Physical Health

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Metabolic Syndrome

Experts/Authors: Katherine Sherif, MD; : http://www.healthywomen.org/condition/metabolic-syndrome

What is it?

Metabolic syndrome is not a disease, but a clustering or “constellation” of health markers. Although there are several definitions of what is required to be diagnosed with metabolic syndrome, in the United States most health care professionals use criteria from the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association.

That definition says you must have at least three of the following five markers to be diagnosed with metabolic syndrome:

• A waist measurement of more than 35 inches around (more than 40 inches in men).

• A fasting blood glucose level of 100 mg/dL or higher; or you’re already taking medication because you have high blood glucose levels.

• A triglyceride level at or above 150 mg/dL. Triglycerides are a form of fat in your blood.

• An HDL cholesterol level (the “good” cholesterol) below 50 mg/dL (below 40 mg/dL in men); or you’re already taking medication to increase your HDL level.

• A blood pressure at or above 130 mm Hg systolic (the top number) or 85 mm Hg diastolic (the bottom number); or you’re already taking medication to treat high blood pressure.

According to the American Heart Association, 47 million Americans have metabolic syndrome, although many may not know it. Metabolic syndrome is a concern because it is linked to several health conditions, particularly heart disease and diabetes. Although rates of metabolic syndrome are the same in men and women, women with a condition called polycystic ovary syndrome (PCOS) are up to 11 times more likely to have metabolic syndrome than those without PCOS.

Additionally, rates of metabolic syndrome increase with age, occurring in about 45 percent of those aged 60 to 69. Researchers have discovered the risk of metabolic syndrome in women begins to rise around perimenopause, which seems to be related to increases in testosterone at that time.

The reason so many Americans have metabolic syndrome is related to three things: weight, lack of exercise and genetics. However, while you’re more likely to have metabolic syndrome if you’re overweight, not everyone who is overweight has it. And you can have it even if you are not overweight. Estimates are that about 22 percent of overweight and 60 percent of obese people have metabolic syndrome, with the risk thought to be directly related to the amount of abdominal fat. Abdominal, or visceral, fat is defined by your waist circumference. Later, we’ll talk more about why this increases your risk for certain diseases.

You also have a higher risk of metabolic syndrome if you’re Hispanic or South Asian (from the Indian subcontinent), don’t get much or any exercise and follow a high-fat diet, particularly one high in fried foods, carbohydrates and so-called “empty calories” like soda. Conversely, following a diet high in whole grains and

The reality, however, is that any one of the five risk factors increases your risk of cardiovascular disease whether you have metabolic syndrome or not. So whether you have one or all five of the components, you and your health care professional need to work together to reduce that risk and any others you may have.

To diagnose metabolic syndrome, your health care professional should measure the five components involved in the condition: blood pressure, blood triglyceride level, HDL cholesterol level, waist circumference and fasting blood glucose level. You will need to fast for at least 12 hours before the blood tests.

If you have polycystic ovary syndrome, or PCOS, you should ask your health care professional to evaluate you for metabolic syndrome. This condition affects between 6.5 and 8 percent of women of childbearing age. Typical symptoms include irregular or absent menstruation, obesity and hair on the face and other parts of the body where women typically don’t have much hair, a condition called hirsutism. Women with PCOS also often have high levels of testosterone and often have trouble getting pregnant.

Some research finds that women with PCOS are up to 11 times more likely to have metabolic syndrome. What we don’t know is whether the components of metabolic syndrome cause the PCOS or vice versa. But women with PCOS tend to be overweight, have insulin resistance, have high levels of fasting blood glucose and, in fact, a much higher risk overall of cardiovascular disease and diabetes.

Treatment

The cornerstone of treatment for metabolic syndrome is simple: improving your diet, restricting calories, losing weight and/or maintaining a normal body weight and increasing levels of physical activity. Losing as little as 5 to 10 percent of your body weight can reduce blood pressure and insulin levels and decrease your risk for diabetes.

Don’t try a crash diet, however; they don’t work. Instead, the best approach is to reduce your total calories. You can cut out 500 calories a day, for instance, simply by skipping that Frappuccino and cutting out one large soda.

Cutting calories isn’t enough, however, if you’re after long-term weight loss. You also have to change the way you eat and view food. That means setting goals for weight loss, planning meals, reading labels, reducing portion sizes and avoiding eating binges. Measuring and cutting calories can be complicated, so you might try simpler techniques like setting aside 10 percent of your meal before you even start. You’ll eat less and not even notice the difference.

And you don’t have to lose a lot of weight; aim for 5 to 10 percent of your weight over six to 12 months. If you weigh 200 pounds, that’s a loss of 10 to 20 pounds, enough to change the way you look and feel and improve many of those metabolic markers.

