Archive for Menopause
As I spent the morning reading numerous articles on diet, weight loss and exercise; several basic principles continue to emerge: 1. It's hard to lose weight as we age, and harder even for women. The body is all about preservation and continually adapts to cope with changing calorie intake and exercise levels. Some key strategies- Don't cut calories too drastically for many days, give yourself at least one day of increased calorie consumption. Vary your exercise to prevent the body from adjusting to what you are doing. Throw in strength training. Stressing muscle helps with metabolism. 2. You must improve your diet as you get older, no two ways about it. All the successful diets have this in common: very limited added sugar, no processed carbs on a regular basis, healthy fats only. Here are some strategies: Cut down on sugar in your drinks, you may actually taste what you are drinking. If you don't like the taste of something without sugar, may you should quit drinking it. Cut down on alcohol. They are empty calories and if you want to lose weight, you cannot afford empty calories. The processed carbs of our modern day are stripped of fiber and act just like sugar when you eat them. Limit consumption to once weekly. Most juices are loaded with sugar and thus act like a soda when you drink them. Limit how much you drink regularly to 4-6 oz daily, tops. Limit meats to 4 oz at a meal, choose organic when you can as the fat within the meat is healthier due to the animal having a healthier diet. 3. You have got to get enough sleep for all of this to work. Important metabolic and appetite suppressing work goes on when we sleep. Additionally, you have the mental energy to focus on what is important and to make the choices that support your goals, in all the arenas of your life. Strategies: I have personally discovered how well I sleep when I limit sugar in the evening, and this includes alcohol. Try it for a week, see how you respond. Exercise helps to make us tired at night, even when done in the morning. Try Adding in a walk, do something more than that at 3 days a week. Don't overeat at night, it can give you heartburn and a pounding heart as you metabolize all those calories without physical action to use them up. Set a regular and relaxing routine and stick to it most the days of the week. This sets in motion the hormones that help us sleep. You may also need to turn off electronics to aid this process. 4. Move. I can't say enough about this. You cannot expect to lose weight and be healthy without movement beyond getting to and from work, hygiene/dressing, activity related to meals. If you do not have an active job, you have to move in some meaningful way. Figure out what you like to do, and do it regularly, almost daily. And get used to more walking. Strategies: there is Zumba, Jazzercise, dance classes offered at gyms, rec centers, churches. You can usually google the activity for in your area and get a variety of listings. Your can try walking and running clubs often hosted by a local athletic shoe company, such as Fleet Feet. My walking partner has been an invaluable sounding board and general conversationalist for job, family etc issues! there are numerous free apps for your phone that can guide you through exercising if you want to go it alone. My favorites have been fit in 5, Couch to 5K, DailyWorkout. And always try to take stairs instead of elevators, park in one spot if you can walk and do several errands, park farther away from the store you are going to, walk your dog a distance and at a decent clip. Readers, write in with your suggestions and tips! Contact me for more specific advice and consider personal coaching to get you past your roadblocks!
This video, available only here is split into two 3 minute sections. In it I discuss the gut microbiome, all the various bacteria of the gut that are involved with our immunity and our physical and emotional health. Through supplementing by eating probiotic foods and by nourishing by eating prebiotic foods (I explain these terms in the videos) you can improve and maintain that improvement in immunity and general health. Enjoy parts one and two then click on the contact form and send me your comments and your requests. I would love to be your guide in this type of healthy behavior improvement. As a physician assistant with 25 years of experience in womens health and a certification from the Cooper Institute as a Healthy Habits Coach, I am in a unique position to be a guide in your quest for health improvement. Let me know how I can help you.
As in previous posts, I recommend you purchase a copy of “The Good Gut” by Erica and Justin Sonnenburg. The link below is my affiliate link. Using it helps keep this blog and the work I do financially afloat. Thanks for your support.
This is a discussion of the gut microbiome and is the first of two parts. For more information on this topic I recommend you read the book “The Good Gut” by Justin and Erica Sonnenburg, bot PhD researchers in this area of Gut Health. I have provided a link to the book on Amazon below. It is an affiliate link. I will receive a few cents if you buy it, though it is the same price whether you use my link or not. Enjoy part one, share it with your friends.
