Archive for Healthy Habits for Menopause


Shorts, Sales and Moving

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Summer is here and the other day I was thinking of hitting the 4th of July clothing sales to get myself some new shorts. My legs aren’t great after years of standing all day, but it is hot here in the south. Around July, I often reach the point of not caring what my legs look like as long as I don’t look in a full length mirror!

Plus there’s that menopausal weight gain and body weight shift issue, and some shorts aren’t as comfortable as they were last year.

Growing older and seeing our bodies and figures change is tough for menopausal women. We usually figure out how to maintain our health and weight through our 30′s and 40′s, but then it all changes without us seeming to change anything!

Or have we changed a lot and just not been aware of it?

A recent study hitting the news reveals some shocking statistics: up to 51% of us women have no leisure time activity or exercise built into our lives! This is up from 14% in 1994; and felt to be the primary cause for obesity.

So it is not that we are actually eating more calories, although admittedly the calories we are eating may be of lesser quality. Our weight problem has more to do with moving much less than in past years. This can happen slowly and without us being aware of it. We get busier at work and at home, and we feel we can skip the exercise today. Today then becomes tomorrow, the next day and onward; until exercise is no longer a habit.

This slide into inactivity can happen quickly, and can easily be blamed on any number of reasons. There is really only one reason though, and it is not making movement and exercise a firm part of our routine. It is not that we are lazy, we just haven’t placed it high on the priority list and that list can be long.

Now that you have decided you do not want to be part of the 51% of women who don’t exercise, it is time to start making some changes.

Starting with your activity level is a good place to begin. I want you to take these next steps.

Decide what you would like to try for exercise and schedule a time. Sign up for an exercise class either with or without a friend. Get out of the house first thing in the morning for whatever amount of time you can, and do something such as walking. Set an alarm on your watch or phone every 60-90 minutes and walk around the house or office; even run up a flight of stairs.

I absolutely know you will feel better with more movement built into your day. You may have to pick specific activities if you have an orthopedic problem, and I can make suggestions for you to discuss with your medical provider.

As for me, I admitted to myself that my shorts are fine and I will like them more if they are a little looser. I don’t need new ones. So I will be doing my floor exercises more faithfully at night while I watch the evening news.

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Quilty Pleasure or Sustenance?

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There is no doubt that much of the world has a weight problem, and the associated diseases that come with being obese.

And there is no doubt that entering menopause causes us to gain weight, and this can be frightening when hearing about the statistics of illness associated with weight gain.

There is also no doubt that the primary reason for weight gain in our current times result from the type of foods available in terms of processing, the overabundance of unhealthy food; as well as the increasing sedentary and stressful lives most of us are living.

New guidelines for the UK address some of these concerns with the recent recommendation of decreasing the amount of free sugar consumed from 10% of recommended calories to 5%. This translates to 25 gm for women and 30 gm for men of added sugar. This recommended amount of consumed sugar is also the recommendation put forth by experts concerned with promoting health.

Added sugar is table sugar and sugar added into drinks and foods, along with what occurs naturally in juices, syrups and honey. 1 tsp is equal to 5 gms, so that is basically 5 tsp. of sugar daily as the limit.

Looking at the nutritional label can often tell you the content of sugar, it is usually named in grams.

This is helpful information for trying to limit sugar intake, but it quickly becomes obvious that it doesn’t amount to much sugar!

Additionally, recent studies have identified stress hormone receptors in our taste buds. It appears that when we are under stress, these stress hormones can make the sweet taste buds less sensitive. As a result, that afternoon cookie may not do it for you, so you reach for more. Sound familiar?

It appears that stress can trigger us to eat more of the sweet stuff for the same fix, even at such a simple level as our taste buds! It hardly seems fair.

Sugar is indeed part of our lives, and eating foods high in sugar directly hits our reward center. When stress is involved, this circuit often bypasses the control center of our brains.

How can we change something so innate and seemingly basic to our psyche?

Strengthening the control center is how. This is done through mindfulness and meditation, practicing substituting other comfort measures to employ when we are stressed. It is well documented that both of these practices strengthen the part of the brain that is responsible for conscious control. This is the prefrontal cortex, the conscious decision maker.

I recently decided to enact my own plans for substituting the mindless eating of food the minute I walk in the door from work.

I love the outdoors and so decided after spending all day inside, I would spend some time in the garden. Evening is a good time to water the plants, so that is what I try to do.