Even if you’re not aiming to lose weight, you should change your diet. Studies find a diet high in saturated fat, simple sugars and cholesterol contributes to metabolic syndrome. Reducing the amount you eat while increasing the fruits, vegetables and whole grains in your diet is best.

Several specific dietary strategies are recommended for the treatment of metabolic syndrome, including the following:

• The Mediterranean Diet, which is high in fruits, vegetables, nuts, whole grains and olive oil. In a study that compared the Mediterranean diet with a standard low-fat diet, participants who ate the Mediterranean experienced greater weight loss, lower blood pressure, lower markers of inflammation and improved insulin resistance and lipid profiles.

• The D.A.S.H. diet, which includes a sodium intake of less than 2,400 mg per day and a higher dairy intake than the Mediterranean diet. When compared with a weight-reducing diet that emphasized healthy food choices, the D.A.S.H. diet resulted in greater improvements in fasting glucose, triglycerides and diastolic blood pressure, even after controlling for weight loss.

• A low-glycemic diet, which includes foods with a low glycemic index and replaces refined grains with whole grains, fruits and vegetables and eliminates high-glycemic beverages. A low-glycemic diet appears to be particularly beneficial for people with metabolic syndrome; however, experts aren’t sure if it is the low glycemic index itself or the increase in high-fiber foods that produces the beneficial effects.

Now on to the second part of the equation: exercise. When you exercise, your cells become more receptive to insulin. Even if you don’t lose weight, regular exercise (a 30-minute walk a day) can make a huge difference in improving most, if not all, of the risk factors for metabolic syndrome.

Although lifestyle changes are the simplest and most effective way to improve all five risk factors associated with metabolic syndrome, in some instances your health care provider may also prescribe medication to treat the individual components of metabolic syndrome.

To improve insulin resistance, for instance, your health care professional may prescribe medications such as metformin (Glucophage), pioglitazone (Actos) and rosiglitazone (Avandia). In fact, studies find that metformin can help prevent diabetes in people with prediabetes.

If you have both high blood pressure and metabolic syndrome, make sure your health care professional knows you have the syndrome. Large doses of some commonly prescribed blood pressure drugs, such as diuretics and beta-blockers, can make insulin resistance worse. ACE inhibitors such as enalapril (Vasotec) and benazepril (Lotensin) and angiotensin receptor blockers like losartan (Cozaar) seem to work best in patients with diabetes.

While there aren’t many drugs that can raise HDL cholesterol, your health care professional may still prescribe a statin, particularly if your LDL cholesterol levels are high; statins can improve HDL cholesterol somewhat. Additionally, if your 10-year risk of heart disease is high, you may want to talk to your health care professional about aspirin therapy. You can learn more about your risk of heart disease at http://www.nhlbi.nih.gov/guidelines/cholesterol/risk_tbl.htm.

Drugs may be prescribed in combination with a healthy diet to reduce high triglycerides. Prescription drugs include omega-3 fatty acids (Lovaza) and the fibrates gemfibrozil (Lopid) and clofibrate (Atromid-S). Talk to your health care provider about the risks and benefits of these drugs, based on your personal medical history.

Generally, your primary care physician—family practitioner or internist—will treat the components of metabolic syndrome, although you may also need to see an endocrinologist, a doctor who specializes in diseases like diabetes that are related to hormones.

Prevention

The best way to prevent metabolic syndrome is identical to the treatment for the condition: maintaining a healthy weight, incorporating at least 30 minutes of physical activity into your day and following a healthy diet high in fruits, vegetables and whole grains and low in sugar and fat. A good place to start is to have a conversation with your health care professional about weight management, weight-related health issues, your personal health risks and the health screenings you should be sure to have.

Facts to Know

1. Metabolic syndrome is not a disease, but a clustering or “constellation” of health markers.

2. To be diagnosed with metabolic syndrome, you must have three of the following:

o Your waist measures more than 35 inches around (more than 40 inches in men).

o Your fasting blood glucose is 100 mg/dL or higher; or you’re already taking medication because you have high blood glucose levels.

o You have a triglyceride level at or above 150 mg/dL.

o Your HDL cholesterol level (the “good” cholesterol) is at or below 50 mg/dL (at or below 40 mg/dL in men); or you’re already taking medication to increase your HDL level.

o Your blood pressure is at or above 130 mm Hg systolic (the top number) or 85 mm Hg diastolic (the bottom number); or you’re already taking medication to treat high blood pressure.

3. About 47 million Americans have metabolic syndrome, although many may not know it, according to the American Heart Association.

4. Women with a condition called polycystic ovary syndrome (PCOS) are up to 11 times more likely to have metabolic syndrome than those without PCOS.

