Monday, November 19, 2018

How Discrimination Can Hurt Women's Physical Health

October is BCAM, and we know that for our readers, preventing breast cancer—or cancer of any kind, for that matter—is front of mind. We also know that sometimes breast cancer just happens, despite our efforts to live a healthy lifestyle. This paradox is why, this month, we decided to share the top science-backed ways to reduce our risk of developing this disease, which will affect one in eight women during their lifetime, and the story of a doctor with absolutely zero risk factors, who got breast cancer anyway. The hard truth is that we can't always prevent it, but we can try to catch it early and give ourselves the best chance at a full recovery should this illness ever come knocking at our door.

In 2018, about 266,120 new cases of invasive breast cancer are expected to be diagnosed in the United States. There's no doubt about it, a lot of women are going to be suffering—and are already suffering— from this disease.

The good news is that treatments are becoming more effective and less invasive, and we're understanding more and more every day what we can do to prevent this disease that has devastated so many. And so, in honor of BCAM, here are six science-backed strategies to reduce your risk of breast cancer:
1. Adopt an anti-inflammatory diet.

This one probably won't come as any surprise, but eating an anti-inflammatory diet can help prevent your risk of cancer—not to mention diabetes, heart disease, autoimmune disease, and basically any health condition out there. So what does an anti-inflammatory diet look like? It can take a lot of forms. But generally, it looks like lots of fresh fruits and vegetables, nuts and seeds, healthy fats like olive oil and fatty fish, and lean proteins and whole grains. Foods to avoid if you're trying to tame inflammation include common health offenders like added sugars, refined grains, hydrogenated oils, and processed foods of any kind.
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2. Try to avoid environmental toxins as much as possible.

If you're trying to avoid breast cancer, it's time to take a deep dive into your household cleaning products, cosmetics, and makeup. Do you see ingredients like phthalates, parabens, and chemicals with names so long you can't begin to pronounce them? It's no secret that the United States doesn't do a great job of regulating chemicals. In fact, Europe has banned hundreds of chemicals that the United States still allows companies to put in our products—which are going on our skin, hair, face, around our eyes, and are being inhaled through our noses and mouths. This could definitely help explain why the United States has some of the world's highest rates of breast cancer. Many of these chemicals—including others like BPA, pesticides, and fire retardants—are known carcinogens. As Sonya Lunder, MPH, wrote in an article for the Environmental Working Group, an activist group that specializes in research and advocacy for environmental health issues, "Once disputed as a contributor to breast cancer, environmental pollutants are now known to play a significant role. Chemicals in our food, water, and homes can alter DNA and gene expression to change the way breast cells develop, making tissues susceptible to cancer."

Not sure where to start? Try one of these natural cleaners (that you'll want to use over and over and over again) or read our guide to finding the best natural beauty products. You don't have to overhaul your self-care routine all at once—but next time you run out, maybe pick up an all-natural sheet mask, a chemical-free deodorant, or some "5-free" nail polish (these ones are perfect for fall).
3. Be aware of how your birth control method might increase your risk.

New research has shown that hormonal birth control—including the pill and hormonal IUDs—can increase your risk of getting breast cancer and cervical cancer. But before you go throwing your pink pill packet in the trash, you should know that the pill also has protective effects against other types of cancer, like ovarian cancer, endometrial, and colon cancer. This is a tough one, and it's a personal choice for every woman. But if you're concerned about breast cancer, it might be worth exploring non-hormonal birth control methods like the copper IUD, condoms, or apps like Natural Cycles—which was just approved by the FDA as contraception—that use the rhythm method paired with some pretty advanced technology to predict your fertile window.
4. Stop smoking, and keep alcohol intake to a minimum.

Avoiding first- and secondhand smoke goes almost without saying. We all know that smoking is bad for our health and increases our risk of virtually every type of cancer and health problem. What's less well-known is that when it comes to preventing breast cancer, it's also important to keep alcohol to a minimum. So how much can you drink? Unfortunately, even as much as one drink per day can increase a woman's risk for breast cancer. This isn't a reason to deprive yourself of a cocktail every now and again if you have a healthy relationship with alcohol, but it is something to keep in mind if you're a "two glasses of wine with dinner every night" kind of gal.
5. Move your body.

