We wanted to make you aware that November is National Diabetes Awareness Month, but especially to call your attention to a disease that all too frequently is, at best, minimized, and, at worst, ignored.

Why is this the case? Probably for many reasons: 1) Diabetes has been around for a long time, and for many years was not discussed much, so that many people think it is just a “nuisance” disease; 2) Many people remember their parents and grandparents having it, and referring to it as “just a little sugar problem”; 3) Many people do not know of the serious complications that are a direct result of diabetes – such as heart attacks , kidney failure, and stroke; 4) Since diabetics usually die of these complications rather than from the diabetes itself, many people unknowingly think that the diabetes itself isn’t serious or cannot lead to death; and 5) Many people think that the available “treatments” for diabetes – pills or insulin injections – are in fact “curing,” or at least “treating,” the disease itself; in reality the medications simply keep the blood sugar in a normal range, but do nothing to treat the underlying disease.

Think that information about diabetes doesn’t apply to you? Think again. Currently, over 23 million people in the United States (8% of the population) have diabetes – 5.7 million of these are undiagnosed; approximately 57 million people in the US have prediabetes, a condition in which the blood sugar is high and may go on to frank diabetes. Research has shown that some people with prediabetes already have the long term damage to the body – especially to the heart and circulatory system – that most diabetics get. If you have been carrying around some extra pounds, you are risk for diabetes (Type II) and prediabetes. You are even more at risk if there is someone in your family with diabetes, or if you had gestational diabetes when you were pregnant. Remember, early on this is a silent disease; your blood sugar can be elevated without any symptoms.

Since the facts about diabetes are readily available in many places, both in hard copy (like in our book!) and online (see websites below), we will not discuss those here, other than to say that although it is indeed a serious disease with serious consequences if left untreated, it is also a controllable disease, and in many cases, a preventable one. The one thing diabetes is NOT: that “little sugar problem” that your grandmother had.

It is because of the misconceptions mentioned above that the American Diabetes Association (www.diabetes.org/home.jsp) and the National Diabetes Awareness Program, sponsored by the National Institutes of Health (www.ndep.nih.gov), work all year to educate everyone about this disease with excellent programs across the country. Please go these websites, learn the facts, and help yourself and others to avoid or control this disease and its devastating complications.

And once again, please read our blog of November 5, “The Danger Season” as it relates directly to weight gain, obesity and diabetes. And, remember to ask your clinician to check your blood glucose level at your next office visit.

RM: Last week you said we would talk about some new information on breast cancer prevention and exercise. Let’s start there this week.

JH:Ok.You know how we talk so much in our book about exercise and its beneficial effects on virtually every organ system in the body as shown by rigorous scientific research in recent years?

RM: Absolutely. During our research for our book we were both surprised by how much research has shown that. Exercise is no longer about “going out for a little walk” to relieve stress or get outside; it’s not a “nice to do” any longer, but a “must do”. In particular, we mentioned that studies have shown that the proper amount of regular exercise may prevent a recurrence of breast cancer in a woman who has been successfully treated.

JH: That’s exactly where I’m going, and there’s even more now.A recent issue of the NCI Cancer Bulletin, which comes out weekly from the National Cancer Institute, put the spotlight on the entire issue of the role of exercise in breast cancer prevention (October 21, 2008; Volume 5, Number 21). More and more research studies indicate that the levels of hormones in the body can be modified by physical activity. Since one of the major theories of breast cancer is that its development is closely related to, and may be caused by, the total amount of estrogen and progesterone a woman is exposed to over her lifetime, knowing that a woman can reduce these hormone levels through exercise is very important information.

RM: In other words, you’re saying that doing regular exercise – by reducing the hormone levels in the body – may be able to actually prevent breast cancer?

JH: That’s the working theory. And there are some good studies to back this up. In one study, known as the “California Teacher’s Study” in which over 133,000 current and retired California teachers and administrators have been enrolled since 1995, the researchers found that the risk of invasive breast cancer (specifically estrogen receptor-negative breast cancer) was inversely related to the amount of strenuous exercise the women had done throughout their lives.

RM: Meaning that the women who did more exercise had a lower risk of invasive breast cancer than those women who didn’t? And how much “strenuous” exercise are we talking about here?

JH: Specifically, the researchers found that those women who had done 5 hours per week of strenuous exercise from the time they were in high school until their current age (around 54 yo), had a significantly lower risk than women who had done ½ hour or less of strenuous exercise over the same time period.

RM: That’s impressive. Are there more studies to back that up?

