I have the same conversation almost every week now.

Someone sits down, a little sheepish, and tells me they've started a GLP-1 medication. Ozempic, Wegovy, Mounjaro, one of that family. Then they ask some form of the same question: "So do I still have to do all the other stuff?"

The other stuff being, you know. Vegetables. Walking. Sleep. All the things I've been gently nagging people about for thirty-five years.

I get why they ask. These medications are genuinely impressive, and the internet has done a spectacular job of selling them as a get-out-of-jail-free card. Take the shot, skip the salad, live forever. It's a lovely fantasy.

A big new study just poured a bucket of cold, useful water on it. And honestly, the answer it gives is more encouraging than the fantasy ever was.

## What they actually looked at

Researchers followed nearly 100,000 people with type 2 diabetes for several years. This was a large, carefully conducted study from the Veterans Affairs system, so we're talking about real people living real lives, not in lab conditions.

They tracked two things.

First, whether people used a GLP-1 medication. Second, how many of the eight healthy habits they kept up. The habits were refreshingly unsexy: a good-quality diet, physical activity, not smoking, getting restful sleep, not drinking heavily, managing stress, staying socially connected, and steering clear of opioid misuse.

Then they watched for what doctors call MACE, which stands for major adverse cardiovascular events. In plain English, that's the big scary stuff. Heart attack, stroke, and death from heart disease.

## What they found

Here's where it gets good.

The people who kept up all eight healthy habits, compared to the folks doing one or fewer, had a **60 percent lower risk** of those major heart events. Sixty. That's not a rounding error. That's the kind of number a drug company would sell its soul for.

The GLP-1 medication on its own lowered the risk by about **16 percent**. Real, meaningful, worth having.

And when people did both, took the medication and lived a healthy life, the risk just kept dropping. The combination beat either approach on its own.

Read that one more time, because it's the whole point. The medication and the habits are not competing for the same job. They're teammates. And the team wins.

## Why I love this

Because it settles an argument I'm tired of having.

There's a camp that treats these medications like cheating, as if losing weight or protecting your heart with pharmaceutical help doesn't count. That's nonsense, and it keeps people who could benefit from ever asking for help.

There's another camp that treats the medication like a hall pass. Take the shot, ignore everything else, the science has got you covered. Also nonsense, and this study is the result.

The truth sits comfortably in the middle, where the truth usually hangs out. The medication is a powerful assist. Your daily habits are still the main event. Put them together, and you get more than the sum of the parts.

The drug was never going to do all the heavy lifting while you watched from the couch,
eating Doritos. It's a teammate, not a substitute. And like any good teammate, it plays a lot better when you show up too.

## The honest caveat

I'd be a lousy doctor if I handed you the exciting number and skipped the fine print.

This study was done mostly in male veterans with diabetes. That's a specific group. So the precise figures, the 60 percent and the 16 percent, are their numbers, not a promise stamped onto every person who reads this. My patients are overwhelmingly women navigating midlife, and I'd love to see this exact study run in that population.

But here's the thing about the principle underneath the numbers. It doesn't wobble. "Medication plus healthy habits beats either one alone" is about as sturdy a finding as we have in medicine, and it shows up again and again across different groups, different drugs, and different diseases. This study just added a very large, very clear brick to that wall.

## So what do you actually do

If you're on a GLP-1, or thinking about starting one, here's your marching orders, and they're wonderfully simple.

Keep taking the medication if it's right for you. And keep doing the boring, beautiful things that were protecting your heart long before any of these drugs existed. Walk. Sleep. Eat like you love yourself. Call your friends. Manage the stress that's been chewing on you.

You don't have to choose between the pharmacy and the produce aisle. That was always a false choice. Do both.

Your heart is keeping score. And this study says it's counting every good decision you make, whether it comes in a syringe or a pair of walking shoes.

Pick one small habit this week. Just one. Stack it on whatever you're already doing. That's how this works. Not a heroic overhaul, just one more good thing on top of the last good thing.

The magic was never in the wand. It was in you all along. The medication just helps you get there faster.

---

*Based on: Nguyen XT, et al. Combined associations of GLP-1 receptor agonists and a healthy lifestyle with cardiovascular outcomes among individuals with type 2 diabetes: a prospective cohort study. The Lancet Diabetes & Endocrinology. 2026 Apr;14(4):317-326.*

You walk into the kitchen with a purpose. A clear, specific purpose. You stand there. The purpose is gone. You open the fridge, hoping it left a note.

If you're somewhere in your late 40s or 50s, you know this moment well. The lost word. The name that vanishes mid-introduction. The reading glasses you're wearing while you tear the house apart looking for your reading glasses. Women call it brain fog, and for years, the medical response was somewhere between a shrug and a pat on the head.

A new study out of the UK just gave us something much better than a shrug.

What they did

Researchers examined 14,234 women aged 45 to 55. They sorted them into three groups: premenopausal, perimenopausal, and postmenopausal. Then they asked everyone about their symptoms over the previous two weeks and ran the whole group through eight cognitive tests measuring memory, attention, reasoning, and mental speed.

The goal was simple. Do the women who feel foggy actually perform worse on tests that measure thinking? For years, the research on this has been a mess of contradictions, so a sample this large is a real gift.