As much as food—and an anti-inflammatory diet—is medicine, exercise can also have powerful health benefits. And the good news is that unlike food, it doesn't really matter what kind of exercise you're getting as long as you're getting it. Don't overthink it: Go on a brisk walk after dinner, join a CrossFit gym, pick up that tennis racket, take a dance class, or go on a jog with a friend. All of it counts toward your health and against your risk for breast cancer. As an added bonus, you'll feel better, as exercise has been shown to improve mood, keep you pain-free and limber, and prevent other diseases as well.
6. If you have the option—breastfeed your babies.

Science shows that breastfeeding reduces your risk of getting both pre- and postmenopausal breast cancer. Wondering how this works? Breastfeeding can keep your menstrual period from returning and prevents ovulation, which reduces your overall exposure to hormones, like estrogen, that are known to promote breast cancer cell growth. You also shed breast tissue during pregnancy and breastfeeding, so it reduces your risk through more than one mechanism.
7. Go. To. The. Doctor.

If you haven't already read Dr. Sheeva Talebian's breast cancer story, now is the time. Because despite doing all these things—exercising, eating healthy, and breastfeeding two children—she got breast cancer. But she's thriving today because of her own vigilant self-breast exams, which led her to go to the doctor early, which likely saved her life. So go for your mammograms and pap smears, and make sure you're aware of what your breast tissue normally feels like so that you know when something feels abnormal.

So many women are suffering from irregular menstrual cycles, painful cramps, or conditions like PCOS (one of the most common hormonal imbalances out there, affecting between 8 and 20 percent of women). We're constantly talking about these issues on mindbodygreen and reminding women that there's a lot they can do to restore their hormone balance naturally—like change their diets, heal their gut, and reduce stress.

But there's one thing that continues to disrupt our hormones on a daily—or should I say nightly?—basis that we don't give nearly enough attention. It's the mistake of not making sleep a top priority.

Sleep is the last big obstacle keeping so many people from optimal health. For some reason, even the most wellness-obsessed have a hard time prioritizing sleep. The consequences of this are vast and affect so many aspects of our health. In fact, there's a strong argument that sleep is more important than nutrition, exercise, and mindfulness.

So how does sleep connect to your hormones as a woman? According to top functional medicine experts, they're connected in more ways than you could ever imagine. For starters, it's thought that women need more sleep than men. "Sleep is critical for hormone balance in women. Most hormones are controlled by the hypothalamus and pituitary—two organs that sit in our brains and rely on normal circadian rhythms. I experienced this firsthand as a medical student, when my shifting sleep schedule in the emergency room severely threw off my hormones." explained Taz Bhatia, M.D., integrative medicine physician and author of the book Super Woman RX.

And it's not just female sex hormones like estrogen and progesterone; it's all of our hormones—from cortisol to insulin to melatonin. According to Amy Shah, M.D., integrative medicine physician and mindbodygreen Collective member, "Sleep has SO MANY effects on the hormones—from lowered cortisol to better insulin sensitivity to lowered leptin and HGH."

According to a study published earlier this year, just one sleepless night can disrupt your hormones, leading to impaired blood glucose sensitivity the next morning. This will affect your mood and energy levels and can lead to poor dietary choices, which spells even more trouble for your weight and other hormones.

And this relationship also goes both ways. According to research published in 2018 in the journal Nature and Science of Sleep, "Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome." This means that lack of sleep can lead to hormone imbalances, and hormones imbalances can contribute to poor sleep. The classic snowball effect." According to Jolene Brighten, N.D., a naturopathic doctor and women's health expert, "Our sex hormones are intimately tied to our circadian rhythms. When we skimp on sleep, we can activate an increase in cortisol and decrease in melatonin, which in term can affect progesterone production. As a result, women can experience more anxiety, PMS symptoms, and insomnia, which only makes the issues of hormone imbalance worse."

