Women's Wellness Blog

Few things are more unpleasant than painful urination. (Wee Wee for those folks perpetually arrested in the kindergarten stage of development).

Unfortunately, this is such a common occurrence I feel compelled, obligated, and otherwise obliged to give a brief overview of the five most common causes in women along with some common treatments. If you are a guy and reading this and your WeeWee hurts…Just let it fall off.

Number one with a bullet is a urinary tract infection.

Commonly called a bladder infection, cystitis, or that raging pain from Hell that makes me want to throw up a lung. These infections are characterized by frequency and urgency along with the burning. Most bladder infections are limited to the lower urinary tract (bladder and urethra) as to be distinguished from a more serious infection involving the kidneys. Luckily, theses are usually easily treated with antibiotics and prayer.

A common but less recognized cause of painful urination is Interstitial Cystitis (IC). Besides sounding like a cool name for a band, IC is not an infection but an inflammation (a somewhat technical and nerdy distinction, but important) so antibiotics will do nothing for this problem. Patients who suffer from IC are horribly frustrated because their classic history is having been treated for multiple bladder infections, and the darn things keep coming back. The reality is that many never had an infection at all and they just paid for their doctor's new car with all their visits to the clinic. If it is properly diagnosed, there are treatments available including medicines and bladder installations (as opposed to military installations).

Third is our perennial culprit, menopause.

Of course menopause has been blamed for everything from hair loss to first-degree murder, but in this case, it actually can lead to an woe in the wee. In menopause, the urethral and vaginal tissues can get thin and you can lose lubrication, resulting in burning both during urination and if the urine hits the labia and vulva. This rather distasteful outcome can be thwarted by a little estrogen cream (a little dab will do ya!) or a new laser treatment cheekily called MonaLisa Touch.

One of my favorite causes is linked to bladder infections, but I feel it deserves its own category because of its catchy name, honeymoon cystitis. In this day of couples living together and virginity at marriage being as rare as an honest congressman, this is somewhat a misnomer simply because it is tied to the initiation and/or frequency of sexual activity. In days gone by, when the earth was still cooling and couples actually waited until the honeymoon to jump each other’s bones, many women complained of urinary burning when they came back from Niagara Falls.

It was more related to repetitive friction (do I really have to paint a picture here?) than infection, but that sometimes occurred. Anyhoo, women still can get this problem if they suddenly have an active evening…I mean a real active evening…out of their norm. The good news is that many times this resolves spontaneously, especially if you have a headache every evening for a couple of weeks.

(wink, wink)

Last, and definitely least, is our friend the STD. For those over 50, that is a sexually transmitted disease. One of the most common of these is the herpes virus. In this day of HPV and AIDs, herpes has become somewhat forgotten (much like Justin Bieber) but it still runs rampant.

The little ulcers that signal an outbreak often are first noticed when urine hits them. Think hydrochloric acid on a paper cut. Herpes cannot be cured but it can be managed with a variety of medicines. Unfortunately, it’s the gift that just keeps on giving.

There are some over the counter medicines (AZO, uristat, uricalm, StopTheBurningOrI’llScream) that can act as a Band-Aid for the problem, but just remember, to really treat things properly you have to get the proper diagnosis, and that only comes from contributing to your doctor’s daughter’s college fund.

It used to be that in polite company you didn’t talk about politics, religion, or sex. That doesn’t necessarily apply today as often times when discussing politics, sex seems to be a factor. Nevertheless, I am going to stay away from politics and religion and focus on sex. In particular, I want to focus on a very common problem, especially in the menopause, of pain and/or discomfort with intercourse. It is estimated that upwards of 75% of women after age 51 will at some time complain of this issue, and that may be underestimated as many feel the incidence is underreported due to women not telling their doctor about it in the first place. Many women mistakenly believe that this is just a normal part of aging and there is nothing to be done about it. There is nothing further from the truth.

The technical term, dyspareunia, comes from a Greek word (don’t they all!) “dyspareunos”, which means “badly mated”. Those who suffer from this malady can confirm that pain every time you have sex creates “bad mating” as well as other problems. The first step in solving this dilemma is properly identifying the factors that play a role. As I mentioned, this is a much more common occurrence in the menopause, although it definitely can occur at other seasons of life. After menopause, either natural or surgical, estrogen levels decline and periods cease. The cells that line the vaginal walls are very hormone sensitive tissues, and with a lack of hormones, the normally thick and lush epithelium (lining cells) can become thin and much less elastic. Over time this results in dry, less pliable tissue that can cause a variety of symptoms. The old terminology for this problem was atrophic vaginitis, however this has been revised to genitourinary syndrome (GS) to properly encompass the potential wide ranging nature of the problem. The tissues of the vagina, vulva, and bladder can all be effected as they are all dependent on estrogen for continued proliferation and lubrication.
Potential symptoms of GS include:
Burning and irritation of reproductive organs and structures
Dryness, discomfort, or pain with intercourse
Urinary urgency
Dysuria(pain with urination)
Recurrent infections.

