The Life-Changing Sleep Secret!

I was born a night owl, loving the quiet of the late evening hours, when all the chores are done, commitments completed, the house nicely buttoned up for the night, and I have time for myself. In my younger decades I could easily stay up until 12 midnight or 1 AM, and wake up at a reasonable hour, refreshed. In the last few years, a strange shift has occurred. Even if I got the needed number of hours of sleep, when I go to bed at midnight, or later, the next day I’m tired and lack my usual pep-a-de-do. I can no longer deny the change.

It began in my early fifties and has slowly, and truly, become my new reality. I fought it for years, but now at almost sixty-one I can no longer stay up late, night after night, and expect to fire on enough cylinders to get through my To-Do list, much less anything on my Want-To-Do list the next day.

Going to bed earlier changed my life. I never thought this would happen, but as a gerontologist, I know retiring earlier to feel more competent is a part of aging well; a fact I wanted to ignore.

While research tells us losing our protective armor of hormones at menopause can also play a part in sleep-related issues– from small to great on a sliding scale depending on the individual woman– that isn’t my issue. Drilling into the science, I find as we get older, we experience a shift in our various circadian rhythms. Our circadian rhythms works as our body’s twenty-four-hour internal clock. Quietly, under the radar, they carry out key functions and processes. It is my circadian rhythm governing my sleep-wake cycle that downshifted when I wasn’t looking.

Much of the more conventional research ties an imbalance with sleep to our light/dark exposure, but I still wake up at virtually the same time I always did; it’s the time I turn off the light that makes the difference.

A few years ago, Dr. Julia Shekleton and her team at the Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, in their ground-breaking article in the Journal of Clinical Sleep Medicine, identified why this phenomenon occurs. They called it the Wake Maintenance Zone.

We know the experience of the Wake Maintaince Zone more commonly as “getting a second wind.” Dr. Shekleton tells us the onset of our second wind usually occurs right before our body switches to “getting ready for sleep” mode by secreting melatonin—the hormone released by our brain that makes us feel sleepy. Looking at the circadian 24-hour clock, our brain begins releasing melatonin around 9 PM to our body’s clock even if you are traveling through several time zones. Additionally, in many women, but not all, melatonin declines more sharply at mid-life, which causes many women (and men) to struggle with getting enough restful sleep.

When our second wind kicks in, we get a seemingly “burst” of energy for two or three hours more, making sleep virtually impossible. By the time this second wind winds down, we are out of sync with our natural circadian sleep/wake rhythm, and so lose precious restorative sleep time. As Dr. Shekleton found, the next day our cognitive function suffers, and we feel tired, even if we slept in to try and make up for getting to sleep later the night before. And, if our stress level is high, our cortisol levels will take an uptick at night, just as we want to float off to slumber land, and further sabotage our ability to get restful sleep.

From my perspective as a gerontologist, what I find is working for me, and is helping my clients, is to turn off the light while we are still in the first phases of melatonin secretion—somewhere before 11 PM.  Research tells us this is the magic hour of demarcation, after which our body begins other processes that seem to also feed a second wind. More research is needed, but I know going to bed earlier than my usual time, makes this night owl a much happier, more energetic, and definitely pleasanter person to be around. 

Until next time…Be Vibrant!

Can You Really Give Up Sugar?

As we nested at home these last few months, and will continue to stick around the house for at least a while longer, I had a fresh look at my processed sugar consumption (white sugar, molasses, maple syrup, etc.) and helped clients answer the question, “Can you really give up sugar?”

Like many of us, it seems the longer I have stayed at home, the more inclined I become to add a little sweet treat to help me deal with being on an extended staycation. Not long ago, I reached a point where I was buying several extra-large brown butter chocolate chip cookies every few days. This was a very bad sign that I had fallen (again) down the white hole. Because sugar creates inflammation in our bodies, and because definitive research showing that along with inflammation, sugar brings on brain fog, I can only claim my brain was so foggy I couldn’t make good, healthy decisions regarding the chocolate chip cookies. That’s my story, and I’m stickin’ to it. 😉

For our short science lesson today let’s look at what sugar does to your body:

Inflammation

Years of consuming too much sugar cause the delicate mix of bacteria in our gut (remember the gut is our second brain) to become so imbalanced we lose all the protective qualities of the good bacteria that once lived there. For more on this, check out my article on the Gut-Brain Connection.  All that sugar we consume results in inflammation that zooms straight to our brains. This action causes not only the aforementioned brain fog, but actually kills brain cells. Our brains shrink. No kidding.

High Blood Sugar

Dr. Vera Novak, M.D., Ph.D. of The Harvard Mahoney Neuroscience Institute looked at how sugar affects the brain and found insulin resistance or “high blood sugar” (and often resulting diabetes) over time attacks the functional connectivity of the brain. Insulin resistance develops when the cells can’t process insulin properly and it backflows into the blood stream, creating high blood sugar, a term we are hearing more and more. We now know that insulin resistance is a major component contributing to dementia and Alzheimer’s.

Vascular Disease

From insulin resistance we end up with vascular disease, which affects the small blood vessels in the brain, reduces blood flow, and causes vascular dementia. In dozens of studies, many scientists find the same results to be true. To repeat, there’s a strong connection between high sugar consumption and Alzheimer’s. High sugar intake also results in a variety of chronic diseases related to inflammation – heart disease, cancer, arthritis – as well as all forms of gastro-intestinal disease. Knowing that sugar can cause anxiety, sugar can cause palpitations, and sugar can make us fat, we might be ready to give up sugar and adopt a new eating plan.

Mediterranean Diet

Time for some Good News! Dr. Martha Clare Morris, director of the Rush Institute for Healthy Aging, analyzed data from 923 people ages 58 to 98 who kept detailed food diaries about what they ate from 2004 to 2013. Dr. Morris found those who adopted the Mediterranean Diet* had a 50% drop in the development of Alzheimer’s (a form of dementia) compared to those eating a typical American diet of processed foods, high amounts of red meat, sugar, white flour, all fake sugar, diet sodas, and fried foods.

I am a front-row cheerleader for adopting the Mediterranean Diet, as years ago it became my way of eating. Not that I don’t occasionally cheat—those chocolate chip cookies sometimes beckon–  but I really try to stick to that diet a majority of the time. And, not only does that food taste good, I love knowing that I’m eating well. Here’s a plan that has worked for me, and others with whom I’ve shared it:

Alternative Sweet Options

Giving up sugar doesn’t mean your life will be without sweets. Summer makes it easier for me to stick to this plan and move toward eliminating all processed sugar, including wine, except for special occasions, because of all the delicious fruits in season. I love the berries and I could live solely on watermelon and the luscious stone fruits. Well, yum! The berries are so low on the glycemic index – GI I can have them anytime.  I save the other fruits higher on the GI for a delicious dessert in place of a piece of Key Lime pie.

The bounty of vegetables also helps release us from our sugar addiction. Just watch the GI for those veggies that score over 50. What happens when we give up sugar and fill up on fresh, organic veggies, fish, lovely salads, and ripe fruit? Our gut flora rebalances in no time, our waistline trims, and our brain fires on all cylinders. Now, that’s a blue ribbon combination!

Until next time…Be Vibrant!

*https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Reversing the Dreaded Dowager’s Hump

Dowager’s Hump. You might know someone who has it. Your mother or grandmother may have suffered from it. You think you are developing one. Whatever your experience, direct or indirect, I am betting you have heard of this term and have seen women, and men, who walk hunched over and with difficulty; who struggle to get out of a chair, and who are unsteady on their feet. All indications of what scientists call age-related hyperkyphosis. Zooming to the end of the story, I have great news for how to counter and even reverse this syndrome!

Ninety percent of the stimulation and nutrition to the brain is generated by the movement of the spine.  Roger Sperry, Nobel Laureate 1981 in Physiology and Medicine

First, let’s look at the research on Dowager’s Hump (DH). A small amount of curvature in the thoracic or upper spine is normal because of the natural shape and curve of our vertebrates and discs which compose the structure of our spines. When our spines have a 40° or greater curve, we have DH. The degree of curvature can even be greater, with more serious consequences, and progress from 40° for women forty years old and beyond, to an average of a 43° angle in women just postmenopausal (fifty-five to sixty), to a whopping 53° angle by the time we reach seventy-six.

The most surprising news? Researchers found an unexpectedly high percentage (35%) of women twenty-to-sixty already had the beginnings of DH. Most interestingly, that stat is from 1993, well before our fingers, and our lives, became glued to a computer or cell phone. The number today? Closer to 65%, and climbing…

Many of us believe DH is caused by “vertebral compression fractures.” Well, dispel that myth! A mega-study encompassing all the major studies done on DH from 1955-2016, found fractures the culprit in just 30-40% of the cases. Another belief brought up short by this study? DH is a result of spinal osteoporosis. Again, not true. Nor, has research found a direct link between DH and calcium consumption, estrogen levels, or follicle-stimulating-hormone levels. What about degenerative disc disease? Folks with DH do have higher incidents of degenerative disc disease, but it doesn’t seem that this is what causes DH, but rather is a result of having DH. Adding to the argument, the majority of those studied who had DH and degenerative disc disease did not have previous vertebral fractures or osteoporosis, meaning if we do something about DH, we can possibly prevent degenerative disc disease, as well. That works in my book!

Let’s look at the result of DH on our bodies and our life expectancy for a moment. As our heads pitch forward, we experience a decline in our entire visual system. Then, our accurate reading of the world around us becomes compromised. Add in other age-related visual issues like cataracts and macular degeneration, and we become accidents waiting to happen. Our mobility suffers, as well. We have trouble rising from a chair. We experience a loss of balance –also tied to our visual perceptions being skewed. We walk slower, we need more support for standing and walking, and our speed at climbing stairs declines—all of which double the chances of us falling and breaking a bone. In fact, the data points to DH as one of the major factors contributing to falls among people over sixty.

Increased pain in the back in 29% of the women studied was caused by loss of height due to increasing Dowager’s Hump, and more than 50% of adults who have lost height report having back pain. Interesting. Pain in the shoulders and pelvis, shorter pectoral and hip flexors resulting in pain in these areas, was noted, as well. Grip and ankle strength diminishes. Our entire quality of life suffers. Last, the development of DH shortens our lives by increasing the development of pulmonary disease and other frontal organ issues, and, with the increase in falls, death from fall-related developments.

Those of us experiencing Dowager’s Hump have difficulty reaching and doing anything more than light housework, and we score lower on overall physical activities and movement. What the new science now tells us is that we can do something about this. Spine-strengthening exercises and postural training, specifically, extension and thoracic strengthening work with resistance, done regularly, can both stop the development of DH in its proverbial tracks, and even more encouraging, can reverse the severity of DH in almost all cases. Flexion exercises—bending forward and rounding forward more often, increases our susceptibility to DH by more than 68%.

My last piece of data for today:  several studies of women, who develop DH four times as often as men, found after thrice-weekly spine-strengthening, extension exercises, saw a decrease in the angle of spine curvature by 11%. To quote Wendy Katzman at the University of California San Francisco in the Journal of Orthopedic Sports Physical Therapy, “Kyphosis and forward head posture were significantly reduced among the compliant exercise group compared with the noncompliant group.” The Mayo Clinic, from their study of postmenopausal women taking part in a back strengthening program, concluded, “Increasing the back extensor strength in healthy estrogen-deficient women helps decrease thoracic kyphosis.” The decrease in the angle of the spines of these women was, in their words, “significant.”

Below I have linked a short video demonstrating the most effective and easiest exercises to strengthen our backs and resign the Dowager’s Hump to its origin–the pages of a James Joyce novel. Here is to standing up straight and tall!

Until next time…Be Vibrant!

Kick Mobility Issues with Vitamin K

I just finished reading the results of a new study on vitamin K and its role in decreasing disability and increasing our mobility as we get older, and I want to share these latest findings.

We gerontologists, and many researchers worldwide, consistently focus on what we call “novel” risk factors affecting vibrant aging. These include things which further limit our mobility as we get older and decrease our ability to do what we want to do in our lives.  With the number of adults living to sixty-five and older projected to double by 2050, anything and everything we can do to keep our bodies movin’ and groovin’ should get our attention.

