TODAY’S DOSE OF HONESTY

Why I am barely drinking alcohol anymore.

Some of you may know that every year for the past 10 years or so, I’ve done dry January. It actually became such a “thing” that I coined the humorous expression “Dry JEN-uary.” I started doing it as a personal experiment: I wanted to see if I noticed any difference in how I looked or felt after one month of not drinking, and I wondered if I would find it challenging, from a social/habitual standpoint. What I discovered was that it was really pretty easy, and I did see a SLIGHT improvement in my skin, lost a pound or two, and slept better (though I normally sleep very well, so it’s hard to improve on that).  

This year, however, I had a change of thinking. It happened in January, as I was doing a segment on “Good Morning America” about the negative health effects of alcohol. Of course, NONE of this was new to me. It is well-known that alcohol is a Class 1 carcinogen. Let that sink in for a second: Something that is a generally accepted part of our culture and lifestyle is conclusively known to cause numerous types of cancer. And yet people—we, I—engage in this behavior on a regular, normal basis. 

Besides causing cancer, alcohol is also KNOWN to cause dehydration, significantly impact sleep, negatively affect the brain, disrupt the gut microbiome, and damage skin. Yet, many very health-conscious people drink, anywhere from occasionally to moderately or more. These are some of the same people who staunchly avoid PFAS, who minimize processed foods, who see their doctors routinely for preventive checkups, who take nutritional supplements. In other words, MAJOR wellness enthusiasts. They/we/I go to great lengths to lead a healthy lifestyle, yet regularly consume something that is significantly harmful to our bodies (even in moderation, sadly).

I’ve been talking about alcohol for years with my patients and on the air to millions of television viewers. When I discuss alcohol with people, I do so without judgment and without standing on a medical soapbox. Simply not drinking alcohol does not make someone automatically “healthier” than someone who does drink; it’s one piece of the puzzle, not the entire picture. So, context is important. It is about who, what, where, when, why, and how (much) is consumed.

My normal alcohol intake before this January consisted of between 1-7 servings of blanco tequila a week. I never drank alone, and I never drank at home. I enjoyed my tequila only in social settings, and in these instances, it was almost automatic. That is to say, it was as reflexive as shaking hands or hugging someone hello. I ordered a drink because everyone else was ordering a drink. It was that robotic. It sounds so silly—very high school!

I do actually love tequila; my favorites are Cincoro or Casamigos, always blanco, on the rocks with a slice of orange. But I never had more than 2 servings, and often didn’t finish the first one. Straight blanco tequila never made me tired—it doesn’t really even give me a buzz—and it’s not loaded with sugar and carbs. So, I actually never felt any of the physical downsides of alcohol, and found it enjoyable and relaxing, as well as delicious.

Note: The definition of a serving is 1.5 oz of hard liquor. Meaning: When I say 1-7 servings, it’s important to realize that if a restaurant pours 3 oz into my first glass, that is one drink, but it counts as 2 servings, health-wise.

So back to January: As I was hearing myself tell GMA viewers about alcohol’s negative health effects, I had my epiphany: I was doing SO much to improve and protect my health and well-being…why would I do ANYTHING to counteract that?

I now no longer drink alcohol “automatically” at social events. Yet I do believe in moderation and enjoy balance, so I decided that for me to take any risk at all with my health, it had to be ”worth it” from an experiential standpoint. This means drinking ONLY if and when the setting or occasion really warrants it. Like on vacation (I love a nice beach cocktail) or at a festive brunch or party. If I feel like having 1 or 2 drinks will enhance my experience, I deem it “worth it.” Otherwise, I don’t. And I’ve noticed that now, when I go out to dinner with friends or my husband or for a business dinner, not drinking is actually easy for me, and I feel good about this. This has reduced my alcohol consumption from 1-7 servings per week to 1-7 servings PER MONTH. 

I probably will stay at this minimal level, because I feel it gives me a good balance of low health risk and high personal benefit. However, if I had breast cancer, for example, I would not drink at all. I would love to hear your thoughts and feelings about alcohol. Have they changed recently? Tell me about it on Instagram! @drjashton

SYMPTOM SOLUTIONS

The science of red light therapy…should you try it?

Red light therapy. It’s one of the hottest wellness and beauty trends around right now. And I confess: I’m a big fan.

Here’s the science behind it. Red light therapy utilizes near infrared or low levels of red light energy, which emits heat but does not contain UV light or damaging wavelengths. When our skin/bodies are exposed to red light energy, the mitochondria (aka the powerhouses of our cells) absorb this energy and, in turn, create more energy. With more energy, certain cells can do their jobs—like repairing skin, boosting new cell growth, and enhancing skin rejuvenation—-more efficiently.