It is important to remember that not all women will be afflicted with this problem, and some women will only manifest a single symptom. Nevertheless, GS is the leading cause of painful intercourse in peri and postmenopausal women.
So what’s a girl to do?

There are a number of treatment options for solving this problem. First realize that doing anything is predicated on the fact that it is a problem. I have a number of patients that have some symptoms, but they are either minor or not a problem given their current situation. If that is the case then realistically nothing needs to be done. Treatment is dependent on the presence of bothersome symptoms. One of the tried and true approaches is to replenish estrogen to these tissues. This can be done in the form of local therapy like a cream, gel, or a silastic ring implanted with the hormone. A woman can also be placed on a systemic treatment like a pill or patch and see improvement in vaginal tissues and symptoms. Any use of hormones has advantages and disadvantages, and I don’t have space to delve into that quagmire here. Suffice it to say that the use of estrogen is a legitimate and effective treatment, but not your only option.

There is a class of medicines called SERMs (selective estrogen receptor modulators) that are used to help vaginal dryness and pain with sex. One in particular has been approved for this use, but again there are potential side effects to be considered.

A relatively recent and novel approach is to use a CO2 laser to stimulate collagen and epithelial growth essentially “rejuvenating” the vaginal tissue and eliminating or lessoning the pain symptoms. This is a painless office procedure that has been extremely successful in clinical trials in improving lubrication, decreasing pain with sex and aiding elasticity.

In addition to menopause, various other causes can be responsible for painful intercourse. Any type of vaginal infection can temporarily create irritation and pain. Obviously treating the infection is key to resolution. Scar tissue in the pelvis from prior surgery or infections can do the same. Urinary tract infections (bladder infections) and even chronic antihistamine use (drying of the vaginal tissues) can be culprits. There is a relatively rare condition called vaginismus where a woman experiences involuntary muscle contractions in the vaginal wall while attempting sexual relations which results in pain and an inability to allow penetration.

This common problem can be adequately addressed in most situations and it is a matter of telling your doctor about your symptoms and together seeking a solution.

Obesity is a chronic illness. The time has come to put away misperceptions, politically correct dialogue, and downright ignorance and understand this medical problem. Being overweight is not a lack of willpower, a character flaw, or anyone’s fault. It is a complex medical disease state that has a multitude of causal factors including genetics, environmental, psychological, metabolic, nutritional, and social.

To understand the complexity of both the origin and treatment of obesity you first have to understand the terminology. Obesity is a clinical diagnosis based on various guidelines, the most common being the Body Mass Index, or BMI. Using this scale a person is considered either normal, overweight or obese based on their height divided by their weight. There are problems with this standardization, as there are with all scales, but suffice it to say for this discussion that there is a difference between being overweight and obese. Most of the medical complications due to excess body fat arise in those folks who fall into the obese category. Granted it is a continuum, with a steady rise in problems as BMI and percent body fat rises, but understand that I am not talking about the middle aged woman who puts on an extra ten pounds. She is not obese and doesn’t have this disease. That is a simple but important distinction.

For those who would challenge this characterization of obesity as a disease I offer the following. The most recent statistics from the American Cancer Society report that:

80% of type II diabetes is related to obesity.

70% of cardiovascular disease is related to obesity.

42% breast and colon cancer diagnosed among overweight individuals.

30% of gall bladder surgery related to being overweight.

26% of overweight people have high blood pressure.

100,000 new cases of cancer a year due to obesity.

The reality is that this is simply the tip of the iceberg as it applies to chronic illnesses and obesity. Any other physical condition that created such a list of maladies would probably have its own telethon by now!

And any who suffer obesity understand clearly that it is a chronic problem. When you consider the physiologic changes that happen in the body - in the endocrine system, brain, and metabolism - you quickly realize that the duration of the problem is often lifelong. Considering the increasing role genetics plays in obesity, one can easily surmise that this is a chronic problem.

Unfortunately, the treatment of obesity has suffered greatly due to the lack of understanding of the origins of the disease. Many if not most approaches are focused on simply one aspect of obesity. For example, many so called treatments simply restrict calorie intake. This is largely based on the fallacy of the energy balance equation that says to lose weight you simply take in less than you burn off. Not only is this a complete oversimplification of the problem, but it can actually worsen the situation. Studies are abundant now that illustrate very low calorie diets that result in rapid weight loss actually alter a person’s metabolism such that once they return to a life sustaining “normal” dietary intake, they gain back all their lost weight and even more. Any therapy that focuses on only one factor is doomed to failure.

That brings me to another important consideration in the treatment of this disease. It would be rather ludicrous for someone with diabetes, for example, to get treatment from a celebrity spokesmodel on a TV infomercial. Yet that is what happens all the time with obesity. Most of the commercial products and diet plans don’t make a distinction between the person who is 10 pounds overweight and the person with clinical obesity, they just lump them all into the category of “folks we can sell stuff to.” Yes, you may be able to lose a few pounds by drinking some shake or eating a prepackaged meal (but 98.6% of the time you won’t keep it off) but understand this is not a treatment for a disease. It is marketing hype and often bad science.