5. The risk of metabolic syndrome increases with age. Researchers have discovered the risk of metabolic syndrome in women begins to rise around perimenopause, which seems to be related to increases in testosterone.

6. Although you’re much more likely to have metabolic syndrome if you’re overweight or obese, you can have it even if you have a normal weight. The most important risk factor is the amount of fat around your abdomen, called visceral fat. This visceral fat tends to accumulate more in women.

7. Metabolic syndrome significantly increases your risk of developing heart disease and diabetes and has been linked to liver disease, chronic kidney disease, sleep apnea and dementia.

8. The only overt symptom of metabolic syndrome is being overweight.

9. The best way to treat metabolic syndrome is by losing weight and maintaining a healthy weight, becoming physically active and following a healthy diet. This is the only thing you can do that will improve all health markers for metabolic syndrome.

10. Your health care professional may prescribe medication to treat the individual components of metabolic syndrome, such as antihypertensives for high blood pressure and certain anti-diabetes drugs to improve insulin resistance.

Questions to Ask

The next time you see your health care professional, ask the following questions about your risk for metabolic syndrome and what to do if you have it:

1. What is my blood pressure? Is it too high?

2. What are my triglyceride levels? Are they too high?

3. Can you measure my waist circumference and let me know if it is too large?

4. What is my HDL level? Should it be higher?

5. What is my fasting blood glucose level? Should I be concerned?

6. Do I need to reduce my risk of cardiovascular disease and, if so, how?

7. Am I at risk of developing diabetes? What can I do to reduce my risk of diabetes?

8. Should I see a nutritionist for help in revamping my diet?

9. Can you review metabolic syndrome with me and help me understand how to prevent and/or treat it?

Key Q&A

1. Do I really need to worry about metabolic syndrome?

While metabolic syndrome itself isn’t a disease that will make you sick or kill you, it is a sign that you have a much higher risk of other diseases that will, such as heart disease and diabetes. Think of it as a warning sign that it’s time to get serious about things like diet and exercise.

2. My friend’s doctor says that metabolic syndrome is very controversial among medical professionals. Why?

Health care professionals don’t always agree on everything, and metabolic syndrome is one of those things. Some health care professionals don’t see the value in identifying the syndrome in patients, because it isn’t itself a disease; others feel that not identifying it is irresponsible, because it is associated with other diseases, perhaps down the line. Whether or not your health care professional gives you a diagnosis of metabolic syndrome, it is important that you are aware of its components, since any one of the five components can increase your risk of heart disease and/or diabetes.

3. How will I know if I have metabolic syndrome?

Ask your health care professional to do the following: Measure your blood pressure and your waist circumference, perform a fasting blood glucose test and test your triglyceride and HDL cholesterol levels. If you have any three of the following—a waist measurement more than 35 inches around; a fasting blood glucose test level of 100 mg/dL or higher; a triglyceride level at or above 150 mg/dL; an HDL cholesterol level (the “good” cholesterol) below 50 mg/dL; or a blood pressure at or above 130/85 mm Hg—then you have metabolic syndrome.

4. Why isn’t there a single medication to treat metabolic syndrome?

Because the markers for metabolic syndrome are so diverse, it’s doubtful one medication could address them all. However, medications are available for several of the individual components, including high blood pressure, high triglycerides and low HDL.

5. Why are exercise and diet so important in treating metabolic syndrome?

When you follow a healthy diet and increase your physical activity, nearly every component of metabolic syndrome improves, even if you don’t lose weight. Exercise makes your cells more receptive to insulin, the hormone that “unlocks” cells to allow glucose inside; thus your blood glucose levels drop. Exercise also increases HDL cholesterol and reduces triglycerides and can reduce blood pressure. Changing your diet from one high in fat and sugar to one high in vegetables and fruits, along with whole grains and lean protein, also changes levels of blood fats like triglycerides while reducing blood pressure. Finally, both these things—more exercise and a better diet—usually lead to weight loss, even if you’re not trying! And weight loss will improve every parameter of metabolic syndrome.

6. Why are women with PCOS so much more likely to have metabolic syndrome?

We know that women with PCOS, or polycystic ovary syndrome, a hormone disorder that can lead to infertility and diabetes, are up to 11 times more likely to have metabolic syndrome. What we don’t know is whether the components of metabolic syndrome cause the PCOS or vice versa. But women with PCOS tend to be overweight, have insulin resistance, have high levels of fasting blood glucose and, in fact, have a much higher risk overall of cardiovascular disease. The condition affects 6.5 to 8 percent of women of childbearing age, and most have one or more of the classic features: irregular or absent menstruation, obesity and hair on the face and other parts of the body where women typically don’t have much hair.

