RM: Happy New Year!

JH: Same to you and to all our readers!  Do I dare bring up the obvious…

RM:  No - New Year Resolutions are a set up.  We all tend to set lofty goals for ourselves, and eventually we break them (usually within the first month).

JH: Then we beat ourselves up, and to compensate for feeling weak, we do the exact opposite of our resolutions, like get a quart of  Ben&Jerry’s Chunky Monkey to eat all at once to keep us company in our misery.

RM: Exactly my point.  We set ourselves up for failure right from the start. 

JH: Yes, and I’ll bet you’ve had some really high-falutin’ resolutions in the past, like doing bungee jumping twice a week, or going on, and winning, “Survivor” on TV, or…

RM: How’d you know?!! And I’ll bet you’ve had some doozies yourself, like becoming a gourmet cook,  or opening a dog breeding kennel and actually giving away/selling all the puppies (and not keeping them for yourself), or …

JH: You got it – no need to go further.  So what’s your solution?

RM: Well, keeping the fact in mind that most resolutions are doomed to fail, I have decided to take a new direction.  I suggest you and our readers do the same. How about making resolutions that we can keep?  They should be simple and fun, while still being good for you.

JH: Great idea! Let’s hear yours.

RM: These are what I propose.  I will:

 Take at least one spontaneous trip this year

 Eat at least one hot fudge sundae without feeling guilty (this is a good one!)

 Make a new friend

 Try to learn to speak a new language

 Go to the movies once a month

 Laugh at least 10 times a day

JH: Love them!! Especially that last one; it’s much easier than drinking a glass of water 10 times a day.  And because they are fun and manageable, you’ll stick to them, and be a better, healthier person because of it.

RM: That’s the idea.  Now, let’s hear yours.

JH: OK.  Hope you don’t think I’m copying you on some of them. I will:

Brush up my speaking Spanish

Do something positive for a different person at least once a week

Think about how good it feels to be healthy at least once daily

Read at least one totally junky novel each month

Rub all of my dogs’ bellies at least once a day

Take more naps

RM: Good job.  Finding things that are fun and do-able allows us all to be successful in keeping our resolutions, which then makes us feel positively about ourselves.

JH: And that then lets us get on with whatever work we have to do, including doing the things that keep us healthy, without that huge bugaboo of self-doubt, negativity, and failure.

RM: You got it. So, now we’ll wish our readers …

Both:  A Happy, Safe, and Healthy 2009!

 RM: So, I can’t imagine what we’re talking about in this blog – what’s with that title?!

JH: You know – “Tis the season to be jolly…”  So, I wanted us to talk about abdominal fat.

RM: Ok, important topic – but what’s the relation to those other things?

JH: I’ll tell you that when we finish talking about belly fat.  In our book, we discuss how body weight and body fat are dangerous for our health, especially as we get older and are more at risk for certain diseases anyway (because of advancing age), like heart disease.

RM: Right. And we discuss how medical people don’t talk about “pounds” of weight, but use the term “body mass index” or BMI to talk about body weight.  BMI takes into consideration one’s weight and height. A normal BMI is less than 25. But being overweight is not the only problem, is it?

JH: No. The distribution of the body fat is just as important. Having much of the body fat concentrated in the abdominal area is more of a risk for heart disease and diabetes than having that body fat concentrated in the area of the hips and thighs.

RM: So, being an “apple” in shape (fat mostly in the middle, or the belly, area) is more dangerous than being a “pear” shape?

JH: Absolutely.  We can tell for sure which of these body shapes a person has by measuring the waist and then the hips, and figuring out what the waist measurement divided by the hip measurement, or the “waist to hip ratio”, is.

RM: So, we’ve known for awhile that being apple-shaped is dangerous to our health; is there more recent information?

JH: Yes. An important study was published in the November 13, 2008 issue of the New England Journal of Medicine in which 359,000 men and women (ages 25-70) in nine different European countries were followed for a little over nine and a half years; the researchers were able to assess the association of each person’s BMI, waist circumference, and waist-to-hip ratio with their risk for death, while controlling for other factors, such as smoking, alcohol consumption, and physical inactivity, that might increase that person’s risk of dying.

RM: That sounds like a very thorough study. What did they find?

JH: Several things. The first one was expected: that those with the lowest risk of death had a BMI around or just below 25.  The risk of death increased as the BMI increased.  For those people with the same BMI, the risk of death increased as their waist circumference and their waist-to-hip ratios increased.  The people with the largest waists had double the risk of death as those whose waists were normal.

RM: That’s impressive. And this was the same for men and women?

JH: Yes.

