Avocados: The Other Fruit

Here is another one of my favorite foods and it can be easily added to your meal without a lot of preparation! Avocados have a lot of essential nutrients such as vitamin A, B, C, E and K, copper, iron phosphorous, copper, as well as fiber, protein, and antioxidants.

Health benefits are many including helping to maintain a healthy heart. Avocados contain B6 and folic acid which help regulate homocysteine levels. Elevated homocysteine levels are associated with an increased risk of heart disease.  Avocados can help lower cholesterol levels, decrease triglycerides and LDL (bad cholesterol) and increase HDL (good cholesterol). Lower cholesterol levels and may help protect against strokes. One avocado contains about 23% of the daily recommended value of folic acid which is known to decrease certain birth defects such as neural tube defects and spina bifida.

Avocados have polyphenols and flavonoids which are antioxidants and anti-inflammatory compounds that decrease inflammation and some degenerative disorders. Antioxidants help prevent cell damage and as a result my help slow the aging process and boost your immune system. They may also help prevent breast cancer and inhibit the growth of prostate cancer.

Avocados are high in monounsaturated fats and fiber, both of which can help with insulin resistance and stabilize blood sugar levels.

Avocados are also high in fat with ½ of an avocado containing 10 gm of fat 7 of which are monounsaturated and 1.5 grams saturated fat. They are high in calorie as well so should be used sparingly.

Ways to enjoy avocados:

  • Fresh slices on a salad
  • Guacamole
  • Try mashing some avocado and using in place of mayonnaise
  • Add some slices to your favorite sandwich or tacos
  • Stuff an avocado half with your favorite tuna or chicken salad

Homemade Guacamole

3 avocados, mashed
1 tomato, finely chopped
1-2 tablespoons minced onion
Chopped fresh cilantro
1 Jalapeño pepper, finely chopped
Salt to taste
Lime juice to taste

Nutritional Information
Serves 4
Calories 262
Fat 22.2 grams
Cholesterol 0 mg
Carbohydrates 18 gm
Fiber 11.4 gm
Protein 3.7 gm

What Grandma DON’T KNOW About Birth Control

Weeding out myth and ridiculous to uncover the truth

[blockquote3]Grandma says: “Birth control gives you cancer.”
Doctor says: “Nope!”[/blockquote3]

Now why would anyone take the doctor/provider’s word against that old wives’ tale / urban legend without an explanation? I submit to you that your doctor really cares to take good care of you and not expose you to anything harmful where the risk outweighs the benefits. I know this is not enough to convince grandma, so hear me out. But first, we’ll let grandma give her side of the story.

First of all, what type of cancer? It’s easy to say, but explain please… C’mon grandma explain it to me. Well, she can’t.

For the most part, hormonal birth control works by preventing ovulation… the process were the egg is released in search of the baby-making sperm. Barrier contraceptives (condoms, etc…) keep the sperm from meeting the egg but do nothing to prevent ovulation. Back to hormonal birth control (pills, patch, vaginal ring, Depo-Provera shot, etc…) which prevent ovulation. These are very low dose in general, and act by decreasing hormones that come from the brain and act on the ovary. Since the ovary is not stimulated, it does not ovulate. Here’s an interesting fact that grandma don’t know. Scientific theory has it that monthly ovulation (being off birth control) may increase risk of ovarian cancer. Each month a cyst forms, ruptures, and damages the ovary. The ovary then has to fix itself over and over and over again. At some point an error occurs in the repair process and may lead to cancer. So, preventing ovulation prevents this constant monthly repair and decreases the chance of a cancer inducing error occurring. It’s actually been shown that a woman who takes birth control for a total of 15 years or more, will decrease her risk of ovarian cancer by 90%. Booyah grandma! How do you like ‘dem apples.?!

[blockquote3]Grandma says: “Birth control makes you infertile.”
Doctor says: “Wrong again granny.”[/blockquote3]

Again, most birth control is so low dose that it’s out of your system pretty quickly. The only common birth control that takes a while to get out and may delay ovulation is Depo-Provera… so it may take longer to get pregnant after Depo, but it doesn’t make you infertile. As for the other forms of birth control, the return to fertility is fast… sometimes too fast leading to an unplanned surprise. 🙁 As a matter of fact, many fertility doctors and I myself use birth control for a few months prior to a patient trying to conceive. These help to control and regulate hormones such as insulin and testosterone, which may be elevated in certain patients. When elevated, these hormones prevent ovulation and conception. So by regulating these hormones, fertility can actually be increased in the few months after coming off birth control. So for infertility patients, I usually use birth control in the few months before starting fertility drugs. Grandma means well, but she don’t know, don’t show, or don’t care about what went on in med school (okay fine, I stole that line from Boys in the Hood).

[blockquote3]Grandma says: “Birth control makes you fat.”
Doctor says: “mmmmmm well maybe.”[/blockquote3]

Most forms of birth control weigh less than 5-10 pounds before they’re used. Does birth control go in your body and expand a thousand fold like Elven bread (Lord of the Rings)? I haven’t seen a study on this, but I’m pretty sure the answer is no. So why the weight gain?

