffeine

By Dr. Madelyn Fernstrom

Caffeine is one of the most widely consumed compounds in the world. Nature’s original stimulant, caffeine is found in coffee beans, tea leaves, and cola nuts. Because caffeine boosts mental focus and alertness, it was an important survival tool in caveman days, when our ancestors had to run away from  predators and search for food.

But nowadays, when it comes to caffeine consumption, a little goes a long way. The LESS you consume, the better it works when you need a boost. Too much caffeine makes your body resistant to the positive effects and can result in health negatives, including rapid heart beat, stomach upset, and jitteriness. When it comes to caffeine, less is definitely more.

Most adults should limit caffeine intake to about 300 mg daily. That’s about two mugs of coffee or five cups of tea. An added  “turbo shot” from a coffee house adds another 100 mg or so. 

Caffeine is well known to help athletic performance, so a large cup of coffee before exercising can help support energy and endurance by directly influencing muscle activity as well as boosting mental focus. Make sure to stick with coffee or tea, and don't take caffeine-containing pills (like No-Doz).

If you want to start decreasing your caffeine intake, you can go cold turkey, but you’ll likely get a headache for a few days. To avoid that headache, try cutting your intake in half every few days. Or, make your coffee half-decaf and drink herbal teas and caffeine-free sodas.

Make sure to check with your doctor if you are “caffeine sensitive,” have a medical condition, or take medications (like asthma medicines) that might mean you need to cut back on caffeine beyond the general health recommendations.

Fighting Back From “Weight Bullies"

By Dr. Madelyn Fernstrom

When did the idea become acceptable that the personal weight issues of other people are somehow everybody’s business? Many people feel entitled to comment and judge others about whom they know nothing. They are who I call “weight bullies.” Weight bullies are occurring with increasing frequency, and I believe they are a big step in the wrong direction! 

Here is a case in point: an overweight television anchor in Wisconsin received an email from a viewer commenting on her obesity. The remarks included (1) surprise that her physical condition had not improved over the years, (2) that she should present and promote a healthy lifestyle, and (3) that she was a poor role model, especially to girls.

While many overweight and obese people are judged – both intentionally and accidentally – the usual response is silence and hurt feelings. Many patients have told me they feel obesity is the last “acceptable” area for open criticism and that they are not only hurt by comments, but feel they are somehow less worthy or deficient as human beings. 

This courageous TV anchor, Jennifer Livingston, fought back. She used the negative email she received as an opportunity to speak out against weight bullies. Talking directly to viewers while on the air, Ms. Livingston addressed all people who are not only struggling with their weight, but with other physical and emotional issues. Her message: “Don’t let your self worth be defined by bullies.” You can watch the entire four-minute broadcast of her inspiring words on YouTube by clicking here. 

Have you experienced weight bullying? I’d love to hear your thoughts on the topic!

Lady Gaga’s Weight

By Dr. Madelyn Fernstrom

It’s not often that a rock star offers us an important public health message. Lady Gaga – real name Stefani Germanotta – is perhaps best known for her outrageous outfits (including her dress made from red meat!) and amazing singing voice. We know her as very thin, but she is now carrying an extra 25 pounds.

Media buzz about the reasons for her weight gain abounds. She revealed that she has been a frequent guest at the restaurant her parents have recently opened. But she also revealed that she has struggled for years with an eating disorder, and that it was time to address and resolve the problem.

This is a courageous and unusual step for such a public figure. Now, Lady Gaga’s focus is on getting to a healthy weight that she can maintain with healthy eating. And her message to millions of women (and maybe men) is that the desire for the “perfect weight” can get out of control and become a health negative.

Her take-home message is that choosing and sustaining a healthy weight is a work in progress for all of us. No matter where you are on the scale, it’s not easy to maintain that “sweet spot” of a healthy weight. But it IS all about health and feeling good about yourself.

Are you trying to get started on your journey to lose weight? Learn to fill your weight management toolbox with the right tools for you. I call this process building your BEAM box – with tools for (B)ehavior, (E)ating, (A)ctivity, and (M)edical Care. Don’t be afraid to reach out for help with friends, family, or your doctor when needed. It is working for Lady Gaga and it can work for you too!

More on Limiting Sugary Drinks

By Dr. Madelyn Fernstrom

Here’s an update on the sugary drink debate and size limits that I wrote about back in June. New York City’s leadership proposed a ban on the sale of sugary drinks larger than 16 ounces. A huge debate followed, ranging from personal choice and cost issues to the increasing presence of the food police. All of this was speculation until the Board of Health voted on this hot button issue. You might be surprised to hear that this ban was recently approved. 

The ban covers sodas and sugary drink blends, not 100% juice. Also excluded are dairy-based drinks containing at least 50 percent milk.

Having thought a little more about this controversy, I wonder if size limit is really the issue – 16 ounces is two full cups (around 200 calories). Could the real issue be the idea that someone wants to limit personal food choice? It’s not like Americans are unaccustomed to smaller serving sizes. If you’re over 40 years old, you can recall a time when 16 ounces was considered a huge serving! Now, we are so used to seeing super-sized servings everywhere, the 16-ounce serving looks puny by comparison.

Do you think this will become a national phenomenon? Many people never thought a bill like this one would pass. Is this a nod to more “mindful eating” or an intrusion of personal rights? 

Please share your thoughts on this controversial issue.