Women's Wellness Blog: 2016

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.

Aileen blew into my office like a Summer storm. “Help me, I’m a poster child for Hormones from Hell!” After catching my breath, I assured her that there were many ways of dealing with the ravages of hot flashes, dry skin, mood changes and forgetfulness. I started by reinforcing that menopause is not a disease. Inaccurately and unfortunately there is a pervasive sense that menopause is the “ultimate and inevitable bad experience” for aging women. I jokingly explained that women were not designed to self-destruct at fifty!

Menopause is a normal, natural transition, and it is vital for women to view it with a positive perspective. That simple understanding is the cornerstone

in building a plan to thwart the symptoms of “the change.” But it is equally important to realize that not everyone has a problem with menopause.

As a physician, my experience treating menopausal women is that there are some universal similarities in women’s experiences, but because of every person’s unique physiology and life journey, this time in a woman’s life is very individualized.

I am a “recovering traditionalist”. I was trained in the old school approach to menopause (which means drugs, and if that didn’t work, more drugs). In almost twenty years of practice I have found that many women are not satisfied with their options and many discover that their “treatments” are worse than their symptoms. Especially in this age of “estrogen panic” where the media (and many physicians) has touted misleading and confusing advice on hormones, many women are looking towards alternative treatments for their symptoms. One woman put it well. She said, “Physicians have a duty to give a woman the best care they can provide, especially their options. However each person is ultimately responsible for his or her own health. We, the patients, need help, guidance, and a listening ear.” Those were powerful and challenging words.

The general dissatisfaction among women is amplified by the observation that only 17% of eligible women in the US are taking some type of hormone replacement and up to 80% of women who start on hormones stop them after two years! The needs of women are not being met! This problem with compliance is due to poor communication and fear. After all, treatment of symptoms is not limited to simply taking a drug. Successfully navigating the potentially turbulent waters of menopause requires a more comprehensive approach.

Herbs, complimentary teachings, diet, and exercise all should be discussed along with hormones. The main caveat surrounding these modalities is that they must be held to the same standard and scrutiny that safeguards traditional hormone replacement.

The major problem in meshing the traditional and complimentary approaches to health is a mistaken perception of mutual exclusivity. These treatments can coexist and be complimentary.

I am saying that choice and personal responsibility are keys to unlock a joyous menopause.

This is an opportunity to live with passion and fulfill your life mission. This is a time to take stock of the past and choose your path for the future. The choice is yours. It is a choice that is difficult if not impossible to make wisely without sound information and guidance.

THE 4 “A”s

Many of the lifestyle choices you make, such as diet and exercise, can dramatically affect your menopausal experience. It is not a time to be complacent or anxious. It is a time- a season- to rejoice and celebrate the joy of living.

Following the four “A”s, Attitude, Action, Aptitude and Apothecary, can be the prescription for menopausal merriment. Attitude- what we believe is our reality, what we know is our truth. Belief plays a major role in the symptoms of menopause. Our thoughts become our actions, our actions become our deeds, our deeds become our habits, our habits become our character, and our character becomes our legacy. In many instances, if you anticipate a horrible experience, you will be right!

Action- this involves two levels. First, acting on your knowing. The key to any successful person, whether it’s in business, raising a family, or celebrating menopause is taking action. There is nothing more sad than a good idea that dies from loneliness or lack of attention. Whether that’s using hormones, herbs, massage therapy or exercise, you have to take action to achieve results.

The second part of action is exercise. It is the fountain of youth and can help in reducing both weight and hot flashes!

Aptitude- educate yourself, learn your options. Ask questions, talk to others, and take responsibility. Through knowledge about menopause, you eliminate fear and create opportunities. M.D. does not mean menopause director! Learn so you can be a partner in your health care.

Apothecary- We have a plethora of medicines and natural substances to treat the symptoms of menopause. These are merely tools; however, they cannot stand alone.

Explore your options and live joyously and healthy.

Have you ever wondered why your wife doesn’t appreciate your love affair with the remote control? Are men really from Pluto and women from Jupiter?

We may not come from different planets, but scientists tell us that many of the differences between men and women may actually stem from differences in brain structure. This variance leads to gender- specific behavioral traits. In addition, female hormones (estrogen, progesterone, and testosterone) can cause microscopic changes in cells which may influence perceptions and thought

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Brain researchers report that the two primary reasons for gender differences are brain structure and hormones. These differences can lead to behaviors that can either help or hinder relationships. God designed the sexes to be different so as to complement each other, yet these gender-specific attributes may also lead to conflict and confusion for many couples. The good news is that we can also discover ways to live in harmony with our mates.

For decades scientists have known that the right and left hemispheres of the brain have different functions. It is well established that the left hemisphere predominantly controls analytical, concrete, goal-oriented behavior, whereas the right side manages more spontaneous, emotional, and artistic actions. Most individuals, independent of their sex, have a dominant lobe that influences their personality.

These two hemispheres are connected by a large network of nerves called the corpus callosum. This superhighway permits the free transfer of complex information between the two lobes. When the corpus callosum is absent (as in some rare birth defects) or severed (by accidental trauma or as medical treatment for otherwise untreatable seizure disorders) the individual’s behavior and personality may become disjointed and unpredictable.

A woman’s brain contains an average of 40% more of these interconnecting nerve fibers: a veritable superhighway for the two sides of the brain in comparison to a man’s two-lane road.

How is this significant? It means that a woman can literally use her whole brain in a task, whereas a man is much more likely to use just one hemisphere at a time. This results in a woman being able to process many tasks at once, whereas a man tends to focus on conquering one task at a time.