JH: Yes. The National Institutes of Health (NIH) and the American Association of Retired Persons (AARP) are doing a similar study known as “The Diet and Health Study” that began in 1995. These researchers looked at the amount of physical exercise done by participating women (between the ages of 50 and 71) at the study’s beginning, and found the same thing: that higher levels of physical activity seemed to decrease the risk of estrogen receptor-negative (ER-negative) breast cancer.

RM: I have two questions about these findings. First, a simple explanation. Breast tumors are categorized based on whether or not they have estrogen receptors; those that do have them are known as ER-positive tumors, and those that don’t are called ER-negative.

My first question is: does the fact that exercise reduced the risk of ER-negative breast cancer, rather than other types, make a difference?

JH: Good question. Yes. Here’s why. There are drugs currently in use that can help prevent the formation of ER-positive breast tumors; these drugs are tamoxifen (Novaldex) and raloxifene (Evista). However, there are no drugs available that prevent ER-negative breast tumors. Knowing that physical activity may do that is crucially important.

RM: Very impressive that we may soon be able to help prevent both types of breast cancer.

My second question: You say that the theory is that it is the amount of physical exercise done over a woman’s entire lifetime that may be important in breast cancer prevention. That sounds to me like you’re implying that the earlier she starts doing regular exercise in her life, the less likely she may be to get it. Is that right?

JH: Bingo. (You’re SO smart; glad you are my coauthor! LOL) Remember the Nurse’s Health Study II (NHSII) that you talk a lot about in the book in regard to the use of hormone therapy at menopause?

RM: How could I forget?!

JH: Well, researchers in that study looked at the amount of lifetime regular activity done, from the age of 12 yo and up, in nearly 65,000 premenopausal women, and found a 23 % reduced risk for premenopausal breast cancer in those women who had regularly exercised. Specifically, the higher the levels of physical activity between the ages of 12 and 22, the lower the risk. The researchers think that may have something to do with adolescence being the period of breast development, a time when the breast tissue is most susceptible to hormones and other influences.

RM: So, to all our readers: Get your daughter, granddaughters, nieces and girlfriends’ daughters out there regularly exercising!!

JH: Absolutely. But also a caution to our readers: just because you may not have been physically active when you were younger doesn’t mean it’s too late for you to reap the benefits of exercise now. Researchers from the NCI, and we, strongly believe that becoming regularly physically active at any age is beneficial, especially since we are all living longer.

RM: So don’t forget to take that long walk after dinner on Turkey Day!

JH: And everyday, for that matter. Or at least 5 days a week.

RM: I thought we were going to talk about the importance of abdominal fat this week, but I guess we’re giving our readers/friends a break before Thanksgiving, right?

JH: Yes. We’ll get to that topic right after the Holiday. In the meantime, please read (or reread) our blog from November 5, “The Danger Season.” You’ll see why we’re recommending it again when you read it.

Both: Have a safe and healthy Thanksgiving!!

JH: Lots to talk about this week. The study that made the biggest splash in the news showed that one of the cholesterol-lowering drugs in the group known as statins (such as Lipitor, Zocor, Crestor) prevented heart attacks and strokes even in people who did NOT have high cholesterol levels. Does that mean that everyone, regardless of their cholesterol levels should now take one of these meds?

RM: Well, it’s a bit more complicated than that. In a study in the New England Journal of Medicine of November 9 (published online ahead of its regular publication date), nearly 18,000 people – including men and women of diverse ethnic backgrounds – who had normal “bad” cholesterol levels (LDL) but high CRP levels, were given either a placebo or a statin drug and followed for almost 2 years. They were being watched for their first occurrence of an event involving the cardiovascular system, including a nonfatal heart attack, a nonfatal stroke, hospitalization for unstable angina, the need for a procedure to open blocked arteries, or death from one of these causes. The study had to be stopped because there was a significant difference found in the occurrence of these events between the group taking a statin drug and the group taking a placebo.

JH: So the group taking the statin drug had significantly fewer heart attacks and strokes and other cardiovascular events?

RM: Yes.

JH: Doesn’t that mean, then, that everyone should take one of these drugs regardless of their cholesterol level?

RM: No, but what it does mean is that you might want to find out what your CRP level is, especially if you have risk factors for stroke or heart attack.

JH: Ok. CRP stands for C-reactive protein, and has been used for years as an indication that some type of inflammation is going on in the body. It is measured by a simple blood test. That inflammation, however, can be due to many causes such as an ongoing infection, certain types of arthritis, like rheumatoid arthritis, and active heart disease. The high level of the CRP only says that inflammation is going on, but does not specify where the inflammation is coming from.

