The question of the benefit of cholesterol medication is a much talked about topic of discussion these days in health and medicine. There are two camps; those who follow the guidelines produced by experts after analysis of medical studies, and those who believe that these guidelines are polluted by the influence of pharmaceutical companies. There are traditional medical providers in both groups, but most nontraditional practitioners would opt for the second group.
You may wonder which group your medical provider belongs to. Many patients believe that physicians who prescribe these medications get a kick back from the drug companies for prescribing these medications.They are therefor leery of the actual need or benefit for themselves.
While it is true that many prescriptions for statin drugs, the class of drugs that can lower cholesterol, are written yearly; this is not because of a financial incentive.
Why so many statin drugs prescribed?
In 3 short words: the American diet! As a medical provider who regularly checks the cholesterol levels of patients, I am disheartened on how many abnormal lab results I see. I am convinced the number one reason for these elevations is the food choices people make. It is true that genetics play a role, but what you put in your mouth plays more of a role.
Not everyone with high cholesterol will have illness from this elevation. Medical research is trying to figure out what the differences are between people who develop heart disease from their elevated cholesterol and those that do not. Researcher do not have all the answers, and sometimes they argue amongst themselves as see with the newest guidelines and risk calculator tool!
What we do know is that a diet high in sugar and fatty meats, as well as highly processed foods, raises cholesterol. A diet low in these items and high in fruits and vegetables tends not to raise the cholesterol. Some people are more genetically predisposed to have high cholesterol. A bad diet can make this happen, whereas a more vegetarian or Mediterranean diet, will help to prevent cholesterol elevations.
We all need some degree of cholesterol, as this is used in cell repair and nerve health. Too much however, collects along the walls of the arteries as it has to go somewhere. Some cholesterol can be broken down and taken out of the body, but not all. Exercise can help with this breakdown, thereby lowering the cholesterol.
It is strongly felt and supported in medical research that cholesterol plaques in the artery walls are capable of growing until they rupture, causing a heart attack. This happens in many people but not all, and unfortunately we do not have the capability of predicting with accuracy who will have this happen. In some people it is a given, others it is more elusive a risk. So for now, medical providers have to go by the odds with their suggestion and recommendations regarding statin therapy.
But you do have some choices. You can decide to ignore the advise to take statins, and take a chance that you will not have a cardiac event; play the odds in other words. If you are wrong however, you may lose big time.
You can chose to address your lifestyle instead of take medication, or do both. Changing your diet profoundly and for good, as well as exercising may make the need for statins a moot point. For me, as a patient and medical provider, is the approach I recommend regardless of whether statin therapy is also used. A healthy diet can do so much more than just lower cholesterol.
So for now, if your medical provider is recommending statin therapy; it is not so they can get a kick back from the drug company. Most likely your cholesterol level is high enough and your risk factors numerous enough that you are at risk for a cardiac event. And now you have a choice: take the medicine, change your diet, do both or do neither and take your chances.
I recently came across this article regarding whether the point of exhaustion we perceive when exercising, is in fact our real point of exhaustion. It occurred to me that this concept can also apply to other areas of our lives.
It is all about self talk, and what we tell ourselves we can and cannot do. During menopause, this is particularly challenging as our bodies are changing and we often do not know how we will feel on a given day.
This study looked at the degree to which the subjects were able to push themselves past the point at which they thought they could do no more. The test subjects were counseled to engage in positive self talk while exercising vigorously. At the end of the study, those that engaged in positive self talk could go further and longer; and perceived their workout to be less of an effort than those subjects who did not employ positive self talk.
Remember the children’s story about the train going up the hill, saying “I think I can, I think I can?” What a valuable lesson to learn at a young age! How easy it is to lose sight of that lesson as we age and experience the trials and disappointments that life can present to us.
Self talk can save us from a challenging day; turning our day completely around. Or it can be our undoing. When we are tired and stressed, it can be very hard to put forth the energy to be positive. It seems easier to let events happen, and then just react. How often though, does this turn out well?