Looking at the current stats, we find that 60% of men and 40% of women over sixty don’t get enough vitamin K in their diets. Because of this, we consider vitamin K a “shortfall nutrient” in older adults. Low levels of this important vitamin open us up to some rather unpleasant problems including worsening of some chronic diseases– cardiovascular disease and osteoarthritis top the list. Physically, a slower gait speed and deteriorating physical performance was noted over the 4-5 years of follow up with the participants of the study. This led researchers to conclude that not enough vitamin K could be associated with mobility disability as we age. We already know vitamin K plays a key role in blood clotting and maintaining healthy bones—another factor keeping us up and moving around. Some sobering news: alcoholics are at a much higher risk for vitamin K deficiency. Also at risk are those with digestive disorders like Crohn’s disease and cystic fibrosis, which make fat absorption more difficult.

Of course there is good news and delicious ways to up our vitamin K! Please check with your health practitioner, DIFM, or RDN* before adding things into your diet as folks on blood thinners could have contraindications.

My bevy of experts recommend striving for 90-100 mcg per day for women, and 120 mcg for men. 

Here is my list. Remember, organic is always the way to go, if possible, to help limit our exposure to more harmful chemicals.

The Delicious List of Vitamin K-Packed Foods:

• Kale (565 mcg per ½ cup, cooked)
• Collard Greens (530 mcg per ½ cup, cooked)
• Spinach (444 mcg per ½ cup, cooked, raw 146 mcg per cup)
• Turnip Greens (425 per ½ cup, cooked)
• Brussel Sprouts (150 mcg per ½ cup, cooked)
• Broccoli (85 mcg per ½ cup, cooked)
• Asparagus (72 mcg per ½ cup, cooked)
• Romaine Lettuce (60 mcg per 1 cup, raw)
• Sauerkraut (56 mcg per ½ cup)
• Edamame (25 mcg per ½ cup, boiled)
• Pickles (25 mcg per cucumber dill or kosher dill)
• Pumpkin (20 mcg per ½ cup, canned)
• Pine Nuts (15 mcg per ounce)
• Blueberries– Ahhhhh, a fruit! (14 mcg per ½ cup)

A good quality multi-vitamin, one from the health food store, can also help with low levels of vitamin K. However, because eating the food in its whole state whether it’s fresh or frozen with its many other vitamins and minerals gives us extra help in staying healthy and mobile, I recommend starting your vitamin K regimen by adding some of the foods listed above into your daily meal plan. Here’s to rockin’ our way through our silver years!

Until next time…Be Vibrant!

* DIFM: Dietitians in Integrative and Functional Medicine/ RDN: Registered Dietitian Nutritionist

Electrolytes - We Need Them

What the devil is an electrolyte, and why do we need them? The main electrolytes in our body are calcium, chloride, magnesium, potassium, phosphate, and sodium. These nutrients, or chemicals, conduct electricity when dissolved in a liquid, like water. Our body is 70% water, and electrolytes are important in so many of our internal functions, from regulating our heartbeat to allowing our muscles to contract so we can move. They also interact with each other and the cells in all our tissues and nerves. One of their key functions involves balancing the body’s fluid levels. You may have heard the term “electrolyte imbalance,” which in most of us can be easily corrected, but in older adults this imbalance can become a serious issue.

We get electrolytes from the food we eat and from drinking certain fluids. We lose some electrolytes most commonly through sweating—usually from exercise or from being in a hot climate for an extended period of time, bowel movements and urinating. We might also develop an electrolyte imbalance when we are ill, especially if we have a stomach issue causing diarrhea and/or vomiting.

For healthy, active children and adults, an electrolyte imbalance is easily remedied by drinking more water and adding in a few electrolyte-rich foods. If following the KETO diet, electrolyte imbalance can happen because of exaggerated water loss. If illness is the cause, adding a few glasses of the house-made electrolyte drink (see recipe below) will put you right in just a short time. Seniors, on the other hand, may have developed a more severe case of imbalance due to a poor diet low in nutrients or whole foods, researchers sometimes refer to as “the tea and toast diet,” too little exercise, and not drinking enough water. Some of the causes outside a senior’s control that can also cause electrolyte problems include:

• Kidney disease
• Congestive heart failure
• Some drugs: diuretics, ACE inhibitors, some antipsychotic drugs and anti-depressants
• Cancer treatments
• Intestinal or digestive issues (trouble absorbing nutrients from food)

Your doctor can easily include an electrolyte panel as part of a routine physical exam, as part of a range of tests, or it can be performed on its own. Check in with your doctor if you have any concerns.

As we get older our kidneys become less efficient, which can lead to frequent urination, and so we pee out the electrolytes we need. This inefficiency can also result in painful urination or incontinence. Many people try to avoid these occurrences by not drinking liquids, but that only makes the problem worse.

The most common electrolytes to go out of balance are potassium, calcium, and magnesium. A deficiency in these doesn’t show up right away but develops gradually. Some of the signs of low electrolytes? Here is a quick list to think about:

• Are you feeling particularly fatigued?
• Do you feel particularly anxious or are having trouble sleeping?
• Do you have weakness or spasms in your muscles?
• More headaches?
• Having a change in bowel movements?
• Do you feel abnormal sensations on your skin?

Any, or all, of these can be an indicator of a low electrolytes. A growing concern among older adults is also the over-use of laxatives and certain antacids. Constipation (from poor diet and lack of water) is a very common complaint, and many people self-treat this with laxatives, when adding whole high fiber and nutrient-dense foods and drinking enough water will go a long way toward correcting the problem.

To prevent electrolyte imbalance and always be well hydrated, strive to eat whole, unpackaged, unprocessed foods. Some of the best choices include dark leafy green veggies, cruciferous veggies like broccoli, cabbage, and Brussel sprouts, sweet potatoes or squash, bananas (in moderation due to their high sugar content) and avocados. Unprocessed hydrating foods also packed with electrolytes: celery, watermelon, cucumber, kiwi, bell peppers, citrus fruits, and pineapple. If you find yourself low in a particular electrolyte here is a short list of foods to add into your eating plan.

• For chloride: low-sodium tomato juice (or fresh!), lettuce, olives
• For calcium: collard greens, spinach, kale, sardines
• For potassium: potatoes with skin, plain yogurt, the occasional banana
• For Magnesium: halibut, pumpkin seeds, spinach

Lastly, drink water!  If you are drinking enough you should need to find the ladies room every three to four hours, which translates for most folks, into eight-ten 8 ounce glasses of clean, good quality water every day.

Here is a great low sugar, non-chemical recipe for an electrolyte replacement drink.

Yield 4 cups (946 ml), serving size 1 cup (237 ml)

• ¼ tsp salt
• ¼ cup (60 ml) freshly squeezed lemon juice
• ¼ cup (60 ml) freshly squeezed lime juice
• 1 ½ cups (360 ml) unsweetened coconut water
• 2 cups (480 ml) cold, filtered water

All of us need to keep an eye on our electrolyte balance. Be especially mindful of our older loved ones to make sure they, too, are well hydrated and replacing those important nutrients we all need to stay vibrant!

Until next time…Be Vibrant!

Powering Up Our Immune System to stave Off Illness

Building up our immune system to fighting fitness always ranks as our first choice of defense against disease, and that holds true for avoiding all pesky colds, flu and viruses. Tapping in a bevy of trusted sources, including Dr. Mark Hyman and the Institute of Functional Medicine (IFM), Dr. Tieraona Low Dog, and Dr. Andrew Weil, I have done the homework and come up with a list of foods and supplements we might begin taking to help bolster our immune system against illness.

As always, check with your health care provider to be clear of contraindications. I have great respect for MDs, however, many doctors don’t know much about supplementation, as they are offered no classes on them in most medical schools.  This is where a DIFM: Dietitian in Integrative and Functional Medicine, or a RDN: Registered Dietitian Nutritionist come in handy, as they can help steer you into what you need and work with your existing medications. The website to find one of these professionals in your area is: https://integrativerd.org/

On the food front, upping our consumption of a rainbow of fruits and vegetables to ten servings—five of each, every day, and drinking eight to ten 8 oz. glasses of good quality filtered water will definitely help keep us well and smiling through this difficult time.

Here is the list of supplements you will want to consider to boost your immune system:

Vitamin C

At the top of the charts is an old favorite, vitamin C. Some of the latest stats show more than forty-three million adults from the ages of twenty to sixty are deficient in vitamin C. That number jumps up drastically for seniors. We get some vitamin C in our food, but now supplementation is a necessity. Taking 1000 milligrams, in 2 or 3 doses throughout the day, perhaps at mealtimes, will boost your immunity system. Don’t take it all at once, as it absorbs and is eliminated each time we visit the loo, and so spread out the doses. Try different types to see which you tolerate best. My personal favorite is a time-released vitamin C.

Zinc

Adding this mineral to your daily regime gives you an edge against illness, and it becomes an even bigger gun if you actually get sick. If a bug finds you, zinc lozenges should be a go-to. Each lozenge should be no more than 10 milligrams, and ideally use five per day, but cap your use of them at seven per day. These can be powerful at stopping the development of a virus if taken at the very first signs of illness.

Vitamin D

New research points to vitamin D as a frontline fighter against illness. The Institute of Functional Medicine (IFM) suggests 4,000 IU a day for people nine to ninety-nine. I take that much every day.

Selenium

Selenium is a key nutrient for immune function. This powerful antioxidant boosts the body’s defenses against bacteria, viruses, and even cancer cells. The IFM says, “It may particularly help to protect against certain strains of flu virus.” Here is the great news! Eating 2-3 large Brazil nuts a day gives us the selenium we need. Now that’s an easy and delicious prescription.

Honey

Preferably raw hone, added to hot tea, or even taken straight by the teaspoon is a potent anti-viral food. It is safe for all ages from one to a hundred, but not safe for babies under one year. I take a teaspoon, now, every day. Yum.

Garlic

This is another delicious anti-viral food. It has been called a poor man’s penicillin for its amazing antimicrobial properties. Garlic is the perfect example of an herb that bridges food and medicine. Find ways to add this yummy vegetable to dishes to benefit from its powerful healing properties.

The secret to activating the medicinal qualities of garlic is fresh garlic and to crush it first and the let it sit for a few minutes before cooking with it. The great news here is you can’t really overdo the garlic from a health stand-point, however, make sure everyone you love has some when you do, as that will solve the problem of the infamous garlic breath we all dread!

In addition to adding crushed garlic to many of the dishes I make, I also take garlic in pill form. Your DIFM or, a knowledgeable person at your local health food store, can guide you to a reputable brand. These will not give you garlic breath, if they do, try another brand.

Probiotics

The easiest, and again, delicious way to add this gut-healing and immune-building super food into your eating plan is to have one cup of unsweetened plain yogurt—I add two big handfuls of berries to mine many a morning– three or four days a week and you will be doing your entire body a world of good, not just your army of disease fighters. If you are lactose sensitive or intolerant, there are good quality capsules that deliver the same benefits. They are often found in the refrigerated section of the health food store. Ask. The most expensive isn’t always the best.    

To this list I add a great Multi-Vitamin with Minerals. Make sure it contains 15,000 IU of mixed carotenoids, including beta-carotene. These are key for boosting our respiratory system.

To insure you are getting a good quality supplements, the smart money is on buying ones from a health food store, versus say, the drug store or a big box store. Talk to the store manager or people who work there and ask questions. The popular one isn’t always the best one.

For some additional remedies to boost your immune system to help stave off illness or shorten its duration, have a look at Great Remedies for Winter Illnesses.

If you are already working with a nutritional expert, you are in great shape. For the rest of us, these recommendations will be a good start for super-charging all your disease-fighting systems and keeping you healthy and in the pink. 😉

Until next time…Be Vibrant!

Susan Lucci's Heart Attack Scare

Last year People Magazine reported that Erica Kane of Pine Valley* suffered a heart attack in October of 2018. As I read the article, it didn’t surprise me that she never mentioned being tested for heart disease before the heart attack scare. Obviously, her doctor failed to order tests for her which would have revealed the 90% blockage in the main artery leading to her heart, and a 70% blockage in a branch artery even though her doctor knew her father had suffered a heart attack in his early forties.

