We’ve heard the same prescriptions for good health repeated for years by our mothers, friends, in magazine articles and, oh yes, by our doctors. Are they true, and are they supported by current research? On “Today’s Woman,” “Today” show medical contributor Dr. Judith Reichman tells us that in some instances this “it’s good for you” advice ain’t necessarily so.
Water, water everywhere! Should I drink it all?
There’s a prevailing opinion that there’s no such thing as too much water. Does the advice “drink eight glasses a day” really hold water? Many women believe that the more they drink, especially when it comes in designer bottles, the less they’ll eat, the more they’ll “flush” toxins from their bodies, and the moister and dewier their skin will be. Countless magazine articles have recommended eight glasses a day (two quarts) as the gold standard of liquid health. None of these suppositions bear medical scrutiny. A diligent review, published in the American Journal of Physiology, could neither locate the origins of this edict, nor any evidence to support it. The moisture in your skin will suffer only if you meet the medical standards for dehydration. There’s no need to monitor the color of your urine or count your empty water bottles. We have a marvelous built-in hydration control. It’s called thirst, which works through multiple hormones and sensors in our vascular system. Also, much of what we consume contains liquid, even though it’s not water, and despite what you’ve heard, coffee, caffeinated soft drinks and other fluids do count. Finally, there are good reasons not to overdo fluids. Many women complain of incontinence problems simply because their overfilled bladder contracts before they reach the toilet. Just like most vitamins, a deficiency of water is bad, but excess is unhelpful and can even be dangerous. If you take in fluid faster than your kidneys can process it, you could even end up with “water intoxication,” causing confusion, coma and even death.
What about other beverages? Should we decaffeinate?
There’s no question that caffeine is a powerful psychoactive drug. We use it as a mental stimulant (and today the act of drinking coffee in coffee shops has become a social stimulant for conversation, business meetings, and logging onto the Web). Caffeine prevents sleepiness and sharpens thinking by blocking the action of certain neurotransmitters and lift moods by affecting dopamine. It “revs you up” by promoting release of adrenaline, starting at doses lower than fifty milligrams, which is about the amount in a serving of black tea or cola. It has been shown to improve muscle coordination and strength if consumed just prior to exercise or an athletic event. It also increases energy expenditure, and to a very small extent helps us burn calories. Because it helps relax the airways of the lungs, caffeine is associated with fewer asthma attacks in asthmatics. And here’s an effect we’ve all noticed: it can act as a laxative. In fact, many women rely on their morning coffee to keep them on schedule from both a gastrointestinal and daily activity perspective. Two to three cups a day may lower the incidence of Parkinson’s disease (according to Nurses’ Health Study data) and seems to decrease gallstone formation, at least in men. However – and there’s always a however – there can be some negative effects, although some of which we’re warned about may be exaggerated. The following have been associated with caffeine and may give us pause in taking that second or third cup of coffee:
There may be as much as a 30 percent increase in early miscarriage of normal pregnancies for women who drink one to two cups of coffee a day. One study has shown this goes up to 40 percent with four cups. There’s also concern about caffeine consumption while trying to conceive. Some studies have shown infertility rates double for women who drink more than two and a half cups of coffee a day.
- Cancer, coffee and smoking
No cancer correlation to caffeine has been found, except that women who smoke often do so at the same time that they drink their coffee. There is no increase in breast cancer from caffeine, although some women find breast tenderness is worsened with increased caffeine consumption.
There is no conclusive link between caffeine and osteoporosis, but if caffeinated beverages (without milk) preclude milk or calcium-containing fluid consumption, the lack of calcium intake will correlate with osteoporosis risk.
Caffeine can raise blood pressure for a few minutes, and in some cases hours. However coffee consumption does not seem to cause ongoing hypertensive disorder. If you already have hypertension, however, a cup of coffee may temporarily raise your blood pressure and this could ultimately increase your more immediate risk of stroke.