More research is needed, but there is data that support possible skin-health benefits that include:

• Stimulating collagen production, which gives skin its structure, strength, and elasticity.

• Increasing fibroblast production, which generates collagen. Collagen is a component of connective tissue that builds skin.

• Increasing blood circulation to skin tissue.

• Reducing inflammation in skin cells.

• Improving the appearance of skin damaged by environmental factors, like too much sun, smoking, poor diet, and airborne pollutants.

Red light therapy has been associated with alleviating and/or improving a number of skin conditions, including:

• Acne

• Stretch marks

• Fine lines, wrinkles, and age spots

• Psoriasis, rosacea, and eczema

• Wound healing and scarring

• Hair loss

And the potential benefits don’t stop with skin: These treatments may also accelerate healing in the body (after cancer treatment, for example); relieve chronic pain from certain types of arthritis and musculoskeletal conditions; improve sleep and mood; and boost energy levels. All this said, there’s not A LOT of science yet to confirm that red light therapy actually will do everything it’s claimed to do. Again, more research is needed.

Is it safe? Red light therapy poses little risk for most people. It’s not invasive, potentially toxic, or harsh like other skin treatments, and it doesn’t utilize cancer-causing ultraviolet light. That said, if the therapy is not administered properly, there is potential risk to the skin or eyes (if they are not covered). And if you have any condition that predisposes you to hyperpigmentation (like lupus), you should stay away from it.

Where to find it. In addition to medical office-based treatments, many salons and medi-spas as well as gyms, tanning salons, and wellness centers now offer red light therapy services to their clients. You can also find a variety of devices for home use at retail and online. Before you buy, though, it’s smart to check in with a qualified professional (aka dermatologist) who can help you weigh the risks and benefits.

My 6-month FITNESS EXPERIMENT
with trainer Korey Rowe!

Full disclosure: I love experiments and I really love challenges. And because I come at everything through a scientific lens, when the opportunity arises to make myself the subject of a “study,” I leap at it. Even if I don’t succeed, I always learn something, so I’m not afraid of failing. And that’s precisely why I decided to start an intensive, 6-month experiment in fitness, health, well-being, and fun by partnering with Korey Rowe, my fabulous trainer in New York City. (@korey.rowe)

At present, I admit that I feel very good. My blood tests are all normal, my BMI and visceral adipose tissue (belly fat that surrounds the organs) are in a very healthy range. I work out 6 days a week and get 7 hours of sleep a night. But deep down, I know this is not my best. It is simply “okay." And last month, when my back and entire left side of my body went into full and painful muscle spasms, I knew it was a sign of something not good lurking beneath a surface of “fairly fit.” 

It was time for my own dose of honesty: I can do better, feel better, look better, move better. And now is the time to do it—to get into the best shape of my life. And I’m going to bring you along with me!

Korey and I started by collecting baseline data (you can do this too). We took measurements of my chest, waist, hips, and maximum quad (thigh) circumferences. My “In Body” body composition results showed a 22% body fat percentage and visceral adipose tissue score of 5, which are very good numbers. (FYI: Many gyms and doctors’ offices have the In Body machine). My cholesterol, CRP (a measure of inflammation), and diabetes screens were all normal. I took photos, and Korey put me through some fitness testing. I was strong, but not evenly strong. This baseline testing showed a fairly significant discrepancy between the strength of my right and left sides (legs and back) and a pretty poor HIIT (high-intensity interval training) capacity. My endurance at lower rates of exertion were good but at high-intensity efforts, I crashed and burned.

And so, it begins. I have committed to a new cardio program, a strength regimen that targets my body’s weakness and does not allow for my strong side to compensate for the other, another hour of sleep a night (totaling 8 hours), and some HIIT workouts. I promise to share updates on this “experiment” with you, and if you’re interested, you can do it with me—there is strength in numbers! I will be posting a lot of it on Instagram along with Korey’s tips, my journey, and finally, the end results. If you want to do it with a friend, forward this email to her/him to sign up and support you!

A quick primer on heart rate
zone training. 

This type of training is based on the principle that at different heart rates, your effort is producing a different outcome and using different sources for fuel. First, some easy math:

• Subtract your age from 220—this is your maximum heart rate.

• Then subtract 10% of that number—this is zone 5 (anaerobic zone). 