Well, the Depo-Provera shot can make you hungry… which leads to eating more… which leads to weight gain. Will power / diet control, exercise, and good genetics can minimize weight gain. The textbook says Depo-Provera causes an average yearly weight gain of 5 pounds. I’ve seen many woman gain more and some who gain nothing at all. I’ve even seen a few lose weight while on the shot.  So, granny might be right when it comes to “the shot” or Depo-Provera causing weight gain.

Other forms of birth control, including the patch, vaginal ring, and pills have not proven to be associated with weight gain. As a matter of fact, one study found that married women on the pill gained weight while single women on the pill lost weight. So, other than “the shot,” there is no proof that the other forms of birth control cause weight gain.

Lesson Learned

So when someone gives you an opinion, whether it be wise ol’ grandma, a know it all friend, or a nosy neighbor, you can do one of two things. You can nod and smile all the while ignoring them in your head and then ask your provider. Or you can, in the most sarcastic of tones, ask them where they went to medical school… wait for the silence… wait for it… and respond with a “that’s what I thought,” then ask your doctor. I prefer the latter, which if you didn’t know already, I’m sure you do now. 🙂

Remember, The Truth will set you free. Now give granny a hug and a kiss.

What Exactly is a Pap Smear Checking For?

As gynecologists, we help our patients through some very personal experiences: the dreaded pelvic exam, birth control, miscarriage, pregnancy, menopause, sexually transmitted infections, and so on. Discussing your cholesterol with a stranger just isn’t the same as discussing a first pregnancy or starting birth control. It is a very special part of our job. The pap is something I talk about everyday. Most women understand that they need to “get a pap to get checked down there.” But what exactly is a pap checking for? And why do you have to keep getting them?

The pap is a screening test for cervical cancer. The cervix is at the top of your vagina, and it is part of the outer uterus. We use a small brush (imagine a small toothbrush) to collect some cells from your cervix. It goes to a lab, and a specialist looks at your cells under a microscope. If the cells look abnormal, we do more tests because we are trying to prevent or detect the worse case scenario – cancer. But most times the result is simply normal or abnormal cells, which isn’t as serious but still very important. These abnormal cells can persist and ultimately develop into cancer. We can surgically remove these abnormal cells to help prevent cervical cancer. This is the gist of the pap test, and this part is fairly clear to most women.

Explaining the role of HPV testing casts a fog on all of the above, and this is usually the turning point in the discussion. Recent research has linked the human papilloma virus (HPV) to cervical cancer. We now know that certain types of this virus is what causes the abnormal cells found on paps. More importantly, the HPV virus also causes most types of cervical cancer. This is very important for two reasons: the HPV test effects the way paps are managed by health care providers and it also stresses the importance of the HPV vaccine.

But before I can even answer why it is so important for the patient’s future, I am often confronted with a question regarding the patient’s past. How did I get this virus? The virus is passed from one person to another during sexual contact, i.e. genital skin-to-skin contact. This type of contact can include vaginal, anal and oral sex. This virus is so prevalent that if you have ever had sex, the chances of having this virus is over 80% for your lifetime. In contrast, less than 10% of American women have chlamydia per year. HPV is the most common sexually transmitted infection. It’s like “the common cold” of sexual activity. Almost everyone you know has had the common cold right? The kicker about HPV is that it is a completely asymptomatic infection; there are no sniffles or sore throat, no discharge or pain. This means you will never know who gave it to you (because almost everyone has had it!). That part is not important, so it is not worth interrogating your partner over it.

It can overstay its welcome, and hang around for years. You may have gotten it on prom night five years ago, or you may have picked it up from your fiancé. And unfortunately there is no treatment for it. No pills, no shot. We just have to wait for the body to naturally clear the infection, which it usually does in about 90% of young people within two years of acquiring the infection.

But all of this, while important, is a bit irrelevant to what we are going to do about your abnormal pap smear. That’s our job, to figure out what to do next. Your job? With regards to HPV and your pap smears, here are the take home points:

  • Don’t stress about a positive HPV test. There is no treatment for it, and unlike an acute gonorrhea infection, it doesn’t mean that you or your current partner have been unfaithful.
  • Most women who have or have had HPV do not actually develop cervical cancer. But most women who have cervical cancer have the HPV virus.
  • Stop smoking. Smoking is like a power bar for the HPV virus, it helps it grow, which is not what we want.
  • Use condoms, but remember that a condom does not cover the entire genital area, and HPV can still be transmitted through contact of the exposed skin.
  • Keep your follow-up appointments with us. Even if your abnormal cells are not severe enough to warrant a surgical procedure to remove them today, the cells may become more abnormal in 6 months, or they may be completely normal next year. And wouldn’t that be a relief?
  • If you are under the age of 26, get the Gardasil vaccine. It’s a vaccine that can prevent a cancer. How fascinating and amazing is that!