What they found

The first result surprised no one. Perimenopausal and postmenopausal women were much more likely to report brain fog and memory problems than younger women, with roughly 30% higher odds. The fog is common, it's real, and it clusters right around the hormonal transition. If you've felt it, you have plenty of company.

The second result is the one worth taping to your bathroom mirror.

On the actual cognitive tests, the scores barely moved. Across all three groups, performance was essentially the same. Perimenopausal women, who reported the most fog, actually scored a touch higher on accuracy than everyone else.

Read that again. The women who felt the foggiest tested slightly sharper.

The association between feeling foggy and performing poorly on tests was weak. The connection between feeling foggy and feeling anxious, low, or moody was much stronger.

What it actually means

Here's the part I want you to sit with, because it's easy to misread.

This does not mean the fog is imaginary. The researchers went out of their way to say so, and I'll say it louder: the symptoms are real, they're distressing, and they can wreck your quality of life. Nobody is telling you it's in your head.

The study suggests that the fog is not coming from a brain that's breaking down. It's coming from everything piled on top of the brain. Sleep shredded by 3am hot flashes. Mood swinging on a hormonal tide. Anxiety humming in the background. Fatigue that no amount of coffee fixes. Stack all of that on any human, at any age, and they'll feel foggy too.

Your brain isn't the problem. Your brain is doing calculus while someone sets off a fire alarm and steals your sleep. Of course it feels sluggish. It's overloaded, not offline.

There's also a timing quirk the researchers flagged. A cognitive test is a 15-minute snapshot in a quiet room. Real life is misplacing your keys during a chaotic Tuesday while three people ask you questions. The little day-to-day lapses that drive you crazy may simply not show up on a tidy test. That gap between how you feel and how you score is not a failure of your brain. It's a limit of the test.

Why this is good news

Because "your brain is declining" is a dead end. There's nothing to do with it except worry, and worry makes the fog worse.

"Your sleep, mood, and hormones are driving this" is a to-do list. Every one of those things responds to attention.

Sleep is the big lever. Get the night sweats under control, and a stunning amount of fog lifts on its own. Movement helps, and not in a vague way, it directly improves mood, sleep, and mental clarity. Managing anxiety and low mood, whether through therapy, medication, or both, tends to clear the mental windshield. And for a lot of women, addressing the hormonal changes directly, hot flashes and all, quiets the whole system down.

None of this requires you to accept that you're losing your edge. You aren't. You're running a marathon through a hormonal thunderstorm, and the fog is the weather, not the runner.

One honest caveat

This study looked at the transition itself, not the long game. It doesn't settle the separate and important questions about hormones and long-term brain health decades down the road. Those matter, and they deserve their own conversation. But the fear that keeps women up at night, the one that whispers this is the beginning of the end for my mind, is not what this data shows. Not even close.

So the next time you're standing in the kitchen wondering why you came in, give yourself the same grace you'd give a friend running on four hours of sleep. You're not slipping.

You're adjusting. And you're going to be just fine.

Based on Naysmith et al., "Cognition and the menopause transition: cross-sectional evidence from a large community cohort," npj Women's Health, 2026.

If you're a woman over 40, I don't need to tell you that sleep gets complicated. You already know. You're the one staring at the ceiling at 3 AM, doing laundry math, and wondering why your body decided the middle of the night was the perfect time for a personal heat wave.

Estrogen and progesterone help regulate sleep. When those hormones start their midlife exit, sleep is often the first casualty. Night sweats wake you up. Anxiety keeps you up. And the sleep you do get is often lighter and more fragmented than it used to be.

So here's the frustrating part of this study, and also the hopeful part. The frustrating part: the thing that predicts your longevity better than your diet is also the thing menopause loves to sabotage. The hopeful part: sleep is fixable. Unlike your genetics, your age, or your mother-in-law, sleep responds to intervention.

The target is seven to nine hours a night. Not on weekends. Not averaged over the month like some kind of sleep 401(k). Nightly.

And quality counts. Eight fragmented hours of tossing and waking may not deliver what seven solid hours will. If you're hitting the pillow count but still waking up feeling like you've been hit by a small truck, that's worth a conversation with your doctor.

A few things that actually move the needle:

Keep a regular schedule. Your brain loves a routine more than a golden retriever loves a tennis ball. Same bedtime, same wake time, even on Saturdays.

Put the phone down an hour before bed. Doomscrolling at 11 PM is not self-care. It's a caffeine drip for your nervous system.

Cool the room. Especially if hot flashes are part of your nightly programming. A cooler bedroom helps everyone, but it helps you more.

And if hormones are wrecking your nights, treat the hormones. This is where I get on my soapbox. Too many women white-knuckle through years of terrible sleep because someone told them it's just part of getting older. Bad sleep is a symptom, not a sentence. Hormone therapy, when it's appropriate for you, can transform sleep. So can treating sleep apnea, which is wildly underdiagnosed in midlife women because it doesn't always look like the snoring husband version.

We have spent decades treating sleep like the negotiable part of health. Diet and exercise got the magazine covers. Sleep got whatever hours were left over after everything else.

This study suggests we've had it backward. You cannot out-supplement, out-run, or out-kale a chronic sleep deficit. The most powerful longevity tool you own might be the one sitting in your bedroom, already paid for, waiting for you to take it seriously.

Tonight, when you're deciding between one more episode and turning in, remember: one of those choices is linked to a longer life. And it's not the one with the cliffhanger.

Sleep well. Doctor's orders.