- Heart disease
Caffeine can cause palpitations, irregular or fast heartbeat, and if you have an existing abnormal heart rate or heart disease, this could be a problem. One study found an increased risk of cardiac arrest in nonsmokers who consumed six or more cups of coffee a day. But in general we can’t blame heart disease or heart attacks on reasonable caffeine consumption.
Caffeine can increase the effectiveness of headache medications (and many of the over-the-counter headache medications in fact combine caffeine with either aspirin or a Tylenol-like component). But these combined products can actually cause rebound headaches. To avoid this “take a pill feel better, then worse” cycle, over-the-counter medications with caffeine shouldn’t be used for more than two days at a time.
Caffeine acts as a diuretic and should decrease discomfort and bloat. But it can also cause a fall in blood sugar, which increases symptoms of PMS. There can be a three-fold increase in PMS if we drink more than three to four cups of coffee a day.
- Bladder conditions
Caffeine speeds the kidneys’ processing of fluid, so we have to go more frequently. It can also irritate the bladder, leading to certain forms of incontinence.
- Caffeine and sleep
Caffeine stimulates the brain and also affects levels of melatonin, which promotes sleep. It takes four to seven hours to metabolize caffeine. The older we are, the longer it takes. And if you are on birth control pills or estrogen, the half life of caffeine may be doubled. So an afternoon cup of coffee can cause late night insomnia.
- Caffeine and anxiety
High doses increase the level of brain chemicals associated with anxiety.
- Caffeine and heartburn
Even decaffeinated coffee can increase stomach acid production and affect the closing of the valve between the stomach and esophagus, leading to reflux and heartburn. If you do have this problem, you not only need to decaffeinate, but you need to de-decaffeinate, i.e. no types of coffee at all.
The bottom line
In summary, caffeine does make us feel better, more alert; we sometimes exercise better, even think better. But we should not be consuming it, especially more than one to two cups per day, if we have:
- Irregular heartbeats or palpitations
- Severe PMS
- Sleep problems
- Bladder problems
- Anxiety and/or panic attacks
If it’s Tuesday, it must be Belgian chocolate! What, if any, is the harm?
There is, of course, another product that we love that also contains some caffeine: chocolate. We’ve been told that it’s fattening and not good for us. “It will rot your teeth, cause acne, make you fat.” Are these warnings true? And what about the recent proclamations that chocolate is, to some extent, a health food?
First, the caffeine in chocolate is not very strong. One chocolate bar contains less than a cup of coffee. Chocolate also contains a group of very healthy ingredients called flavinoids, which are antioxidants and are also contained in fruits, nuts and vegetables (and red wine). These flavinoids, which are present in the cocoa bean, can reduce the blood’s ability to clot (like aspirin) and may also help to lower blood pressure. Part of the fat content in chocolate comes from steric acid, which works on the body like a healthy monounsaturated fat. There is even some evidence this may help protect against cavities. But remember, a cup of chocolate is very dense in calories, containing up to a thousand calories or more, whereas a cup of broccoli contains less than forty. Moreover, white chocolate contains no flavinoids. Dark chocolate, which is considered the healthiest, contains two to four times the amount of flavinoids that milk chocolate has. If you want to have a couple of pieces of dark chocolate a day, consider the calories in your total count, but in the end this may not be such an anti-health treat.
We’ve been told women should take iron supplements. Is that true?
To start, it is very important to know that iron supplements are the most common cause of poisoning deaths among children, and overload is dangerous at any age. If you’re not anemic, doses over forty-five milligrams can cause constipation, vomiting, nausea or diarrhea. While we have our periods and lose blood and deplete our iron stores, taking a multi-vitamin with a small amount of iron is acceptable. But as we get older and stop having periods this is not necessarily so. One out of two hundred and fifty people of Northern European descent (and also persons of other ethnic backgrounds) have a genetic disorder called hemochromatosis. In this condition, iron absorption is so efficient that there is build up of excess iron in the body’s organs, which can cause serious liver, heart, thyroid and joint problems, as well as liver cancer. As women menstruate for thirty or forty years this problem may not show up until after menopause. Iron may also aid the formation of free radicals, those unstable agent disease-promoting molecules. In fact, one theory of why younger women have less heart disease than men is that prior to menopause women’s mild iron deficiency acts as a cardiac shield against free radical damage.