There are now new guidelines regarding the frequency of mammogram screening, and yes, this debate continues to go on!
These recommendations however, are backed by most professional medical organizations. The American Cancer Society agrees, and that carries a lot of weight.
These newest recommendation apply to women of low risk, and include starting age 45 instead of 40; and having a mammogram yearly until 55 yrs of age. At this point, women are recommended to have a mammogram every other year until within 10 yrs of life expectancy (when the average woman dies); then they can stop. The new recommendations recommend against monthly self breast exams, and against your medical provider doing breast exams.
If you are at high risk, ie have a family history of breast cancer or a personal history of cancer as well as some unhealthy life style practices; you are recommended to discuss your screening with your provider.
- In other words, if you have had a sister, mother, daughter with breast cancer; you are at higher risk and need to be screened more regularly and start a little earlier.
- If you have had any other cancer, you are considered at risk for future cancers from other sites; so you are at higher risk.
- If you smoke, drink more that 10-14 alcoholic drinks a week (ie 12 oz beer, 5 oz wine, 1-1.5 oz liquor), are in the obese weight category, and are not active; you should get regular screening.
Many providers, myself included, do not agree with the lack of provider breast exams. I personally, will not give that up in my clinical practice. A lump is a lump and how are you going to know it is not cancer unless it is found and evaluated?
The reason for this shift in recommendations involve trying to minimize aggressive and fear inducing procedures and treatments for abnormalities that ultimately are benign or so slow growing they will not impact longevity. Cancer occurring in the 40′s and early 50′s are felt to be more aggressive and faster moving.
One major and important organization, the American Congress of Obstetricians and Gynecologists do not agree with these new recommendations.
They feel screening should begin at age 40 and continue yearly, no end point specified. They still approve of self breast exams and yearly provider exams.
What do I, as a provider, recommend? Somewhere in the middle.
I do agree with yearly exams in the 40′s and 50′s. As stated above, if I see a woman for a yearly female exam, she is getting a breast exam. Self breast exams are fine every other month or so. It is probably ok to skip a year here and there with mammograms if someone is low risk. If a woman has no family history or personal history of cancer, but her healthy habits are not good; I will recommend yearly mammograms. I feel it is likely safe to stop screening in the late 70′s for most healthy women who expect to live well into their 80′s.
This is my take on the new recommendations. Let me know what your experiences, questions and thoughts are!
What do you consider most important health factor that will enable you to continue to live life the way you want?
For some of us, it is to have a sharp mind to continue with the creative pursuits we want to engage. Our brains and creative process are the most part to us. We then hope our bodies are healthy enough to carry those minds around for a while.
For others it is to have the energy and strength to be as physically active as we want.
There is no doubt however, a healthy heart is needed for both types ways of living. It turns out that quite possibly striving for a healthy cholesterol profile may not be enough for menopausal women!
A recent study out of the Univ. of Pittsburgh School of Public Health reveals that having a high HDL cholesterol can cause cholesterol plaque, just as the bad LDL can. This study followed 225 women in their mid to late 40′s for 9 yrs. They were determined to be clear of cardiovascular disease at the beginning of the study. It was noted that the women with higher HDL levels as they transitioned through menopause had a greater number of cholesterol plaques formed that the other participants. The researchers theorize that the changing levels of estrogen affects cholesterol metabolism, but they admit they do not know more than that.
We have been taught for years that having a high HDL, or “good cholesterol”, is protective against heart disease. We do not know all there is about cholesterol and how it is metabolized, but this small study would indicate that a lot more has to be determined before we have a clear picture or the final word on cholesterol and aging.
What can we women do in the meantime to protect our hearts?
We can improve all the other potential risk factors we may have for heart disease.