Menopause Is More Than Hot Flashes. And Medicine Is Finally Catching Up.

For a long time, we boiled menopause down to a short list of symptoms. Hot flashes. Night sweats. Mood swings. A sudden, fierce loyalty to the nearest portable fan.

That list isn't wrong. It's just small.

The newer research suggests menopause is something much bigger than a handful of symptoms. It looks more like a whole-body transition, one that touches your heart, your bones, your metabolism, your muscles, your sleep, your inflammation, and even how your brain feels day to day. Not just a hormonal moment. A systems-wide event.

One recent analysis looked at hundreds of millions of lab measurements and found something worth paying attention to. A lot of these changes don't drift in slowly over the years. They show up more like a step than a slope, clustering around the menopausal transition itself.

That changes how we ought to think about the whole thing.

Because when menopause is only about symptoms, we miss the part that actually helps the most: getting ready before the symptoms show up.

From Reacting to Preparing

For most of medical history, the menopause conversation has been reactive. A woman develops symptoms. The symptoms get worse. Then, eventually, somebody talks about doing something.

But if your cardiovascular, metabolic, and bone changes are already underway years before your final period, waiting for symptoms is a little like waiting for a broken hip before you'll consider lifting weights. Technically, a plan. Not a great one.

The better conversation is about healthspan, not just symptom control. How well you live, not just how you feel this week. That distinction matters more than almost anything else here.

So What Actually Changes?

More than reproductive hormones, that's for sure. The effects reach into:

Cholesterol and heart risk
Bone strength and fracture risk
Muscle mass and raw strength
Insulin sensitivity and body composition
Sleep and recovery
Mood, focus, and energy

None of this means decline is your destiny. It isn't. But the physiology is real, and it deserves the same respect we give every other big transition in a person's health.

The Good News: You Can Get Ahead of It

Here's my favorite part. The most powerful tools for this transition are already sitting right in front of us. They're not glamorous. They're not expensive. They don't come with a slick startup pitch and a six-month waitlist.

They're the basics. The deeply proven, slightly boring, enormously effective basics.

Strength training. Muscle loss accelerates in midlife, especially without resistance exercise. Lifting weights protects muscle, builds bone, helps manage blood sugar, and keeps you steady on your feet. It also lets you carry every grocery bag in from the car in one heroic trip, which I consider a legitimate medical goal.

Protein. As we age, protein matters more, not less. It's worth putting on the plate on purpose, rather than hoping it sneaks into lunch by accident.

Cardio. Aerobic exercise is one of the strongest interventions we have for the heart, the brain, metabolism, and mood. The evidence here is almost boring in its consistency.

Sleep. Menopause loves to wreck sleep, and bad sleep quietly damages everything else: recovery, appetite, blood pressure, thinking, and patience. Protecting your sleep may be the highest-return decision you make in midlife.

An honest hormone therapy conversation. Hormone therapy is no longer the scary, one-size-fits-all topic many of us were taught to fear. The modern version is individual, risk-based, and grounded in much better evidence. Not everyone needs it. Not everyone is a candidate. But everyone deserves a real conversation about it.

The Bigger Point

We spend a lot of energy chasing futuristic anti-aging breakthroughs while overlooking a massive biological transition happening right in front of us. Menopause isn't a niche topic. It affects half the population directly, and pretty much everyone else through the women they love.

And here's the most encouraging thing the research keeps telling us: healthy aging doesn't start at 70. It starts long before getting older feels like an actual thing.

Someday, medicine will hand us better biomarkers, sharper therapies, maybe even ways to nudge the biology of aging itself. I'm genuinely excited for that. But today, the fundamentals still do the heavy lifting.

Move. Lift. Sleep. Eat well. Stay ahead of it. Pay attention early.

Sometimes the most powerful longevity tools are the least exciting ones. And honestly, for all of us, that's pretty good news.

I first saw her that afternoon after she had been in labor for close to eight hours. It was Christmas Eve, and I was on call for another doctor and therefore had not met her before, so between contractions, I introduced myself. She was about halfway there, and it was obvious from her countenance why it was called labor. Sweat was beginning to roll off her brow, and fear, expectation, and pain intermittently contorted her young face. This only further supported my contention that women are the stronger sex, for I am sure that if men had babies, we would all have one child families.

She continued to progress, each contraction harder than the previous. Her breathing became panting, and those little beads of sweat became a drenching shower of effort. I would periodically pop in and out to check her progress- noting each time her quiet determination and her resolute understanding that this was all for a greater purpose. It came time for the delivery, and she reached the state of labor some label “transition”; others call it “possession.”. This is the checkpoint where fatigue and pain overrule decorum, and I assure moms that I will repeat nothing that is said during this time. She pushed heroically and delivered a beautiful baby girl with relatively little effort.

I first noticed the problem with the eyes. They were more widely spaced than normal, and then I saw the clubfoot. Upon further examination, it became obvious that this beautiful baby girl had Down’s syndrome. As I carried this newly swaddled baby to her awaiting mother, I struggled with how to tell her my suspicions. I said a quick prayer and decided to be forthright. As I laid the infant on Ally’s belly, I gently touched her on the shoulder and told her I thought the baby had Down’s, and I showed her the clubfoot. She paused for what seemed like an eternity, her eyes never leaving her baby, and said, “Isn’t God great!” This response jolted me as it was not exactly what I had expected. Then she continued, “Isn’t God great,” she repeated. “He knew to send this baby to someone who would love her just as she is.” And at that, she brought her left arm out from under the bedsheets, and I noticed for the first time her own misshapen arm and hand. Yes, God is good and wise.