Looking at this information in black and white, it seems incredulous that her doctor had never ordered the four tests that could have saved her from having a heart attack: a simple stress test, a Coronary Calcium Score to help gauge her risk.  And, once she had that number, a Carotid Intima-Media Thickness Test (CIMT) to measure the thickness of the inner two layers of the carotid artery, the artery located at the side of our necks. Further tests such as a Doppler Ultrasound, a MRI Angiogram or MRA, or a Cardiac CT Scan, all which I discussed in detail in my previous blog post: https://www.ljrohan.com/blog/women-and-heart-disease-the-facts-may-surprise-you-part-ii/

All this begs the question, why didn’t Erica Kane’s doctor order any of these, especially with a history of heart disease in her family?

I have some history of heart disease in my family, and since I reached mid-life, my doctor orders both a coronary calcium score and a CIMT every time I have a physical. I don’t want to put Erica’s doctor on the defensive, but even today in 2020, women are far less likely to receive the same care and treatment as men when it comes to their health outside of female issues. We are also three times more likely than men to die following a serious heart attack as a result of receiving less equal care and treatment.

In a landmark study done in Sweden over a ten-year period, 2003-2013, involving almost sixty-one thousand women, the researchers found this to be true. I watched my mother languish in a recovery facility, virtually ignored by her (male) physician after undergoing quadruple by-pass surgery. During that stay, she suffered from a host of easily avoidable complications due to basic negligence. I tried to intervene on her behalf, but since I was the baby in the family, no one would listen to me.

The anger I feel as I write these words is almost uncontainable, but the above study, published in the Journal of the American Heart Association in 2017, makes one thing absolutely certain: We must take control of our own health and ASK, or more likely in most cases, DEMAND, that at least once, more if results merit it, we have our coronary calcium scores taken, and for sure, have a CIMT test, especially if heart disease runs in the family or we have any other heart attack scare. If the results are good, the peace of mind is worth it. If the tests show issues, you can do what is necessary so that you will never be like Erica, out shopping one day and then suddenly feel as if an elephant has just sat down on your chest.

 Until next time….Be Vibrant!

*Susan Lucci is one of the stars of the daytime soap opera, All My Children.

Women and Heart Disease: The Facts May Surprise You Part II

Since my focus is always retention and prevention, today I will talk about some important tests that will help women avoid a heart attack – a silent or not-so-silent one – and help prevent heart disease. My goal is to keep you well informed, and hopefully, urge you to speak up, and then step up to take control of your heart and your life.

As I mentioned in Women and Heart Disease Part I, over eleven hundred women were surveyed by the Women’s Heart Alliance about their knowledge of and experience with discussing heart disease with their physicians.

Heart Disease Discussions

While a majority of the women in the survey had a routine physical or wellness exam sometime in the previous twelve months, only 40% of those exams included a heart health assessment, despite 74% of these women having at least one risk factor for heart disease. A tiny number – only 16% – were told by their doctors that they were at risk.

Please take a moment to let that sink in, only 16% were told they were at risk.

To confound me even more, I learned only 22% of primary care physicians, and 42% of cardiologists, felt they were comfortable and prepared to assess cardiovascular risk in women!

The last distressing fact: Only 16% of primary care physicians, and 22% of cardiologists discussed giving their patients life-saving tests I will cover below. They also failed to suggest preventive choices to safeguard a woman’s heart health. This makes my head explode! How can this be true in the twenty-first century, with women being the majority of folks in the U.S. (and around the world)?

The short answer: We seem to care more about how we look, and the medical profession may be reinforcing that idea. A full 63% of the women responding admitted to putting off a doctor’s visit at least some of the time, and 45% of women canceled or postponed an appointment until they lost some weight. (The reasons they gave were difficulty losing weight or finding time to exercise.)

With our primary care physicians spending on average 17.5 minutes with us, we don’t feel safe enough to reveal additional information about any heart symptoms we may be having or call further attention to what might be wrong with us. We are embarrassed to talk to our doctor, family, and friends about heart health because we think it’s tied to solely to our weight, and not a combination of many other important factors—stress level, emotional health, diet choices, sleep, other medications, and dental hygiene. Adding to that burden, many of our doctors are men, and the bias some of them carry about women compels them to discount the importance and risks of heart disease and concentrate primarily on how much a woman weighs.

Heart disease is the number one cause of death for women. It kills twelve times as many women as breast cancer, which gets much more press. Heart disease must be addressed first. Of course, we must also remove the stigma and stereotype of “weight gain equals heart disease.” The good news is that those of us who had our hearts checked by a doctor in the last year were twice as likely to feel comfortable discussing the topic with our family and friends.

Now that all the right cards are in my hand, here are three key tests to ask for the next time you see your physician. Together with ways to prevent heart disease, which I will cover next time, I will lay down my Royal Flush in hearts!

Tests for Heart Disease

A Stress Test

The most familiar of the three, a stress test takes less than an hour and serves as the baseline for understanding the health of your heart. It is done on a treadmill – in sneakers and street clothes – with complete supervision. You set the pace, and no one will ask you to do more than you can.

Coronary Calcium Test

This easy and painless test assesses your level of risk for a heart attack by measuring the amount of calcium deposit(s) in your arteries. This is a coronary CT scan, done with the same equipment as a CT scan.

CIMT: Carotid Intima-Media Thickness Test

Another easy, painless and quick test, a CIMT measures the thickness of the inner two layers of the carotid artery, the artery located at the side of your neck. This test can let doctors know if there is any thickening in the artery walls long before you might experience symptoms of a cardiac incident. This test is a sonogram of the carotid artery in the neck—Gel on the neck, quick scan, off the table in fifteen minutes!

If the results of the CIMT are concerning, your doctor will request further tests such as a Doppler Ultrasound—an ultrasound to watch blood flow through the vessels and heart, a MRI angiogram or MRA—which allows her to see inside your blood vessels, or a Cardiac CT scan—a dye-free, multiple x-ray that provides images of the heart and blood vessels. All of these will give defining information about the state of your arteries and risk level for a heart attack.

I often print out the list and give it to women to take to their routine exams. Knowledge is power and in this case, very possibly life-saving.

I will wrap up my in-depth discussion on women and heart disease next time with the best things we know – this red-hot minute – that will keep our hearts healthy and humming.

Until next time…Be Vibrant!

Women and Heart Disease, The Facts May Surprise You Part I

“Cardiovascular disease is the number one cause of death for men and women in this country,” says Jennifer Haythe, MD, Director of Cardio-Obstetrics, an internist at NYPH/Columbia and co-director of the Women’s Center for Cardiovascular Health at Columbia.”

Before I went back to school, I wouldn’t have known this fact: My first thought, especially for women, would have been cancer, and therein lies a big part of the problem. A 2017 survey conducted by the Women’s Heart Alliance interviewed 1,011 U.S. women aged 25-60 years and collected physician survey data from 200 primary care physicians and 100 cardiologists, as well. The goal of the surveys was “to determine knowledge, attitudes and beliefs regarding heart disease in women.” The results mirrored my own thinking.

Let’s separate the various strands of this knotty problem. First, the researchers found that 45% of women twenty-five to sixty, and 35% percent of women fifty to sixty– that included me—were unaware that heart disease annually kills 500,000 women in the U.S. Add to that, another 15.2 million women, worldwide, who die from the disease every year. Even more surprising– only 13% of Americans know how great a woman’s risk is for developing heart disease. That percentage of awareness falls even more in women with lower levels of education and income, and women of color.

 The next shocking fact: 71% of women almost never discussed heart health with their physicians, assuming their doctors would ask if there were a problem. To further curl your hair, physicians often didn’t or don’t, discuss cardiovascular disease with their female patients because in spending only 17.5 minutes per patient, according to studies, either the patient had a more immediate health issue, or she didn’t fully report her symptoms. This reflects a wholesale lack of interest (or knowledge) in making prevention a priority before a woman experiences symptoms, or worse, has a cardiac incident.

We all have seen someone in a TV show or movie pretending to have a heart attack (usually a man). He clutches his chest, his breath becomes short and shallow, his eyes bug out, and he makes some dramatic yelp as he falls onto the floor, or into a chair, if he’s lucky.

Realistically, heart attacks come in several different flavors and their symptoms vary. Let’s begin with maybe the most dangerous —The Silent Heart Attack.

The symptoms of a silent heart attack can be subtle, and often dismissed as sudden fatigue, nausea, or shortness of breath that occur when exercising or just out and about. Those symptoms disappear when resting, according to cardiologist Suzanne Steinbaum, MD, director of Women’s Heart Health at Lenox Hill Hospital in New York City.

Additionally or differently, especially in women, there might be nontraditional signs like unexplained fatigue, pain or discomfort in the throat, neck, or jaw, or what seems like heartburn — symptoms so mild, they’re barely noticed, or that go completely unnoticed during times of heightened stress.

 The damage from these silent attacks is usually only discovered accidentally while testing a woman’s heart for other reasons. If we have had a silent heart attack, we are 3x more likely to die from heart disease.

One might also experience the following heart attack symptoms:

• Feeling very full, as though you have eaten a large meal, even if you haven’t eaten recently
• Followed by feelings of indigestion and a large person sitting on your chest
• Ribs tightening and becoming short of breath
• Pain in your right shoulder and arm (not left, as many believe)
• Pain in the front of your neck and up into your jaw

I suggest you memorize all possible heart attack symptoms. Make a copy and keep it on your phone or pin it on your fridge. I have!

In Part Two of this discussion, I will talk about some empowering choices we can make to keep a heart attack a thing of fiction.

Until next time…Be Vibrant!

Is Your Cruisin' Causing You Bruisin'

As I get older, one thing that truly bothers me is how much more easily my skin bruises. Every time my upper arm so much as taps the corner of a cabinet door, or my thigh grazes the edge of a hard chair, I used to end up with a big ol’ purple bruise that could take weeks, even months, to heal. Both these calamities, plus the times I drop something on the top of my foot, like a pot lid, or a book, prompts a wardrobe re-think so the bruise doesn’t show. For someone who is a bit of a klutz, any notions or potions which could shorten the healing time get my full attention.

Those of us in post-menopause suffer the effects of these slight dings to a far greater extent than any other age group. The main reason is the loss of our protective armor of hormones, which, in this case, literally gives our skin an armor-like invincibility to these minor collisions. Without estrogen and progesterone to keep it thick and supple, our skin thins, and becomes much drier. The fat cells in our skin also shrink. Adding to the list of reasons to stay out of the sun and use sunscreen when we are in the sun: ultraviolet light breaks down our collagen and the elastin in our skin. Our blood flow also decreases as we age, and the capillaries—the blood vessels closer to the surface of our skin, become more fragile and can be broken easier, which leads to bruising. Regular exercise can help keep our blood pumping strong, creating a variety of chemical reactions that keep the blood vessel walls stronger than those of non-exercisers. Vitamins C and D, when taken in adequate amounts, help keep these vessels in good shape, as does the spice Turmeric. Talk with your DIFM (Dietitian in Integrative and Functional Medicine), or RDN (Registered Dietitian Nutritionist), about adding these to your regime, if you aren’t taking them already.

These are some of the internal tools to help with bruising, but what can we do when we bang into something and know we are in for a plum- colored spot? After sifting through all the best science, I find it confirms what has become my lickety-split response, I call it my AIE: Arnica gel and Arnica homeopathic tablets* (more on this in a moment), Ice, and Elevation. Here is the scenario: I slam one of my body parts into a non-yielding inanimate something. Ouch! I immediately pop some homeopathic Arnica tablets under my tongue (I am so convinced this works, I carry them in my purse at all times). Next I grab an ice pack from the freezer, if at home, or if I am out I get some ice in a plastic bag, or even a cloth napkin, and ice and elevate the area for twenty minutes. If I am at home, I also apply a nice layer of Arnica gel to the area before I put on the ice pack. If out and about, the Arnica tablets will suffice until I get home and can apply the gel. It is hard to describe my elation the next day when the area is either virtually free of any discoloration, or the discoloration is so slight I don’t have to worry about what I wear. It is important to take the tablets and/or apply the gel once every few hours for the first twenty-four hours, then continue for a few days with the gel, if there is any sign of the mishap.

Now to talk a bit more about Arnica. Several studies in both the US and the UK find applying topical Arnica gel at 20% strength can significantly reduce bruising. A 2016 study published in American Journal of Therapeutics, found that both Arnica gel and homeopathic tablets reduced swelling, inflammation, and bruising without causing issues by interacting with other allopathic or pharmaceutical drugs being taken. Of course, it is always necessary to speak with your nutritional expert before taking homeopathic tablets. While the gel seems to be safe in all cases—just ask. So when next you bang a tender spot, you might give this remedy a try!