- Consume a diet low in animal fats, trans fats and saturated fats. Increase healthy plant based fats
- Decrease and eliminate processed starches, sweets and packaged foods. Studies have suggested that when saturated fat is consumed with processed starch (think chicken biscuit, pastries, fast food meals) more harm is done than consuming saturated fat by itself. Having said that, you still need to LIMIT the saturated fat you consume.
- Stop smoking or using nicotine products. Nicotine basically inflames the walls of blood vessels, allowing cholesterol particles to adhere and gather.
- Exercise in any way that is enjoyable and tolerable for you. Moving helps metabolize food energy so it is used, not floating around looking where is will live.
Talk with your medical provider about your cholesterol profile and how it may impact your health. There is a relatively new way of analyzing cholesterol called the NMR lipoprotein. This technology looks at the particle size and count of both good and bad cholesterol. We all make different sized cholesterol particles, and the more yours are large, the less likely they can stick to the walls or arteries and create plaques.
Until we know more about cholesterol, do what you can with your habits. This way you can be more active, creative, influential, involved, thought provoking and connected for many more years!
Like many of us, I am constantly trying to tweak my health habits to improve health, weight, and energy. As I look at ways to improve my diet, one thing has become clear to me.
The importance of preparing your own meals.
Luckily, many stores can provide us with healthy alternatives in the form of organic produce, eggs and meats from animals raised humanely and feed quality nutrition.
When looking at nutrition that is optimal, the safety and quality of many commercially prepared version of foods is often questionable and inferior to what we can prepare at home. We put a lot of trust into food manufacturers and regulatory powers overseeing the health of additives used by large food corporations. In many instances, they have done a good job, but there may be a myriad of ways that these chemicals may affect us that have not adequately been looked at.
Take the example of high fructose corn syrup.
This was felt at one time to be a healthy additive that improved commercially prepared foods. We now understand how this item has contributed to obesity. The chemical makeup of HFCS causes it to be metabolized differently in the body, contributing to diabetes, liver disease. The shear volume of sugar hidden in foods with HFCS adds calories that our brain does not necessarily acknowledge, preventing us from feeling full. Contrary to industry claims that sugar is sugar; this form of sugar does not act like regular table sugar. If you are interested in reading more about this, Mark Hyman is a well recognized leader in nutrition and integrative health.
While organic foods may be more expensive, you may find that you can eat less and still afford the better quality food. Plan some time over the weekend or your off days, to prepare some meals and dishes. You will be happier knowing what has gone into your food and may even notice a change on the scales!
How comfortable can we really be handing over control of the quality of our meals to total strangers?
You may have heard in the new recently, that a recent study on Vitamin D did not show any benefit for bone health in post menopausal women.
I want to point a few things out however, before you stop your supplement, thinking it is not doing any thing.
- This study was done in a small group of women.
- It only last 1 year.
- It compared women taking 800 IUs of Vitamin D3, and those taking 50,000 IUs of Vitamin D3, and women taking a placebo.
The study did show there was greater absorption of calcium in the high dose supplement group, but it did not show any increase of bone density or muscle mass. Additionally, the sit-to-stand test was also unchanged.
It is important to understand that this study was only done for a year, and this may very well not be long enough to see a change of bone density. And it was done on a small sampling of women.
It is also important to understand that levels of Vitamin D above 30 ng/ml is felt to have benefit for muscles, brain, colon. You may not need 50,000 IUs, but I still adhere to a daily 2,000 IU tablet.
It does seem that small studies are released regularly with conflicting information. What is important to remember, is that we need strong bones that won’t break when we fall. We need strong muscles to give us strength, stability and balance; to help prevent us from falling.
We can accomplish this with a diet high in calcium and Vitamin D, supplement when our diet is lacking these important nutrients. And we can further help ourselves by exercising both aerobically for our hearts, and strength training for our strength and balance.
We likely enjoy the actions that cause our weight gain, eating tasty food and lots of it. Or maybe it feels like the only way to get in nutrition; we are busy so we reach for fast food, convenient food or even quality restaurant food. It all tastes good. Of course, that is the point of the food industry. Keep us coming back for more.
The problem is that most of our health issues start with weight gain. And stress, with the associated behavior changes that come with stress. Smoking, eating, drinking, not sleeping, and probably not exercising.