RM: Exactly. We say that the CRP test is nonspecific. Therefore, we’re not sure who in this study really had active heart disease, and who didn’t, even though they all had a high CRP.

JH: So, if someone has a normal cholesterol, but other risk factors for heart disease, they should ask for their CRP level to be checked, and then let their doctor decide if they need a statin, right?

RM: Yes. Although the statins are relatively safe, there can be side effects to them and they are expensive; therefore, one should only take them if they really need them. And that should be decided individually for each person. More studies need to be done to follow up this one.

JH: Another study receiving a lot of press attention recently showed that postmenopausal women who had a migraine diagnosis had a lower risk for breast cancer. The authors of this study, which appeared in Cancer Epidemiology, Biomarkers and Prevention, speculate that this difference is due to lower levels of estrogen occurring in migraine patients.

RM: I’ll bet you were especially interested in this study, right?

JH: Yes – it’s the first good thing about migraines I’ve seen! And since I have migraines, I’ll be very interested to see if further studies on this show the same thing. Another study, reported in the August 19 issue of Neurology, showed that chronic migraines were underdiagnosed and undertreated in this country.

RM: Interesting. That finding leads directly to one of the mantras in our book: that women need to advocate for themselves. If you have recurrent and severe headaches, even if your clinician does not make much of them, you should ask if it’s possible you are having migraines, or ask for a referral to see a neurologist.

JH: Absolutely. There are good treatments for migraines these days, including medications to prevent them from occurring. So, there’s a good possibility that if you have migraines, you don’t have to suffer as much, or at all, with them by taking treatment.

RM: Right. Next time we’ll talk about placebos and another new study on the relationship of exercise and breast cancer.

JH: Now that the election is over, and we know the worst about the economy (or least hopefully we do), we can get back to work and focus on day to day matters. And that means, as usual, our health. Time to stop making excuses about all the potato chips we’ve grabbed as we plop down in front of the TV to hear the latest polls, and about the new Ben & Jerry’s ice cream we’ve eaten every night for comfort as we try to deal with our checkbooks. And…

RM: Hey! Wait a minute – aren’t you forgetting something? What time of year is this? You know, the one you have a name for and always talk to your patients about?

JH: Oh, you’re right. It’s what I call the “Danger Season”: that period of time from Halloween until January 2.

RM: Why do you call it that? And how does this time of year impact on all those things we’re saying about getting back to work on health, eating better, walking?

JH: It’s absolutely the worst time of year for taking care of ourselves. The Holidays (which have become almost one long holiday), Thanksgiving, kids home from school, days off for shopping and gift buying, stopping for that double mocha latte and scone, candy canes at all the counters in stores, holiday parties, holiday cookies (love those Mexican wedding cookies smothered in powdered sugar), hot toddies, holiday dinners, weddings….

RM: Whoa! You’re really stressed out here!

JH: That’s why I call it the danger season: because of all the good cheer and easy food just sitting there for grabbing, it’s way too easy to rationalize forgetting all our healthy habits, and giving in to the easy life. Then in January, we are so out of shape and have gained so much weight, it is positively demoralizing. So, what do you suggest we do to avoid that?

RM: I do have tips, but too many to give all of them here. So, I will start by giving a few now, and adding to them in this blog as the weeks go by. Let’s start with:

• • Be aware that the upcoming 8 weeks can be dangerous to your health. Keep reminding yourself.
• • Be alert to your inner voice telling you “it’s ok to eat that holiday candy, just this once” and other destructive messages. Don’t listen to it!
• • Take action to avoid getting into difficult situations healthwise. For instance, give away or throw away the remains of that Halloween candy now, before you eat it all. Don’t leave bowls of goodies (candies and cookies) sitting out in your house because “it’s that time of year”; put them out only when company is coming. Look at your schedule closely: be realistic about all you have to do and the time it takes, and make a place for exercise.
• • Advocate for yourself. Don’t get that fattening holiday drink when you’re out with friends just because they insist that you do; stick with your regular skinny latte.

JH: Those are great. We’ll give more as these holiday weeks arrive.In the next blog, we’ll talk about some recent studies about docs prescribing placebos, more on exercise and breast cancer, and about an interesting study about which diets work the best.

Yes, we do strongly believe in the necessity of exercise to maintain our health, and this particular exercise – that of exercising the right to vote – is no exception. No matter what your beliefs are or which candidates or party you favor, your vote is crucial not only for the health of our country and of democracy in general, but for your own sense of wellbeing. This coming Tuesday, don’t forget to do all of your exercises – including voting!

More discussion on recent medical studies right after the election.