Until next time…Be Vibrant!

*“Homeopathy is a medical system based on the belief that the body can cure itself. Those who practice it use tiny amounts of natural substances, like plants and minerals. Homoeopathists believe these stimulate the healing process. It was developed in the late 1700s in Germany. It’s common in many European countries, but it’s not quite as popular in the United States.”

“Though oral homeopathic Arnica is believed to help with bruising, it’s listed as a poisonous plant by the FDA and considered unsafe for oral ingestion. Homeopathy remedies are so diluted that it’s unlikely poisoning will happen. In homeopathy, there’s a belief that the dilution makes the remedy more effective because of how it works on an atomic level. The FDA hasn’t approved any homeopathy remedies such as Arnica, and hasn’t evaluated any remedy for effectiveness or safety. According to the Memorial Sloane Kettering Cancer Center, you should avoid ingesting Arnica if you’re pregnant or breastfeeding, as it can harm the fetus or baby. You also shouldn’t ingest Arnica if you’re on Warfarin (Coumadin) or any blood-thinning medication.”

Healthline.com

Some Ideas for Bringing in 2020

Recently, I heard a great idea for starting out the New Year and the new decade. It got me thinking about how I could mark this milestone in our evolution. I love, as do many of us, to clearly designate a beginning (and sometimes an ending) to a phase of our life journey, or the life journey of our loved ones. It makes for bite-sized, manageable chunks we can understand and file away in our brains, or in the cabinet. The calendar makes for convenient segmenting in this regard, and the year 2020 seems especially auspicious, being the sequential year of the century, and the beginning of a new decade. (Some folks argue that technically the decade starts in 2021, but I am going by the feeling we have that a new decade is dawning in a few weeks.)

Here is the idea: my friend plans to walk one mile each hour from 12:00 noon on December 31, 2019 through 12:00 pm midnight on December 31, 2019. She will finish in the wee hours of 2020, and welcome in the New Year and the decade, just as it begins. It will take her about seventeen minutes to walk each mile. I think this is a winning triple-play to bring in the New Year—combining exercise, a personal commitment to oneself, and being fully present for those twelve hours. Following through with this suggestion gets the New Year off to a positive start with three great choices we can make to help us be more vibrant. What could be better? I offer this idea now so that you can make plans to work it seamlessly into your holiday.

Do you have something special planned to bring in the New Year and the new decade? I would love to hear from you. Please share your yearly ritual, or what you are planning for this new chapter in your life!

Until next time…Be Vibrant!

Great Remedies for Winter Illnesses

I began my studies of herbal remedies back in the early 1970’s when I was in middle school. Back then, I read everything in print, and started my own herbal remedy library. (To be followed by my supplements library when I was diagnosed with endometriosis at twenty-two.) My first, and many of my second-wave baby boomer readers will recall those years where all of us in America were initially exposed to the power of herbs–both in the kitchen and in the medicine cabinet. I remember buying fresh herbs for the first time at the farmer’s market, putting them on my bathroom window sill, and lovingly tending them like a mama hen looking after her chicks.

Soon my mother and I were replacing the dried herbs—the only way I knew herbs existed — with my fresh sprigs in recipe after recipe from Joy of Cooking. In my bathroom laboratory I created beauty potions and medicinal remedies that actually worked. I was hooked! Fast forward four plus decades, I am still using some of my recipes. Here, I pass on my tried and true ones, and a few I learned about more recently.

There exists a doctor’s bag full of non-allopathic (non-pharmaceutical), deeply researched, offerings to help shorten the duration of illnesses and speed us back to glowing health. Since respiratory infections effecting the sinuses, bronchial areas, and lungs, seem to be the most common areas of the body to succumb to illness, we will focus on remedies to help heal these areas. The multi-layer benefits of using complementary medicine is that other parts of the body get a boost as well from the remedies, so we get extra healing and protection all in one! These are recipes which have been around for years, decades, and even centuries, in some cases, and have helped heal the body with time-proven solutions.

One important thing is the dosage. Most of us are used to the dosage of pharmaceuticals: One three times a day; two twice a day, etc. In complementary and herbal medicine, dosage is much more frequent. In so many cases, more times used/administered, but not more medicine, is better. Some of the frequencies may seem like a lot, so I wanted to make that clear.

Before you begin:

• Run the jar(s) you will use (I like Mason or Ball jars) with new lids, through the hottest cycle in the dishwasher, let dry completely
• Wash and let the herbs dry completely before making recipes (damp herbs will mold)

It Usual Begins with a Sore Throat

You know the feeling: hurts a little to swallow, your head starts to feel just a little stuffy or light. Start immediately with a Sage Leaf Gargle*. Sage is a powerful antiseptic for internal and topical use. Recommended usage: gargle every 1 to 2 hours. Swish and spit.

• 1 cup boiling water
• 2 teaspoons fresh or dried sage leaves
• ¼ ounce salt
• Pour the boiling water over the sage, cover and steep for 20 minutes.
• Strain and add the salt. Gargle as needed. Store in the refrigerator for a couple of days

Also high on the list of other medicinal uses for sage is Sage Honey**.  This honey is also a powerful remedy for sore throats.

• Fresh sage to fill ½ the Mason jar
  Local, raw honey to fill the jar to the brim
• Chop your fresh sage up as fine as you can and add it to the jar until it fills up about half way.
• Cover the jar with a lid and allow to sit in a cool, dark, dry place for 2-4 weeks.
• Take one teaspoon every 1-2 hours until sore throat lessens.

Turn jar upside down regularly to keep herbs well mixed

If You Come Down with a Cold or Cold with Cough

There are a couple of items you should always have in your medicine cabinet: Black Elderberry Syrup/Extract and Thyme Syrup***. Elderberry syrup is great for colds, influenza, and even fever. It is carried at health stores. Purchase a product containing 5,000-6,000 mg of black elderberry fruit in the extract. Keep the fresh thyme syrup in the fridge.

• 4 cups water
• 4 ounces Lemon thyme leaf (or plain thyme)–fresh is best, but dried will work
• 1 cup raw, organic honey
• 1/4 cup brandy, optional (works as a preservative)
• Put thyme and water in a pan over low heat. Cover with a lid left slightly ajar, simmer until the liquid is reduced by half, about 45 minutes. 
• Strain the liquid and discard the herbs. When mixture is just warm, add the honey and brandy (if using). Whisk until smooth. Transfer to a glass jar and store in the fridge for up to four weeks (without brandy) or four months (with brandy).
• Take 1-2 tablespoons every 2-3 hours to help get the gunk out

Oregano de la Sierra, also called Wild Oregano, or Bee Balm is also an important herb to aid healing when a cold or cough strikes. The recipe for Oregano Honey is simple to make:

• Pack a Mason jar with fresh oregano
• Cover completely with local honey and let sit for 2 weeks
• Can be added to tea, or just taken by spoon
• Take one teaspoon every 1-2 hours

Two additional outstanding remedies for winter illnesses like colds and coughs are Echinacea and ginger.

The wise folks suggest Echinacea within 72 hours of coming down with a cold or cough, when the herb is most effective at eliminating viral and bacterial infections. ONE NOTE: DO NOT take Echinacea for the flu, as it can make it worse.

Last is one of my favorites, ginger. This Ginger Syrup is a snap to make, works wonders when you feel yourself coming down with a cold or have a chill. It helps kill viruses that can lead to an upper respiratory infection, helps soothe and shrink swollen nasal passages, and calms a sore throat.

• Chop a 3 inch piece of fresh ginger.
• Add to 1/2 cup of lemon juice, 2 tablespoons of honey and 2 cups of boiling water.
• Stir well and then cover it with plastic wrap for about 10 minutes.
• Strain and drink 1-3 times a day

With your fridge and cabinet stocked with these powerful healing tools you’ll be ready for anything Old Man Winter throws at you–including snowballs!

Until next time… Be Well and Be Vibrant!

Always check with your health care provider for any contraindications.

A version of these recipes is found here:

*Motherearthliving.com

**Thekitchn.com

***Wholefully.com

Powering Up Our Immune Systems

Building up our immune system to fighting fitness always ranks as our first choice of defense against disease. Not to get sidetracked, but even the leaders in cancer research have finally recognized that strengthening the immune system offers the best protection against disease. (More about that in future posts.) Now, before the temperatures drop and stay down, adding these supplements to our daily routine will help us stay well. As always, check with your health care provider to be clear of any contraindications.

Vitamin C

At the top of the charts is an old favorite, vitamin C. Some of the latest stats show more than forty-three million adults from the age of twenty to sixty are deficient in vitamin C. That number jumps up drastically for seniors. Why? The short answer is we don’t eat enough fresh fruits and veggies, and the depletion of the nutrients in the soil over the last fifty years has lowered the nutrient content of our agricultural products. As many respected experts tell us, we now cannot get all the vitamins we need by simply eating the right foods. Added pollution, stress, and medications have also contributed to our deficiency.  We get some Vitamin C in our food, but now supplementation is a necessity. Taking 1000 milligrams, in 2 or 3 doses throughout the day, perhaps at mealtimes, will boost your immunity system. Don’t take it all at once, as it absorbs and is eliminated each time we visit the loo, and so spread out the doses. Try different types to see which you tolerate best. My personal favorite is  1000 milligrams of time-released vitamin C.

Zinc

Adding this mineral to your daily regime gives you an edge against illness, and it becomes a even bigger gun if you actually get sick. If a bug finds you, zinc lozenges should be a go-to. Make sure the lozenge contains at least 50 milligrams of zinc; ideally 75 to be effective, but cap the strength of each lozenge at 10 milligrams. Taking more interferes with the absorption of copper. Some great advice: pop a lozenge just before you get on a plane!

Vitamin D

New research points to vitamin D as a frontline fighter against illness. The Institute of Medicine suggests 4,000 IU a day for people nine to ninety-nine. I take that much every day.

To this list I add a great Multi-Vitamin with Minerals. To insure you are getting a good quality one, the smart money is on buying ones from a health food store, versus say, the drug store or a big box store. Talk to the store manager or people who work there and ask questions. The popular one isn’t always the best one.

If you are already working with a nutritional expert, you are in great shape. For the rest of us, these recommendations will be a good start for super-charging all your disease-fighting systems

Until next time…Be Vibrant!

Food as Prevention in Stopping Breast Cancer

In drilling deep into breast cancer prevention for women, I find recommendations based on several factors. In aiding prevention for women before mid-life, prevention for postmenopausal women, and what suggestions help postmenopausal women who have had breast cancer, there exists some common approaches which are very encouraging.

Regular, focused exercise across the lifespan wins the day as the number one risk reducer. I know this seems like I never get off this one subject, but think of how many positive benefits we get from regular exercise, not the least exciting result is a trimmer figure and higher metabolism–allowing for the occasional pizza splurge, since isn’t the holy grail about having pizza? For me it is, but, I digress.

On the subject of diet, the latest research reveals some strong pros and cons for what we put on our plates. Several very large studies from both the US at the National Cancer Institute and The Oregon Health and Science University, and in China through The Shanghai Breast Cancer Study (SBCS), and including research from Vanderbilt University, indicate making friends with vegetables is a great idea, especially a family of veggies call cruciferous vegetables. Don’t ask me to pronounce it, but I know them when I see the on the produce aisle:

• Arugula
• Bok Choy
• Broccoli
• Cabbage
• Cauliflower
• Collard greens
• Horseradish
• Kale
• Radishes
• Rutabaga
• Turnips
• Watercress
• Wasabi

This wide variety of vegetables can lower our risk of breast cancer (50%) and pancreatic cancer (38%), and a man’s risk of prostate cancer (46%) or pancreatic cancer (35%). One serving a day for postmenopausal women without a history of breast cancer gave them a 50% advantage over non-cruciferous vegetable eaters. That’s some heavy leafy armor. More studies are going on as I write, and I am hopeful the above finding are further supported by these study results. If the vegetables were rated for firepower, the Bazooka Award would go to the simple cabbage and humble turnip, both vegetables readily available in many, many parts of the world and still pretty much ignored by Top Chefs.  