Lifestyle Tips

1. Limit yourself to two processed or pre-made foods a day.

So, for instance, if you have sugary cereal instead of plain oatmeal and a Hot Pocket instead of a sliced turkey sandwich, you’re done with processed foods for the day. Processed foods are swimming in salt, sugars and unhealthy fats and are often destitute in all-important fiber.

2. Have a piece of fruit or a vegetable with every meal.

Having toast with melted cheese for breakfast? Slice up some strawberries. Fixed a sandwich for lunch? Dip some raw broccoli in low-fat ranch dressing to go alongside. More is always better when it comes to fruits and veggies, but aim to eat around five servings a day. A big leafy salad for lunch can take care of three of those servings.

3. Limit eating out.

Your waist and pocketbook will thank you.

4. Schedule at least three hours a week for yourself.

This is time you’re not driving the kids, not cleaning the house, not at work, not doing anything to please anyone except yourself. This time is yours to do with as you like. Women need stress busters like this to help reduce the dangerously high levels of stress hormones we walk around with all day, hormones that lead to numerous diseases, as well as pack on the fat around our middles.

5. Walk wherever you can.

If you’re going less than six floors, take the stairs––up and down. Park at the far end of the parking lot and walk into the building; park and walk into the restaurant instead of zooming through the drive-through; get up and go talk to your coworker down the hall instead of sending an e-mail. At the end of the day, those steps add up.

6. Wear a pedometer and aim for 10,000 steps a day.

The evidence on these little battery-operated machines is amazing. Studies show that people who reach a daily goal of 10,000 steps (the equivalent of five miles) experience significant improvements in their fitness level, blood pressure and body fat.

7. Keep a food diary.

Not so much to track what you eat, but to track why you eat. Too many people eat as a way to smother emotions or assuage boredom. If you find you’re doing this, you need to talk to someone about finding a healthier way to cope.

8. Stop drinking soda and fruit juice.

They are huge sources of extra calories that don’t pack much nutritional benefit but have lots of unhealthy sugars. Instead, stick to low-fat or skim dairy, water or unsweetened iced tea.

9. Find a physical activity you enjoy.

It could be gardening, kayaking, golf (walk the course), tennis, hiking, biking, rock climbing or many other choices. You’ll meet new people, become more physically active and reduce stress––all at the same time.

Organizations and Support

For information and support on coping with Metabolic Syndrome, please see the recommended organizations and Spanish-language resources listed below.

National Heart, Lung, and Blood Institute (NHLBI) – NHLBI Health Information Center
Web Site: http://www.nhlbi.nih.gov
Address: Attention: Web Site
P.O. Box 30105
Bethesda, MD 20824
Phone: 301-592-8573
Email: nhlbiinfo@nhlbi.nih.gov
American Heart Association (AHA)
Web Site: http://www.americanheart.org
Address: 7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA-1 (1-800-242-8721)
Email: Review.personal.info@heart.org
Medline Plus: Metabolic Disorders
Website: http://www.nlm.nih.gov/medlineplus/spanish/metabolicdisorders.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

References:

“The Metabolic Syndrome.” Uptodate.com. May 2009. Subscription necessary to view text. Accessed October 2009.

“Metabolic syndrome.” The American Heart Association. February 2009. http://www.americanheart.org/presenter.jhtml?identifier=3063528. Accessed October 2009.

Lovaza (omega-3-acid ethyl esters) Capsules Prescribing Information. U.S. Food and Drug Administration. June 2008. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021654s023lbl.pdf. Accessed February 2, 2010.

“What is metabolic syndrome?” The Cleveland Clinic. Last updated February 2007. http://my.clevelandclinic.org/disorders/Metabolic_Syndrome/hic_Metabolic_Syndrome.aspx. Accessed October 2009.

“Clinical manifestations of polycystic ovary syndrome in adults.” Uptodate.com. May 2009. Subscription necessary to view text. Accessed October 2009.

“Risk of metabolic syndrome rises near menopause.” Reuters.com. July 2008. http://www.reuters.com/article/healthNews/idUSCOL16324020080731. Accessed October 2009.

“Menopause and the metabolic syndrome: the Study of Women’s Health across the Nation.” Arch Intern Med. 2008 Jul 28;168(14):1568–75. http://www.ncbi.nlm.nih.gov/sites/entrez. Accessed October 2009.

“10,000 Steps.” Shape Up America. 2009. http://www.shapeup.org/shape/steps.php. Accessed October 2009.

“Year-long physical activity and metabolic syndrome in older Japanese adults: cross-sectional data from the Nakanojo Study.” J Gerontol A Biol Sci Med Sci. 2008 Oct;63(10):1119–23. http://www.ncbi.nlm.nih.gov/pubmed/18948564?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. Accessed October 2009.

Abbasi F, Brown BW Jr, Lamendola C, McLaughlin T, Reaven GM. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol. 2002 Sep 4;40(5):937—43.