Recently while driving to work after a particularly bad night of sleep, I was feeling the challenges of the day weigh on me. A recent reading about positive self talk crept into my consciousness and I seized on it. Telling myself that fatigue is only that, and that I could survive one day at least; I repeated to myself that my day will be good, and I will be patient and thoughtful with my interactions. It worked, and that day has become a template for other similar sleep deprived days.
Coming back to the above mentioned study, our perceptions of what we are capable of can always be challenged and extended when we feel positive and in control. Menopause challenges that sense of control but does not have to control us.
Take a moment when you are rested and feeling contemplative, and write down some positive phrases that are motivating for you. Make these phrases about your success, and ability to control the outcome of a task or situation. Practice these phrases so that they sound genuine to you, and feel that they are an extension of you.
The next time you are faced with a challenge, remind yourself that the outcome can be good if you approach it that way. Take some time to repeat your phrases, and engage in positive self talk.
You may find that this strategy helps you successfully overcoming obstacles to changes you want to make!
Many patients ask me what I think the best exercise is.
My answer is ” any exercise you enjoy and will do consistently”. With one caveat: healthy exercising as we age must include aerobic exercise to help the heart, strength exercise to help the muscles and bones, and stretching to help the ligaments and muscles. This triad of exercise maintained balance, strength, flexibility and endurance.
This sounds overwhelming to someone just starting an exercise program, but a good start may be either yoga or Pilates; or both. Which program is better? That depends on what you want to accomplish and which you feel better suited for.
Both yoga and Pilates strengthen muscles and help with stretching; yoga perhaps helping stretching a little more. They appear very similar to the uninitiated. I believe the biggest difference is in the mental aspect of yoga. There is much concentration on breathing and maintaining a pose that becomes increasingly hard, and breathing slowly and focusing your mind on controlling the discomfort. This skill can be very helpful in other areas of life!
Pilates lovers will site the efficiency and strength of the workout, with some of the same mental benefits of yoga. Holding a difficult pose in Pilates takes focus and concentration, just as in Yoga. Pilates concentrates mostly on the body, where Yoga focuses on aligning your spiritual center through rigorous physical poses. Pilates focuses on control of movements, strength of core muscles, centering and concentration as you move through precise movements. With this, there is focus and controlled breathing. So on the outside, Pilates and yoga seen very similar.
A big difference is the philosophical and spiritual component of yoga, compared to the physical strengthening of Pilates. Both are very adaptable to any level, and can be done to some extent without equipment. Most communities have classes available without needing to belong to a workout facility.
I admit that I prefer Yoga over Pilates primarily to help me learn to still my mind. It does not always work, but there are still the benefits of strengthening and flexibility I have achieved. Either way, both exercise programs can be done for strength and flexibility and are known to be beneficial for posture; as well as achieving health benefits for heart!
Losing your hair is a pretty scary thought, and when we begin to experience this, we worry that we may actually go bald. While I am sure most men experiencing hair loss are not thrilled, somehow it is different for women.
Rest assured, most menopausal women do not actually go bald, but some hair loss is to be expected. There are a few things that are important to do if you notice significant thinning of your hair.
First, it is important to determine the cause of your hair loss. This can be addressed by your medical provider, and sometimes a dermatologist is needed to help make a diagnosis and treatment plan.
When you go to see your medical provider, make sure they understand how important this issue is for you. Do not list it along with several other issues, as it may get overlooked or glossed over.
The causes of hair loss can include a condition called Androgenic Alopecia. This is a genetically determined condition where the hair follicles are more sensitive to the level of androgen in the body. As we enter menopause, our androgen (and other hormones) start to fall. The hair follicle cannot sustain the hair, resulting in the hair falling out. This is the most common cause of hair loss in women, and varies in severity according to your genes. This is some treatment available though, and the sooner your start the better the response is. Topical minoxidil, or Rogaine, causes the follicle to be better supportive of the hair.