I also practice delay tactics by telling myself I can have those snacks I crave after I water the garden, if I still want them. The trick is getting by the food cabinets on the way to changing my clothes!

Weight control and weight loss at all ages, but especially that associated with aging requires being aware of the type of food we eat in terms of the level of processing with added fats and sugars. Along with this is the need to control stress and comfort food eating, as this type of eating is usually unneeded calorie consumption.

Here are some tips for decreasing foods that undermine your health goals:

  • You can practice delay tactics by telling yourself to wait 5 minutes before eating that candy bar.
  • You can identify the times of day that you are particularly vulnerable to mindless eating and devise a diversion; eg. talk to a coworker instead of walking to the snack dispensing machine
  • Don’t buy anything in a box (or bag) to have at your house
  • Substitute a serving of fruit, or drink a flavored seltzer water
  • Make yourself have to physically go to a store to buy something sweet, the time it takes to do this my dissuade you from the errand

These are just a few tactics, write in with your own tricks fostering better eating! We can all use some help in improving our diet and health. The focus on food as pleasure continues as we age, and we just don’t seem to burn it off like we once did!



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Habits Can Change Your Life

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What exactly are your habits and why are they important for change? Habits are what we do throughout the day; actions that govern our lives, often without us even thinking about it. Habits are what save our cognitive powers for the more important tasks of the day.

Most people think that focusing and strengthening willpower is what it takes to resist temptation, or to make a life style change. We often concentrate too much on willpower to make the changes we want. How many times have you told yourself in the morning: if I have enough willpower today, I will be able to resist smoking/sugar/sweets/etc; whatever it is you want to change.

Dr Kelly McGonigal states in her book “The Willpower Instinct” , that research has shown that the people who believe they have the strongest will power are the ones most likely to fail at resisting temptation!


They are the least self informed about where, what and why they fail temptation. By not knowing what their triggers are, they expose themselves to situations that will tempt them.

So how can we change our bad habits if willpower will not provide us with the tool we need?

Habits! Our habits are what we do without thinking, without expending energy to make a decision. Establishing firm and consistent habits is not as hard as you may think, and it is the cornerstone of making healthy changes.

As Charles Duhigg discusses in his book, The Power of Habits; habits influence everything we do throughout the day including how we get dressed in the morning, to interacting and working and continuing to whether we reach for food and a beer at the end of a day. We can change our habits repeatedly over time, in order to adjust to what we need at any given time of our lives.

Habits can help you change your life, or can keep you mired in the same routine that is creating the very problems you want to change.

Either way, if change is in your future to become your wanted future self; you must change your habits.

Start with one small change you want to make. Plan for it in your routine and imagine yourself doing this thing. Construct a routine around this habit, or the avoidance of this habit.

A personal example I will share with you involves my suspicion of  vegetables. I am a health care provider, and I preach all day long about the power of healthy diet. I try to follow the example of my own words, but I admit I find it hard to eat my vegetables every day.

In searching for a habit that would some how allow me to increase vegetables, I came upon green smoothies.  So I tried it for a week or so and realized I could handle raw spinach or Kale as long as it was pulverized and blended with some sweet fruit. To reinforce this habit, I leave the blender on the counter next to the sink and below the cabinet with coffee cups. Can’t miss it. I make myself buy the big tub of baby spinach and because I hate throwing out food; I am compelled to use it up every week.

After 3-4 months of this, it is firmly imbedded in my morning routine. Low and behold, my husband, who hates vegetables even more than I do; drinks them also!

Forming a new habit involves a commitment to this habit, as well as setting triggers and tools in place to help you with your commitment to this habit. With regular practice and focusing on the positives of this change, you just might find yourself sauteing broccoli for dinner!

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Poor Sleep and Poor Bones

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Sleep is powerful medicine and as our sleep deprived society continues, research continues to reveal to us how lack of sleep is seriously affecting our health.

A recent study published in the Journal of Clinical Endocrinology and Metabolism supports the importance of sleep. A study performed in Taiwan involving over 1300 people diagnosed with Obstructive Sleep Apnea revealed that these patients had more than twice the rate of osteoporosis compared to an equal group without a diagnosis of OSA. All other potential contributing factors were eliminated or adjusted for.

Osteoporosis is a significant health risk for all aging women, and many men. It can lead to hip fractures and immobility, further declining our health. The reduced amount of  oxygen distributed to the bones during the poor sleep associated with OSA was felt to be the causative factor.