Adams RJ, Appleton S, Wilson DH, et al. Population comparison of two clinical approaches to the metabolic syndrome: implications of the new International Diabetes Federation consensus definition. Diabetes Care 2005;28:2777—9.

Babu A, Fogelfeld L. Metabolic syndrome and prediabetes. Dis Mon. 2006 Feb-Mar;52(2-3):55—144.

Cholesterol-Lowering Drugs. American Heart Association. Available at: http://www.americanheart.org.

Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005;28:2745—9. Dis Mon. 2006 Feb-Mar;52(2-3):55—144.

Ford ES, Abbasi F, Reaven GM. Prevalence of insulin resistance and the metabolic syndrome with alternative definitions of impaired fasting glucose. Atherosclerosis. 2005 Jul;181(1):143—8. Epub 2005 Feb 12.

Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356—9.

Freiberg MS, Cabral HJ, Heeren TC, et al. Alcohol consumption and the prevalence of the Metabolic Syndrome in the US.: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey. Diabetes Care 2004;27:2954—9

Grundy SM. A constellation of complications: the metabolic syndrome. Clin Cornerstone. 2005;7(2—3):36—45.

Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; National Heart, Lung, and Blood Institute; American Heart Association. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004 Feb;24(2):e13—8.

Lipitor [package insert]. Dublin, Ireland: Pfizer Ireland Pharmaceuticals; 2005.

McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003 Nov 18;139(10):802—9.

Sevick MA, Dunn AL, Morrow MS, et al. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Am J Prev Med. 2000 Jul;19(1):1—8.

Singh GK. Metabolic Syndrome in Children and Adolescents. Curr Treat Options Cardiovasc Med. 2006 Sep;8(5):403—413.

Sonnenberg L, Pencina M, Kimokoti R, et al. Dietary patterns and the metabolic syndrome in obese and non-obese Framingham women. Obes Res 2005;13:153—62.

Create Date: Tue, 2006-11-14
Last date updated: Tue, 2010-02-02
Medical Review Date: Mon, 2010-02-01
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Source URL: http://www.healthywomen.org/condition/metabolic-syndrome

DIABETES

Diabetes is a disease caused by high blood glucose (sugar) levels. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. With diabetes, the body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in the bloodstream. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a primary healthcare provider for diagnosis. They might have SOME or NONE of the following symptoms:

• Frequent urination

• Excessive thirst

• Unexplained weight loss

• Extreme hunger

• Sudden vision changes

• Tingling or numbness in hands or feet

• Feeling very tired much of the time

• Very dry skin

• Sores that are slow to heal

• More infections than usual.

• Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

What are the types of diabetes?

Type 1 diabetes, previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5% of all diagnosed cases of diabetes. Type 2 diabetes, previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, accounts for t 90% to 95% of all diagnosed cases of diabetes. Gestational diabetes is a type of diabetes that only pregnant women get. Gestational diabetes develops in 2% to 10% of pregnancies but usually disappears when a pregnancy is over.

What are the risk factors for diabetes?

Risk factors for type 2 diabetes include older age, heavier weights, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at high risk for type 2 diabetes Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10–20 years.

Do lesbian/bisexual women get diabetes more often than heterosexual women?

No, it appears from several studies that the rates of diabetes are about the same in lesbian and bisexual women as in heterosexual women. Other factors, such as genetics, your individual diet, age, and racial/ethnic group, seem to be more important predictors of diabetes risk. However, there is research that lesbian/bisexual women are less likely to see routine, preventative health care, thus the signs of diabetes may not be caught as early as they would for women who get regular care.

What is the treatment for diabetes?

Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing. Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high. People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

Can diabetes be prevented?

Researchers are making progress in identifying the exact genetics and “triggers” that predispose some individuals to develop type 1 diabetes, but prevention remains elusive. A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Type 2 diabetes is associated with heavier weights and diet. Thus far, there is no cure for diabetes.

References

Cochran, S D., & Mays, V.M. (2007). Physical health complaints among LGB and homosexually experienced heterosexual individuals: results from the California Quality of Life Survey. American Journal of Public Health, 97, 2048-2055.

Conron, K.J., Mimiaga, M.J. & Landers, S.J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953-1060.

Dilley, J., Simmons, K.W., Boysun, M.J., Pizacani, B.A., & Stark, M.J. (2010). Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health, 100(3), 460-467.

Farmer, G.W., Jabson, J.M., Bucholz, K.K., & Bowen, D.J. (2013). A population-based study of cardiovascular disease risk in sexual minority women. American Journal of Public Health, published online ahead of print, doi: 10.2105/AJPH.2013.301258.