So just as that birth was a new and unexpected beginning for that family-so the birth of a baby boy in a far off country to young mother in a shabby horse stall was a new beginning for all of us. In the first breath of that newborn, the world changed. It was a new beginning.

We all remember new beginnings- first times. A first kiss, a first bike, a first love. On my first day of high school, I was the new kid. I had just moved to a new town and was marked by “high water” pants and “Coke bottle bottom” glasses. I hid out for three weeks, spending between class time avoiding bullies and wedgies. At my first prom, I had to stand on blocks for the dance picture because my date was five inches taller than me.

I was transformed by the birth of my first child. I was the daddy and not the doctor, and what a difference that made! I understood not just the mechanics of birth but the miracle of birth. It was surely God’s way of saying he thinks the world should continue. From that moment on, not only was my wallet a lot lighter, but also my heart, because that little girl stole a piece of it.

That birth 2000 years ago also reminds me of the sheer miraculous nature of life. When you think that two little cells, each smaller than the head of a pin, come together to fuse, grow, and change perfectly to form a unique individual- no two alike- the magnitude of such a miracle is immense. We take it for granted. The birth of a baby is such an amazing occurrence- in an instant, it goes from being totally dependent to breathing on its own, circulating blood on its own, interacting on it’s on-it is truly miraculous in a sense.

The birth of Jesus is miraculous not only for the physical commonality that we all share but for the miracle that it created in all our lives. The miracle of salvation. The Greek word for salvation used in the New Testament is “Sozo,” and it can also be translated as healing. When a child is born, there is unbridled hope. When Jesus went about his ministry, whether it was preaching, teaching, or healing- there was always the common denominator- and that was hope.

Christmas is that seed God has planted in each one of our hearts; a seed that contains the hope of a new beginning and the miracle of salvation. Our charge is to water that seed with the Word, nourish it with fellowship, and fertilize it with faith, and it will grow and fill our soul with the joy and beauty that God always intended.

I have learned a great deal from a great number of people in the last few years, often by what they say, do, or think. Almost all of the books I have read, podcasts I have listened to and cool places I have traveled have come from other’s recommendations, examples or writings. Many times the initiator has no idea they influenced me or impacted my life, and that adds a bit of authenticity to their actions.

Everyday I get questions about what I do, what I eat, what I think about a certain topic, not because I am a savant or authority, but because folks are genuinely interested or curious. As a textbook introvert, I have to admit I am a bit leery of getting very personal when it comes to what I do and think outside of my professional duties, but I have developed a pestering sense of paying it forward, so I wanted to put together a semi comprehensive list of stuff before the end of the year. My singular desire is to provide just a sliver of value that may improve your day by 1%. If I can spark an interest, motivate an action, or trigger a desire, I will have met my own expectations.

Here is my list:

Things I Am Eating:

Many of you know that my wife and I are empty nesters, a joyous condition many of you also enjoy, but it has proven somewhat of a dilemma as far as dinner meals. Neither of us are particularly good cooks, or should I say are particularly good at doing what it takes to be a good cook, and we both know the perils of eating out a lot, so our solution was to try those meal preparation services that deliver ingredients and leave the execution to yo. This solved three problems for us. First it gave us just the right ingredients to not waste anything and suddenly find you have no kale to make the dish. Second, it kept us from the nutritional black hole of Mexican restaurants, and third, it was reasonably priced. We started 2 years ago and haven’t looked back. Currently we are using Blue Apron and Home Chef. Blue Apron has a bit more complicated recipes, but still comprehensible by most third graders and Home Chef has a ridiculous variety of options to choose from each week. Well worth a try.

Here’s a summary of what I try to do in its most basic description:

Eat balanced, low saturated fat, low sugar, high fiber, mostly plants, as close to their origin as possible, and nothing containing the phrase high fructose corn syrup!

Guilty Pleasures I’m Eating: (just to reinforce that I am human)

Mochi Ice Cream balls. We discovered these little treats at a friend’s house and now keep a box handy. They are little dough balls filled with ice cream of various flavors. They are 110 calories a ball, but quite honestly, one ball for dessert and you are golden.

Supplements I Take:

A word of caution, these should be chosen based on your individual needs and health and not just consumed willy-nilly.

GNC psyllium seed capsules. 6 a day. None of us get enough fiber. It’s one of those neglected nutrients that influences a great deal, including regularity (if your bowels are happy, you are happy!). This is soluble fiber meaning that it forms a goo in your GI tract that pulls in water (a good thing) and decreases the absorption of sugars and fats (also a good thing). You don’t have to be too concerned about brands here because it’s hard to mess psyllium up.