Telogen effluvium is another cause of hair loss, often experienced after an illness or major stress; sometimes even pregnancy. All hair follicles have 3 different stages, growth, maintenance and resting (anagen, catagen, telogen). It is considered normal to lose up to 100 hairs a day; hairs in the telogen phase. After a major stressful event to the body such as an illness or surgery, or even emotional stress; the hair follicles enter the telogen phase prematurely. This can cause unusual hair loss, sometimes as much as 6 months following the event. Other causes of this sort of hair loss include some medications, rapid and major weight loss, malnutrition, and some endocrine abnormalities.
Treating telogen effluvium often requires treating the underlying cause. Talk to your provider about changing or discontinuing medication if you think this is the cause. Improving your diet to include plenty of nutrients, and getting plenty of rest and stress reduction are also helpful. A supplement of Biotin can be helpful in restoring the health of the follicle.
There is also traction alopecia, where increased stress on the hair follicle occurs with tight pony tails and hair buns, as well as use of hair extensions. Consider stopping these hair styles, adding a biotin supplement to your diet. Overuse of chemicals on your hair as well as frequent use of heat can also contribute to hair loss through increased breakage of hair. Discontinuing these treatments and adding biotin also helps promote healthy hair growth.
There are a variety of skin related inflammatory conditions that can cause hair loss, and these are best diagnosed and treated by a dermatologist. However, if you notice that more hair loss that you feel is abnormal; it is most likely from one of the causes above.
Some simple steps to arrest your hair loss is good nutrition, stress reduction, a biotin supplement; as well as eliminating any harsh chemical or heat treatments you use. Adopting a hair style less stressful to your hair and scalp should help maintain a relatively full head of hair!
I mentioned in the last post that Telomere length is not all there is to anti aging process and I will explore this more in this post. It may seen a little scientific but here it goes.
Telomere length is an important factor in the healthy replication of our DNA. The machinery performing this function is not perfect and sometimes gets it wrong. These cells are often destroyed through other protective mechanisms of our bodies. With each DNA division, the telomeres at the ends of the DNA get shorter and shorter until eventually the length is too short to allow replication. It is this process that is felt to cause aging, and the progression of chronic disease.
Telomerase is an enzyme that is present to protect the telomeres but it is often dormant within the cell. When we are growing within the womb, and as young being, telomerase is switched on and very active. At some point of a cells growth process, this enzyme is switched off the guard against run away cell growth. When telomerase becomes active, it protects telomere length and therefore makes the cell “immortal”. This may sound great but this immortality often means increased cell growth which often means tumor, or cancer.
Scientists have identified all these compounds, but not the secret to longevity and immortality. As I mentioned in the previous post, preserving telomere length may be achieved through exercise and meditation.
What are the recognized factors which trigger telomerase, resulting in cellular overgrowth and cancer formation? No one really knows quite yet, but this is an area of exciting research. Many cancer treatments being studied deal with inactivating telomerase in the cancer cells. There is a suspicion that certain viruses can help activate telomerase in certain cancers.
A recent study which evaluated telomere length and life style intervention attributed the increased length to increased telomerase activity in the circulating blood cells.
The life style interventions included adopting a plant based diet, moderate activity/exercise, stress reduction and increased social support.
In other words, this study showed increased health of cells after 5 years of eating fruits and vegetables, exercising at least 150 minutes a week, working on relieving stress and interacting with friends and loved ones in a meaningful way. This sounds like a healthy prescription for living your life!
Remember when you were young and learning to tie your shoe laces and how older shoe laces were always missing those plastic tips? It would be impossible to feed them through the loops of your tennis shoes with the frayed ends always becoming more unraveled.
The ends of our DNA can be like those laces, with the tips fraying with overuse, in this case, repeated replication. That is where your telomeres come in, they keep the ends of your DNA from fraying.
Why is this important, or something you should care about?
Our DNA needs to split when our cells divide during periods of growth and repair. That splitting can cause the tips of our DNA, or telomeres, to shrink with each division. At some point, these tips will become too short and not be able to divide any longer.
They say that every pair of DNA only has a certain number of divisions it is capable of before it can go awry. We need those rapid divisions when we are young and growing. As we age, this cell replication slows except during times of repair after an injury or illness; or possibly repair from sustained inflammation.