As you can surmise from the preceding rant, treating obesity is not for one size fits all. Not every plan works for everyone…but everyone needs a plan. Here is a quick way to tell if the plan you hope to use is worthwhile. It must meet these basic criteria or I would look elsewhere:

Is it healthy?

Is it meant for the long term?

Does it involve exercise?

Can you learn from it?

Are there ways to hold you accountable?

Is it flexible?

Is it easy to follow?

Does it meet the “smell” test?

If your approach falls short, so will your weight loss.

The only reasonable approach to treating a chronic disease is to first have a qualified and knowledgable doctor evaluate your individual situation and understand what factors are contributing to your specific condition. There is absolutely no room for a cookbook approach to weight control. Next, you need a multi pronged management plan that looks at all factors including nutrition, genetics, lifestyle, associated medical conditions, activity level, social and economic factors, and psychological influences. Just as every person with diabetes has a detailed plan of differing medications and lifestyle changes, so the person with obesity should have an approach to treatment that is individually tailored.

The final critical factor in treatment is understanding that this is a lifelong issue. Once a person reaches a goal weight, their treatment plan has to include ways to maintain and persist. Reaching a goal is certainly reason to celebrate, but understand that this treatment process is a marathon, not a sprint. You are setting yourself up for failure if you don’t have a plan in place to maintain your success.

After the publication of my book, A Woman’s Guide to Hormone Health, I had the opportunity to speak around the country to audiences of women about some very “feminine” subjects. I was in San Diego speaking to a group called The Red Hot Mammas (sort of a cross between a menopause support group and a motorcycle gang) and during the question and answer session a grandmotherly octogenarian sheepishly raised her hand and asked, “Doc, my sex drive has driven off and I don’t have a map! What do I do?” I heard an audible “thank goodness” from several other folks in the audience as they wanted to ask the same question but didn’t have the courage of my blue haired inquisitor. Over the ensuing years I don’t think I have ever hosted a forum where this topic didn’t raise its libidinous head.

Next to questions about losing weight, a declining or absent sex drive is one of the top complaints heard in gynecologist’s offices nationwide. A recent report from the National Institutes of Health states that 43% of women will experience some form of sexual dysfunction at sometime in their life. A majority of these problems, especially in perimenopausal and menopausal women, is a lack of desire. Loss of libido is defined by the Diagnostic and Statistic Manual (the book doctors use to categorize diseases) as "persistently low sexual desire resulting in distress or relationship dysfunction, where lack of desire is not due to another condition or circumstance." There are two important parts of this definition that are cogent to understanding the causes and treatments of this problem. First, the lack of desire must cause a problem either in the person’s psyche or in their relationships. So, for example, a woman with a low desire who is purposefully abstinent may not view that lack of desire as bothersome. Secondly, the low libido should not be due to a physical problem or medication. A common example of this in the menopause is the woman who experiences pain with intercourse due to vaginal changes in lubrication. It only makes sense that if it hurts, consciously or unconsciously, you are going to avoid intimacy like Republicans avoid taxes. Also various medications can have libido squashing side effects. For example, many of the anti depressants such as Prozac and Zoloft can flatten libido like a steamroller on asphalt.

The causes of a low or non-existent sex drive are legion, but they can generally be divided into four categories: physical, psychological, relationship, and hormonal.

Physical reasons include many nonsexual diseases such as arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Think of poor sex drive as side effects of these disease processes, and often once the physical malady is remedied, the libido returns. In addition, a glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive. Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex. A huge secondary cause is fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.

I already alluded to the role of hormones, and any major hormonal shift such as menopause, pregnancy, and breast feeding can affect desire.

There are many psychological causes of low sex drive such as anxiety, depression, poor body image, low self-esteem, and a history of physical or sexual abuse. One of the most overlooked but common causes of poor libido is stress. This can be stress related to work, finances, kids, or just life.

We all know that much of a satisfying sex life originates as much above the neck as it does below the waist; therefore, relationship issues are huge in dissecting libido malfunction. For many women, emotional closeness is an essential prelude to sexual intimacy. If you are having problems between the sheets, don’t pull the covers over your eyes!

So what can be done about this tsunami of libido lack? Obviously if there is an underlying issue, such as medications or hormone problems, they must be addressed first and often sex drive creeps back. If stress and relationship issues are paramount then talking with a counselor skilled in addressing sexual concerns can help with low libido. Therapy often includes education about sexual response, techniques, recommendations for reading materials, and couples exercises.

In women suffering from painful intercourse, vaginal estrogen may markedly improve vaginal elasticity, lubrication, and response. Testosterone, present in females at a much lower concentration than males, has a libido enhancing effect for women; however, testosterone supplementation is controversial and should be closely regulated by a knowledgeable clinician.