Obstructive Sleep Apnea is a problems often associated with aging and the relaxation of supportive structures within the throat and mouth. This loss of support can cause obstruction of the breathing airway as we sleep, lessening the amount of oxygen that reaches our lungs and as a result, our blood stream. This lower oxygen can then cause the heart to work harder to deliver oxygen to our tissues for metabolism. Lower oxygen means less healthy metabolism, including in our bones.

The researchers of this study admit that although the exact mechanism of this increased incidence of osteoporosis is not known, there still appears to be a high association between OSA and osteoporosis that is important to keep in mind.

Helping to improve your life style to avoid both OSA and osteoporosis includes a healthy plant based diet to control weight, as well as ensuring consumption of calcium and Vitamin D. Smoking cessation helps improve the function of lungs. Exercising will do the same as well as control weight and help stimulate bone forming cells to lay down new calcium.

If you have OSA, or poor sleep that includes snoring; it is important to be evaluated and treated. This will decrease stress on the heart, improve lung function, improve sleep quality and energy; and now to help preserve healthy bones!

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March was the designated month for colon cancer awareness; and what could be more timely than news of a new method for screening awaiting approval by the FDA. The American Cancer Society states that over 140,000 new diagnosis of colon cancer occurred in 2011 alone, with up to 49,000 deaths. Similar statistics noted for 2013 and are expected for 2014.

If you are over 50, or have a family history of colon cancer; your medical provider has most likely spoken with you regarding the importance of a colonoscopy. This is an important conversation given the above statistics.

In the event you have studiously avoided any talk with friends or family regarding this often dreaded procedure; I will take a moment to review it for you! Polyps are the usual precursors to colon cancer, and when discovered early and removed; can prevent cancer from occurring. Colonoscopy is the best way for this to happen, often called “the gold standard” for colon cancer detection.

Colonoscopy is a procedure where a long tube with a fiberoptic lens at the end in inserted moved upwards through your large bowel to the end, where the appendix is or was. The specialist is looking at the walls of your large bowel, searching for abnormalities. If any are found, the area can be biopsied or a polyp removed through tools inserted through a channel of the endoscope.

Sounds lovely, right! Thankfully, you are usually asleep for this procedure. As you can imagine however, your bowel walls must be clean so that abnormalities are not hidden by waste-that would be stool. The colonoscopy is actually the easier part, it is the cleaning process that can be more challenging.

Having worked for over 10 years for the division of Gastroenterology at Duke Medical Center, I am well aware of the benefits of colonoscopy. I observed and assisted with hundreds of colonoscopies, and I am a major advocate for this procedure. In the hands of an experienced colonoscopist, it is extremely safe.

In my role as a medical provider, I have instructed countless patients regarding the ease at which this procedure is often done. What I did not realize, despite many conversations with people; is how loathsome the clean out can be! When I personally experienced this, I understood clearly, the reluctance with which many people approach this procedure!

This new test is potentially an exciting screening tool for low risk people to use, possibly in place of colonoscopy. It detects the presence of DNA, or genetic code, shed by polyps and cancers into the stool. It is potentially far more accurate than stool guiaic testing, which only tests for the presence of blood in the stool.

Co-author for this study, Dr. Steven Itzkowitz, also director to the fellowship training program at The Icbahn Medical School at Mount Sinai; excitedly states what a breakthrough this test is. “That kind of result is really unprecedented for a non-invasive stool based screening” speaking of the 90% accuracy the study found with test subjects.

Better yet, this test is done in the privacy of your home! Before you get too excited, this test is not yet available for wide spread use. So if you have been holding out hope for a more comfortable test, one is on the way!

Do not hold out for this test though, if you are experiencing blood in stool, a persistent change in the size or shape of stool, abdominal,pelvic or rectal pain. These may all be signs of colon cancer and need immediate evaluation, especially if you have a family history of colon or rectal cancer.

As a medical provider, I recommend routine screening and feel it is easily tolerated. However as a person who now undergoes these invasive routine screens, I fully understand the reluctance!

Hopefully you will get a 10 year reprieve as I did, if there are no polyps!


Is Your Lotion Making You Sick?

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How can something so benign as body and face lotion, or shampoo cause serious harm?

Parabens. What?

Parabens are chemical preservatives added to lotions, cosmetic and shampoos to guard against bacterial growth and contamination. Sounds like a good additive, right? The problem is that these chemicals are also in a class called endocrine disruptors, and pathologists have discovered them in some breast cancer tissue.

An endocrine disruptor is a chemical, either man made or naturally occurring; that mimics a certain hormone. These chemicals can cause an inappropriate response by its target, or it can latch to a receptor making the actual hormone ineffectual.