A recent, albeit small study, has shown that healthy diet and exercise along with meditation can lengthen our telameres. This lengthening can protect the integrity of DNA replication with cell division. In other words, maintaining telomere length can potentially protect our bodies from chronic illness and even cancer. Now before you think the secret to longevity has been discovered, this is unfortunately not all of the answer.
I know I talk a lot about the importance of diet and exercise, but think about what you want to do as you age and how capable you want to be doing it. Exercise is not the be all and end all of our lives and existence, but merely a tool you can use to help you remain engaged in the activities and pursuits you love. Many valuable and creative people focus more on the activities of their brain and not so much on their bodies; and this is the choice we all have.
You do not have to become an athlete, just adopt more movement through walking and activities you enjoy. Consuming a plant based diet, with less animal fats and more healthy fats from nuts and vegetables is key. That doesn’t mean you need to cut out everything you love, just try and change the balance a little. One step at a time.
Now we have a another positive health reason to engage in healthy life style habits. Maintaining the health of your DNA will may very likely extend your life and health, as well as protect against many chronic diseases. This will allow you to age still doing the things you love. That sounds good to me!
Uterine cancer affects tens of thousands of women yearly, roughly 49,000 new cancers diagnosed a year! It is the most common female cancer and you may be at risk for this!
This sort of cancer occurs when there is a production of estrogen without progesterone to counter estrogen’s affects on the uterine lining. Estrogen does many things for our bodies, and when we are still menstruating; it thickens the uterine wall. Progesterone stabilizes that lining and with an increase in production once a month, the lining separates from the uterine wall and comes out. So without progesterone, this lining would develop without any periodic shedding, and a potential cancer can then occur.
At this point you may be saying to yourself “Anne, I am menopausal and do not have periods any longer. What is the big deal?”
Unopposed estrogen may still be occurring even without your ovaries working!
It is true that the bulk of estrogen production comes from our ovaries, but a little is made by the adrenal glands. This production is minor and helps keeps us going after the ovaries stop functioning. It has very little impact on the uterine lining. There is another source of estrogen that can contribute to uterine cancer however, and that is adipose tissue, or fat.
That’s right, the fat we develop at middle age is active and secretes hormones. It can store and secrete estrogen. This is the reason for the increased risk of breast and uterine cancer with excess weight gain and obesity. The uterus is especially susceptible to developing cancer from being obese and having higher estrogen levels.
Does that mean you will get uterine cancer if you are obese, or if you gain 20 or more pounds following menopause? Probable not, but you should know your risk. While being overweight can increase your risk of uterine cancer, researchers at the American Institute for Cancer Research state that your risk can be reduced by 60% with 30 minutes of exercise daily leading to better weight control.
In addition to weight control and a healthy diet; taking HRT will for menopausal symptoms should always be accompanied by progesterone in order to prevent uterine lining development.
The signs of uterine cancer is almost always unusual vaginal bleeding and discharge. Most uterine cancers are diagnosed in women after 60, well beyond the years of normal menstruation. Any vaginal bleeding that occurs post menopausal requires immediate attention. Pelvic pain can also be a symptom and this should be reported also.
Lessening your risk of endometrial cancer, or uterine cancer; can be as simple as a healthy diet and regular exercise. If there is a strong family history of uterine cancer, avoiding hormone replacement therapy may be advised by your medical provider. Regular checkups and reporting any unusual vaginal bleeding, discharge or pelvic pain immediately can usually catch a problem early.
The minor aches and pains of living are common to us all, however the orthopedic specialists are poised to become one of the busiest specialties in medicine! As we baby boomers age, we do not like to be told we cannot continue with our favorite activities! As we age however, joint pain can become much more persistent and even serious.
Many a patient I see in the clinic is very concerned about the possible causes of their joint pain, hoping not to be side lined for too long. The list of possible causes is indeed long. Being active with joint pain can be difficult, as the aches and pains of aging can make you feel older that you are.
Some causes of joint pain are obvious, and are easily addressed and treated. Other causes can be more obscure, and require longer or more complicated treatment.