To give us a little protein, eat fish, but stick to low mercury fish. A list of these low-mercury swimmers is regularly updated on www.nrdc.org, the top contenders by potency: mackerel, salmon, cod liver oil, herring and oysters. Red meat does not make the list, and on the big no-no list is charred (grilled) red meat. It seems that crusty, (slightly) burned areas are very carcinogenic (poisonous) for us humans and turn the breast cancer risk-meter way up.  Cutting out food which appears high on the glycemic index (www.dlife.com), something, along with insulin resistance, I discussed in my blog post Move it and Improve It can trim our risk.

The science dovetails nicely with what we know makes up a healthy diet, providing many crossover benefits which raises our resistance to breast cancer, while making our hair shinier, our skin clearer, lowering inflammation throughout our bodies, and helping us sleep better, and last, but such a bell-ringing winner, feeding our brains to improve our cognitive functions. Give those veggies a gold medal! (Cue national anthem ;-).

Until next time…Be Vibrant!

Great Information on Breast Cancer Prevention

• Can breast cancer ever be cured? What is the percentage of return if contracted before menopause? After menopause?

Using the word “cure” is problematic because it doesn’t answer the question of WHY the cancer developed in the first place. A better way to look at this is “what do we know about preventing breast cancer recurrence?” The number of breast cancer survivors in the United States continues to increase. A review article quoted that there were 2.5 million breast cancer survivors in the United States in 2012 and showed the number expanded to 3.4 million in 2015. This is happening because of improved early detection, improved chemotherapy options both during treatment and after treatment is completed, and a better understanding of hereditary breast cancer with the use of proactive “prophylactic” surgeries. If breast cancer is detected before menopause, we know there is an increased risk of a second cancer whether it is in the same breast in the same location (considered a recurrence) or in a different location in the same breast or in the opposite breast (considered a second primary cancer) over that patient’s lifetime. Why is this? Again, as I said before, one of the biggest risk factors is age. Increasing age will increase the risk of cancer. The percentages of recurrence or, a second primary cancer, is difficult to pin down. We know that one in five women will develop either a recurrence or, a second primary cancer, after completion of five years of post-treatment adjuvant therapy (tamoxifen for example). Recurrence rates are related to:

• The initial stage of cancer (how far it had spread)
• The type of breast cancer or grade (what the cells look like or what part of the breast tissue is involved)
• The family history or presence of a gene associated with increased risk
• Other treatment related factors such as radiation therapy
• Post treatment anti-estrogen therapy
• The use of granulocyte colony-stimulating factors (such as Neupogen™, Granix™ etc.) during treatment

BUT NOW let’s talk about what we know that reduces the risk of recurrence!  Increasing good carbohydrates (fruits, vegetables, legumes, beans/lentils, whole grains, and natural soy products) and good fats (flaxseed, omega-3 fatty acids and nuts) are associated with improved survival. (Conversely, decreasing animal protein such as beef and pork along with trans-fats used in fried food will decrease your risk.) Increased exercise of 30 minutes five days a week is protective. Stress management techniques such as heart rate variability training (HeartMath™), meditation and decreasing body weight to less than 30 kg/m² is protective. Avoiding tobacco use completely (both smoking and “vaping”) and limiting alcohol consumption to one drink/day is also protective.

• Are there any symptoms to watch for?

Screening for breast cancer comes down to knowing your body and taking advantage of the technology that exists for screening. Watch for a lump in the breast or chest wall or armpit area. I often use the analogy of a grain of rice dried and stuck to the countertop when I teach women to detect their own cancer with their fingertips. Cancer is often (but not always) fixed or “stuck”, irregular to touch and associated with a skin dimple where it is pulling on the supportive ligaments of the breast. Nipple retraction, nipple discharge either clear or bloody, redness, scaling or thickening of the nipple can also be found. A rash on the breast that is unresponsive to antibiotics should be evaluated. Symptoms of recurrence can be new-onset localized bone pain, persistent chest pain, persistent cough, persistent abdominal pain, unintended weight loss, persistent headache, personality changes, new-onset seizures or loss of consciousness.

• Does contracting breast cancer before menopause increase the risk of getting it again after menopause?

The short answer is yes. Cancer incidence increases with age – likely due to a cumulative effect of cell damage and less efficient repair. See the survivorship answer in question seven…

Breast cancer rates are increasing. Why? Is that for both pre and post- menopausal women?

 Actually, the risk of being diagnosed with breast cancer in the United States began decreasing in the year 2000 after increasing for the previous two decades. The risk dropped by 7% from 2002 to 2003. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy by women after the results of the large study called the Women’s Health Initiative that showed a connection between hormone therapy use (specifically conjugated equine estrogen or Premarin™ and synthetic progestagens Provera™) that was published in 2002.  Reasons for the increased rates in the 1980’s and 90’s is likely related to improved screening techniques and increased numbers of women receiving screening.

• Is post-menopausal breast cancer hereditary?

Although post menopause breast cancer can be hereditary about 10% of the time, most women with a genetic mutation causing breast cancer develop the tumor statistically earlier in their lives.

I am very grateful to Claudia for her thoughtful answers to some of the most pressing questions women have regarding breast cancer. I hope you have found them helpful, I know I have.

Until next time…Be Vibrant!

The Doctor Answers Questions on Breast Cancer and Prevention

We ride the Pink Wave and talk about breast cancer, and I hope not to rehash the same old lettuce. We will begin by answering some of the most frequently asked questions by women 55+. Since I am a gerontologist, and breast cancer is not an area I can speak about with authority, I went to an expert in the field, Dr. Claudia Harsh.

Claudia Harsh, MD is board certified in ob-gyn, was fellowship trained in integrative medicine through the University of Arizona and is trained in medical acupuncture through the Helms Medical Institute. She retired from Texas Oncology at the Sammons Cancer Center in Dallas, Texas working in gynecology surveillance and survivorship.

Here are some of the most frequently asked questions about breast cancer at mid-life.

Q: Can a woman get breast cancer from going through menopause?

Dr. Harsh: I think this question is asking: does menopause increase our risk of getting breast cancer?

We know that our risk of breast cancer increases as we age. About 95% of breast cancers occur in women over age 40. We also know our lifetime risk of getting breast cancer is 1 in 8 but if we break that down by decades it looks like this:

•  At age 30 we have a 0.44% or a chance of 1 in 227
•  By age 40, 1.47% or a chance of 1 in 68
•  Age 50 means 2.38% or a chance of 1 in 42
•  At age 60, 3.56% or a chance of 1 in 28
•  And age 70 we see a 3.82% chance, or 1 in 26

But, these chances are averaged across all women of all ethnicities. Maybe the question we should be asking is “who doesn’t get breast cancer and why?” and that’s where a lot of the interest in lifestyle, medicine and nutrition, can help change the conversation and the risk numbers.

Q: I don’t have a family history of breast cancer. Why did I get it?

Dr. Harsh: About 10% of people who get breast cancer have a family history of the disease. (Or, put another way, 90% of people with breast cancer do NOT have a family history!)

We’ve known for years that some families have an increased risk of breast cancer and once we analyzed the human genome (the genetic “book of life” that resides in our cells – one half from our mother and one half from our father), the first gene associated with breast cancer was BRCA1. This was identified in the early to mid 1990’s and has been shown to be a gene that codes for proteins that repair damaged DNA. For this reason, it is known as a tumor suppressor: if there is a mutation in this gene, it is unable to repair damage and the cell can grow and divide without control and form a tumor.

This field of study is exploding with information – now there are dozens of genes that may impact our risk of breast, ovarian, endometrial or colon cancer (to name just a few!). Genetic counseling makes sense if cancer plays a strong role in your family. It is because of this that the term “previvor”[sic] has been developed for someone who found out they have a high risk genetic mutation and took proactive measures such as having a mastectomy or oophorectomy (removal of breasts or ovaries) to reduce their lifetime risk of the disease.

Q: What are the most important risk factors for breast cancer?

Dr. Harsh: Again, this is an area that is exploding with information. I mentioned before that our risk increases with age. This implies that there is a hormonal association (post menopause vs. pre menopause).

Another important risk factor is family history (genetic mutations) – accounting for approximately 10% of all breast cancers.

Mammographic breast density is a risk factor. Women with denser breasts (more ducts, glands and connective tissue) have an increased risk of cancer mostly because the tumors are harder to see on mammogram.

Personal history of breast cancer increases a woman’s chance of developing a recurrent cancer. Biopsy findings in the ducts can develop into cancer. Previous radiation therapy to the chest prior to age 30 for cancers such as Hodgkin lymphoma has been shown to be a risk factor.

Reproductive/menstrual history: Starting menstrual cycles before age 12 and/or concluding menopause after age 55 are both associated with an increased risk of breast cancer. Long-term use (more than 5 years) of postmenopausal hormonal therapy is associated with an increased risk of breast cancer.

Ethnicity may be a risk factor for breast cancer. To date more cancer is found in Caucasian women than in African American/black, Hispanic/Latina, Asian/Pacific Islander or American Indian/Alaska Native women. The degree to which this is due to increased screening in the white population is still being determined.

Research continues into sleep cycles and their association with breast cancer incidence, nutrition, vitamin and nutritional supplementation (especially Vitamin D), and stress management.

Q: How does age at menopause effect breast cancer risk?

Dr. Harsh: As mentioned before, our risk of breast cancer increases with chronologic age.

Two strong factors are likely the culprits here – increased cell DNA damage over time and a change in our hormonal production.

If we look at the hormonal question, we know that reproductive hormones estrogen and progesterone are produced by a woman’s ovaries and serve to stimulate cell growth in her breasts to prepare for nursing and her uterus to prepare for pregnancy. Anything that prolongs the duration and/or levels of exposure to this stimulation (late age at first pregnancy or never having given birth) increases breast cancer risk.

On the flip side, anything that shortens the duration of exposure (pregnancy or breast feeding itself for example) reduces breast cancer risks. There is a theory that breast feeding causes the cells in the breast to change or differentiate and they then become more resistant to becoming transformed into cancer cells.

Q: Will breast cancer show up in a blood test or in blood work?

Dr. Harsh: No. Although there are types of specialized testing that are designed to pick up circulating cancer cells, at this point there is no well-researched commercially available blood test to detect breast cancer.

Having said this, there are several measurements called “tumor markers” that can be checked in someone with a cancer diagnosis. Examples such as CA27-29 or CA125 are markers that can be elevated in some cancers. It is the standard of care to measure a variety of markers at the time of diagnosis to see if the blood tests can be used to mark the presence or recurrence of disease.

Similarly, some traditional blood chemistries such as calcium level, liver enzymes and electrolytes help point to the health of liver, kidneys and bone both at the time of diagnosis and throughout treatment.

In my next post we will return to answer more questions about breast cancer and some good news about prevention!

Until next time… Be Vibrant!

Food for Thought: Which Foods Slow Down Aging?

I am asked everyday a version of the same question: “Do you have any great anti-aging advice?” The answer is a bold YES! However, I am not a fan of the word “anti-aging” when it implies stopping aging, because as an expert in the aging process, I know for true that nothing exists which can do this, short of calling it a day and hanging with the angels. However, in my quiver are many arrows available to drastically slooooow down the aging of our minds, bodies, and spirit.

Today, I pull the arrow marked telomeres and aging as it relates to what we decide to put into our mouths. Once again, my favorite girl gang (G.G.), Dr. Elizabeth Blackburn and Dr. Elisa Epel and their team have looked at how proper diet can strengthen and lengthen our telomeres.  A little refresher to define telomere: telomeres are the protective endcaps on the threads of our DNA, like those on the tips on our favorite lace-ups, and are found in the brain, where they affect all our cognitive function, as well as in every cell of our bodies. So, they are well worth preserving in any way we can.

My G.G. looks at the three key factors affecting telomeres:

• Inflammation
• Oxidative Stress
• Insulin Resistance

Excess weight on our bodies, and thus on telomeres, results in shorter telomeres, which allow cells to become easily damaged when reproducing. Not only does reproduction slow down but also our brains and memory can malfunction, and we experience greater cellular aging which makes us look and feel older.