RM: And wasn’t being underweight dangerous as well?

JH: Absolutely.  But since there’s a lot to talk about with that issue alone, we’ll save that for another blog. Back to the study and the risks of being overweight,  more impressive was that even people who were not considered to be much overweight, but had increased abdominal fat, were at an increased risk for death.

RM:  So, we’re not even safe if we’re at a good weight but have a paunch – how unfair. Two questions: isn’t the reason that increased fat in the belly area is dangerous is that it’s thought to be a special type of fat different than elsewhere in the body?  And, can’t we just go get liposuction of the belly so we’ll live longer?

JH: Yes to the first question.  No to the second one – go look at chapter 11 in the book again to remember why! 

RM: Ok, so we know again that too much fat in the belly is bad for us.  What should we do?

JH: Women should know their waist-to-hip ratios, as well as their weight and BMI.  And all of this should be considered when coming up with a comprehensive plan for staying healthy.  For instance, if a woman has too much belly fat, she may be advised to lose more weight through increased aerobic exercise in order to specifically get rid of the belly fat.

RM:  Right.  Those crunches and sit-ups just won’t do that. Actually, we should talk more about the different types of exercise and what each type specifically does for our bodies when the New Year rolls around… in 2 weeks!  Now, you promised to tell what this whole topic has to do with the holidays and Santa.

JH: Easy.  This time of year, there are always office and neighborhood and kids’ parties to go to, and all forms of peppermint and other candies and sweets to eat, and wonderful sequined and sparkly clothes that we pull out of the closet to wear… which often don’t fit, especially in the belly area, which makes us buy Spanx or a real girdle…

RM: I get it. You’re saying that we shouldn’t wait until the Holidays, and those glittery but too-tight clothes, to figure out that our belly is too big; and we shouldn’t make it worse by sampling all the delicious sweets sitting out this time of year!  It’s best to work on it all year by keeping the body weight normal, and trying to go without the Spanx once in awhile to see how bad that paunch really is.  And what about Santa?

JH: Remember the poem “Twas the night before Christmas”?  What did it say about Santa?

RM: I’m supposed to recite a poem in this blog?!!! Are you nuts?

JH: Ok then, I will.  About Santa, it said: “He had a broad face and a little round belly, that shook, when he laughed like a bowlful of jelly.”

RM:  So the moral of the story is that Santa needs Spanx!

JH: Not quite!  But on the risk of getting silly…or more silly… let’s just wish our readers…

BOTH: Happy and Safe and Healthy Holidays!

The Centers for Disease Control and Prevention has designated this week as National Influenza Vaccination Week not only to highlight the importance of the appropriate people (that includes us – anyone over the age of 50) getting the vaccine, but also to let people know that the months of November. December and even January are not too late to get the vaccine.  Why is this? Because many people believe that if they haven’t gotten their flu shot by October, it’s too late to get it. This is not true.  The activity of the influenza virus does not reach its peak until February, or later depending on your location; therefore there is still a lot of time to get it.

Who specifically should get a yearly flu shot?  A new recommendation of the  2008 Advisory Committee on Immunization Practices (ACIP) is that all children and adolescents between the ages of 5 years and 18 years should now be getting it.  Previous to this, only children ages 6 months to 4 years, and children of other ages who have a chronic medical condition were advised to have a flu shot.  What has not changed is that children below the age of 6 months are not advised to have it.  In sum, children ages 6 months to 18 years should be getting a yearly flu shot.

The recommendation for which adults should get a yearly flu shot has not changed, and basically includes any adult who wants to reduce the risk of getting the flu, or of transmitting it to others.  Adults who are especially advised to have the vaccination are those who are at high risk for getting the medical complications of the flu, like pneumonia and other infections with the bacteria Staph aureus,  or those adults who are close contacts of others who are at high risk. 

These recommendations specifically name the following groups of adults who should definitely get the flu shot every year:

·        People over the age of 50

·        People who have chronic lung, heart, liver, kidney, blood, or diabetes

·        People whose immune system is suppressed – by having cancer or HIV/AIDS, or by taking medications that suppress the immune system (steroids or chemotherapy or drugs to prevent rejection of transplanted organs)

·        People who live in nursing homes or other chronic care facilities

·        Health-care workers

·        People who live with, or are caregivers of, adults over the age of 50 or children under the age of 5 and especially under the age of 6 months

·        People who live with, or are caregivers of, others with chronic medical conditions who would be at high risk for complications if exposed to the flu

Why is getting vaccinated so important? Many people think that getting the flu is no big deal, and just amounts to a few muscle aches and pains, fever, and respiratory symptoms that go away quickly.  This is definitely not always the case.  For instance, during flu season last year (the 2007-2008 season), influenza was associated with a higher death rate, and with higher rates of hospitalizations in children ages 0-4 years, than in each of the three prior years.  Also notable is the fact that flu season peaked in mid-February, and continued to be seen into the month of May last year.