Fredriksen-Goldsen, K., Kim, H., Barkan, S.,Muraco, A., & Hoy-Ellis, C.P. (2013). Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. American Journal of Public Health, e1-e8; doi: 10.2105/AJPH. 2012.301110.

Mays, V.M., Yancey, A.K., Cochran, S.D., Weber, M., & Fielding, J.E. (2002). Heterogeneity of health disparities among African American, Hispanic, and Asian American women: Unrecognized influences of sexual orientation. American Journal of Public Health, 92(4), 632-639.

The basic information about diabetes is from the Centers for Disease Control and Prevention (www.cdc.gov).

BREAST CANCER

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. In the United States in 2013, 232,340 women are expected to be diagnosed with breast cancer, and 39,620 women will die from the disease.† Except for skin cancer, breast cancer is the most common cancer among American women. CDC supports breast cancer surveillance and research, and provides free or low-cost mammograms to underserved women.

What are the symptoms of breast cancer?

Different people have different warning signs for breast cancer. Some people do not have any signs or symptoms at all. A woman may find out they have breast cancer after a routine mammogram.

Some warning signs of breast cancer are—

1. New lump in the breast or underarm (armpit).

2. Thickening or swelling of part of the breast.

3. Irritation or dimpling of breast skin.

4. Redness or flaky skin in the nipple area or the breast.

5. Pulling in of the nipple or pain in the nipple area.

6. Nipple discharge other than breast milk, including blood.

7. Any change in the size or the shape of the breast.

8. Pain in any area of the breast.

Keep in mind that some of these warning signs can happen with other conditions that are not cancer.

What are the types of breast cancer?

The kind of breast cancer depends on which cells in the breast turn into cancer. Breast cancer can begin in different parts of the breast, like the ducts or the lobes. Common kinds of breast cancer are—

  • Ductal carcinoma. It is most common kind of breast cancer. It begins in the cells that line the milk ducts in the breast, also called the lining of the breast ducts.
  • Ductal carcinoma in situ (DCIS). The abnormal cancer cells are only in the lining of the milk ducts, and have not spread to other tissues in the breast.
  • Invasive ductal carcinoma. The abnormal cancer cells break through the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.
  • Lobular carcinoma. In this kind of breast cancer, the cancer cells begin in the lobes, or lobules, of the breast. Lobules are the glands that make milk.
  • Lobular carcinoma in situ (LCIS). The cancer cells are found only in the breast lobules. Lobular carcinoma in situ, or LCIS, does not spread to other tissues.
  • Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

One of the best discussions about types of breast cancer can be found at http://www.mayoclinic.com/health/breast-cancer/HQ00348

What are the risk factors for breast cancer?

• Reproductive Risk Factors

1. Being younger when you first had your menstrual period.

2. Starting menopause at a later age.

3. Being older at the birth of your first child.

4. Never giving birth.

5. Not breastfeeding.

6. Long-term use of hormone-replacement therapy.

  • Other Risk Factors

7. Getting older.

8. Personal history of breast cancer or some non-cancerous breast diseases.

9. Family history of breast cancer (mother, father, sister, brother, daughter, or son).

10. Treatment with radiation therapy to the breast/chest.

11. Breast density by mammogram.

12. Being overweight (increases risk for breast cancer after menopause).

13. Having changes in the breast cancer-related genes BRCA1 or BRCA2.

14. Drinking alcohol (more than one drink a day).

15. Not getting regular exercise.

16. Smoking

Having a risk factor does not mean you will get the disease. Most women have some risk factors and most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

Do lesbian/bisexual women get breast cancer more often than heterosexual women?

The short answer to this question is we don’t know. The large cancer registries that are used to determine the amount of breast cancer in specific groups do not collect data about sexual orientation. Some people currently believe that lesbians have an increased risk of developing breast cancer, based on a “cluster of risk factors” theory.* Of the risk factors listed above, numbers 3,4,5,12,14,16 occur more often in lesbians that heterosexual women. We just don’t know if these risk factors taken together result in more breast cancer for lesbians.

What is the treatment for breast cancer?

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. Treatments include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. People with breast cancer often get more than one kind of treatment.

1. Surgery. An operation where doctors cut out and remove cancer tissue.

2. Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.

3. Hormonal therapy. Some cancers need certain hormones to grow. Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.

4. Biological therapy. This treatment works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.

5. Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating breast cancer. Surgeons are doctors that perform operations. Medical oncologists are doctors that treat cancers with medicines. Radiation oncologists are doctors that treat cancers with radiation.

Can breast cancer be prevented?

Researchers are making progress in identifying the exact genetics and “triggers” that predispose some individuals to develop breast cancer, but prevention remains elusive. Risk reduction by modifying your behavior risk profile is the best alternative at this time.

†American Cancer Society, Surveillance Research, 2013.