A direct correlation exists between insulin resistance and diabetes, and shorter telomeres. The greater our waist-to-hip ratio is—the classic “apple” shape, with extra belly fat and love handles– the higher our insulin resistance will be. A damaging cycle forms with this situation: people with belly fat develop shorter telomeres over the years, and these shorter telomeres may worsen the insulin resistance problem. Researchers tell us abdominal fat causes more inflammation in our bodies than thigh fat. As the GG says, “The pathway from belly fat to diabetes may also be traveled via chronic inflammation.” Inflammation and telomere damage go together, one causing the other in a continual feedback loop.

Even more important than losing weight, improving one’s metabolic health keeps telomeres longer and stronger. Good metabolic health includes having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications.  How do we perk up our metabolic health? Exercise. Weight cycling, something so many of us are too familiar with—the gaining and losing of those same bloody ten pounds– shortens our precious telomeres. Blackburn and Epel also think being physically active and eating nutritious, low Glycemic Index foods are better choices than “dieting” by restricting calories. In fact, they found that “calorie restriction has no positive effect on human telomeres.”

Well, that’s good news. Not good news: A study at the University of California at San Francisco found shorter telomeres in the cells of folks who had restricted their calories for long periods of time. Even worse, the telomeres in their immune cells and vital T-cells were also affected. The findings suggest a link between our immune systems and aging. I have more to say on this important topic, so stay tuned!

Until next time…Be vibrant!

How Much Water Should I Drink a Day? Part II

The topic of water is as big as an ocean, and so to continue…

In addition to the benefits of drinking water I mentioned last time, drinking enough water can help us cut calories by filling up the available space in our stomachs with this zero-calorie fluid verses, say, Orangeade™. “What works with weight loss is if you choose water or a non-caloric beverage over a caloric beverage and/or eat a diet higher in water-rich foods that are healthier, more filling, and help you trim calorie intake,” says Penn State researcher and multi-published author, Barbara Rolls, PhD.

One of the most widely known benefits of drinking water is good kidney function. Poor kidney function can cause all kinds of problems, including kidney stones. One in twenty of us will suffer from kidney stones in our lifetime, and the scale tips toward seniors as those who will suffer the most. Why? Because as we age, our thirst dial gets turned down and we are less able to register the need for water, so it becomes doubly important for us mid-lifers and seniors to consciously adopt the habit of drinking enough water. Dr. Barry Poppins at UNC Chapel Hill found that even after seniors were in dehydration, they were less thirsty and drank less replenishing fluids that did the younger folks in the study. Even when offered yummy drinks, the seniors in the study failed to drink enough to fully hydrate themselves. They had to choose to drink enough.

You may have read or heard about the connection between delirium/dementia and seniors. To stay on point here about the benefits of hydration for seniors, let me just say seniors are sometimes misdiagnosed as suffering from dementia, when in fact they are suffering from delirium—delirium being a serious disturbance in their cognitive abilities that results in confused thinking and a reduced awareness of their surroundings. A possible cause for the delirium? You guessed it, not enough water.  Another strong connection with not drinking enough water is an increased expression of Bronchopulmonary Disorders like asthma and other bronchial issues when people, especially seniors, are dehydrated and exercise. These folks need to be sure to drink adequate amounts of water to prevent an episode when they raise their heart rate.

Lastly, do you want your skin to feel and look younger? Drink enough water. Dehydration makes older skin look even drier and more wrinkled–a state improved overnight by drinking enough water to be properly hydrated. It can’t erase wrinkles, dang it, but softer more supple skin when glowing from being properly hydrated does make those laugh lines look positively endearing.

So the ten million dollar question on the front burner of your brain: How much water should I drink in a day? The answer varies according to a few factors, but a minimum of sixty-four (64) ounces of good quality, filtered water will cover your needs, adding in a few more glasses during and after exercise, and in very hot weather—like Texas in July and August. This means only water. Other liquids—iced tea, juice, coffee, or vodka– don’t count toward your total daily intake. Those are just extra.

I started with a little cup with a dial on it as my way in, but there are now new-fangled ounce-and-cup- counting vessels all over the market. Choose the one that appeals to you and buy two—one for the office and one for home. Your brain, your heart, and your parched skin will thank you for it. We can beat dehydration in old age and move toward being vibrant just by drinking water—and it’s calorie free!

Until next time…Be Vibrant!

How Much Water Should I Drink a Day? Part I

My mother wasn’t a water drinker, and so I wasn’t a water drinker until I was in my late twenties when I first read about the benefits of good hydration, learned how much water I should drink in a day, and the importance of staying hydrated for healthy aging. It took a while for me to add this habit into my life. I used to have an eight-ounce cup with a dial, and each time I drank a full cup of water I got to turn the dial to the next opening. It somehow made it easier, and a little more fun to chug down those glasses.  Now, thirty-plus years later, it comes naturally. What’s more, I can feel the effects of dehydration when I don’t get enough water.

Here is the really, really terrific news about drinking water: the effects are virtually immediate, and the positive feelings (which I will discuss in more detail) you will experience become accessible anytime you fill your body with this life-enhancing elixir. Now that’s pretty great in my book.

Our science lesson for today: Think back to high school biology class for a moment, where we learned that our bodies are made up of 60% water, our brains and hearts are 73% water and our lungs 83% water. Every organ in our bodies, and every system and process of our bodies, require water to run properly. And, they all need enough water to work optimally.

Some of the most important functions of proper hydration include our digestion, circulation of our blood, the transportation of nutrients in and out of our cells, removal of toxins and waste from our organs and cells, and maintaining our body’s temperature. Whew, and that’s just the short list! Without enough water our body downshifts into crisis mode, causing stress to all parts, inside and out.

Importance of Electrolytes

How much water you drink in a day can impact all of the systems in your body. Without enough water, our cells can’t stay balanced (with the correct amount of fluid) and so electrolytes (a substance present in all our bodily fluids) can’t do their job effectively. Electrolytes are needed for all nerve reactions—in our muscles and…you guessed it, our brain. According to research, an electrolyte imbalance can cause a variety of negative symptoms, some potentially deadly. Fatigue after only limited activity is a sign of dehydration; the muscles don’t perform as well, and cramping may occur. This is especially crucial for folks who exercise regularly, and/or do so in a warm climate.

Proper Hydratoin to Combat Brain Fog

Brain fog and mental confusion are also triggers that tell us our bodies need more water. Remember when you drank too much alcohol at your niece’s wedding?  The headache and foggy thinking you felt the next day were due to dehydration from choosing to replace your water intake with gin and tonics. 😉  

The Impact of Dehydration

In a large study published in Nutrition Reviews in 2010, researchers found that a steady practice of denying your brain the water it needs can speed up the development of dementia. They also discovered being even mildly dehydrated causes mood fluctuations, difficulty in maintaining concentration, and influences the short-term memory process in all people regardless of their ages.

It seems no one is immune. Running on empty, water-wise, impairs higher brain functions we use in math calculations. Insufficient water also affects the use of fine motor skills—think sewing or silver-smithing – as well as our eye-hand coordination needed to fold laundry, put on make-up, or write a letter (in the olden days, that is). Again, filling our internal tanks will alleviate most of these difficulties in double-quick fashion, so drink up!

I have more to say about how much water you should drink in a day, so stay tuned, and…

Until next time… Be Vibrant!

Are You Out of Balance?

Until I pass on into the next world, I want to be independent and mobile; if I can prevent it, no wheelchairs or rocking chairs for me. I’m sure you feel the same, right? I have covered many aspects of aging which will help us stay out of those kind of chairs, and maintain our ability to get out of our favorite chair.

Today, we will look at one more: Keeping and improving our balance. So if you are in your fifties reading this, you might thing, “well, that’s not something I need to worry about now,” but, au contraire, the research shows balance begins to slow down in our fifties and continues declining unless we stop and reverse this tendency.

First, let’s breakdown all the elements contributing to our ability to get out of a chair with ease and walk down the sidewalk in high heels without ending up in the street, embarrassed and bloody.

Balance is actually a complex whole-body exercise.

Your science lesson for the day: balance requires your sensory systems, your brain, and your muscles and joints to work together. Our sensory system is made up of our eyes, ears and sense of touch. Our eyes tell us where we are in relation to other objects, and if these objects are still or moving; our inner ear has tiny hairs and tiny nerves which work together to tell our brains the position of our head, and like the rudder of a boat or airplane, the hairs and nerves are constantly trying to right the ship and keep it in perfect alignment to the earth, standing still or in motion.

Additionally, small crystals of calcium inside our ears help us sense the pull of the earth-gravity, and recognize movement. No small tasks for such fine hairs! Our feet and joints let us know if we are on even ground or moving across rough terrain, and our brain takes all this in and sends messages to our cerebral cortex. We then understand all this input as “Watch out, it’s dark and the path is angled and covered with loose rocks!”  

The worst part of taking a fall when we are over sixty comes more from the psychological toll than the physical one: the fear of falling. Suddenly, we might start limiting what we do—traveling, going out to unfamiliar places, resisting new experiences, all because we might fall. That wheelchair or rocking chair now starts looking positively inviting. STOP HERE! Do not past GO and collect your $200 to use on one of these. There is good news, and it is this: falling is NOT a normal part of aging.

You have the power and the ability to keep your balance until the day the angels take you away, but you must, like all things, work on it to keep. Thankfully relief from the fear is as close as your YMCA/YWCA, gym, or rec center. Tai Chi, the ancient Chinese practice of slow, meditative movements done in a particular sequence ranks as one of the most effective practices to enhance or restore balance. It also works great on lowering your stress and cortisol so you will live longer to dance with your favorite partner. Additionally, yoga is an outstanding practice for shoring up balance, there is even a one-footed balancing pose to get right to it! 

Outside of organized classes there are some very effective daily practices we can incorporate to help us be fall-free:

• Try heel-to-toe walking as if you were on a balance beam like an Olympic gymnast
• Sit on an exercise ball to strengthen your core and practice getting up without holding on to anything or toppling over
• Exercise on a wobble board or Boscu ™ ball (one of those half balls nailed to a flat board
• Practice standing on one foot while you brush your teeth—left in the morning, right one at night.

All of the above should be done once your doctor has given you the go-ahead and ruled out any serious inner ear disorders, Parkinson’s, diabetes and/or certain medications which might affect balance.

Keeping our balance throughout our lives is such an empowering, and doable thing one wonders why we don’t all work on it every day. What might be stopping you? 

Until next time…..Be Vibrant!

3 Simple Tests to Help Prevent a Heart Attack

Recently reported in People Magazine, Erica Kane of Pine Valley* suffered a heart attack in October of 2018. As I read the article, it didn’t surprise me that she never mentioned being tested for heart disease before the attack. Obviously, her doctor failed to order tests for her which would have revealed the 90% blockage in the main artery leading to her heart, and a 70% blockage in a branch artery even though her doctor knew her father had suffered a heart attack in his early forties. Looking at this information in black and white, it seems incredulous that her doctor had never ordered a Coronary Calcium Score to help gauge her risk.  And, once she had that number, she also needed a Carotid Intima-Media Thickness Test (CIMT) to measure the thickness of the inner two layers of the carotid artery, the artery located at the side of our necks. This simple, and painless, test can let doctors know if there is any thickening in the artery walls long before we might experience any symptoms of a cardiac incident. If the results of the CIMT are concerning, further tests such as a Doppler Ultrasound, an ultrasound for the blood vessels and the heart to see blood flow through the vessels and heart, a MRI Angiogram or MRA which allows doctors to see inside the blood vessels, or a Cardiac CT Scan, which produces dye-free multiple x-ray images of the heart and blood vessels, will give defining information about the state of our arteries and risk level for a heart attack. Even beginning with a simple stress test, doctors can get an idea of the condition of our hearts and whether some or all of the above tests are needed. 

All this begs the question, why didn’t Erica Kane’s doctor order any of these, especially with a history of heart disease in her family? I have some history of heart disease in my family, and since I reached mid-life, my doctor orders both a coronary calcium score and a CIMT every time I have a physical. I don’t want to put Erica’s doctor on the defensive, but even today in 2019, women are far less likely to receive the same care and treatment as men when it comes to their health outside of female issues. We are also three times more likely than men to die following a serious heart attack as a result of receiving less equal care and treatment. In a landmark study done in Sweden over a ten-year period, 2003-2013, involving almost sixty-one thousand women, the researchers found this to be true. I watched my mother languish in a recovery facility, virtually ignored by her (male) physician after undergoing quadruple by-pass surgery. During that stay, she suffered from a host of easily avoidable complications due to basic negligence. I tried to intervene on her behalf, but since I was the baby in the family, no one would listen to me.