Resveratrol. I don’t have the space to bloviate about the science behind this substance, just know that it has been tied to longevity and health span in both animals and humans. (Read more here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164842/)

I take 1 gram a day. (Trunature Resveratrol Plus from Costco)

Omega XL (Omaprem) a concentrated omega 3 fatty acid that has a number of studies that show anti inflammatory effects and especially good for joint discomfort (Great Health Works)

Red Yeast Rice extract for lowering LDL cholesterol (when combined with exercise and diet) 2 a day (HPF Cholestene Red Yeast Rice)

CoQ 10 (only because I’m taking the red yeast rice extract which has Statin like activity. If you are on a Statin you may benefit from this also) 100 mg a day (Member's Mark - Co Q-10 100 mg)

Zinc, when I have a cold (Cold-Eeze lozenges)

Nicotinamide Mononucleotide (NMN) an interesting molecule I am considering starting. Read more here: (en.wikipedia.org/wiki/Nicotinamide_mononucleotide)

Books I’m Reading (or have recently read)

Talking to Strangers by Malcom Gladwell. Anything by Gladwell gets my attention because of the quirky way he sees things. This book tackles why we misinterpret stuff when interacting with folks and how to avoid making dumb assumptions. By not recognizing patterns, we are inviting conflict and misunderstanding in ways that have a profound effect on our lives and our world.

Subscribed by Tien Tzou. A fascinating look at how the business models for everything from home businesses to massive corporations are changing. The subscription model puts customers and their experiences with your product/service at the forefront and may make the difference between your business still being alive in 5 years.

The Body by Bill Bryson. Bryson is one of my favorite authors for light, laugh out loud reading. This book is both educational and fun, but heavy on the fun. Great for before bed.

Atomic Habits by James Clear. This may be the singular most influential read in the past year. Habits influence almost everything we do, so it is critical to understand what makes the formation of good habits and what needs to happen to get rid of bad habits. It has transformed how I approach our weight loss clients. Your thoughts become your actions, your actions become your habits, your habits influence your character, and your character determines your legacy.

Lifespan by David Sinclair. This was personally the most impactful as I am aging every day (now there’s a profound thought). Any of you folks over 50 need to read this book...period. It’s full of science but expressed in easy to understand fashion with massive practical applications.

Estrogen Matters by Dr.Avrun Bluming and Dr. Carol Tavris. Few things continue to be as polarizing as hormone use. Obviously this is very near and dear to my heart so I love diving into this book which gives a very balanced case for sing estrogen in menopause. Great for anyone considering their options (after my book of course, A Woman’s Guide to Hormone Health)

Bottle of Lies by Katherine Eban. This book gets the award for making me want to throw things and cuss out loud. It is an exposé of the generic drug industry and how we are bring duped, and possibly damaged, daily. If you or a loved one is on a generic drug, this is a must read.

Why We Sleep by Dr. Matthew Walker. This has changed my clinical practice probably more than any other recent book. I can truly say I had no idea how critical sleep was to everything from weight gain to senile dementia until I read this book. There’s a lot of science, but also some practical advice on getting better sleep. Great to read when you can’t sleep at night!

What I Listen To:

Podcasts. With my running schedule, podcasts have become an essential partner. It’s amazing the wealth of free stuff out there and honestly it’s more a matter of sifting through everything than about anything else. You can find all these on ITunes or other Apps.

The Drive by Peter Attia. A bit geeky primarily for health and longevity nerds, but an amazing array of advice on how to live longer and better

The Tim Ferris Show. Great for entrepreneurs and people just interested in life hacking. If you’re not sure what that is, this may not be for you.

How I Built This from NPR. A fun exploration of how companies started and grew. More about the personalities, trials, tribulations, successes and failures than wonky advice.

The Mike Dillard podcast. An online entrepreneur superstar talks to other high achieving folks about life, love, and cost per click.

Sigma Nutrition with Danny Lennon. Again, if you’re a nutrition nerd, this is your Nirvana.

Hustlenomics by Katie Eaker Thompson. Yep, that’s my daughter! A perfect podcast for young, female entrepreneurs packed with amazing interviews from people just like you making it in today’s self employed environment.

The People’s Pharmacy. A great podcast on natural approaches to health and wellness.

Dan Carlin’s Hardcore History. For something totally different, this is a long form production on history that is both entertaining and fun.

Found My Fitness with Rhonda Patrick. Okay, I know I am totally nerding out on fitness and nutrition, but this is actually good for all comers.

And finally...Women’s Wellness Podcast with Dr.Ron Eaker...’nuff said!

My wife has a completely different interest profile, so here are a few of her favorites:

Dr. Death an exposé of a psychopathic surgeon who kills!

S Town: a radio play of a thriller drama

Up and Vanished. A cold case in South Georgia of a horrible murder mystery

Over My Dead Body. True crime about a perfect couple falls apart

The Dropout. The story of Elizabeth Holmes and the fraudulent company Theranos.

(Do you see a scary trend here!)

Books I’m Listening To:

Anything by G.K. Chesterton. When people you respect all continually quote someone, you should pay attention. This is the case with Chesterton. I get some audio books through a discount service called Chirp. Amazon has their own called Audible, although it’s a subscription so you have to listen a good bit to make it worthwhile. I especially like the Father Brown series.

The Innocents Abroadby Mark Twain, a classic and especially fun as an audio book.

Zero Dayby David Baldacci a good ole distracting thriller to pass the miles.

An untapped jewel is getting the Plus version of The Great Courses. This gives you access to audio or video of hundreds of college level courses on everything from religion to interior design. Check it out here: https://www.thegreatcourses.com/tgcplus4

Shows I Am Watching:

While I still have cable (I know, so very nineties) I have embraced the streaming services with a vengeance. I use Netflix, Hulu, and Amazon Plus. I have loved series like Rome, The Last Kingdom, Game of Thrones (are you seeing a trend here?). For shear relaxation and fun it’s reruns of The Office and Parks and Recreation. If I really want to laugh out loud and make my wife mad it’s Bob’s Burgers or Arrested Development.