Potential causes of joint pain include:
- Activity-too much, not enough, new activity, no activity, improperly executed activity.
- Weight gain-extra weight puts stress on the joints
- Menopause- researchers not sure why, has to do with estrogen fluctuations
- Fibromyalgia-a problem where the ligament attaches to the bone
- Arthritis either rheumatoid or osteoarthritis-causes inflammation or destruction of the joint
- Vitamin D deficiency-makes ligaments less flexible
- Polymyalgia rheumatica-weakens muscles supporting the joints
- Infections-tick illness, viral illnesses-can cause inflammation of joints
- Medications-statins for example
You may wonder how to figure out what has caused your joint pain and whether or not to be worried.
If you have a red, swollen joint; this needs to be evaluated. It could be an infection; or an inflammatory arthritis such as gout or rheumatoid. These can be serious and cause joint destruction.
If your joint pain travels around to different joints on any given day, this could be Lyme’s disease, fibromyalgia or it could be menopause. Vitamin D deficiency can cause various aches and pains that are not necessarily in the same joint every day.
If your joint pain is associated with a fever, it could be a viral infection such as influenza; or something more serious such as an autoimmune illness.
Joint pain associated with significant muscle weakness that does not go away after a week or so can also be an autoimmune illness such as Lupus, Rheumatoid arthritis, or Polymyalgia rheumatica.
Most people over 40 with joint pain are most likely to have it associated with an old injury or a new injury. A history of active sports in the younger years will often cause a more accelerated “wear and tear” of joints as well as the supporting structures of muscles and ligaments.
Being overweight one of the most common causes of knee, ankle and foot pain. The increased weight supported by these joints will cause increased stress on them. The lack of activity that often leads to obesity also contributes as muscles are not strong enough to adequately support the weight bearing joints. Many patients I have seen have been able to avoid surgery and have good improvement of their pain with some degree of weight loss; and it doesn’t need to be much!
How can you prevent your joint pain, or lessen its’ intensity? Believe it or not-activity! Being active can prevent weight gain, and help keep joints flexible. Stretching is vital to joint flexibility as this helps keep ligaments and muscles flexible and pliable. Strength training will help keep muscles strong which further helps with joint support.
If your joint pain is from an injury or specific activity, then adjusting your routine will help. If your joint pain is from an autoimmune illness, often an exercise program prescribed by the specialist is the cornerstone of therapy.
Seeing your provider is suggested if your pain lasts more than a week, is associated with fever or weakness, if the joint is swollen, if it is limiting your ability to perform your usually daily routine, of if the pain is severe.
Your provider can perform lab work to evaluate for causes, suggest or prescribe medication to help with inflammation and pain. They may also need to do an XRAY, and refer you to a physical therapist. Some joint pain resolves quickly, some joint pain will take longer and may cause some frustration.
Some joint pain is preventable, and some is unavoidable. It is important to remember to listen to your pain and not necessarily push through it. Pain in a joint indicates a problem, and needs to be dealt with to prevent worsening injury.
Preventing joint pain that impacts your life can often be helped with some lifestyle modifications. Activity appropriate for your age including aerobic, strength training and stretching are key to maintaining a strong and fit skeletal system. Maintaining a near to normal weight as you can is key to reducing stress on joints.
Menopause can be confusing, and it can make you feel as if you are falling apart or losing your mind!
For most of us, we have the irregularity of our menstrual cycle to clue us into a possible cause for the slew of new symptoms we are experiencing! This can become a very confusing time for women who do not have a menstrual cycle any more because of having had a hysterectomy.
When a woman has a hysterectomy, usually the ovaries are left in. This means that a women will still be getting estrogen that the ovaries produce. That is until the ovaries sputter out and stop functioning. When this sputtering is occurring, the symptoms of menopause occur and can be continuous or come and go.
Women with a uterus with have irregular periods during this peri menopausal time. This menstrual irregularity is sometimes, but not always, accompanied by some or all of the symptoms of menopause: hot flashes, sleep disturbance, fatigue, joint and muscle pain to name a few. If you do not have a uterus, you can still experience these symptoms but you may not get clued into menopause as a cause!