Men and women also use their brains differently (when we use them). Fascinating studies utilizing state-of-the-art technology show that during identical tasks, women tend to use the right and left sides of the brain equally whereas men use one hemisphere more intensively. This female “whole brain” thinking, supported by the corpus callosum interconnections but not dependent on them, gives a physiological basis for the enigma of women’s intuition. Being able to use the whole brain in processing information allows women to perceive things in a broader sense and make conclusions based on a vast array of input. This sixth sense is founded on the “whole brain” thinking that takes input from a multitude of sources to produce uncanny and often unexplainable insights.

A woman’s brain has more nerve cells than a man’s in an area called the hippocampus, the area of the brain that is intimately linked to processing and expressing emotions. The hippocampus is also the switchboard for regulating the response to stress. This area is also very sensitive to the effects of estrogen, which partly explains the emotional changes seen with fluctuations in female hormones, i.e., puberty, PMS and menopause. Because women have more neurons in this switchboard, emotions are more closely linked to other behaviors, and stress is perceived differently

Hormones are nature’s messengers. They are chemicals that transfer information from one cell to another, in some cases even altering the structure and function of the target cell. The development of female brain function and structure is especially dependent on estrogen. As the female fetus develops, estrogen works its magic by altering brain structure and sensitizing receptors for the important neurohormone serotonin. Serotonin is the critical “mood messenger” hormone that is responsible for the expression of various emotions, including depression. Any alteration in the workings of serotonin can present as a clinical depression or anxiety disorder. Estrogen is closely tied to the function of serotonin and that is why women are twice as likely to develop clinical depression as men. This connection with serotonin also partially explains why fluctuations in hormones (as in puberty, postpartum, and menopause) can cause changes in emotions. For years, the male-dominated medical fraternity downplayed this episodic mood shift as largely due to external stresses: the “it’s all in your head” approach. We now know that it is all in your head, just in the literal sense, because of the interaction of estrogen with brain cells and serotonin.

One of the most important steps a man can take in helping his wife who is suffering the emotional trials and tribulations of PMS or menopause is to understand that these changes are real and based on both physical and emotional factors in addition to the stresses of her life situation. Fortunately, clarification of the roles played by hormone fluctuations and brain functions had also led to parallel discoveries of how diet, exercise, and nutritional supplements can correct imbalances to restore health and wholeness.

“Hey doc, my face looks like a war zone. I wouldn’t mind having the complexion of a sixteen year old if I could have the body of one also, but this is ridiculous for a grown woman!” Gladys was a victim of adult onset acne, and she was not pleased. She is not alone. Some experts estimate that up to 50 % of women over 30 suffer from some type of acne or acne like complexion disorders.

It is not known what triggers adult onset acne. The development of hormonal irregularities in the

menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts. The classic situation is one in which a woman experiences irregular cycles, setting up an over production of estrogens and testosterone. These hormones stimulate oil production in the skin glands which in turn become inflamed and irritated. Sometimes these sebaceous glands continue producing a higher amount of sebum well into adulthood and thus acne infection continues even at that age. Androgens have also been associated with acne flare-up in women before menstrual cycles or sometimes during pregnancy. Whatever the cause, it is not wanted or welcomed.

Most acne treatments require prolonged care, from months to years. These treatments include topical creams and gels and/or oral medicines. Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause. The suspected hormonal disruptions that trigger adult onset acne are often treated by attempting to regulate the hormonal imbalance. The modalities used most in hormonal acne treatment are oral contraceptives and antiandrogens. (medicines that counteract the effect of too much testosterone in a woman’s system).

There are several simple things to do to minimize adult onset acne. Washing with soap and water once or twice daily is a good way to keep debris and oils from the day accumulating on the skin surface. Salicylic acid and benzoyl peroxide are both common over-the-counter treatments for acne. Benzoyl peroxide exfoliates the skin and the anti-bacterial agents in it clear the excess debris from the skin to help prevent infections.

Retinoids are a class of molecules in the vitamin A family. The retinoids are potent against acne because they stabilize abnormal growth and death of cells in the sebaceous follicle. These abnormal growth cycles are believed to play a key role in the formation of blackheads, whiteheads, and other acne. The danger in retinoids is that they cannot be used by pregnant women or women who might be getting pregnant because of the high rate of serious birth defects in unborn children.

Topical and oral antibiotics are used together with other agents. Topically, antibiotics neutralize the skin-based bacteria and, when used with other agents, help deplete the excess sebum or oil secreted by the sebaceous glands, allowing acne spots to heal without infection.

Oral contraceptives prescribed for women are based on their ability to regulate hormones. A birth control pill stimulates the production of a protein that binds testosterone, thus reducing the androgen’s ability to affect oil glands.

Occasionally, adult onset acne can be confused with a condition known as rosacea. Although it is not exactly acne, its red-faced, acne like appearance can cause many physical, psychological and social problems if left untreated. In a recent survey by the National Rosacea Society, nearly 70% of rosacea patients said that this skin disorder lowered their self esteem, and 41% of patients said that they avoided social contact or functions because of their skin disease.

The cause of rosacea in unknown and there is no cure, but with available medical help this skin disorder can be controlled and minimized. Its typical symptoms are redness on the cheeks, nose, chin or forehead, small visible blood vessels on the face, bumps or pimples on the face, and watery or irritated eyes.

Whatever the cause, whatever the result, if adult onset acne is cramping your style, see your doctor because there is help.

“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

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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