Is there anyone who should not get the flu vaccine? Yes. If you have an allergy to egg yolks, you should not get the flu shot; this is because the vaccine itself is made up in egg yolk. Also, if you’ve had a severe reaction to the flu shot in the past, you should tell your health care provider about that.  Many of these so-called “reactions” will not prevent you from receiving it again.

Today, December 9^th, is Children’s Vaccination Day, and this Thursday, December 11^th, is Seniors’ Vaccination Day (remember that Medicare pays for the flu vaccine).  So, if you haven’t gotten your flu shot yet, get it!  And if you know someone that hasn’t gotten it, especially if they fall into one of the groups mentioned above,  remind them that it is definitely not too late in the season to get it.

We wanted to make you aware that November is National Diabetes Awareness Month, but especially to call your attention to a disease that all too frequently is, at best, minimized, and, at worst,  ignored. 

Why is this the case?  Probably for many reasons: 1)  Diabetes has been around for a long time, and for many years was not discussed much, so that many people think it is just a “nuisance” disease;  2) Many people remember their parents and grandparents having it, and referring to it as “just a little sugar problem”;  3) Many people do not know of the serious complications that are a direct result of diabetes – such as heart attacks , kidney failure, and stroke;  4) Since diabetics usually die of these complications rather than from the diabetes itself,  many people unknowingly think that the diabetes itself isn’t serious or cannot lead to death;  and  5) Many people think that the available “treatments” for diabetes – pills or insulin injections – are in fact “curing,” or at least “treating,” the disease itself;  in reality the medications simply keep the blood sugar in a normal range, but do nothing to treat the underlying disease. 

Think that information about diabetes doesn’t apply to you?  Think again.  Currently,  over 23 million people in the United States (8% of the population)  have diabetes – 5.7 million of these are undiagnosed; approximately 57 million people in the US have prediabetes, a condition in which the blood sugar is high and may go on to frank diabetes.  Research has shown that some people with prediabetes already have the long term damage to the body – especially to the heart and circulatory system – that most diabetics get.  If you have been carrying around some extra pounds, you are risk for diabetes (Type II) and prediabetes.  You are even more at risk if there is someone in your family with diabetes, or if you had gestational diabetes when you were pregnant. Remember, early on this is a silent disease; your blood sugar can be elevated without any symptoms.

Since the facts about diabetes are readily available in many places, both in hard copy (like in our book!) and online (see websites below), we will not discuss those here, other than to say that although it is indeed a serious disease with serious consequences if left untreated, it is also a controllable disease, and in many cases, a preventable one.  The one thing diabetes is NOT: that “little sugar problem” that your grandmother had.

It is because of the misconceptions mentioned above that the American Diabetes Association (www.diabetes.org/home.jsp)  and the National Diabetes Awareness Program, sponsored by the National Institutes of Health (www.ndep.nih.gov), work all year to educate everyone about this disease with excellent programs across the country.  Please go these websites, learn the facts, and help yourself and others to avoid or control this disease and its devastating complications. 

And once again, please read our blog of November 5, “The Danger Season” as it relates directly to weight gain, obesity and diabetes.  And, remember to ask your clinician to check your blood glucose level at your next office visit.

 RM: Last week you said we would talk about some new information on breast cancer prevention and exercise. Let’s start there this week.

JH:  Ok.  You know how we talk so much in our book about exercise and its beneficial effects on virtually every organ system in the body as shown by rigorous scientific research in recent years?

RM: Absolutely. During our research for our book we were both surprised by how much research has shown that. Exercise is no longer about “going out for a little walk” to relieve stress or get outside; it’s not a “nice to do” any longer, but a “must do”.  In particular, we mentioned that studies have shown that the proper amount of regular exercise may prevent a recurrence of breast cancer in a woman who has been successfully treated.

JH: That’s exactly where I’m going, and there’s even more now.  A recent issue of the NCI Cancer Bulletin, which comes out weekly from the National Cancer Institute, put the spotlight on the entire issue of the role of exercise in breast cancer prevention (October 21, 2008; Volume 5, Number 21).  More and more research studies indicate that the levels of hormones in the body can be modified by physical activity.  Since one of the major theories of breast cancer is that its development is closely related to, and may be caused by, the total amount of estrogen and progesterone a woman is exposed to over her lifetime, knowing that a woman can reduce these hormone levels through exercise is very important information.