It is critical to remember that libido can’t be separated from the context of a relationship. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.

The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully dieing. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today! The seventy-five and older age group is the fastest growing segment of our population. These are folks who are not satisfied with the status quo. They are not happy to go gently into that good night. We (and I must include my rapidly aging self) want to grow old with gusto. We want to

come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us. We want to age without becoming aged!

In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”. They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”. In other words, they lived to the max and then had a rapid demise.

One of their key points was that there was not a way to prevent aging or reverse the aging process. Human’s will always age, that is a given of biological and cellular processes. The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging. The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”. We tend to think of this as aging gracefully, yet I believe that is much too passive. We must, as the study found, take an active role in doing some things and avoid doing other things.

So what did these scientists conclude? They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life. It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled. They further defined active engagement as having relationships with people and behavior that is productive. They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics.

The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained. For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.

Here are my top ten keys to successful aging culled from the MacArthur Study and my own research.

1. Exercise. Whether you are 10 or 100, exercise is the key to getting and staying healthy. Surprisingly the studies indicate that only a minimum of exercise (20-30minutes a day) can have a marked effect in lowering your risk of a number of diseases such as cancer, diabetes, and hypertension.

2. Get regular check ups. One of the secrets to successful aging is either preventing risk factors or identifying problems very early. Both of these tasks are facilitated by regular exams.

3. Stay current on routine screenings. Somewhat linked to regular checkups, availing yourself of things like mammograms, Pap smears, prostate exams, colonoscopies, bone densities, and blood screenings can be a lifesaver and allow you to enjoy a disease free old age.

4. Don’t smoke. Enough said. You would have to be a total fool to not realize the damage that this does to your system.

5. Take an aspirin a day. The evidence is mounting that a 61 mg aspirin a day can reduce the incidence of heart disease, stroke and colon cancer, especially in older folks. Remember that some people should not take aspirin, so check with your doctor before starting something new.

6. Get appropriate vaccines. For older folks the pneumonia and flu vaccines are important as these infections are responsible for thousands of deaths every year in people over 65.

7. Eat fewer total calories. The studies are conclusive that decreasing your total calorie intake is associated with lower rates of disease and longer lives. Specifically try to increase the protein and reduce the fat, but keeping the overall amount of calories lower is the most important guideline.

8. Develop social networks. As the song goes, people who need people are the happiest (and healthiest) people. An expanding network of family, friends, church membership, and social activities have all been associated with longer, less sickly aging.

9. Stay mentally engaged. Retire only if you must and if you must, find something else to keep you mentally active and challenged.

10. Be continually productive. By that I mean participate in either voluntary or paid activities that generate goods or services of economic value. That is a broad calling, but studies indicate that those who continue to find purpose, find health.

Remember, the goal is not just to live long, but to live long and well!

Libido or sexual desire is a complex drive that doesn’t lend itself to quick fixes. Because it is so multifaceted; however, it does lend itself to a variety of behaviors that may enhance an individual’s sexual appetite. Not all of these will work for everyone, but most will at least see some improvement if adopted.

Exercise.

Studies that have looked specifically at libido and

physical activity show a very positive correlation. Simply stated, the more you move, the more you can improve your sex life. This encompasses many aspects of low desire such as poor health, lack of energy, and emotional stress. Physical activity can help alleviate many of the causes of a low sex drive, so it acts in a domino effect: exercise improves some factors that lower libido thus indirectly improving your love life. And it doesn’t mean that you have to suddenly train for a marathon (actually too much exercise can have a negative effect) but simply walking 45 minutes a day is enough to get your groove back!

Take a look at your medicines.

A surprising number of medications can markedly affect sexual desire. A prolific example is a class of medicines known as the SSRIs. This includes such antidepressants as Zoloft, Prozac, and Paxil, as well as others. These medicines can damper desire in up to 50-60% of folks who take them, many of which were completely unaware of this side effect. The good news is that often there are substitute medicines that can help with the depression but have less of an effect on libido. Other medications that can effect both desire and function are blood pressure meds (B blockers) and antihistamines. An important category to consider, especially for women, is birth control pills. Many of these formulations cause the liver to produce a protein that binds up testosterone, the female hormone that contributes to desire, thus making less of it available to stoke the fires. Some pills are less likely to do this than others, so it’s worth looking at your options if this is a problem.

Get happy.

A massive number of people who suffer from depression, anxiety, and other mood disorders experience a poor sex drive. The relationship between your mental functioning and libido is complex, but remember that how you feel emotionally can drastically effect your desire. There are physiological as well as psychological reasons for this but the bottom line is that as you improve in your mental functioning, often you improve in libido. Noting that some anti depression meds can inhibit libido, sometimes this improvement can be masked or erased, yet there still is a positive connection between improved mood and improved desire.

Get a good night’s rest.