Tech I’m Excited About:

Muse Meditation (https://choosemuse.com/muse-2-guided-bundle/) a really interesting piece of tech that solves the problem of learning how to meditate and relax. If you’ve ever wanted to meditate effectively, this is worth a look.

Ebb Sleep. This might potentially be a game changer for folks with sleep problems. It’s based on the science of frontal lobe cooling to enhance the quality and quantity of sleep. Check it out here: https://www.ebbsleep.com/product/

Projects I Am Working On:

Reduce! Revive! Reignite: a six month Master Class on overcoming menopause problems, losing weight, gaining energy, and restoring passion. I envision an intensively interactive program that includes me, dietitians, psychologists, counselors, and online learning. Stay tuned!

Continuing to provide value through the Women’s Online Wellness private Facebook page (go here to sign up https://www.facebook.com/groups/womensonlinewellness/?ref=share)

Goals I Have This Year:

Learn to meditate

Take up Yoga

Run...a lot

Be happier

Travel to wherever my wife wants to go

Grow the WOW Facebook page

I’ve been thinking a lot about change lately. I don’t know if that is a symptom of aging neurons, brain cells drowning in a sea of Metamucil and Tums, or simply where my wine-fertilized brain is gravitating, but nevertheless, that is what I am musing over.

Change is both necessary and hard. On a macro level, change is one of the few human characteristics that has allowed our species to propagate to the point of suffocation. If we as Homo Sapiens weren’t adept at change, both in our physical and psychological makeup, we would still be quivering blobs of protoplasm scouring the savannah for leftover brontosaurus brisket. Our ability to adapt is possibly the singular characteristic that makes us human. One constant about both our physical environment as well as our between-the-ears milieu is that, given a skinny minute, things will change. If we are not changing, whether it is changing our immune system to ward off the latest mutant virus or our beliefs to deal with the latest emotional crisis, we are dying. If change is so prescient - so primary - to our existence, why is it so darn hard?

Even though we are psychologically programmed to accomplish change, we are equally preset to embrace stability, and stability and safety often mean staying the same. The devil we know is somewhat preferred over the devil we don’t know. Neurologically this can be seen in the connections our brain cells make when we create habits through repetition. Habits, by definition, are behaviors that are repeated over and over the same way, an apparent antithesis to change, yet the brain is wired to make these pathways more accessible and useful. In other words, your brain likes repetition because it takes less energy to accomplish whatever it is you are repeating. And if anything, your brain likes the idea of energy conservation. Whatever burns less fuel, like repeating the same behavior, is the default mechanism.

So even though change is needed for survival, it takes extra calories and therefore extra work to accomplish. This is a simple physiological reason for us getting nauseated at the thought of a new challenge or a change in routine. Probably a bigger reason for our aversion to change is not rooted in synapses and dendrites but in perceptions and beliefs. When it comes down to it, change is often a head game. How does this change make me feel? What scares me about this different way of doing or thinking? What will happen if this change takes place, or even what won’t happen if this change takes place? All of these questions, consciously or unconsciously, arise when faced with shifting landscapes. Thus change is hard from both a physiological and a psychological perspective. So why does this matter?

Enough of the psychobabble. Just tell me how to embrace change and not make it so scary. Our hurry-up society screams, “Tell me how to get from here to there with the least effort, energy, sweat, and sacrifice.”

Step number one is simple cognitive restructuring. (There you go again with the big words). Translated, that means accept the fact that change is inevitable and move on (to put it in terms my kids get, s#*t happens!). Sometimes just accepting that it is what it is, is the most healthy way to go.

Step number two is deciding whether this change in behavior, actions, habits, or environment, is congruent with where you want your life to go. That is predicated on you know where you want your life to go! If you’re not there yet, turn off your computer and decide right now what you want your life to mean. (As if it was that easy). But you get my point. Judge the value of any change by your life’s mission. If it furthers you on the path, jump in with both feet. If it doesn’t, rethink it. Notice I didn’t say if it would be easy, fun, or what your mother would want.

Step number three is to be the agent of change. Influence your own destiny by preempting situations, thoughts, and actions to align with who you are or want to be. Be an influencer, not like a Kardashian, but like someone who actually has depth and a desire to see a positive change in self and others.

Be the change you want t see in your world. Embrace it, encourage it, fear it, but face it.

She wasn’t supposed to have a heart attack. I mean, she was only 42, but the EKG didn’t leave anything to the imagination. There it was, clear as day, an elevation in the ST segment, a STEMI in doctor jargon, a classic sign of a heart attack. She didn’t need this right now, with the new job and all.

Even though Carol was not the classic heart attack victim: relatively young, female, normal blood pressure, she was 35 pounds overweight, had increased inflammatory markers and a lousy family history. She is a perfect representative of the new wave of cardiac patients that are literally reducing the lifespan of US citizens for the first time...ever.

And one of the big culprits is excess weight. A whopping 74% of adults over 20 are either overweight or obese. Excess weight is a precursor for a variety of problems including type 2 diabetes, hypertension, fatty liver and senile dementia. Obesity is the new smoking when it comes to public health issues. The successful anti smoking campaigns of the 70s and 80s reduced this form of slow suicide fairly successfully, and there was a corresponding drop in deaths due to cardiovascular disease. However, with the rise of obesity and weight issues, the likelihood of heart attacks and strokes also increased, to the point of offsetting deaths from cancers and other maladies.