The anger I feel as I write these words is almost uncontainable, but the above study, published in the Journal of the American Heart Association in 2017, makes one thing absolutely certain: We must take control of our own health and ASK, or more likely in most cases, DEMAND, that at least once, more if results merit it, we have our coronary calcium scores taken, and for sure, have a CIMT test, especially if heart disease runs in the family. If the results are good, the peace of mind is worth it. If the tests show issues, you can do what is necessary so that you will never be like Erica, out shopping one day and then suddenly feel as if an elephant has just sat down on your chest.

 Until next time….Be Vibrant!

*Susan Lucci one of the stars of the daytime soap opera, All My Children.

This Week's Wonder Woman: Ruth Bader Ginsburg

This month is Women’s History Month, and I am beginning each newsletter in March by highlighting a woman from history, or presently alive, that I particularly admire. Honestly, it would take a year to even get halfway through my list, but I will pick a few for this month and save the others for the future.

How could I not start with RBG?

Supreme Court Justice Ruth Bader Ginsburg was only the second female justice appointed in United States history, nominated and confirmed in 1993, at the age of 60. She is still there influencing key decisions and helping furthering the rights of women. In her quiet yet deadly way, she makes her points so brilliantly as to leave the opposition (usually a man) literally speechless. I wish for that talent! I recently learned she is also the subject of the popular Tumblr blog Notorious RBG celebrating her judicial accomplishments as well as her status as an inspirational part of women’s history. She will celebrate her 86th birthday on March 15th. Go RBG!

Sugar Land

As I eat lunch today, I am looking over the Food Section of the newspaper and reading easy cookie recipes for people who don’t know how to bake, or just don’t love to bake. Before reading the recipe, I hone in on how much sugar each recipe uses; I sigh.

I think back to last December, when I had gained a few pounds after returning to school. While there, I had relearned the hard sparkling truth about white sugar, and so I decided to give up all sugar from Thanksgiving Day until Christmas Day. ALL sugar. That included wine, too, not just festive holiday cookies you see in bakeries and at parties once a year, or the Panettone specialty bread and other yeasty delights available only during December, and let’s not even talk about forgoing chocolate. Just thinking about that loss makes me close my eyes and center myself with five deep breaths. 

You may be thinking, “Were you just crazy, or what, to forgo sugar at the very best time for all things sweet?” Honestly, there was a method to my madness beyond becoming a masochist for thirty days. First, I had experienced a number of holiday seasons: this wasn’t my first rodeo. I truly believed I had tasted all the holiday treats anyone has ever invented, and so giving up sweets for one season seemed doable. Desperation to fit into my clothes became a strong motivator, after failing to lose the weight after my courses ended. On Thanksgiving Day the pumpkin pie slid too easily down my throat for me to truly grasp that those bites were the last sugar, in any form, I would have for thirty days, except for one-half cup of berries three times a week the nutritionist said I needed to keep me healthy and flu-free.

Yes, a couple of times I fell into the sugar ditch and took a bite of something made with the forbidden plant, but I didn’t beat myself up or dwell on it. I just considered how I felt emotionally and physically, and vowed to get back on the high road, ASAP.  I did, and I noticed several things as the month went on: I was less wired, less irritable, and my head was clearer. I even slept better, despite the stresses of the season. The best part came while packing to travel at Christmas…almost all my clothes fit! I had dropped five pounds and I was a few inches smaller in the classic three measurements-bust, waist, and hips. I had done it, and to be completely honest, it wasn’t as hard as I thought it would be, mainly because I had become very motivated to lose weight. An additional benefit I experienced, which I know from my work, came from a decreased desire for sugar after the month ended. I was free of its pull, free from wanting sweet things. That was empowering, very empowering, a sensation I continue to relish.

Have I gone back to eating sugar? Yes, but so much less than before. Feeling free from, well, let’s face it, sugar addiction, is powerful, and knowing I can take it or leave it feeds that awareness even more. Now, when I have sugar it’s a conscious decision, and I can take two or three bites of something and be satisfied. (Since I love to cook, I do like to taste everything!)  

I am not suggesting you give up sugar during the holidays, but I think it is important for me to walk the walk and talk the talk, if I am asking you to consider your sugar intake this holiday season. Writing to suggest you eat less sugar, in say June, would be a piece of cake, oops, sorry, a lovely cup of berries.????

Until next time…Be Vibrant!

More Answers From Dr. Claudia Harsh

I am ending this month by returning to our expert, Dr. Claudia Harsh, who offers us all more good information about breast cancer and women 55+.

Q. Can breast cancer ever be cured? What is the percentage of return if contracted before menopause? After menopause? 

Dr. Harsh: Using the word “cure” is problematic because it doesn’t answer the question of WHY the cancer developed in the first place. A better way to look at this is “what do we know about preventing breast cancer recurrence?”

The number of breast cancer survivors in the United States continues to increase. A review article quoted that there were 2.5 million breast cancer survivors in the United States in 2012 and showed the number expanded to 3.4 million in 2015. This is happening because of improved early detection, improved chemotherapy options both during treatment and after treatment is completed, and a better understanding of hereditary breast cancer with the use of proactive “prophylactic” surgeries.

If breast cancer is detected before menopause, we know there is an increased risk of a second cancer – whether it is in the same breast in the same location (considered a recurrence) or in a different location in the same breast or in the opposite breast (considered a second primary cancer) over that patient’s lifetime.

Why is this? Again, as I said before, one of the biggest risk factors is age. Increasing age will increase the risk of cancer. The percentages of recurrence or, a second primary cancer, is difficult to pin down. We know that one in five women will develop either a recurrence or, a second primary cancer, after completion of five years of post-treatment adjuvant therapy (tamoxifen for example).

Breast cancer recurrence rates are related to:

• The initial stage of cancer (how far it had spread) 
• The type of breast cancer or grade (what the cells look like or what part of the breast tissue is involved)
• The family history or presence of a gene associated with increased risk
• Other treatment related factors such as radiation therapy
• Post treatment anti-estrogen therapy
• The use of granulocyte colony-stimulating factors (such as Neupogen™, Granix™ etc.) during treatment 

BUT NOW let’s talk about what we know that reduces the risk of recurrence!

L.J has covered the most important tips for breast cancer prevention in her blog post these last few weeks, so to recap: 

• Increasing good carbohydrates (fruits, vegetables, legumes, beans/lentils, whole grains, and natural soy products) and good fats (flaxseed, omega-3 fatty acids and nuts) are associated with improved survival.
• Conversely, decreasing animal protein such as beef and pork along with trans-fats used in fried food will decrease your risk.
• Increased exercise of 30 minutes, five days a week is protective.
• Stress management techniques such as heart rate variability training (HeartMath™), meditation and decreasing body weight to less than 30 kg/m2 is protective.
• Avoiding tobacco use completely (both smoking and “vaping”) and limiting alcohol consumption to one drink/day is also protective. 

Q. Are there any symptoms to watch for? 

Dr. Harsh: Screening for breast cancer comes down to knowing your body and taking advantage of the technology that exists for screening.

Watch for a lump in the breast or chest wall or armpit area. I often use the analogy of a grain of rice dried and stuck to the countertop when I teach women to detect their own cancer with their fingertips.

Cancer is often (but not always) fixed or “stuck”, irregular to touch and associated with a skin dimple where it is pulling on the supportive ligaments of the breast. Nipple retraction, nipple discharge either clear or bloody, redness, scaling or thickening of the nipple can also be found. A rash on the breast that is unresponsive to antibiotics should be evaluated.

Symptoms of recurrence can be new-onset localized bone pain, persistent chest pain, persistent cough, persistent abdominal pain, unintended weight loss, persistent headache, personality changes, new-onset seizures or loss of consciousness. 

Q. Does contracting breast cancer before menopause increase the risk of getting it again after menopause? 

Dr. Harsh: The short answer is yes. Cancer incidence increases with age – likely due to a cumulative effect of cell damage and less efficient repair.

Q. Breast cancer rates are increasing. Why? Is that for both pre- and post-menopausal women?

Dr. Harsh: Actually, the risk of being diagnosed with breast cancer in the United States began decreasing in the year 2000 after increasing for the previous two decades. The risk dropped by 7% from 2002 to 2003.

One theory is that this decrease was partially due to the reduced use of hormone replacement therapy by women after the results of the large study called the Women’s Health Initiative that showed a connection between hormone therapy use (specifically conjugated equine estrogen or Premarin™ and synthetic progestagens Provera™) that was published in 2002. 

Reasons for the increased rates in the 1980’s and 90’s is likely related to improved screening techniques and increased numbers of women receiving screening.

Q. Is post menopausal breast cancer hereditary? 

Dr. Harsh: Although post-menopause breast cancer can be hereditary about 10% of the time, most women with a genetic mutation causing breast cancer develop the tumor statistically earlier in their lives.

I am very grateful to Claudia for her thoughtful answers to some of the most pressing questions women have regarding breast cancer. I hope you have found them helpful; I know I have.

Until next time…Be Vibrant!

Prevention On Our Plates

In drilling deep into breast cancer prevention for women, I find recommendations based on several factors. In aiding prevention for women before mid-life, prevention for postmenopausal women, and what suggestions help postmenopausal women who have had breast cancer, there exists some common approaches which are very encouraging. 

Regular, focused exercise across the lifespan wins the day as the number one risk reducer. I know dear reader, this seems like a broken refrain, but think of how many positive benefits we get from regular exercise, not the least exciting result is a trimmer figure and higher metabolism–allowing for the occasional pizza splurge, since isn’t the holy grail about having pizza? But, I digress. 

On the subject of diet, the latest research reveals some strong pros and cons for what we put on our plates. Several very large studies from both the US at the National Cancer Institute and The Oregon Health and Science University, and in China through The Shanghai Breast Cancer Study (SBCS), and included in research from Vanderbilt University, indicate making friends with vegetables is a great idea, especially a family of veggies call cruciferous. Don’t ask me to pronounce it, but I know them when I see the on the produce aisle:

• Arugula
• Bok Choy
• Broccoli 
• Cabbage
• Cauliflower
• Collard greens
• Horseradish
• Kale
• Radishes
• Rutabaga
• Turnips
• Watercress
• Wasabi

This wide variety of vegetables can lower our risk of breast cancer (50%) and pancreatic cancer (38%), and a man’s risk of prostate cancer (46%) or pancreatic cancer (35%). One serving a day for postmenopausal women without a history of breast cancer gave them a 50% advantage over non-cruciferous eaters. That’s some heavy leafy armor. More studies are going on as I write, and I am hopeful these finding are further supported by these study results. If the vegetables were rated for firepower, the Bazooka Award would go to the simple cabbage and humble turnip, both vegetables readily available in many, many parts of the world and still pretty much ignored by Top Chefs.   

 To give us a little protein, eat fish, but stick to low mercury fish. A list of these low-mercury swimmers is regularly updated on www.nrdc.org, the top contenders by potency: mackerel, salmon, cod liver oil, herring and oysters. Red meat does not make the list, and on the big no-no list is charred (grilled) red meat. It seems that crusty, (slightly) burned areas are very carcinogenic (poisonous) for us humans and turn the breast cancer risk-meter way up.  Cutting out food which appears high on the glycemic index, something, along with insulin resistance, I discussed in my blog post Move it and Improve It can trim our risk. 

The science dovetails nicely with what we know makes up a healthy diet, providing many crossover benefits which raises our resistance breast cancer, while making our hair shinier, our skin clearer, lowering inflammation throughout our bodies, and helping us sleep better, and last, but such a bell-ringing winner, feeding our brains to improve our cognitive functions. Give those veggies a gold medal! (Cue national anthem ;-).

Until next time…Be Vibrant! 

Belly Up To The Bar...Or, Not

I do love red wine, and I’m married to a wine lover, and I have really cut back on my alcohol consumption, wine included, since I learned about the connection between alcohol and breast cancer. 

From the Breast Cancer News website:

Just one alcohol-containing beverage a day — less than a standard drink — is sufficient to increase a woman’s risk of breast cancer, according to a new report by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF).