Finally, in a recent report of the Nurses’ Health Study, in which they followed thirty-two thousand women for more than ten years, they found that those women with higher iron stores were found to be at increased risk for development of type 2 diabetes. Too much iron, as in too much of any supplement, can be harmful. So once you’re menopausal, do not take a multivitamin with iron unless told to do so by your doctor after appropriate blood testing.
The Pap smear – does it really need to be done every year?
After age 30 we can decrease the frequency of our Pap smears to every two to three years if our past routine Pap has been normal, we are in a monogamous relationship, don’t smoke, don’t take steroids, and are not DES-exposed ( meaning your mother took DES when she was pregnant with you). Nearly all cervical pre-cancer and cancer is due to the sexually transmitted human papilloma virus (HPV), which, although readily transmitted, is cleared by most women after a few years. If this virus is not cleared, it will take three years or more to cause mutations in the cervical cells leading to pre-cancer and cancer. Some physicians are adding a special test for HPV and if this and the Pap smear are negative, feel very assured that a three year wait (and not the usual yearly Pap) is safe and warranted.
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Are carbohydrates really as bad as Dr. Atkins said?
Once again, not necessarily. A recent review published in the Journal of the American Medical Association found that there is not enough evidence to make health or diet recommendations for or against low-carb diets. Another article, published in the New England Journal of Medicine, showed that low-carb diets (with high fat and high protein) are more effective for weight loss in obese individuals when compared with low fat diets (fewer than twenty-five percent of calories from fat), but only during the initial three and six months. By the end of the year, those who stayed on the low-carb diet (and many couldn't) did not lose more weight. And those who succeeded in losing weight in the first place did so because they ate fewer calories. It’s the total calories that count! The American Heart Association has not recommended a low-carb diet, stating that there is no evidence that the diet is effective long term in improving health. Against a strict restriction of carbs for weight control is a 12-year Harvard study of 74,000 women which showed that those who consumed more fruits and vegetables were 26 percent less likely to become obese than women who ate fewer fruits and vegetables over the same period of time.
Part of the puzzle is that not all carbs are created equal. Refined carbohydrates, such as white rice, white bread and of course sugar – and potatoes – cause rapid spikes in blood sugar and hence raise insulin levels. Insulin can then cause fat to accumulate in the body, especially around the waist, and wrong fats (triglycerides) to accumulate in the blood stream, contributing to plaque and heart disease. Complex carbs (think whole grains that are not denuded during so-called "refining") are digested slowly and don't cause a sudden blood sugar surge. They also contain important fiber, vitamins and phyto (plant) chemicals. When you stop consuming these "made for us by nature" carbohydrates and substitute protein and fat, you can eventually cause considerable harm. In the short term you may feel tired, dizzy, nauseated and dehydrated. With time, lack of carb balance can lead to deficiencies in vitamins and minerals. A lack of fiber often results in constipation and this increases your risk for development of diverticulosis (weakened pouches that develop in the bowel wall) and possibly even colon cancer. A diet with the wrong fats, i.e. saturated fats found in meat and whole milk and the trans fats in many processed foods and margarines, will contribute to heart disease. Too much protein can lower absorption of calcium, leading to osteoporosis, and can stress your kidneys.
We don't need a general carb-out. If you want to keep your weight down and stay healthy, do the known, right stuff: eat plenty of vegetables and fruits, and substitute whole grains, some nuts, and healthy oils for sugar, white starch and saturated fats. And of course, don't smoke, and make sure you exercise!
Dr. Judith Reichman has practiced obstetrics and gynecology for more than 20 years. She is a regular “Today” show contributor.
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