This may be counterintuitive as most sexual activity occurs in bed at night, but studies have shown that fatigue is one of the greatest inhibitors of libido, and one of the greatest influencers of fatigue is poor sleep. People who get restful sleep are more likely to have an improved mood as well as more energy, both of which can enhance desire. One caveat however is that those who use chemical sleep aids generally don’t see as much an improvement, even if they seem to sleep better. It probably has to do with the medicines themselves having a bit of an inhibitory effect and not so much with the quality of sleep. The truth remains that a regular good night’s rest may provide the energy and desire for a healthy sexual appetite.

Talking

What? Yes, talking with your partner about life, love and everything in between helps libido. Anything that fosters a sense of intimacy can have a profound effect on desire. Some experts speculate that they can tell a lot about a relationship by the quality of their sex life, and this goes back to communication, trust, respect, and self esteem. Probably the most important of those variables, as it relates to libido, is communication. That is the fulcrum upon which the others turn. With regular intimate communication couples can foster many of the settings in which desire can be translated into action. Likewise, poor communication can kill the mood quicker than an Adam Sandler movie. You communicate with words and actions, so be in tune with your partners needs and express that understanding and watch the sparks fly.

At first I was mad, then I was embarrassed, then I was just frustrated. I had just come from a lecture and my world had been

upended. Well, maybe that's a bit melodramatic. I mean it’s not like I found out I had AIDS or my daughter was kidnapped by Russian drug lords, but what I discovered was disturbing.

For the last 37 years of conscious adult life (I consider myself brain dead and uninformed at least until I was 20) I had been smothered by the misconception that eating fat and meat was tantamount to ingesting roach feces. I thought my proclivity towards vegetarian consumption was based on science and common sense. I mean after all, have you ever seen a fat vegan? These people look like they are refugees from the set of the Walking Dead. Realistically this should have been a deterrent unless I was wanting to become a permanent halloween character, but I was focused on the 2% body fat that these meat shunners tended to espouse. I equated skinny with healthy. I know now that this is somewhat like equating having an English accent with being smart, it ain’t necessarily so!

Granted, there are a lot of skinny folks who are fairly healthy and there are a lot of fat folks who are very sick, but there are also some thin people who are sick as sin and some plump people who are healthier than a hound dog with a pork chop collar. So fact number one that blew my medical doors was what we look like on the outside has very little correlation to what we look like on the inside. It’s a whole lot more complicated than that. If you want to get all esoteric about this you can say that a person’s beauty is on the inside and, while that may be true in a spiritual sense, you can be pretty ugly on the inside (physiologically speaking) and be a 10+ on the outside. Statistically it is more likely for you to have diabetes, heart disease, stroke, cancer and a plethora of other illnesses if you are seriously overweight, so I am not advocating being heavy, it’s just that moderation from both ends seems to be the ideal.

Fact number two, sugar and his devil twin insulin is the root of all evil, not money. Too much money and all you suffer from is exuberant luxury and terminal opulence, too much sugar and you…die! We have been bamboozled by years of false teachings regarding nutrition, and unfortunately the guided gentry of the medical society are largely responsible for perpetuating the myth. I have swallowed this gospel hook, line, and lard and have preached for thirty years that a low fat diet is the holy grail of health. I learned today that I have been a harbinger of hubristic hoohoo. First, this is ridiculously simplistic. The mechanics of metabolism would make a Swiss watchmaker jealous. Stating with legalistic finality that limiting one class of nutrients was the cure of all the world's ills is dangerously dogmatic and simply wrong. When momma said eat a balanced meal those many years ago, she was right. Moderation in all and nothing in excess, except maybe Pokemon Go.

The third fact is that what sometimes thought of as good can actually turn out to be bad, sort of like watching Seinfeld. There was an old Greek philosopher, it’s hard to remember which, there were so many, who said “everything in moderation, nothing in excess”. It was known as the Greek Ideal, as opposed to Venus, who is Greek, but not that ideal. In this case it is our old friend insulin. This pancreatic hormone does a very good thing when it is in small quantities. It regulates blood sugar and prevents your serum from becoming molasses. But when there is too much, and too much for a long time, bad things happen, much like that uncle who visits for weeks at a time. Insulin resistance, like the French resistance , lead to death and destruction. The insulin problem is at the root of many maladies such as diabetes, obesity, hypertension, and impotence. That is not a pretty picture. Control the sugar and you control the insulin. And in this particular sense sugar is synonymous with carbohydrates. You can’t lump all carbohydrates together, just as you can’t lump all college professors together, some are good, some are bad and some just smell funny. The key is identifying which carbs elevate the insulin most and avoid those like you would a herpes invasion. Increase your protein and even your fat (I still cringe when I say that it is so entrenched in my being) but limit carbs if you want to hang around as long as possible.

I have revamped my simplistic nutritional mantra, Eat balanced, lower trans-fats, low sugar, and high fiber.

