D6 N THE NEW YORK TIMES, TUESDAY, AUGUST 6, 2019Living near oil and gas
wells may increase a
woman’s risk of having
a baby with a con-
genital heart defect.
Researchers writing in Envi-
ronment International reported
on 3,324 infants born in Colorado
from 2005 to 2011, comparing 536
babies with heart defects to 2,860
controls matched for sex, ma-
ternal smoking, race and
ethnicity.
They correlated maternal ad-
dresses with locations of oil and
gas wells and estimated the inten-
sity of maternal exposure
(drilling, well completion, produc-
tion) from three months before
conception through the second
month of pregnancy.
Compared to the one third with
the lowest intensity of exposure,
the one third with the highest
were 70 percent more likely to
have a baby with a heart defect.
The association was more promi-
nent in rural than urban areas,
perhaps because other sources of
pollution in cities may mask
potential harms from the drilling
sites.
The study is observational and
does not prove cause and effect.
Still, there are plausible reasons
for the association.
“The greatest suspect is the
hazardous air pollutants that are
emitted during the production of
oil and gas,” said the lead author,
Lisa M. McKenzie, an assistant
research professor at the Col-
orado School of Public Health.
As a public health issue, the
problem is potentially significant.
Other studies have linked living
near gas and oil sites to prema-
ture births, smaller babies, mi-
graines and fatigue. “About 17
million people live near these
sites in the U.S.,” Dr. McKenzie
said.PREGNANCY
Oil Wells Tied to Heart Defects
A new study confirms
earlier reports that
anemia — a condition
caused by having too
little hemoglobin, the oxygen-
carrying component of red blood
cells — increases the risk for
dementia. It found that having
high hemoglobin levels does so as
well.
Dutch researchers looked at
12,305 people without dementia at
the start of the study, measuring
their hemoglobin levels and fol-
lowing them for an average of 12
years. Over the period, 1,520
developed dementia, including
1,194 with Alzheimer’s disease.
The study is in Neurology.
The scientists divided the he-
moglobin levels into five groups,
low to high. Compared with those
in the middle one-fifth, those in
the highest fifth had a 20 percent
increased risk for any dementia
type, and a 22 percent increased
risk for Alzheimer’s. Those in the
lowest were at a 29 percent in-
creased risk for dementia and a
36 percent increased risk for
Alzheimer’s.
The researchers controlled for
education level, blood pressure,
diabetes, lipid-lowering medica-
tion, alcohol intake and other
health and behavioral character-
istics.
“We don’t have the intervention
studies that would show that
modifying hemoglobin could
prevent dementia,” said the lead
author, Frank J. Wolters, a re-
searcher at Erasmus University
Medical Center in Rotterdam, the
Netherlands, “and we can’t rec-
ommend interventions based on
this study. In the meantime, given
the other beneficial effects of
treating anemia, this study pro-
vides an extra incentive.”MIND
Dementia Risk and Hemoglobin
In Brief NICHOLAS BAKALAR
We l l
PEOPLE WHO EXERCISEin the morning
seem to lose more weight than people com-
pleting the same workouts later in the day,
according to a new study of workouts and
waistlines. The findings help shed light on
the vexing issue of why some people shed
considerable weight with exercise and oth-
ers almost none, and the study adds to the
growing body of science suggesting that the
timing of various activities, including exer-
cise, could affect how those activities affect
us.
The relationship between exercise and
body weight is somewhat befuddling. Multi-
ple past studies show that a majority of peo-
ple who take up exercise to lose less weight
drop fewer pounds than would be expected,
given how many calories they are burning
during their workouts. Some gain weight.
But a few respond quite well, shedding
pound after pound with the same exercise
regimen that prompts others to add inches.
This variability interests and puzzles
Erik Willis, a data analyst with the Center
for Health Promotion and Disease Preven-
tion at the University of North Carolina at
Chapel Hill. For almost a decade, he and col-
leagues at the University of Kansas, the
University of Colorado Denver and other in-
stitutions have overseen the Midwest Exer-
cise Trial 2, an extensive examination of
how regular, supervised exercise influences
body weight.
In that study, about 100 overweight, pre-
viously inactive young men and women
worked out five times a week at a physiolo-
gy lab, jogging or otherwise sweating until
they had burned up to 600 calories per ses-
sion.
After 10 months of this regimen, almost
everyone had dropped pounds. But the ex-
tent of their losses fluctuated wildly, even
though everyone was doing the same, su-
pervised workouts.
When, for a 2015 study, the researchers
tried to tease out what had distinguished
the biggest losers from those who had lost
less, they turned up surprisingly few differ-
ences. In line with other recent studies, they
found that some participants, especially
men, had begun eating more than before the
study, but only by about 100 calories or so a
day.
Flummoxed, Dr. Willis and one of his col-
laborators, Seth Creasy, a professor of exer-
cise physiology at the University of Col-
orado Denver, started brainstorming other
possible, perhaps unexpected contributorsto the enormous variability to weight loss.