So how much sleep should you be getting to be as kind as possible to your hormones? According to Dr. Shah, "To ease hormonal imbalance, I often ask women to prioritize sleep. Eight to nine hours can really help keep hunger hormones, sex hormones balanced. When you sleep your body can make more hormones, repair itself, and clean out old or access hormones." What else can you do? According to Alissa Vitti, women's hormone and functional nutrition expert and author of WomanCode, cutting caffeine, increasing your magnesium intake, and experimenting with stress-busting adaptogens like ashwagandha are great places to start improving your sleep for better hormone balance.

Pregnancy and birth are among the many areas of women's lives that have become increasingly medicalized and depersonalized. A woman birthing in the United States has a tremendous chance of having labor induced, a high likelihood of receiving pain medication in labor, and a one-in-three chance of a cesarean section. Each of these interventions—although of course, sometimes necessary and lifesaving—also carry the risk of "unintended consequences," which include, to name a few, a substantially higher rate of adverse medication reactions, hemorrhage, organ damage, infections, and dangerous blood clots above and beyond that for vaginal birth.

In fact, U.S. hospitals are now one of the riskiest places in the Western world for a woman to give birth. Most of us have heard our fair share of horror stories about long labors and challenging births, long before we've even become pregnant ourselves. Naturally, we want to do our best to prepare our bodies ahead of time to have the healthiest and easiest labor possible.

If you, like so many pregnant women, soon-to-be pregnant women, or someday moms, are freaking out at the thought of pushing a small cantaloupe-size head out of your vagina—while also wanting to do everything you can to avoid unnecessary medical procedures, including caesarean—it's important to do your homework ahead of time. With some forethought you can increase the odds that this upcoming passage into motherhood is as short, easy, empowering, and as safe as possible for yourself and your baby.
How to support a healthy labor through diet and lifestyle change.

Thirty-five years of practice initially as a homebirth midwife, and then as an M.D. specializing in women's health, including obstetrics—as well as being a momma of four—has shown me that labor and birth can be hard work but also a beautiful, powerful event. While there should be absolutely no judgment about what type of birth experience you prefer or ultimately require, it's worthwhile to consider what natural tools we have at our disposal to can help us avoid the speed bumps that often lead to preventable birth interventions (the most common being not going into labor within a reasonable amount of time after your due date, having a long labor, or needing pain medication).

Fortunately, our bodies are wise and know what they need to do to bring our babies into the world. That said, we can support the process first and foremost with:
It might surprise you, but having the support of another woman in labor—whether it be a doula who is supportive of you and knows the tricks of the trade and how to protect your space if you're birthing in hospital or a midwife in a hospital or at home—has been shown to dramatically reduce the need for medications, forceps, and caesareans. Oftentimes, calling upon these resources leads to happier, healthier moms and babies at the end of the day.

In addition, a few favorite books on preparing for birth include Spiritual Midwifery, Birthing From Within, Ina May Birth Book, and for a deeper understanding of which medical inventions are necessary and which are overused, Henci Goer's book Optimal Care in Childbirth.
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Herbs to ease and support birth.

There's also some good science, and safety, red raspberry leaf and red dates for helping with labor. They are two of my go-to natural remedies for my pregnant patients, and I used them during pregnancy as well. Calling on these natural remedies can give you that little bit of extra assurance that you're doing everything possible to help your body get ready for birth.
1. Red raspberry leaf

Red raspberry leaf comes from the leaves of the plant that provides us with delicious raspberry fruits. It's been used for centuries in Europe and among North American native tribes as a mineral-rich tonic tea to support a healthy pregnancy and to "tone" the uterus, which helps women prepare for birth. It remains popular today, with about 63 percent of midwives in the United States recommending it.

Red raspberry (RRL) leaf is high in vitamins C, E, A, and B and has significant amounts of major minerals like magnesium, potassium, calcium, and phosphorus that not only nourish the uterus but provide the minerals it needs to contract and relax—which is exactly the combination required for labor to work effectively and for the powerful muscles of your uterus to push your baby out. It's also rich in a natural plant constituent called fragarine, which is thought to also tonify and stimulate uterine muscle.