RM:  In other words, you’re saying that doing regular exercise - by reducing the hormone levels in the body - may be able to actually prevent breast cancer?

JH: That’s the working theory. And there are some good studies to back this up. In one study, known as the “California Teacher’s Study” in which over 133,000 current and retired California teachers and administrators have been enrolled since 1995, the researchers found that the risk of invasive breast cancer (specifically estrogen receptor-negative breast cancer) was inversely related to the amount of strenuous exercise the women had done throughout their lives.

RM: Meaning that the women who did more exercise had a lower risk of invasive breast cancer than those women who didn’t?  And how much “strenuous” exercise are we talking about here?

JH: Specifically, the researchers found that those women who had done 5 hours per week of strenuous exercise from the time they were in high school until their current age (around 54 yo), had a significantly lower risk than women who had done ½ hour or less of strenuous exercise over the same time period.

RM: That’s impressive. Are there more studies to back that up?

JH: Yes.  The National Institutes of Health (NIH) and the American Association of Retired Persons (AARP) are doing a similar study known as “The Diet and Health Study” that began in 1995.  These researchers looked at the amount of physical exercise done by participating women (between the ages of 50 and 71)  at the study’s beginning, and found the same thing: that higher levels of physical activity seemed to decrease the risk of estrogen receptor-negative (ER-negative) breast cancer.

RM: I have two questions about these findings.  First, a simple explanation. Breast tumors are categorized based on whether or not they have estrogen receptors; those that do have them are known as ER-positive tumors, and those that don’t are called ER-negative.

My first question is: does the fact that exercise reduced the risk of ER-negative breast cancer, rather than other types, make a difference?

JH: Good question. Yes. Here’s why. There are drugs currently in use that can help prevent the formation of  ER-positive breast tumors; these drugs are tamoxifen (Novaldex) and raloxifene (Evista).  However, there are no drugs available that prevent ER-negative breast tumors.  Knowing that physical activity may do that is crucially important.

RM: Very impressive that we may soon be able to help prevent both types of breast cancer. 

My second question:  You say that the theory is that it is the amount of physical exercise done over a woman’s entire lifetime that may be important in breast cancer prevention.  That sounds to me like you’re implying that the earlier she starts doing regular exercise in her life, the less likely she may be to get it. Is that right?

JH: Bingo. (You’re SO smart; glad you are my coauthor! LOL)  Remember the Nurse’s Health Study II (NHSII) that you talk a lot about in the book in regard to the use of hormone therapy at menopause?

RM: How could I forget?!

JH: Well, researchers in that study looked at the amount of lifetime regular activity done, from the age of 12 yo and up, in nearly 65,000 premenopausal women, and found a 23 % reduced risk for premenopausal breast cancer in those women who had regularly exercised.  Specifically, the higher the levels of physical activity between the ages of 12 and 22, the lower the risk.  The researchers think that may have something to do with adolescence being the period of breast development, a time when the breast tissue is most susceptible to hormones and other influences.

RM: So, to all our readers: Get your daughter, granddaughters, nieces and girlfriends’ daughters out there regularly exercising!!

JH: Absolutely. But also a caution to our readers: just because you may not have been physically active when you were younger doesn’t mean it’s too late for you to reap the benefits of exercise now. Researchers from the NCI, and we, strongly believe that becoming regularly physically active at any age is beneficial, especially since we are all living longer.

RM: So don’t forget to take that long walk after dinner on Turkey Day!

JH: And everyday, for that matter. Or at least 5 days a week.

RM: I thought we were going to talk about the importance of abdominal fat this week, but I guess we’re giving our readers/friends a break before Thanksgiving, right?

JH: Yes. We’ll get to that topic right after the Holiday. In the meantime, please read (or reread) our blog from November 5, “The Danger Season.”  You’ll see why we’re recommending it again when you read it.

Both: Have a safe and healthy Thanksgiving!!

JH: Lots to talk about this week. The study that made the biggest splash in the news showed that one of the cholesterol-lowering drugs in the group known as statins (such as Lipitor, Zocor, Crestor) prevented heart attacks and strokes even in people who did NOT have high cholesterol levels. Does that mean that everyone, regardless of their cholesterol levels should now take one of these meds?