They hit upon activity timing.
The science of chronobiology, which stud-
ies the ways in which when we do some-
thing alters how our bodies respond, is of
great interest now. Many recent studies
have looked at how meal timing, for in-
stance, affects weight control, including
whether exercising before or after break-
fast matters. But far less has been known
about whether the timing of exercise, by it-
self, influences whether people lose weight
with workouts.
So, for the new study, which was pub-
lished in July in The International Journal
of Obesity, Dr. Willis and his colleagues
sifted through their data again, this time
looking at when people in the Midwest trial
had shown up at the university lab.
In that study, participants could visit the
gym whenever they wished between 7 a.m.
and 7 p.m., signing in each time, so re-
searchers had plenty of precise information
about their schedules. The scientists also
had tracked everyone’s calorie intakes and
daily movement habits throughout the 10
months, using activity trackers and liquid
energy tracers. They knew, too, whether
and by how much people’s weights had
changed.
Now, they checked weight change
against exercise schedules and quickly no-
ticed a consistent pattern.
Those people who usually worked out be-
fore noon had lost more weight, on average,
than the men and women who typically ex-
ercised after 3 p.m. (For unknown reasons,
very few people went to the gym between
noon and 3.)The researchers uncovered a few other,
possibly relevant differences between the
morning and late-day exercisers. The early-
exercise group tended to be slightly more
active throughout the day, taking more
steps in total than those who worked out lat-
er. They also ate a bit less, although the dif-
ference amounted to barely 100 calories per
day on average. Over all, such differences
were barely discernible.
Yet, they may cumulatively have contrib-
uted to the striking differences in how many
pounds people lost, Dr. Willis said.
Of course, this study was not large or de-
signed from the start to delve into the
chronobiology of exercise and weight. The
researchers had not randomly assigned
people to work out at particular times, so
the links between exercise timing and
weight loss they saw now in their re-analy-
sis could be odd accidents related to individ-
ual participants’ preferences and schedules
with little relevance for the rest of us.
Still, the statistical associations were
strong, Dr. Willis said. “Based on this data, I
would say that the timing of exercise might
— just might — play a role” in whether and
to what extent people drop pounds with ex-
ercise, he said.
But he also points out that most of those
who worked out later in the day did lose
weight, even if not as much as the larkish
exercisers, and almost certainly became
healthier.
“I would not want anyone to think that it’s
not worth exercising if you can’t do it first
thing in the morning,” he said. “Any exer-
cise, at any time of day, is going to be better
than none.”PHYS ED GRETCHEN REYNOLDSThe Early Bird Gets the Weight Loss
People who exercise before
noon drop more pounds than
those starting later, study finds.
JEENAH MOON FOR THE NEW YORK TIMESFor many women, sex after menopause is
not as satisfying as it used to be. But is
menopause entirely to blame?
New research suggests that the hormon-
al changes that come with menopause are
only part of the reason a woman’s sex life
declines with age.
It’s true that many women experience
symptoms after menopause, including va-
ginal dryness, painful intercourse and loss
of desire — all of which can affect the fre-
quency and pleasure of sex.
But the new study shows that the reasons
many women stop wanting sex, enjoying
sex and having sex are far more complex.
While women traditionally have been
blamed when sex wanes in a relationship,
the research shows that, often, it’s the
health of a woman’s partner that deter-
mines whether she remains sexually active
and satisfied with her sex life. (Most studies
have focused entirely on heterosexual
women, so less is known about same-sex
couples after menopause.)
“We know that menopause seems to have
a bad effect on libido, vaginal dryness and
sexual pain,” said Dr. Stephanie Faubion, di-
rector of the Mayo Clinic Center for Wom-
en’s Health in Rochester, Minn. “But what is
coming up as a consistent finding is that the
partner has such a prominent role. It’s not
just the availability of the partner — it’s the
physical health of the partner as well.”
The latest study, published in the medical
journal Menopause, is based on surveys of
more than 24,000 women taking part in an
ovarian cancer screening study in Britain.
The women, ages 50 to 74, answered multi-
ple-choice health questionnaires about
their sex lives at the start of the study. But
the survey data are unique because about
4,500 of the women also left written com-
ments, giving researchers a trove of new in-
sights about women’s sex lives.
Over all, 78 percent of the women sur-
veyed said they had an intimate partner, but
fewer than half the women (49.2 percent)
said they had active sex lives. The women’s
written answers about why they stopped
having sex revealed the pain and sadness
behind the percentages.
The main reason was losing a partner to
death or divorce, which was cited by 37 per-
cent of the women. (Women who were not
having sex cited multiple reasons for the de-
cline, which is why the percentages exceed
100.)
“I have been a widow for 17 years. My hus-
band was my childhood sweetheart, there
will never be anyone else.” (Age 72)
Some women said life was too compli-
cated to make time for sex — 8 percent said
their partner was too tired for sex, and 9
percent of women said they were also too
tired for sex.