Commandment Six

You Shall not Self-destruct:

How You Think Can Keep You Healthy

At times we can be our own worst enemy. Just as it is vital to know what to do, it is almost as important to know what not to do. Seven of the top ten causes of death are accurately described as lifestyle illnesses. This means they are largely triggered by actions and choices. In terms of our health, genetics loads the gun, but behavior pulls the trigger. The top offenders are cigarettes and

alcohol, yet more insidious behaviors such as sexual promiscuity and the spread of life threatening sexually transmitted diseases have to be brought into the forefront of the discussion. For the first time in history, our daughters, in particular, are faced with behavioral based diseases that can result in cancer and death at an early age. The epidemic of such STDs as Human Papilloma Virus is no longer simply an embarrassment or inconvenience; it can kill. Choose to avoid behaviors that can significantly increase your risk of illness. This should be appreciated not as restrictions but as opportunities to make wise choices that can have lasting benefits.

Commandment Seven

You Shall Not Fear Cancer:

Simple Steps to Reduce Your Risk

The word itself, cancer, creates a blanket of fear that can smother the most stoic and strong. In particular, breast and ovarian cancer concerns dominate the thoughts of women especially those saddled with a strong family history of either disease. The good news is that seven of the top ten risk factors for these cancers are controllable. There are steps that every woman can take to reduce their risks up to 50-60% of ever hearing the words, “You have cancer.” In the end, we all are at some risk of an aberrant cell forgetting how to stop growing, but it seems only logical that anything we can do to reduce the risk is a good thing. It is, indeed, a good thing to lower chances, especially if doing so also leads to looking better, feeling better, and acting better.

Commandment Eight

You Shall be Heart Healthy:

Just Say No to Heart Attacks and Strokes

Heart disease and stroke combined are the leading killers of women over the age of fifty. Cutting edge research is shedding new light on factors that influence heart heath specifically in women. For decades studies on heart disease and stroke looked almost exclusively at males, assessing risks and treatments. Only in the past decade has medical researchers acknowledge that women are different when it comes to their characteristics and proclivity towards cardiovascular disease. Hormones (both intrinsic and extrinsic), diet, cholesterol levels, and blood pressure are a few of the areas of special note in designing a specific plan for heart health.

Commandment Nine

You Shall Drink…Water:

The Real Fountain of Youth

The human body is anywhere from 55% to 78% water, and virtually all body systems rely on adequate hydration for proper functioning. A leading cause of morbidity is moderate, chronic, inadequate fluid intake. Myths abound regarding the safety and contamination of tap water supplies. The “six to eight glasses of water” mantra we all know and never do is nevertheless true. Our bodies enjoy a well designed, miraculous constitution, but it is our responsibility to be good stewards of this gift by filling it with the “elixir of health”: water.

Commandment Ten

You Shall Worship:

God Wants You to be Healthy

Studies have shown that regardless of your religious affiliation, folks who worship God in whatever fashion are healthier. This basic act of obedience not only fulfills one of our inherent purposes, but also has been shown to be good for our health. Cutting edge research from such institutions as Duke University and Harvard Medical School show the surprising health benefits of worship. Obviously this is not the purpose of worship, and it has been shown that those who practice false religious piety don’t exhibit the same benefits as those who display intrinsic religiosity. Praise and adoration is an end in itself, but it is characteristic of God to add a wonderful “side effect” to worship like improved health. Worship in its many iterations ties together many of the other nine commandments and creates an environment for health and healing. There is no right or wrong way to worship; no template for healing. It is shown that any heart felt act of praise and obedience can result in a harmony of wholeness.

In this turbulent time of change, one thing remains constant; your health is largely a choice. More importantly the health of your family is a legacy that will either bless or afflict those for generations to come. With the full understanding that new resolutions are kept for an average of 36.4 seconds, I challenge you to make 2016 the year of the health nut. Be abnormal! Get healthy!

A few weeks ago my wife and I picked up our daughter from the Atlanta airport. She was returning from a "Maymester" in Ireland. This is a new concept to me which I found out was a clever semantic substitution for "vacation." Colleges make reciprocal arrangements with foreign universities for study abroad programs and then give a few hours credit for classes like "media studies" and "Living History." I guess when students come to the U.S. they can study "Imagineering" and "The Broadway Experience". I must admit some genius administrator was sitting around the faculty lounge one day, eating his bologna sandwich between lectures to sleeping freshmen, and thought there must be a better way. Why not set up a program where I get paid to tour Europe, spend two hours a day talking about a subject that I mastered from an online Khan Academy course, and then drink wine all night. Thus the birth of the travel abroad program at your local university.

I'm sure these kids have a great time, but let's get real as Dr Phil might say. They are not getting a massive amount of edumacating! Some of these classes claim to cram three credit hours into two weeks of backpacking through Croatia. That's like saying I can learn astrophysics while strolling around Disney World. It's hard to see how intensive instruction can be wedged between touring various pubs and kissing the Blarney Stone! After all, if you tour enough pubs everything begins to sound like Blarney.