This mega-report, “Diet, Nutrition, Physical Activity and Breast Cancer,” brought together 119 studies and included information from 12 million women, 260,000 who had breast cancer. The study found that there is a 5% increase in risk for women before menopause, and a 9% increase for women after menopause. That doesn’t sound like much, but if there is a family history of breast cancer, or if a woman has had breast cancer, the risk more than doubles. Double-digit risk of anything is enough to give a person something to think about before she orders that frozen strawberry margarita. 

In another study, The Women’s Health Initiative Observational Study, researchers at the Fred Hutchinson Cancer Research Center looked at 87,000+ postmenopausal women without a prior history of breast cancer and found that the more drinks a woman had per week, the more her risk of invasive breast cancer increased. Again, if a woman has a family history or previous diagnosis, her risk more than doubled at 14 drinks per week, or two glasses of wine a night. Eek!

Now for the good news (whew!) There are ways to lower one’s risk. I don’t want to sound like the proverbial broken record, but our old friend, exercise, is showing up as a great way to lower our risk. In the mega-report mentioned above, pre-menopausal women who participated in vigorous exercise like running, biking fast, HIIT—High Intensity Interval Training (see my blog, Slowing Down the Aging Clock  from February 26, 2018), lowered their risk by double digits, 17%, to be exact. Postmenopausal women who Just Did It with vigor, lowered their risk by a full 10%. Moderate exercise lowered a woman’s risk when compared to women who weren’t active. For younger women of childbearing age, breastfeeding the wee ones gave these women added breast cancer protection at all stages of later life.

The American Institute of Cancer Research estimates that one in three cases of breast cancer can be prevented if a woman will cut out alcohol and be physically active every day. That’s good news to think about.  It’s also something we can control!

Until next time…Be Vibrant!

Weighing In On Breast Cancer Preventions

Several very large and extended studies—The Women’s Health Initiative Observational Study involving 85k+ women over five years, and the Iowa Women’s Health Study looking at 33k+ women come to the same conclusion: weight gain directly effects a postmenopausal woman’s risk of getting breast cancer. 

The Iowa study found,

First, the highest rates of postmenopausal breast cancer were observed among women who progressively gained weight throughout adulthood. Second, loss of weight, regardless of when it was initially gained during adulthood, was associated with a lower risk of postmenopausal breast cancer compared with the typical pattern observed in this cohort of continued weight gain.

The results of this study done in 2005 have held up over time and the release of subsequent research. In the Women’s Health Initiative Study, more details came forward to reveal that weight gain from age 50-59 had very strong associations with increasing a woman’s risk, while weight gain during one’s 70’s– 70-79 didn’t raise our risk.  The results are similar for both women who have taken hormone replacement therapy, and women who have not. But, the research indicates non-users, without a history of breast cancer or family history, were at greater risk.

For every 2.2 lb increase in a postmenopausal woman’s Body Mass Index, her risk of contracting breast cancer goes up by 3%. So carrying that extra 10 lbs. around at menopause and beyond raises our risk by almost 15%. That doesn’t sound like much, but if we don’t exercise or eat healthfully, and choose to smoke, the risk more than doubles when all these factors are added together. The risk goes up considerably when we up our alcohol consumption along with gaining weight. Additionally, the newest science is now exploring is the effect of environmental elements on the breast cancer statistics. 

Now for the good news? The latest look at these studies and others tell us healthy lifestyle choices can lower our risk by 30%, and that these “modifiable” factors are more important than was once thought. Now that is good news!

To leave you with the latest word on the subject from the American Association for Cancer Research,

In keeping with this, other studies have reported that women who adhered to the World Cancer Research Fund/American Institute for Cancer Research and the American Cancer Society  recommendations (maintaining a healthy weight, being physically active daily, limiting consumption of energy-dense foods, red meats/processed meats, high sodium foods and alcoholic beverages, consuming a variety of vegetables, fruits, whole grains and legumes, and breastfeeding exclusively for up to 6 months) had reduced risk of breast cancer.  Our findings suggest that a healthy lifestyle may be associated with reduced risk of breast cancer irrespective of the tumor characteristics.

Until next time…Be Vibrant!

The Doctor Is In With Answers

This month we will come along with the Pink Wave and talk about breast cancer, but I hope not to rehash the same old lettuce. We will begin by answering some of the most frequently asked questions by women 55+. Since I am a gerontologist, and breast cancer is not an area I can speak about with authority, I went to an expert in the field, Dr. Claudia Harsh. 

Claudia Harsh, MD is board certified in ob-gyn, was fellowship trained in integrative medicine through the University of Arizona and in trained in medical acupuncture through the Helms Medical Institute. She recently retired from Texas Oncology at the Sammons Cancer Center in Dallas, Texas working in gynecology surveillance and survivorship. She now lives in North Carolina where she awaits licensing.

Can a woman get breast cancer from going through menopause? 

I think this question is asking: does menopause increase our risk of getting breast cancer? We know that our risk of breast cancer increases as we age. About 95% of breast cancers occur in women over age 40. We also know our lifetime risk of getting breast cancer is 1 in 8 but if we break that down by decades it looks like this:

•  At age 30 we have a 0.44% or a chance of 1 in 227
•  At age 40 1.47% or a chance of 1 in 68
•  At age 50 2.38% or a chance of 1 in 42
•  At age 60 3.56% or a chance of 1 in 28
•  At age 70 3.82% or a chance of 1 in 26 

 But, these chances are averaged across all women of all ethnicities. Maybe the question we should be asking is “who doesn’t get breast cancer and why?” and that’s where a lot of the interest in lifestyle, medicine, and nutrition can help change the conversation and the risk numbers.

I don’t have a family history of breast cancer. Why did I get it? 

About 10% of people who get breast cancer have a family history of the disease. (Or, put another way, 90% of people with breast cancer do NOT have a family history!) We’ve known for years that some families have an increased risk of breast cancer and once we analyzed the human genome (the genetic “book of life” that resides in our cells – one half from our mother and one half from our father), the first gene associated with breast cancer was BRCA1. This was identified in the early to mid 1990’s and has been shown to be a gene that codes for proteins that repair damaged DNA. For this reason, it is known as a tumor suppressor: if there is a mutation in this gene, it is unable to repair damage and the cell can grow and divide without control and form a tumor. This field of study is exploding with information – now there are dozens of genes that may impact our risk of breast, ovarian, endometrial or colon cancer (to name just a few!). Genetic counseling makes sense if cancer plays a strong role in your family. It is because of this that the term “previvor”[sic] has been developed for someone who found out they have a high risk genetic mutation and took proactive measures such as having a mastectomy or oophorectomy (removal of breasts or ovaries) to reduce their lifetime risk of the disease.

What are the most important risk factors for breast cancer? 

Again, this is an area that is exploding with information. I mentioned before that our risk increases with age. This implies that there is a hormonal association (post menopause vs. pre menopause). Another important risk factor is family history (genetic mutations) – accounting for approximately 10% of all breast cancers. Mammographic breast density is a risk factor. Women with denser breasts (more ducts, glands and connective tissue) have an increased risk of cancer mostly because the tumors are harder to see on mammogram. Personal history of breast cancer increases a woman’s chance of developing a recurrent cancer. Biopsy findings in the ducts can develop into cancer. Previous radiation therapy to the chest prior to age 30 for cancers such as Hodgkin lymphoma has been shown to be a risk factor.

Reproductive/menstrual history: Starting menstrual cycles before age 12 and/or concluding menopause after age 55 are both associated with an increased risk of breast cancer. Long-term use (more than 5 years) of postmenopausal hormonal therapy is associated with an increased risk of breast cancer. Ethnicity may be a risk factor for breast cancer. To date more cancer is found in Caucasian women than in African American/black, Hispanic/Latina, Asian/Pacific Islander or American Indian/Alaska Native women. The degree to which this is due to increased screening in the white population is still being determined. Research continues into sleep cycles and their association with breast cancer incidence, nutrition, vitamin and nutritional supplementation (especially Vitamin D), and stress management. 

How does age at menopause effect breast cancer risk?

As mentioned before, our risk of breast cancer increases with chronologic age. Two strong factors are likely the culprits here – increased cell DNA damage over time and a change in our hormonal production. If we look at the hormonal question, we know that reproductive hormones estrogen and progesterone are produced by a woman’s ovaries and serve to stimulate cell growth in her breasts to prepare for nursing and her uterus to prepare for pregnancy. Anything that prolongs the duration and/or levels of exposure to this stimulation (late age at first pregnancy or never having given birth) increases breast cancer risk. On the flip side, anything that shortens the duration of exposure (pregnancy or breast feeding itself for example) reduces breast cancer risks. There is a theory that breast feeding causes the cells in the breast to change or differentiate and they then become more resistant to becoming transformed into cancer cells.

Will breast cancer show up in a blood test or in blood work? 

No. Although there are types of specialized testing that are designed to pick up circulating cancer cells, at this point there is no well-researched commercially available blood test to detect breast cancer. Having said this, there are several measurements called “tumor markers” that can be checked in someone with a cancer diagnosis. Examples such as CA27-29 or CA125 are markers that can be elevated in some cancers. It is the standard of care to measure a variety of markers at the time of diagnosis to see if the blood tests can be used to mark the presence or recurrence of disease. Similarly, some traditional blood chemistries such as calcium level, liver enzymes and electrolytes help point to the health of liver, kidneys and bone both at the time of diagnosis and throughout treatment.

Later this month we will return to answer more questions about breast cancer. Next time, some good news about prevention!

Until next time… Be Vibrant!

The Physical Aspects of AGING VIBRANTLY

Today, in my opinion, what defines the physical aspects of aging vibrantly has undergone the greatest expansion since Rowe and Kahn first addressed the murky issue of “successful aging.” R&K narrowed their pool of vibrant agers to the small majority of people exhibiting an “absence or avoidance of disease and/or disability, and the maintenance of high levels of physical functioning.” Later, researchers began asking seniors themselves (Gee, what a novel concept ;-0) where they rated their “health life.” Interestingly, they rank the absence of disability and disease third, after 1) an engagement with life, and 2) an active life. We will further explore these ideas in subsequent posts this month, but for now our lens is turned on the physical aspects. 

Millions of seniors in America and around the world believe they are aging vibrantly. This is in spite of having some disabilities or chronic diseases, which may limit their physical activities, or call for adaptation of their earlier levels of ability. Researchers at the University of California at Berkeley found this to be true.

I love this attitude, as it mirrors my worldview of the glass half-full, and reflects yet another aspect of vibrant aging— compensation. In a study from the UK where actual words of seniors are included, those older adults said as they have gotten older they have modified their intensity level, range, and time spent doing physical activities to coincide with their energy level and ability at the time. Far from giving up they are adapting and compensating for their limitations.

One lady who was a life-long dog lover and avid gardener “downsized,” (her word) by adopting a cat and becoming a “potted gardener.” Well done, I say! Over and over again, older adults at every stage, who are still actively engaged in the game of life, are adapting similarly, even those with disabilities and diseases. What is consistent among these spry folks is their attitude about aging. Even with fewer physical abilities, people who have a positive attitude about life and about aging, and see themselves as aging well, are rated by researchers as “younger” than their chronological age. In some cases by up to a decade making the phrase “young at heart” more than just a song by Johnny Richards and a movie starring Doris Day and Ol’ Blue Eyes.

In another study done through the Division of Gerontology and Geriatric Medicine at the University of Washington, Seattle, scientists also questioned seniors about what vibrant aging meant to them. The number one answer was being autonomous or independent for as long as possible: “Being able to take care of myself until close to the time of death” and, “being able to meet all my needs and some of my wants.” The seniors in the UK also emphasized this point of self-care.  While that also brings in cognitive functioning, a large part of staying independent sits squarely in the physical realm. Their third priority was to “remain free of chronic disease.” A wish we all share, no matter our age. 

To what does all these desires point? Keeping one’s body– one’s house, in order. My top recommendations for how to keep the home fires lit? Exercise is the number one recommendation for the physical aspect of aging vibrantly, as our bodies were made to move, and the more we move and groove our bodies, as I discussed in detail last spring, the better off we will be.

Into the good health mix I add clean, unprocessed, and organic when possible, food, and a range of researched supplements to cover any shortfalls. I sprinkle in plenty of high quality, filtered water and turn the lights out for at least seven hours every night. The result will be the very best version of you, ready to rumble.

Until next time…Be Vibrant!