“I feel my role in life at present is to bring
up my 12-year-old son; relationships come
second.” (Age 50)
“Caring for older parents at the present.
Lack of energy and worrying about them
causes a reduction in sexual activity.” (Age
53)
“Husband busy with work. I’m busy with
two children. Both collapse into bed at the
end of the day.” (Age 50)
A husband with serious health issues was
another common theme. About one in four
women (23 percent) said the lack of sex was
because of their partner’s physical prob-
lems, and 11 percent of women blamed their
own physical problems.
“He does not maintain erection strong
enough for penetration (after prostate
surgery and diabetes). My sexual activity is
limited by what my husband’s health is.”
(Age 59)
“My husband had a stroke which left him
paralyzed. Sexual relations are too difficult.
I remain with him as a caregiver and com-
panion.” (Age 52)
“My husband has had a heart attack — his
medication leaves side effects, which makes
sex very difficult, which has saddened us.”
(Age 62)
Others cited mental health and addictionissues as the reason for lack of sex.
“He drinks approximately 1 to 1.5 bottles
of whiskey a day. Sex is once or twice a year.”
(Age 56)
“My husband suffers from anxiety and de-
pression and this has an effect on our rela-
tionship and my sleeping.” (Age 53)
“I take an antidepressant, which blunts
desire for sex.” (Age 59)
About 30 percent of women said their sex
lives had halted because they had “no inter-
est.”
“Have lost all interest and feel guilty, and
that makes me avoid any mention of it at all.”
(Age 53)
“Several symptoms of the menopause
have affected my desire for sex, which I find
disappointing because I wish I had the same
desire as I had in recent years.” (Age 58)
“I find it uncomfortable and sometimes
painful. I use vaginal gels but doesn’t help
much, so do not have sex these last months.”
(Age 54)
“I love my partner very much, this prob-
lem upsets me. However if I didn’t have a
partner (for sex) I wouldn’t miss it — it’s
very hard to desire something you don’t
want. I feel sad when I think of how we used
to be. He is very understanding.” (Age 54)
And 21 percent of women said their part-
ners had lost interest in sex.
“Only [have sex] twice a year maybe. My
partner has lost his libido and never thinks of
it, although he loves me and worries about
it.” (Age 60)
While most of the written comments wereabout problems with sex, a few women left
more hopeful messages.
“As I have a new partner since one year, I
find my sexual life has never been better and
it is certainly very frequent. Very much the
reason for my happiness, contentment and
well-being.” (Age 59)
Sex happens “less often than when young-
er. We both get tired, but when we do it, it’s
good.” (Age 64)The data and comments were analyzed
by Dr. Helena Harder, a research fellow at
Brighton and Sussex Medical School, and
colleagues. Dr. Harder said the comments
show that doctors need to have more fre-
quent conversations with women about sex.
“Women say that they are sorry that
things have changed. They wish it was dif-
ferent,” Dr. Harder said. “But in general, it’s
not being brought up in discussions. Pa-
tients need reassurance that it’s O.K. to dis-
cuss sex and ask questions. If you do that,
it’s probably a good step toward making
changes.”
Dr. Faubion, who is also medical director
for the North American Menopause Society,
noted that treatments are available to help
women with vaginal dryness and painful
sex. In addition, two libido drugs have been
approved to help increase female desire.
One is a pill and the other, an injectable,
should be available this fall, although both
drugs have drawbacks, including cost, lim-
its on when they can be used and side ef-
fects, so they aren’t an option for every
woman, she said.
A better option may be educating women
and couples. Working with a sex therapist
can help women deal with anxiety and low-
desire issues. A therapist can help teach
women that while spontaneous sexual de-
sire may dim, they can plan for sex, and de-
sire often returns once a woman is engaged
in intimacy.
Nan Dill, a 53-year-old Cincinnati woman
with three children ages 15, 18 and 21, said it
wasn’t until her doctor asked her questions
about her sex life that she realized how hot
flashes and low desire related to
menopause had taken a toll on her sex life.
“I thought, ‘Life is busy. This is what hap-
pens,’ ” she said.
Ms. Dill began using an estrogen patch
for hot flashes and a non-estrogen vaginal
dryness treatment. Learning that changes
in desire are normal helped both her and
her husband understand that they were
simply entering a new chapter in their rela-
tionship.
“When you have the right information, it
helps you understand the change not just in
your body but the change in your bedroom,”
she said. “You learn sex might be different,
but it will still be good, and it will still work
for both of you.”Your Sex Life After Menopause
A new analysis gives voice to
the many reasons it often
falters with age for women.
GETTY IMAGESBy TARA PARKER-POPE‘Patients need
reassurance that it’s O.K.
to discuss sex and ask
questions.’
DR. HELENA HARDER
BRIGHTON AND SUSSEX
MEDICAL SCHOOL