So the question is how do you want to live your life? And what are you willing to do to achieve this?
You may not feel empowered to make the changes needed to avoid illness and disease that your genes may predispose you to. Or you feel it is inevitable. You may not feel you have the time and energy, or deep down, deserve the time and energy to devote to yourself. It could be a combination of all or none of these reasons. Granted there are many exceptions to this, diseases that a life style change will not prevent or treat. Or it feels too late and medications are needed to improve and prolong life.
Most likely your medical professional has not devoted the time to talk with you in depth about diet; they may not even be very well trained in this themselves. Add to this, the confusing internet barrage of diets promising a quick fix. This is why the drug industry has become “big pharma”.
But most of it starts with weight gain.
Weight gain causes inflammation and a host of hormonal responses that makes it extremely difficult for the body to maintain its balance. As a result, systems start to malfunction, causing production of other substances that more profoundly affect the balance within our body. This can even set us up for cancer.
If you want to avoid all this, it is not too late. But you do have to change, and maybe change big-time; but not necessarily all at once.
Some simple rules to live by:
- Eat 3 meals daily, starting with a lot of protein at breakfast. Eat enough to space meals 5 hrs apart at least; and do not snack. If you must snack, make it healthy.
- NO SUGAR, or anything that acts like sugar when you eat it. This includes processed foods with any sort of fructose corn syrup or any syrup, agave, honey, sugar. No white rice, white potatoes, white pasta, white bread, white tortillas, snacks like pretzels, chips, cookies, cakes, pies, candy etc. No biscuits, donuts, bagels. They are all compressed white flour and are the equivalent to sugar in your body and brain.
- Get 7-8 hours of sleep at night. I cannot stress how important this is. The hormones that regulate your appetite and food metabolism are actually to some degree, secreted and regulated at night. Not sleeping interferes with this.
- Do not eat after dinner. Your liver needs a rest from all of this food metabolism and giving your body a 12 hr fast during the night helps it to work at producing the right hormones at the right time. This is also why not snacking helps.
- Get rid of as much stress as possible. I know this can be a hard one. You have one life to live and your life would be so much better if stress were reduced. Some things we cannot get rid of, but we can change how we react. Look into meditation, even 5 minutes a day is beneficial. Exercise helps to reduce the stress hormone cortisol, which contributes to the unhealthy cascade that aging can bring. And sleep of course, helps reduce stress as it places parts of your brain in standby mode, helping to reset certain functions.
Ok, this all seems overwhelming perhaps.
Pick one item on the list above and work on it for a month or so. Figure out what will work for you. Then start on the next thing. You do not have to do it all at once, but you may notice a curious affect. When we change one habit for the better; sometimes other habits change without us really making an effort.
It is up to you, but I am here to help. Trust me, I have seen it, done it, lived it; and to some degree successfully changed it. Contact me with questions, and consider contracting for some coaching time if you are stuck and need help.
All this change may seem hard, but it is really not hard once you start taking steps.
Last week I gave you all some links sent to me by the NIH to help women come to terms with the possibility of heart disease. What is it you need to know about to determine if you need to be worried?
Here are some of the basics.
1. What is your blood pressure, glucose, and cholesterol? These 3 things are the early warning signs of potential harm to your heart and blood vessels.
An elevated blood pressure occurs for a variety of reasons but basically the blood vessels are too narrow and the heart has to work harder as a pump to get the blood to flow through and make it to the organs. The heart over time can enlarge, and not work as effectively.
An elevated glucose causes problems with the walls of the blood vessels, making them less healthy, inflamed and eventually not effective as conduits for the blood flowing through.
Elevated bad forms of cholesterol can infiltrate into the lining of the blood vessels, causing blockages. These can eventually rupture, causing a complete blockage. When this happens in the brain, it is a stroke; in the coronary blood vessels it is a heart attack.
2. What are your genetics for heart disease? In other words, have many family members had early heart attacks and strokes?