• Subtract the same 10% number from the lower number—this is zone 4 (your aerobic cardio zone).

• Keep subtracting that same 10% number three more times until you get to 50% of your max—zone 1.

• For example, my maximum heart rate is 165 (I am 55 years old). So, for me:

 Zone 5: 149-165

 Zone 4: 132-148

 Zone 3: 115-131

 Zone 2: 98-114

 Zone 1: 80-97 

You can check your heart rate during exercise with a wearable device OR by checking your pulse for 6 seconds and multiplying it by 10. I will talk more about heart rate zone training in upcoming issues of TODAY’S AJENDA.

COMMUNITY

Breast cancer, estrogen, and HRT: What you need to know. 

I am always thinking about the health of women. I’m a board-certified OB-GYN, it’s my job. So, I have more than a passing concern about threats to the health of women. Among the scariest of those threats is breast cancer, and there are many questions and misconceptions surrounding it—in particular, the role that estrogen does or doesn’t play in its development. I asked our Core Expert, breast cancer surgeon Dr. Elizabeth Comen, to answer a few questions for us.

Can you address the misperception that having estrogen receptor-positive breast cancer means that estrogen CAUSED the cancer?

The causes of any type of cancer, including breast cancer, are complex and stem from a variety of genetic, environmental, and lifestyle factors. Estrogen receptor-positive, or ER+, breast cancer is a type of cancer that is common; about 70% of all breast cancer cases (including men and people assigned male at birth) in the U.S. are ER+. The estrogen receptor in the cancer cell binds estrogen that is circulating in the bloodstream—think of the receptor like a keyhole; the estrogen is the key that fits into the keyhole. This process initiates a series of intricate events that enhances the ability of the cancer cells to grow and multiply more efficiently.

However, having estrogen in your body does not mean that it unilaterally caused an ER+ breast cancer. This is understandably a common misconception because we often treat ER+ breast cancer by suppressing estrogen levels. But this does not mean that estrogen alone caused breast cancer.

Can you address the fact that the Women’s Health Initiative (WHI) data on hormone replacement therapy (HRT) and increased risk of breast cancer has actually been debunked, and that the slight increase with combination HRT was not statistically significant?

Unfortunately, the interpretation of the WHI data, which was first published back in 2002, led many women—and healthcare providers—to believe that HRT uniformly increased the risk of breast cancer. This was certainly the case during my own medical training.

Estrogen-only HRT does not increase the risk of breast cancer and may actually reduce that risk; however, it can impact the risk of uterine cancer.

For combination estrogen + progesterone HRT, there is an evolving and far more nuanced understanding of its usefulness and associated risks. There is no one-size-fits-all answer for when and how a woman should initiate HRT. One thing is certain: All women should have the opportunity to discuss with their doctor what their specific options are and what potential risks may be relevant based on their personal medical and family history.

What are the options for treatment of menopause symptoms if a woman can’t take HRT?

For women who cannot take HRT, it’s essential that they talk to their doctors about their menopausal symptoms so they can be specifically addressed. For example, there are nonhormonal options for hot flashes and sleep disturbances. Addressing lifestyle factors, such as diet, exercise, and sleep hygiene can help improve symptoms. A critical component of improving menopausal symptoms is taking the time to really unpack what each woman is facing so that an individualized and realistic plan can be developed.   

Can women with breast cancer use vaginal estradiol or estradiol cream on their faces for wrinkles?

There is ample data for the safety of intravaginal estradiol for women with a history of breast cancer. Intravaginal estrogen can be dramatically helpful for some women, especially those with genitourinary symptoms. There is less data available on estradiol cream on the face because it depends on the amount applied and level of absorption.

What about tamoxifen and the increased risk of endometrial polyps and hyperplasia? 

Tamoxifen increases the thickness of the lining of the uterus and can increase the risk of endometrial polyps and hyperplasia (when the uterine lining becomes too thick). There is also a well-known increased risk of endometrial cancer (cancer of the uterus) for patients on tamoxifen. It is critical that patients on tamoxifen follow up with a gynecologist to discuss any concerns, including any abnormal vaginal bleeding.  

ABOUT DR. JEN

Elizabeth Comen, M.D., is a medical oncologist with Memorial Sloan Kettering Cancer Center and an assistant professor of medicine at Weill Cornell Medical College. She is the author of the newly released book All in Her Head: The Truth and Lies about What Early Medicine Taught Women About Their Bodies and Why It Matters Today. Buy it here. @drelizabethcomen

GOT A QUESTION FOR DR. JEN? Click here to send it.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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