The most frightening statistic is that much of this rise in heart disease is in younger folks, mostly women. Elevated body fat creates a number of scenarios that lead slowly to heart problems. Elevated blood sugars and increased inflammation set up a process that ultimately results in blocked arteries and disease. This doesn’t happen overnight. Carol didn’t just wake up one morning and have a heart attack. The process had been building for years. With 45% of children being overweight, and 70% of overweight kids becoming obese adults, it easy to track why younger and younger people are experiencing problems. The damage begins early.

The good news is that if the weight issue is addressed early, the less damage is done. And this is truly a case of it’s never too late. Studies indicate that losing weight and adopting a healthy lifestyle with exercise, no smoking, and healthy eating can actually reverse damaged vessels.

So why is losing weight so hard? Because in many instances it’s not so much about the weight but everything surrounding the weight. By that I mean your stress level, how well you sleep, your home environment, social interactions and stories you tell yourself about your abilities. Nutrition and activity level are, of course, important, but weight control is much more complicated than simply calories in versus calories out.

Michael Jordan, even at the height of his basketball superiority, had a coach. He knew a fundamental principal about human nature, we have a hard time seeing ourselves. A coach can look from the outside, see things we miss or ignore, and make suggestions as to how we can better achieve our goals. So it is with weight loss. A trusted coach can be the key ingredient in any program and the difference between success and frustration. As a bariatric trained physician working with hundreds of folks losing weight, one thing I can say with great confidence is that if you want to lose weight, working with a knowledgeable, caring partner will increase your likelihood of success immensely. This is not where you want to “pull yourself up by your bootstraps” because those straps are likely to snap leaving you frustrated, confused, and probably at the same weight.

The older I get, the more I qualify as an “athlete.” One of the great things about running in races is that some bright soul years ago decided that footraces needed age categories to properly handicap the event. Indeed it seems a bit queer to equate a long lean 20-year-old with a frumpy, hair growing out of their ears, middle-aged, middle-of-the-packer, like me. If I was the 20 something, I would be insulted just to be lumped in the same race as grandfather time. But the running gods were smiling on us pentagenarians when races from 5k to the marathon divided the finishers based not on time but age. There is a natural attrition in runners once you get into the fifties that is playing right into my hands. As fewer and fewer men in my age group compete, the closer I get to finishing in the top one hundred. It’s not that I am any faster than I was a few years back, in fact, I have decelerated to the pace of a pregnant slug, but I have steadily risen in my age group as more and more men my age have either stopped running or now enter the walker with the tennis balls on the end division. I figure if I am still running by the time I am 109, I might even place in the top ten!

Running as you age does have its perils. I was pushing mile 23 at what I thought was a respectable pace in my last marathon only to be passed by a runner on a prosthetic leg. In my defense; however, this guy was really moving, but then I saw he was also blind, being led by a rope tethered to a sighted of a runner whose dust I was also eating! It’s just this kind of ego demolishing event that the older runner must assimilate so as not to stop in the middle of a race and hide out in a porta potty. Over the last few years, I have been passed by kids as young as eight and every possible challenged runner you could imagine. In fact, I no longer get upset unless the kid that passes me is younger than the underwear I have on at the time. I even was passed in one race by one of the wheelchair competitors. Now, this on the surface doesn’t sound so unusual because the racing wheelchairs can get going really fast, but in this case, the competitor was going backward! Something about setting a Guinness World record of racing backward and humiliating as many old men as possible.

Aging runners also have a propensity to wear running outfits that not only embarrass and humiliate their offspring but also scare small animals off their path. I will never forget purchasing some running shorts and a shirt online and proudly parading through the house before my morning run. The silence of daybreak was shattered by the howling laughter of my daughters and wife and they almost choked on their PopTarts. Once they settled down I asked them what was so funny, and they immediately went into another laughing paroxysm that left me wondering if General Mills was now lacing their products with marijuana. My wife mercifully explained that my outfit looked like I was a guest on Richard Simmon’s Dancing with the Oldies infomercial and she and the girls would move that afternoon if I went out into the neighborhood looking as I did. Granted the shorts were cut a bit high and my kids explained that most folks don’t equate their waist with their sternum. Also, they thoughtfully pointed out amidst sobs of uncontrolled hysteria, that mesh see-through jerseys went out with Metallica and Kiss. Needless to say and under threat of physical harm, I changed clothes and once again regained a portion of dignity. I now understand the web sites no return policy.

The older runner also has to deal with a variety of physical maladies that are unique to their station in life. A cacophony of noises, grunts, and sounds emanate from unexplainable sources while putting in the miles. I have begun a little game during my runs called “where oh where did that come from?” to not only pass the time but also tune in to any life-threatening changes in my organ systems. I figure that if I can identify an errant noise, much like when your car engine is about to explode after 100,000 miles, I stand a chance of dialing 911 before leaving to the ants and small animals that would find me on the side of the road. At 20 you don’t think of such things. At that age any strange eruption you write off to the ham and cheese burrito and six pack the night before. At 50 and beyond these same noises may signify anything from a bowel obstruction to a cerebral aneurysm. Not that I am paranoid, but at more and more races as I converse with fellow age groupers, there seems to be a morbid trend to our discussions. “Did you hear about Harry? He was doing a 10 miler and his spleen fell out! They didn’t find him for 2 days and that was only after tracking him by his Garmin 350. What was really sad was according to his Garmin he was at a 7-minute pace! What a waste of a good run!”

