Mayo Clinic Women's HealthSource – June 18, 2002

Tuesday, June 18, 2002

Understanding Triglyceride Levels

SCOTTSDALE, Ariz. — If you have high triglyceride levels but your cholesterol levels are normal, you may think you're in the clear. You might be surprised when your doctor hands you a laundry list of lifestyle changes to correct those triglyceride levels. According to the June issue of Mayo Clinic Women's HealthSource, recent research shows that high triglycerides alone can increase your risk of cardiovascular disease.

Last year, the National Cholesterol Education Program issued new guidelines for cholesterol management, and they cited high triglyceride levels as a special concern requiring increased attention. Along with increased cardiovascular risk, high triglyceride levels are associated with insulin resistance, a major factor in type 2 (adult onset) diabetes. High triglycerides also increase the risk of pancreatitis — an inflammation of the pancreas.

Women's cardiovascular health seems to be more influenced by triglyceride levels than men's. Levels higher than 190 milligrams per deciliter (mg/dL) increase a woman's cardiovascular disease risk, while men don't see the same increased risk until triglycerides reach 400 mg/dL.

It is especially important for women with high triglyceride levels to take action to reduce those levels. You can lower triglyceride levels by losing weight and reducing carbohydrate and alcohol intake. Reducing carbohydrates in the form of sugary foods and drinks can result in large triglyceride decreases for some people. Losing weight and increasing your activity level also increase your body's sensitivity to insulin — a hormone that is effective in reducing triglyceride levels.

Other triglyceride-reducing techniques include eating fish high in Omega-3 fatty acids instead of meats that are high in cholesterol. The use of oral estrogen can increase triglycerides 20 to 25 percent. Some people may be able to use estrogen patches to bypass this effect.

If you test high on a triglyceride test, work with your doctor to develop the most effective triglyceride-reduction strategy. Untangling the Mammogram Muddle

SCOTTSDALE, Ariz. — Mammograms are in the news again, causing confusion and dismay. This time it's a study that concludes there's no evidence that mammograms save lives. Many women are wondering if they should continue having this long-recommended screening test. The June issue of Mayo Clinic Women's HealthSource reports that the consensus of many major medical organizations — including the U.S. Preventive Services Task Force (USPSTF), the National Cancer Institute, the American Cancer Society and Mayo Clinic — is a resounding yes.

The current controversy centers on a Danish report that evaluated eight previously published studies about mammograms. The Danish study reported major flaws in six of the eight studies and pointed out that the other two studies showed no effect on the reduction of breast cancer deaths due to mammography screening. The medical community reacted strongly against the Danish analysis, so the Danish researchers reanalyzed their data, only to come to the same conclusions.

In response, the USPSTF completed its own review of mammography studies. It looked at the eight most current mammography trials (all of which have been published since 1996), and while they found some important shortcomings in some of the study methods, the task force concluded that these limitations were not likely to change the overall results of the studies. In fact, the USPSTF found reductions in breast cancer deaths averaged about 25 percent.

Mammograms are not perfect. They do miss some cancers, and they sometimes indicate cancer where there is none. Nonetheless, mammography is still the best test available to detect breast cancer early. After reaching its own pro-mammography conclusion, the task force came out with an even stronger recommendation for regular mammography screenings. They now recommend that all women over age 40 have mammograms every one to two years, depending on their personal medical history. Managing Fatigue

SCOTTSDALE, Ariz. — Fatigue is a symptom that challenges doctors. It is hard to define because it can feel different for each individual. According to June's Mayo Clinic Women's HealthSource, fatigue is perplexing because it can accompany many different physical ailments, and it can also be related to anxiety, depression, not enough sleep, too much sleep, lack of exercise, too much exercise or stress.

A physician will usually proceed like a detective, getting as much information about your symptoms and medical history as possible, and then following leads and exploring possibilities. The doctor may uncover a medical disorder such as a thyroid imbalance, anemia, depression or diabetes. If no illness is found, your doctor may recommend these approaches to managing your fatigue.

Exercise gradually but steadily. Start slowly, so you don't increase your fatigue, and try to build up to 20 to 30 minutes of activity per day. Learn stress-reduction techniques such as deep breathing or meditation. Set a manageable and even pace. Set priorities and manage your time and energy efficiently. Practice good sleep habits. Establish a ritual for going to bed. Limit naps, don't take work to bed, don't consume caffeine (from coffee, teas, colas and chocolate) and maintain a firm time for going to bed and waking up. Eat a healthy diet and drink plenty of water. Don't fill up on high-fat or sugary foods, which tend to make you feel sluggish.

Remember, you weren't always tired all of the time. Whether an underlying medical condition or an overwhelmingly busy life brings on fatigue, practical strategies can eventually improve your energy level. ###

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