* Margolies, L. Lesbians and breast cancer risk. Downloaded 9/4/13 from http://www.cancer-network.org/cancer_information/lesbians_and_cancer/lesbians_and_breast_cancer.php.

^ Gaudet MM, Gapstur SM, Sun J, Diver WR, Hannan LM, Thun MJ. Active smoking and breast cancer risk: original cohort data and meta-analysis.J Natl Cancer Inst. 2013 Apr 17;105(8):515-25. doi: 10.1093/jnci/djt023. Epub 2013 Feb 28.

References

The basic information about breast cancer is from the Centers for Disease Control and Prevention (www.cdc.gov).

1.Case P, Austin SB, Hunter DJ, et al. Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J Womens Health (Larchmt). 13(9):1033-47, 2004.

2.Zaritsky E, Dibble SL. Risk factors for reproductive and breast cancers among older lesbians. J Womens Health (Larchmt). 19(1):125-31, 2010.

3.Austin SB, Pazaris MJ, Rosner B, Bowen D, Rich-Edwards J, Spiegelman D. Application of the Rosner-Colditz risk prediction model to estimate sexual orientation group disparities in breast cancer risk in a U.S. cohort of premenopausal women. Cancer Epidemiol Biomarkers Prev. 21(12):2201-8, 2012.

4.Boehmer U, Miao X, Linkletter C, Clark MA. Adult health behaviors over the life course by sexual orientation. Am J Public Health. 102(2):292-300, 2012.

5.Cochran SD, Mays VM. Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the national health interview survey, 1997-2003. J Womens Health (Larchmt). 21(5):528-33, 2012.

6.Austin SB, Pazaris MJ, Nichols LP, Bowen D, Wei EK, Spiegelman D. An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women. Cancer Causes Control. 24(3):539-47, 2013.

7.Brandenburg DL, Matthews AK, Johnson TP, Hughes TL. Breast cancer risk and screening: a comparison of lesbian and heterosexual women. Women Health. 45(4):109-30, 2007.

COLORECTAL CANCER

Colorectal cancer is cancer that occurs in the colon or rectum. The colon is the large intestine or large bowel and the rectum is the passageway that connects the colon to the anus.

Colorectal cancer affects men and women of all racial and ethnic groups, and is most often found in people aged 50 years or older. In the United States, it is the third most common cancer for men and women not including skin cancer.

Of cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the United States, but it doesn’t have to be. If everybody aged 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented.

Colorectal cancer screening saves lives. Screening can find precancerous polyps—abnormal growths in the colon or rectum—so that they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment often leads to a cure. About nine out of every 10 people whose colorectal cancer is found early and treated are still alive five years later.

In 2013, about 143,000 people in the United States will be diagnosed with colorectal cancer and about 48% will be women.(1)

What are the symptoms of colorectal cancer (2)?

Early colorectal cancer often has no symptoms, which is why screening is so important. Most colorectal cancers begin as a polyp, a small growth in the wall of the colon. As a polyp grows, it can bleed or obstruct the intestine. See your doctor if you have any of these warning signs:

1. Bleeding from the rectum

2. Blood in the stool or in the toilet after having a bowel 
movement

3. Dark-or black-colored stools

4. A change in the shape of the stool

5. Cramping pain in the lower stomach

6. A feeling of discomfort or an urge to have a bowel movement when there is no need to have one

7. New onset of constipation or diarrhea that lasts for more than a few days

8. Unintentional weight loss

9. Weakness or fatigue

Keep in mind that some of these warning signs can happen with other conditions that are not cancer.

What are the types of colorectal cancer?

About 96% of colorectal cancers are adenocarcinomas, which evolve from glandular tissue. The great majority of these cancers arise from an adenomatous polyp, which is visible through a scope or on an x-ray-like image.

What are the risk factors for colorectal cancer?

The risk of developing colorectal cancer increases with advancing age. More than 90% of cases occur in people aged 50 or older. Other risk factors include having—

1. Inflammatory bowel disease.

2. A personal or family history of colorectal cancer or colorectal polyps.

3. A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).

4. Lifestyle factors that may contribute to increased risk of colorectal cancer include—

• Lack of regular physical activity.

• Low fruit and vegetable intake

• A low-fiber and high-fat diet.

• Overweight and obesity.

• Alcohol consumption.

• Tobacco use.

Having a risk factor does not mean you will get the disease. Most women have some risk factors and most women do not get colorectal cancer. If you have colorectal cancer risk factors, talk with your doctor about ways you can lower your risk and about screening.

What screening tests are used for colorectal cancer (3)?