While RRL doesn't actually appear to be very effective at stimulating or shortening labor, research has found that drinking RRL tea or taking capsules can have a number of benefits. The results of a double-blind, randomized, placebo-controlled trial consisting of 192 low-risk, first-time moms found that RRL tablets, taken daily starting at 32 weeks' pregnancy until labor, reduced the rate of forceps deliveries. Another study found that raspberry leaf was associated with:

    Decreased likelihood of preterm labor
    Decreased likelihood of going too far past your due date
    Decreased need for having your bag of waters artificially ruptured to stimulate labor
    Lower overall rates of caesarean section, forceps delivery, and vacuum extraction

Are there any risks? While RRL has been used for a long time without any obvious downsides, two studies on rats did find some curious results that I want you to at least be aware of. In one study, RRL tea and capsules at typical doses were found to have the effect of stimulating uterine contractions—as we'd expect them to do to support healthy labor. However, in very high concentrations, contractions were inhibited, which is quite the opposite effect we'd be looking for. In another study, this one also conducted on rats, the authors observed that pregnancy seemed to last longer, and there were some changes in the rat offspring (they appeared to go into puberty early). Now, these are not problems that have been observed in humans, in spite of centuries of use, and the rat mamas in both studies consumed RRL products in doses far higher than humans would normally ingest. So while we should be aware of these findings, the bottom line is that there are a lot of differences between rats and humans.

When should you start taking RRL? As a pregnant midwife-herbal-momma, I drank RRL daily starting about halfway into my pregnancy, always carrying my Mason jar of tea with me. This was in the 1980s (long before the days of green juice!), so I got some strange looks when I was out and about having a swig! While some recommend starting it in the first trimester, I generally recommend avoiding it then because, while there are no studies associating it with miscarriage, there is some evidence that it increases uterine contractility. Herbalists and midwives consider raspberry leaf to be a gentle, effective, nutritious herb to use in the second and third trimesters—and I concur.

How much should you take? One to two cups of tea daily is known to be safe during pregnancy, and several studies have now shown that taking one to two cups regularly in the last trimester can make labor easier. You can also use capsules or tablets (1.5 to 5 grams daily) since RRL doesn't have the most pleasant taste when taken as a tea by itself. In my practice, I generally recommend mixing RRL in with some spearmint and rose hips for a delicious tea that can be taken daily throughout the second and third trimesters.

Many of the popular pregnancy teas you see on the market came from one of my original blends, published in my now classic book The Natural Pregnancy Book. This is a simple, delicious version you can drink hot or iced. For use as a "Labor Day" tea, I actually use 4 tablespoons of RRL and make the whole thing in a quart of water for sipping throughout labor and after the baby is born. You can even make ice pops to enjoy during labor.

Make sure any herbal tea products you purchase contain actual RRL because raspberry-flavored teas don't have any of the RRL benefits. Mountain Rose Herbs is a great online source for purchasing bulk organic herbs.
2. Red dates

Date fruits are perhaps one of the most ancient "sweets." Delicious, they are also nutrient-rich, loaded with fats, proteins, carbohydrates, and a variety of vitamins, minerals, and fiber. It also turns out that they are a common remedy for preparing for labor in certain parts of the world. In one study 919 Iranian women were asked what natural remedies they used in pregnancy for labor preparation, and 26 percent said they ate red dates as part of their preparation at the end of pregnancy. Talk about food as medicine! While we still don't fully know how dates work, it appears they might have an impact on the oxytocin we need for labor to start and progress effectively and on time.

A 2011 study found that women who ate six dates a day for the four weeks leading up to their due date were significantly more dilated when they got to the hospital, had a significantly higher rate of intact membranes, were significantly more likely to go into labor spontaneously (i.e., without induction), and had nearly half the length of the first stage of labor. A 2014 study found that women who ate dates from 37 weeks on had greater cervical dilation at admission and higher success rates of labor induction when needed. Another study found that eating dates in pregnancy led to less bleeding immediately after birth.