It can be mystifying and sometimes scary if you are experiencing these symptoms and do not realize it is menopause.
You may think you are sick from an infection if you are tired and achy, feeling hot and cold. You may wonder if you have diabetes with some of these symptoms. The heart palpitations that come with menopause can cause concern over your heart health. The brain fog of menopause can make you wonder if you are developing dementia.
Before you become frightened about what your health is doing, see your medical provider. A few easy tests can tell you the answer. Your provider can do a test looking at the hormones that control ovarian function to see if you are in menopause. This is called the FSH and LH hormone test. An estrogen level can also be tested but this hormone fluctuates so much, it is not always diagnostic. At the same time, a thyroid test can be done to check for this as a cause. A check for anemia is a good idea, as this can help determine if anemia is contributing to your fatigue.
If you have not had a physical in over a year, the onset of menopause is an excellent time to get a health check. You may think you do not need a female exam following a hysterectomy, but you do! A breast exam and an ovarian exam are two important exams to participate in. Additionally, blood work to check for diabetes and elevated cholesterol, as well as blood pressure measurement are all important yearly measurements.
Whether or not you have had a hysterectomy, discussing your concerns with your medical provider can allay your fears and concerns regarding your health. Having had a hysterectomy can confuse the picture for you, but your provider has tools at his or her disposal that can be used to clear up any confusion!
Menopause is well known to interfere with aspects of our lives that we would like to remain stable and routine. Talking about sleep problems during menopause leads most women to think about their disruptive, night time hot flashes. These are certainly a major cause of sleep deprivation for women as they age.
A more insidious cause of insomnia may be present though, and this cause has far more serious health implications. I am talking about Obstructive Sleep Apnea.
Nobody wants to sleep with a mask over their face, attached to a pump making noise throughout the night. Many women do not want to even discuss, much less get tested for OSA because of this device, called a CPAP machine.
There is a surprising prevalence of OSA, with 1:7 women aged 55-70 having severe sleep apnea. This is in part because of weight gain that typically occurs as we age as well as when we go through menopause. It is also caused by the aging process itself, weakening the muscles in the roof of the oral cavity which suspend the tissues.
The typical symptoms of OSA are snoring and sometimes breathing cessation following by a loud gasp; then resumption of snoring. This is often diagnosed by sleeping partners! Fatigue during the day and not awakening feeling refreshed is a common complaint among people with undiagnosed or treated OSA.
You may wonder what the big deal is, so you snore a little!
According to a recent article published in Sleep; women will have more health problems from their sleep apnea than men. Studies have shown an increase in depression, as well as more damage to parts of the brain associated with mood and decision making. This has been demonstrated in studies by alterations on MRI scans. OSA can also eventually cause enlargement of the heart, hypertension, and lung disease.
How can you prevent sleep apnea? The biggest prevention is weight control. Weight gain in the neck, face and shoulders can place increased pressure on the muscles that help suspend the roof of the mouth. As we lay down to sleep, gravity can cause the soft tissues of the roof of the mouth to partially collapse and obstruct or block the airway. This decrease of air, and more importantly oxygen, reaching the outer portions of the lungs can put a strain on the heart.
As a part of weight control is exercise which also helps the sleep cycle. Adopting as healthy a lifestyle as possible will help strengthen heart and lungs.
What if you have done all this and your sleep test still shows OSA. The CPAP machine helps to increase the pressure on the roof of your mouth and throat, preventing collapse of tissues. There are many devices, and luckily technology advancement has created some very small and quiet devices.
Using a CPAP machine can dramatically improve your health through lowering the blood pressure, reducing stress on the heart and improving the function of the lung. All of this results in improved energy, better sleep, reduction of headaches. It can even help facilitate weight loss.
Many people imagine treatment of OSA to resemble sleeping with a gas mask, but this is not the case any longer. I encourage you to share with your provider any symptoms or suspicions that you may have sleep apnea.