Simply put, these are chemicals that interfere with the normal hormonal response of our body. Examples include compounds found in soy and certain vegetables that can interfere with the thyroid hormone. A diet high in these compounds can fool the body regarding the amount of thyroid hormone floating around the blood stream, causing the thyroid to become over or under active.

These parabens in lotions and toothpaste are weak estrogen mimics, causing increased cell growth in estrogen sensitive tissue, like our breasts. Another examples of an endocrine disruptor the chemical BPA, which is used to line cans and in plastic bottles. The amount of this chemical capable of leaching into the product it contains, is unknown. Increased amounts of this has raised concerns regarding behavioral and developmental issues for children as well as a developing fetus.

Whether you are menopausal or not, it is wise to check your beauty products for parabens, and perhaps chose a product without this additive. Additionally, switch from plastic bottles to glass or metal water bottles that can be refilled. This is better for the environment also! Limiting canned products will also reduce the sodium you consume which will help control blood pressure.

The EPA is more concerned about the amount of exposure we are all getting rather than this exposure coming from one place. Now that DDT has been eliminated from use, there is rarely one big exposure. It is more the slow, small, day to day use of these products that contain endocrine disruptors that may be harmful.

It seems that a few simple small changes may be worth while for health AND environmental reasons!

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Escape the Code!

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Think it is impossible to escape your genetics? Are you destined and resigned to end up looking just like one of your parents, or Aunt Sally or Uncle Benny?

An interesting study looking at just that was recently released to the news. This research is centered on the genetic risk of breast cancer, and possible explanations for healthy members within clusters of families with strong histories of cancer.

Having a family history of  the BRCA1 and BRCA 2 gene mutation significantly increases a woman’s risk for developing breast cancer. This specific gene mutation is only responsible for some of the incidences of breast cancer. Researchers have been looking at other factors explaining this cluster of familial cancers. This has led to the exciting research regarding epigenetics!

It just may be possible to some degree, to escape your genetic code!

Genetic code is in all of our cells and it is the blueprint from which our cells, organs and bodies will work. Epigenetics is the machinery that actually turns on or turns off this blueprint. It can, and will determine what happens within your cells and your body.

Researchers and scientists are talking about something called methylation. This methylation process can prevent cancer from growing in certain situations, or help it to grow in other situations. It depends on the where in the body it is working, how much methylation is happening, and what is actually making it work.

It turns out that a decrease in the healthy methylation process may be responsible for aging. This decrease of healthy methylation can lead to hyper or hypomethlyation, which can then promote growth of cancer cells. This type of decrease is considered a somewhat natural process associated with normal aging. It then seems that certain life style habits can cause the wrong type of over methylation, leading to problems with glucose metabolism and also to cancer.

Getting back to the study I mentioned above. Unaffected women from high risk families with breast cancer were found to have different methylated blood cells when compared to affected family members. Researchers are not sure yet what this means, but it suggests a changed expression in the genetic code.

Another recent study regarding the incidence of breast cancer in British women revealed another surprising difference. White women residing in the UK were noted to have a higher incidence of breast cancer compared to South Asian women and black women, also residing in the UK. This difference was attributed to a higher consumption of alcohol and decreased amount of breast feeding by white women as compared to women of other ethnicity. When these habits were removed from the equation, the rate of breast cancer was equal throughout the different groups of women.

Diet has been shown to affect the expression of cells, specifically a diet low in folic acid is associated with gastrointestinal malignancies. Use of opiates, nicotine, and over use of alcohol have all shown  changes in cells leading to cancer through abnormal cell repair and DNA expression. This is the route believed to allow cancer cells to grow. Exercise has shown to elevated protective chemicals within our bodies which help prevent this abnormal methylation process.

Why are we talking about this? Researchers are beginning to identify the different affects healthy and unhealthy habits have on the incidence of disease. This empowers us to make decisions that allow us to take more control of our health and hopefully, longevity.

You may not be destined to develop diabetes or heart disease as you age, you may not be at risk for cancers. It may be possible to escape your genetic code by choosing certain habits that are beneficial to your epigenetics.

Think back on all the good advise from our mothers or fathers regarding healthy habits. Teachings such as eat your vegetables, get enough sleep, no drinking to excess or smoking at all; they were talking epigenetics!

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The Quandry of Cholesterol Medication

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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.

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Your Exercise Prescription

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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!


More On Telomeres

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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!

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