Are there any risks? Dates are delicious, and unfortunately, they are also high in sugar—which means there are concerns about their effects on insulin levels and blood sugar balance. Studies have looked at blood sugar levels in women eating dates this way and have found no significant negative changes; however, this has not been studied in women with diabetes, so if you do have gestational, type 2, or type 1 diabetes, do discuss their use with your midwife or doctor.

How much do you take? Based on the studies available to reference, it's recommended that you eat about 70 to 80 grams (about 2.5 ounces) of red dates daily starting at about 36 or 37 weeks of pregnancy and continuing until labor begins. The 2007 study I mentioned specifies deglet noor dates and suggests that about six to eight per day is the magic number. Medjool dates are likely fine as well but typically are twice as large, so keep it to three to four of those per day.
A word about intention and surrender.

Each baby and momma have their own story that they create together—and we don't have total control over how it all happens in the end. Our bodies are beautifully wise and know how to birth our babies. In fact, surrender and openness can go a long way toward helping us open for birth. Complex cultural factors and changes in how we live in modern times, along with overmedicalization, mean that we do need to put some intention and conscious effort into creating the birthing experience we hope for. And natural remedies, along with a healthy pregnancy and doula or midwife support (or both), can make this all the more likely.

Thanks to movements like #MeToo and Black Lives Matter, our collective society feels more aware than ever of the systematic oppression faced by women and especially women of color. But while it's more obvious how discrimination can hurt people emotionally, socially, and economically, what about the harm it can cause to our physical health?

In a recent study published in the Annals of Behavioral Medicine, researchers examined whether women's exposure to everyday discrimination could predict the risk of cardiovascular disease. They looked into existing data from the Study of Women's Health Across the Nation, examining responses from over 2,100 women who self-identified as white, black, Chinese, Japanese, and Hispanic. The study asked the women to describe their day-to-day experiences with discrimination, including being treated with less courtesy than others, receiving poorer service than others, or having people ignore them or act like they aren't there. They ranked the frequency of their experiences on a scale—often, sometimes, rarely, or never. Meanwhile, the study also tracked the women's blood pressure, hypertension status, waistline circumference, and body mass index (BMI). The researchers followed up with these women annually for over a decade.

The results? Women who regularly reported exposure to discrimination at least "sometimes" or "often" were more likely to experience increased body fat and higher blood pressure over time.

Interestingly, there wasn't any variation in the link between discrimination and increased blood pressure when it comes to race or ethnicity, suggesting women's experience of discrimination hurts their health regardless of race. However, black women reported the highest rates of exposure to everyday discrimination, which resulted in the highest waist circumference, BMIs, and risk of hypertension.

These findings add to a growing body of research that suggests discrimination really does harm people in a way that goes beyond inflicting emotional distress and keeping its victims at a lower place in society. In addition to the negative impact on cardiovascular health, discrimination has been associated with greater rates of diabetes, respiratory problems, sleep disturbances, daytime fatigue, and depression.

How can this be? One possible explanation is stress, some studies suggest. Every time we're discriminated against, we're adding to the pile of extreme stress that so many of us are carrying on a daily basis—on top of the fear, anxiety, and ever-growing to-do lists that every adult deals with. That chronic stress, which releases an unhealthy amount of the hormone cortisol into the body, can be incredibly toxic.

"When cortisol is not in balance, it can lead to weight gain, low libido, headaches, anxiety, depression, low energy, insomnia, blood sugar issues, skipped menstrual periods, infertility, gut issues, osteoporosis, and cardiovascular disease," explains Dr. Serena Goldstein, N.D. "Cortisol is a huge part of our body's 'fight or flight' response, which is activated in times of high stress—like running from a bear."

But instead of being in a state of high stress when we're actually in danger, that daily dehumanization caused by discrimination—and the latest current events—may be causing many women to experience heightened stress constantly. That's seriously bad news for our bodies, which stop functioning properly when flooded with that amount of cortisol.

These findings highlight the reality of just how tangibly harmful discrimination can be. It doesn't just destroy the possibility of a truly equal society; it's actually wreaking havoc on our physical bodies. People's lives and well-being are on the line, and in a country that was built on life, liberty, and the pursuit of happiness, it's becoming more clear than ever before that these palpable problems require equally palpable solutions.

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