Screening tests help your doctor find polyps or cancer before you have symptoms. Finding and removing polyps may prevent colorectal cancer. Also, treatment for colorectal cancer is more likely to be effective when the disease is found early. To find polyps or early colorectal cancer:

People in their 50s and older should be screened.  People who are at higher-than-average risk of colorectal cancer should talk with their doctor about whether to have screening tests before age 50, what tests to have, the benefits and risks of each test, and how often to schedule appointments.

The following screening tests can be used to detect polyps, cancer, or other abnormal areas. 
Your doctor can explain more about each test:

• Fecal occult blood test (FOBT): Sometimes cancers or polyps bleed, and the FOBT can detect tiny amounts of blood in the stool. If this test detects blood, other tests are needed to find the source of the blood. Benign conditions (such as hemorrhoids) also can cause blood in the stool.

• Sigmoidoscopy: Your doctor checks inside your rectum and the lower part of the colon with a lighted tube called a sigmoidoscope. If polyps are found, the doctor removes them. The procedure to remove polyps is called a polypectomy.

• Colonoscopy: Your doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. Your doctor removes polyps that may be found.

• Double-contrast barium enema: You are given an enema with a barium solution, and air is pumped into your rectum. Several x-ray pictures are taken of your colon and rectum. The barium and air help your colon and rectum show up on the pictures. Polyps or tumors may show up.

• Digital rectal exam: A rectal exam is often part of a routine physical examination. Your doctor inserts a lubricated, gloved finger into your rectum to feel for abnormal areas.

There are pros and cons to each test. Be sure to discuss them thoroughly with your physician or nurse practitioner.

Do lesbian and bisexual women get colorectal cancer more often than heterosexual women?

The short answer to this question is we don’t know. The large cancer registries that are used to determine the amount of colorectal cancer in specific groups do not collect data about sexual orientation. Some people currently believe that lesbians have an increased risk of developing colorectal cancer, based on a “cluster of risk factors” theory (4). Of the risk factors listed above, numbers 7, 8, 9, 10, 11, 12 occur more often in lesbians that heterosexual women. We just don’t know if these risk factors taken together result in more colorectal cancer for lesbians. A Danish study of more than 1600 women in same-sex couple relationships found no difference in rates of colorectal cancer from those in the general population (5). A recent study also found no differences in screening rates for colorectal cancer by sexual orientation (6).

What is the treatment for colorectal cancer?

Colorectal cancer is treated in several ways. It depends on the type and location of colorectal cancer and how far it has spread. In addition the age and vitality of the individual is taken into account. Treatments include surgery, chemotherapy, biologic therapy, and radiation. People with colorectal cancer often get more than one kind of treatment.

1. Surgery. An operation where doctors cut out and remove cancer tissue.

2. Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.

3. Biological therapy. This treatment works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.

4. Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating colorectal cancer. Surgeons are doctors that perform operations. Medical oncologists are doctors that treat cancers with medicines. Radiation oncologists are doctors that treat cancers with radiation. More specific information can be found in reference 2.

Can colorectal cancer be prevented?

At least 6 out of every 10 deaths from colorectal cancer could be prevented if all men and women aged 50 years or older were screened routinely.Precancerous polyps (abnormal growths) can be present in the colon for years before invasive cancer develops. They may not cause any symptoms. Colorectal cancer screening can find precancerous polyps so they can be removed before they turn into cancer. In this way, colorectal cancer is prevented. Screening can also find colorectal cancer early, when there is a greater chance that treatment will be most effective and lead to a cure.

Some studies suggest that people may reduce their risk of developing colorectal cancer by increasing physical activity, eating fruits and vegetables, limiting alcohol consumption, and avoiding tobacco.

References

The basic information about colorectal cancer is from the Centers for Disease Control and Prevention http://www.cdc.gov/cancer/colorectal.

1. American Cancer Society (2013). Cancer Facts & Figures 2013. Atlanta: American Cancer Society. Available on the web at http://www.cancer.org/research/cancerfactsstatistics/index

2. American Cancer Society (2011). Colorectal Cancer Facts & Figures 2011-2013. Atlanta: American Cancer Society. Available on the web at http://www.cancer.org/research/cancerfactsstatistics/index

3. National Cancer Institute (2006). What you need to know about Cancer of the Colon and Rectum. National Institutes of Health, US Department of Health and Human Services. Available on the web at www.cancer.gov/cancertopics/types/colon-and-rectal

4. Brown, JP & Tracy J.K (2008). Lesbians and cancer: An overlooked health disparity. Cancer Causes & Control, 19, 1009-1020.

5. Frisch, M, Smith, E, Grulick, A, & Johansen, C (2003). Cancer in a population-based cohort of men and women in registered homosexual partnerships. American Journal of Epidemiology 157, 966-972.

6. Austin SB, Pazaris MJ, Nichols LP, Bowen D, Wei EK, Spiegelman D. An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women. Cancer Causes Control. 24(3):539-47, 2013.

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