Having a strong family history of heart disease indicates there is a tendency to inflammation in your blood vessels that contributes to poor health of arteries. This genetic predisposition may include diabetes, high cholesterol, high blood pressure.
Having a family history does not mean you are fated to have an MI or stroke, but it does mean you need to be very careful what you do in terms of lifestyle and habits. You can avoid the fate of your genes with careful living.
3. What are your health habits? Yes, yes; this is what we medical people preach about day in and day out!
It is the one most important modifiable action you can take however, which is why we stress healthy habits so much. You have the power to change the fate of your genes!
Exercise helps the heart get a good work out, it exercises the muscle and gets the blood flowing all over your body. It uses up the excess calories you may have eaten. It lowers cortisol levels that are elevated in most of us due to the stress of our lives. This lower cortisol following exercise causes the muscle layer around the outside of the blood vessel to relax a little, making the tube a little wider and easing the heart from having to pump so hard. The idea is for your heart to work hard during exercise, and not all the time. Additionally, exercise helps your liver make more of the good cholesterol which then helps the body get rid of the bad cholesterol.
A healthy diet low in animal fats, trans fats, and saturated fats that come from fried foods, packaged and processed baked foods; helps to keep cholesterol lower and inflammation in the blood vessels lower. Then the cholesterol flowing through your blood stream doesn’t have as much inflammation to latch onto, creating a plaque or potential blockage.
Lowering sugar in the diet also helps reduce inflammation, avoid diabetes with its’ destructive actions; and helps with weight.
Sodium is a major contributor to high blood vessel for many people through retention of fluid and tightening to the blood vessel walls, making them more narrow.
Maintaining a health weight reduces the amount of blood vessels your heart has to pump blood too, as fat needs blood vessels also. There is less mileage that the heart has to pump blood through. The actions that it takes to maintain a healthy weight also helps the heart, and is described above.
Do you smoke cigarettes or use nicotine products? Nicotine contributes to heart disease mostly through the inflammation and disease to blood vessel walls. Nicotine also contributes to tightening of the blood vessels, making them more narrow. The inflammation and narrowing then helps cholesterol do its’ bad thing with blockages.
Do you get enough good quality sleep? Hey, everything has to rest! Sleep helps aid in repair of the body, lowering of inflammation, mobilizing excess fluid.
OK, quick tips:
- Instead of frying foods, saute in a little olive oil or other healthy oil
- Add very little salt to food, use other seasons like pepper and herbs, spices
- Get out and move every day, figure out a way this will work for you
- Get a good nights sleep, work on sleep habits to aid this occuring
- ditch the sodium, nicotine products, fast foods, fried foods, fatty meats. Make them a rare occurrence
- decrease sugar, white starches like bread, pasta, potatoes, rice; as they basically act like a big dose of sugar in the body
- limit alcohol and caffeine products to a healthy consumption
- have your glucose, cholesterol and blood pressure monitored regularly and talk to your provider about what to do to reduce them if they are elevated.
Think about it, the only rest your heart gets is between each beat. Not to scare you, but that muscle keeps going, all the time. Why would you not be kind to it, protect it, pay attention to it?
We never really thought about our hearts when we were younger, did we?
Aside from the issue of love and relationships, we have pretty much taken our hearts for granted all these years. Until it starts palpitating, jumping wildly around in our chest for no reason.
Now we are paying attention.
We may feel like someone who never remembers to have the oil changed in their car until is starts stalling or hesitating.
The good news is, it is likely not too late-depending on how much you have abused your body with bad habits. It is certainly never too late to improve a few things.
We have to realize that we are at risk for a heart attack or a stroke at this age of menopause, just like all the men we know, care about and love.
Take some time at your next medical appointment and talk about your heart health and how you can preserve or improve it. Along with some helpful tips and information from the NIH included in these brochures, you can think about ways to start the conversation with your provider.
Both of these links have pdf forms you can down load and print, give it to a woman you care about who may still be ignoring their heart. Help spread the word that we women are at much at risk for heart disease, stroke or heart attack as men. This is one area we have equality, whether we want it or not!