My oldest daughter also did a stint in Europe. She was in London, Rome and Florence for about eight weeks. This was a bit less of a whirlwind tour of the breweries and a bit more of the classroom, but it was still a pretty sweet deal. The best part of her extended stay is that my wife and I could use it as a rationalization for us to visit. We had no doubt that she would completely decompensated unless we arrived to bolster her and take in a few wineries and museums while we were there. We didn't get any college credit however, and she would have done just fine without us, but we went anyway. The most recent excursion by our youngest offspring was, alas, too short notice for us to plan a visit, and I suspect she planned it that way.

It had been a while since I had been in the International terminal at Hartsfield International airport and it was a pleasant surprise. Being used to the cattle call that is the main terminal, I bathed in the relative spaciousness of the international terminal and never felt I was being groped liked I often did on terminal A-D, or especially on the germ infested people transporter claiming to be a tram system. The international terminal actually had Muzak you could hear (a nice mix of Burt Bacharach tunes), relatively short lines and TSA agents who looked like they wanted to be there, and a nice place to meet deplaned loved ones. Both Susan and I had a grand time watching arriving passengers being greeted by what appeared to be family, friends, lovers, acquaintances, and drug sniffing dogs. It was so fun to imagine the stories behind each arrival. Being the international terminal, we didn't much have to worry about people hearing what we made up because English was definitely a second and possible a third language. Whatever the story, they were all punctuated by joy, relief, and not a few tears. If you ever want a pick me up, go watch families greeting each other at the international terminal.

The reception area where arriving passengers depart is a bit deceiving however. There is the main chute where it seems the majority of folks arrive and run into the arms of awaiting family and friends, and then there is a back way that allows some passengers to go around, passing directly behind those anxiously awaiting them. I mention this because Susan and I were standing at the rail, waiting to completely embarrass our daughter with a totally unnecessary display of affection, until we got a text asking where we were. Of course my genius answer was "here". She appropriately replied, "and where might here be?" At this point I decided instead of thirty texts to clarify the matter, I was better off actually having a conversation so I called her. It seems she had cleverly bypassed us at the gate and had already picked up her luggage and was waiting rather impatiently for her chauffeurs...us.

I am thankful that I have the resources to let my girls experience the travel and study abroad phenomenon. They both appreciate and understand that they, like many of their peers, are blessed, and they both came back with a special and unique perspective that they couldn't get anywhere else.

When I die, I want to come back as my kids!

Many years ago a desert dweller climbed a mountain and talked to a bush on fire. What resulted was a set of laws that was to revolutionize mankind’s behavior. These were not ten suggestions formulated by a long range planning committee nor were they ten proposals put forth by a strategic consultant, they were commandments from a Holy God. These laws have become almost universally accepted, even by divergent religions, as wise and worthy of adopting.

With all humility and a sincere desire to be unpretentious (I am not even worthy enough to scrape the grasshoppers from Moses’ designer goat skin sandals), I propose the Ten Commandments of good health to serve as a lamppost for your journey down fitness lane. It seems unfair to hurry through these guidelines, so I will opine in both this month’s and next month’s column to cover them all.

Commandment One

You Shall Exercise:

Live Longer, Reduce Stress, and Grow Your Brain

Exercise is the elusive fountain of youth. If you are heavy, harried or hormonal, moving with purpose is a critical part of the solution. Everyone knows exercise is good for you, but few of us follow through. Exercise begins above the neck with a commitment to self and family. Part of this motivation lies in the hidden benefits of exercise that are not common knowledge such as the prevention of breast and prostate cancer, reduction in the onset and progression of Alzheimer’s disease, and as a cure for clinical depression. Start with a simple walking program and free yourself from the “couch of doom”.

Commandment Two

You Shall Rest:

A Nap a Day May Keep the Doctor Away

We live in a hurry-up culture where “Just Do It” supplants “Let It Be”. Busyness has become a virtue that is without merit. Idle hands are the devil’s playthings only in those who haven’t learned the discipline of relaxation. Certainly there is a place for goal setting and industrious behavior, but there is also a purpose in rest and play. Relaxing on purpose is healthier than just doing something aimlessly. A major area of our lives that is most affected by this culture of chaos is sleep. The average adult requires eight hours of restful sleep a night to function best the next day. The average adult actually gets around six hours of sleep a night. This obvious disconnect leads to chronic fatigue and foggy thinking. 40% of Americans (100 million people) are moderately to severely sleep-deprived!

Commandment Three

You Shall Not Worry:

Make Stress Work For You

Stress is the little yapping dog biting at the heels of our health. It is generally an annoyance, but, if it goes on long enough, can become a festering wound. There are a number of books and counselors that provide a wealth of guidance on effective stress management in a world that oozes anxiety. Studies indicate that up to 75% of visits to doctors are related to anxiety. Stress is simply a perception of an internal or external event and thereby can be influenced by our thoughts. One person’s stress is another person’s opportunity. You will never be without stress, but you can control and minimize the adverse effects.