I may not be getting any faster as I age, but dadgummit, I’m out there and so should you be! The secret to longevity is exercise, even in spite of the intrinsic dangers facing older runners. There is much evidence that running in your later decades reduces your risk of cancer, dementia, impotence, and the heartbreak of psoriasis. Exercise is truly the fountain of youth. If Ponce De Leon had entered the St.Augustine marathon instead of traipsing around in the swamps looking for some mythical elixir, he might have had more than a road named after him. Even though we may get passed by runners in Elvis costumes, us older runners have one thing in common; we will very likely live longer which will allow for more time to embarrass children, sip vintage Merlot, and make a difference in the lives of those we touch. Live long and taper!

There is a point where all good fantasies need to be put to rest. For example, Bigfoot doesn’t exist; politicians aren’t honest; Justin Bieber isn’t very bright, and vaccines are bad. I don’t care much about most of those, but the poor misguided fools who still support the idea that vaccinating your kids is a bad thing need to get a dose of reality medicine.

As I understand it, the anti-vaccine argument hinges on the idea that vaccines cause a variety of illnesses ranging from autism to autoimmune problems. The only problem with this theory is that there is absolutely no credible evidence that any of it is true. Granted, an individual may have a local reaction to an injection, or even an allergic reaction to one of the components of the vaccine, but no legitimate studies have ever shown a connection of vaccines to chronic health problems. Dr.William Schaffner, a professor, and infectious disease specialist at Vanderbilt states, “We have roomfuls of evidence showing that vaccines are some of the safest medications available, but rumors and conspiracy theories still spread.” ^{^[1]}

Many of these conspiracy theories are propagated by websites that clearly have an agenda or are selling a product. I found several that were promoting “vaccine alternatives” for a tidy sum of cash. Many of these products were homeopathic (which equates to worthless) and provided no scientific backing for their claims. A red flag in almost every site was their reliance on anecdotes and personal stories to propagate their message. While this is engaging and emotionally appealing, it does nothing to establish the truth of their claims.

I agree with many who say we all must take responsibility for our health decisions, but part of that responsibility is researching legitimate science and not listening to pseudo-science propaganda. The number of outright falsehoods and misinformation spewed on some webpages I researched was frightening. Statements like, “Fully vaccinated children are the unhealthiest, most chronically ill children I know”, which appears prominently on one anti-vaccine site, are illustrative of so much illogical reasoning I hesitate to even draw attention to it, but it is a great example of what is wrong with these arguments. First, there is absolutely no documentation to back up this statement. The author bases her opinion on talking to a few of her like-minded friends at playgroup yet uses this conclusion as a foundation for her disdain of vaccines. Second, she falls in the trap of personal testimony as evidence of cause and effect. If I ate Fruit Loops for breakfast yesterday and got hit by a car that afternoon, then I could correctly assert that eating Fruit Loops and car accidents are associated, but one does not cause the other. This is a classic ploy used by the anti-vaccine crowd who assume an association (a vaccine) is the cause of a condition (autism) when in reality no such cause and effect exists (as proven in many studies).

The travesty would not be so bad if the only adverse effect of not getting vaccinated was limited to those who choose that path. Unfortunately, this is not the case for two reasons. First, most vaccines are given to children who must depend on their parent's judgment and therefore they bear the brunt of a disease not prevented, not their parents. I am all for parental rights, but that is intimately tied to parental responsibilities. Second, the population as a whole suffers if a significant number of people aren’t vaccinated. It creates an environment where outbreaks of previously controlled illness (whooping cough, measles, etc) can once again proliferate.

Enough of the negative. What is there to gain from properly vaccinating you and your child? The Centers for Disease Control estimate that vaccines given over the past two decades will prevent 322 million illnesses, 21 million hospitalizations, 732,000 deaths, and save upwards of $295 billion in direct health care expenditures. ^{^[2]} In an Obamacare world where prevention and cost containment is paramount, the benefits are astounding. The vaccine for HPV (Human Papilloma Virus) is one of the most recent and controversial vaccines. It is extremely effective at preventing infection by the type of HPV associated with cervical cancer. The National Cancer Institute states that “High-risk HPVs cause virtually all cervical cancers”^{^[3]}, so essentially this is now a preventable disease. 12,000 women a year potentially could avoid the life-threatening agony of cervical cancer if they were vaccinated against this pathogen.

The science is clear: vaccines are safe and effective. Are there isolated instances where a person could have a reaction to the drug, of course. But the evidence is overwhelming that this bastion of modern medical preventive care should be widely and confidently accepted by us all.

^{^[1]}USA Today April 25, 2014

^{^[2]}http://www.cdc.gov/vaccinesafety/index.html

^{^[3]}http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

What they did

What they found

What it actually means

Why this is good news

One honest caveat

Menopause Is More Than Hot Flashes. And Medicine Is Finally Catching Up.

From Reacting to Preparing

So What Actually Changes?

The Good News: You Can Get Ahead of It

The Bigger Point

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Ron Eaker

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