Love nuts? Keep indulging. They’re great for your heart
Q: My father loved peanuts and cashews, and my mother was a fan of macadamia nuts. They were told they should avoid nuts because of their high fat content. Lately, though, I have heard that nuts are heart healthy. Is that true?
A: It is. The results of the Women’s Health Initiative, including more than 100,000 postmenopausal women, show that substituting nuts for meat, dairy products and eggs results in fewer deaths from heart disease (Journal of the American Heart Association, February 2021). Plant protein in general was associated with lower mortality in this study.
Apparently, one way that nuts influence health is through their impact on intestinal microbes. A Mediterranean diet focused on high-fiber plants, legumes, vegetables, fruits and nuts encourages beneficial bacteria (Nutrients, February 2021).
Q: My libido had dropped to zero after menopause. A new doctor prescribed testosterone cream specially formulated by a compounding pharmacy.
I was like a teenage boy until I found the right dose! It doesn’t take much. My bone density is excellent, and I now have an active sex life.
A: TRT (testosterone replacement therapy) is quite controversial. The Food and Drug Administration cautions that “prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions.”
A review in the journal U.S. Pharmacist (Aug. 19, 2019) reports that “TRT has been shown to be effective for improving libido, sexual desire, arousal, sexual frequency and sexual satisfaction in women.” The long-term effects of this off-label use have not been wellstudied, though, and safe dosing guidelines are not well-established.
Q: I want to thank you for your story about whether to take blood pressure medications in the morning or at bedtime. I’ve been taking BP meds for about 20 years.
In January, I visited my doctor about another problem, and he became concerned about my blood pressure. He wanted me to monitor it every day for a month and check back in.
During that month, I read your article. I’d been taking my meds with breakfast, and I decided to change that.
The effect was quite remarkable. My systolic pressure dropped from about 145 to 135. (Those are averages of about 70 readings before the switch and 21 readings after the switch.)
I’ve had serious side effects from BP meds in the past and I was apprehensive that my doctor would change my meds. Lately, I’ve been on amlodipine and HCTZ, and the side effects seem minimal. Yesterday, my doctor decided to not to make any changes and I want to thank you for that.
A: We are glad to hear that this is working for you. Research shows that people taking their blood pressure pills in the evening had better BP control and were less likely to have heart attacks or strokes (Sleep Medicine Reviews, Jan. 23, 2021).
An important exception: People with glaucoma should not follow this schedule. In addition, people taking diuretics may find that bedtime pills result in more frequent overnight bathroom trips.
Q: I am seven months pregnant with my first child. My obstetrician said I have ureterocele. He also mentioned bladder prolapse. I am not having incontinence at the moment, but I have a lot of pain and always feel like I’m on the verge of an accident. I am trying to understand the condition, how I may prevent it from worsening, and if there is any treatment.
A: Pelvic organ prolapse is the general term that is applied to any relaxation of the supportive tissues around organs in the pelvis and vaginal area. The condition occurs as a result of changes to your body.
There are three areas that often are affected:
The uterus, known as uterine prolapse;
The back wall of the vagina, known as rectocele; and
The bladder, known as cystocele.
Pregnancy is a commonly known risk factor that predisposes women to development of prolapse, although it typically occurs after delivery. Chronic constipation and genetics can also elevate a woman’s risk.
In your case, I would venture that the pressure from your uterus and pregnancy are contributing most to your prolapse.
While women who give birth via vaginal delivery also may have a slight increased risk, I do not think there is any reason for you to consider a cesarean section because you are experiencing symptoms of prolapse. It is likely that many of your symptoms will improve after delivery.
It is estimated that 40% to 50% of women who are postmenopausal have some degree of prolapse, although many are asymptomatic. Other women report bulging in the vaginal area, a feeling of pelvic pressure or heaviness. For some, if the prolapse is severe, they may see something hanging if the tissue has broken through the plane of the vaginal area. Pain is not usually a symptom.
Discussing prolapse may be uncomfortable, but it is important to talk with your health care provider because an accurate diagnosis can help with respect to treatment.
A visit with a specialist, such as a urogynecologist, is a great place to start. A thorough physical examination of the pelvis can confirm the relaxation of the tissues and identify the affected areas.
Treatments for prolapse vary based on the severity and the patient’s wishes. If a woman does not have any discomfort, we may simply do “watchful waiting.” Unfortunately, we have no way of knowing if a woman’s prolapse will worsen over time.
The most common nonsurgical treatment is to insert a silicone rubber device into the vagina called a pessary. Similar to a diaphragm, a pessary sits in the vagina to essentially hold things up. It is relatively easy for a woman to put in and remove on her own.
Surgery is also an option to correct prolapse. There are various procedures based on the severity and individual woman’s situation.
Pelvic floor physical therapy can provide a benefit to relieve symptoms, but it is unlikely to substantially improve the prolapse itself.
As your pregnancy continues, you may want to talk to your doctor about a pessary, as that may provide you some relief until delivery. If your discomfort continues after delivery, you might consider surgery once you are done with childbearing.
— John Occhino, M.D., Urogynecology, Mayo Clinic, Rochester, Minnesota