Commandment Four

You Shall Get Checkups:

Prevention Pays Lifelong Dividends

A healthy mind and body is dependent on action and education, not passivity and ignorance. You must be an advocate for you and your family’s well-being by embracing prevention. Men are especially negligent in this arena, and often decisions regarding family health are delegated (by default) to women in the household. Seventy percent of health decisions involving the family are made by mom, which includes checkups, vaccines, nutrition, and screening tests. Most importantly, the woman, by her actions and decisions, sets the tone for current and future health decisions. A major health care crisis today is not cancer, AIDs, or heart disease, but people not making healthy, proactive lifestyle decisions. We have to transform a system based on sick care to one that truly embraces well care, and that can only be achieved by practicing individual, responsible prevention.

Commandment Five

You Shall Not Be Gluttonous:

Eat Your Way to Good Health

We are often called a society of consumption. The talking heads are referring to consumerism; however, the real consumption issue is what we eat. Our diet has more of an impact on our health and longevity than almost any other activity. Content and quantity are the evil twins of gluttony. There are four simple guidelines that, if followed consistently, will provide a foundation of healthy nutrition that will build a legacy of wellness. Simply stated, eat balanced, low fat, low sugar, and high fiber meals. It is possible to alter the health inheritance of our kids and grandkids by changing how we think about food. You can spring the family from the prison of poor nutrition and not be held captive by your genetics through a simple and doable eating plan. We truly are what we eat.

Next week…what else but six through ten!

“I’m sick and tired of being sick and tired!”

“I just have no energy.”

One of the most common problems of the 21^st century woman is fatigue. I am not exaggerating by stating that well over 40% of women I see in my office complain at some stage of their life of excessive tiredness. Lack of energy is not a local phenomenon either (in

spite of the claims of one woman who was sure that SRS had something to do with her low energy level. Of course this was the same gal who had been nabbed by aliens and forced to watch reruns of “Geraldo”). National statistics are equally as impressive. One study even went as far to claim that 30.3 % of adolescents experienced excessive fatigue (PEDIATRICS Vol. 119 No. 3 March 2007, pp. e603-e609)

The classification of fatigue runs the gamut from a transient mild tiredness to a debilitating lack of energy. One of the inherent problems in studying a condition such as this is the subjectivity of the diagnosis. Those who suffer with chronic fatigue are often perceived as malingerers and patronizingly dismissed. There is still reluctance on the part of many medical practitioners to legitimize chronic fatigue syndrome, the most extreme form of tiredness, as a genuine entity; however, this appears to be an area where the science is finally catching up with the clinical observation. As with any medical problem that is poorly understood, the treatment of excessive fatigue is varied, sometimes unconventional, and often unsuccessful. It is important to distinguish chronic fatigue syndrome from “garden variety” tiredness as they differ in numbers of symptoms and degree of disability. For many sufferers it comes down to how much the lack of energy interferes with normal day to day activities. The Center for Disease Control in Atlanta has set down certain criteria for physicians and researchers to use in making the diagnosis of chronic fatigue syndrome. A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:

cognitive dysfunction, including impaired memory or concentration
exhaustion and increased symptoms for more than 24 hours following physical or mental exercise
unrefreshing sleep
joint pain (without redness or swelling)
persistent muscle pain
headaches of a new type or severity
tender lymph nodes
sore throat

You can see from these symptoms that there is tremendous overlap with other common problems. We all may experience some of these problems some of the time. The key is the persistence and intensity of the problem and, importantly, no other medical or emotional troubles that serve as a cause.

There is hope! Since becoming a more universally defined syndrome, additional research has been done on ways to thwart this bothersome illness. Many of these treatments and suggestions also apply to the woman who has only mild symptoms. So whether you are unable to get out of the bed or just collapse at the end of a busy day, these pointers may be worthwhile pursuing.

First and foremost, get a good checkup by your doctor. Many medical conditions such as hypothyroidism, menopause, Lupus, depression, anemia, and sleep apnea have fatigue as a primary symptom. If you check out well with your doc, consider the following:

1. Check your sleep habits. We are a culture of sleep deprivation. It makes logical sense that if we don’t sleep restfully we will be tired the next day. I am amazed at the number of folks that forget this simple connection. Improve your sleep and your energy will rebound.

2. Force yourself to get off the couch. Multiple studies show the positive effect of exercise on energy level. You may be saying, “I would exercise if I wasn’t so darn tired!” It is tough, but forcing yourself to do something, even a good walk, will, over time, improve your energy level.

3. Garbage in equals energy gone. We are what we eat, and this applies to energy level. In fact, energy derives from the body’s ability to metabolize food. If we put molasses in our car’s gas tank, it won’t go far. If we put junk in our gas tank, we won’t go far!

4. Reduce stress. Stress magnifies everything! The more stress, the more your lack of energy. It’s as if the body tries to shut down to save itself from the stress. The more you can minimize stress, the more energy you will have.

I realize this is a very superficial treatment of very complex solutions, but maybe it can stimulate you to investigate these approaches on your own.

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Ron Eaker

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