RM: Well, it’s a bit more complicated than that. In a study in the New England Journal of Medicine of November 9 (published online ahead of its regular publication date), nearly 18,000 people – including men and women of diverse ethnic backgrounds – who had normal “bad” cholesterol levels (LDL) but high CRP levels, were given either a placebo or a statin drug and followed for almost 2 years.  They were being watched for their first occurrence of an event involving the cardiovascular system, including a nonfatal heart attack, a nonfatal stroke, hospitalization for unstable angina, the need for a procedure to open blocked arteries, or death from one of these causes. The study had to be stopped because there was a significant difference found in the occurrence of these events between the group taking a statin drug and the group taking a placebo.

JH: So the group taking the statin drug had significantly fewer heart attacks and strokes and other cardiovascular events?

RM: Yes.

JH: Doesn’t that mean, then, that everyone should take one of these drugs regardless of their cholesterol level?

RM: No, but what it does mean is that you might want to find out what your CRP level is, especially if you have risk factors for stroke or heart attack.

 JH: Ok. CRP stands for C-reactive protein, and has been used for years as an indication that some type of inflammation is going on in the body. It is measured by a simple blood test. That inflammation, however, can  be due to many causes such as an ongoing infection, certain types of arthritis, like rheumatoid arthritis, and active heart disease. The high level of the CRP only says that inflammation is going on, but does not specify where the inflammation is coming from.

RM: Exactly. We say that the CRP test is nonspecific. Therefore, we’re not sure who in this study really had active heart disease, and who didn’t, even though they all had a high CRP.

JH: So, if someone has a normal cholesterol, but other risk factors for heart disease, they should ask for their CRP level to be checked, and then let their doctor decide if they need a statin, right?

RM: Yes. Although the statins are relatively safe, there can be side effects to them and they are expensive; therefore, one should only take them if they really need them. And that should be decided individually for each person.  More studies need to be done to follow up this one.

JH: Another study receiving a lot of press attention recently showed that postmenopausal women who had a migraine diagnosis had a lower risk for breast cancer.  The authors of this study, which appeared in Cancer Epidemiology, Biomarkers and Prevention, speculate that this difference is due to lower levels of estrogen occurring in migraine patients.

RM: I’ll bet you were especially interested in this study, right?

JH: Yes - it’s the first good thing about migraines I’ve seen! And since I have migraines, I’ll be very interested to see if further studies on this show the same thing.  Another study, reported in the August 19 issue of Neurology, showed that chronic migraines were underdiagnosed and undertreated in this country.

RM: Interesting. That finding leads directly to one of the mantras in our book: that women need to advocate for themselves. If you have recurrent and severe headaches, even if your clinician does not make much of them, you should ask if it’s possible you are having migraines, or ask for a referral to see a neurologist.

JH: Absolutely. There are good treatments for migraines these days, including medications to prevent them from occurring. So, there’s a good possibility that if you have migraines, you don’t have to suffer as much, or at all, with them by taking treatment.

RM: Right. Next time we’ll talk about placebos and another new study on the relationship of exercise and breast cancer.

JH:  Now that the election is over, and we know the worst about the economy (or least hopefully we do), we can get back to work and focus on day to day matters. And that means, as usual, our health. Time to stop making excuses about all the potato chips we’ve grabbed as we plop down in front of the TV to hear the latest polls, and about the new Ben & Jerry’s ice cream we’ve eaten every night for comfort as we try to deal with our checkbooks. And…

RM: Hey! Wait a minute – aren’t you forgetting something? What time of year is this? You know, the one you have a name for and always talk to your patients about?

JH: Oh, you’re right. It’s what I call the “Danger Season”: that period of time from Halloween until January 2.

RM: Why do you call it that? And how does this time of year impact on all those things we’re saying about getting back to work on health, eating better, walking?

JH: It’s absolutely the worst time of year for taking care of ourselves. The Holidays (which have become almost one long holiday), Thanksgiving, kids home from school, days off for shopping and gift buying, stopping for that double mocha latte and scone, candy canes at all the counters in stores, holiday parties, holiday cookies (love those Mexican wedding cookies smothered in powdered sugar), hot toddies, holiday dinners, weddings….

RM: Whoa! You’re really stressed out here!

JH: That’s why I call it the danger season: because of all the good cheer and easy food just sitting there for grabbing, it’s way too easy to rationalize forgetting all our healthy habits, and giving in to the easy life. Then in January, we are so out of shape and have gained so much weight, it is positively demoralizing. So, what do you suggest we do to avoid that?

RM:  I do have tips, but too many to give all of them here. So, I will start by giving a few now, and adding to them in this blog as the weeks go by.  Let’s start with:

·        Be aware that the upcoming 8 weeks can be dangerous to your health. Keep reminding yourself.

·        Be alert to your inner voice telling you “it’s ok to eat that holiday candy, just this once” and other destructive messages.  Don’t listen to it!

·        Take action to avoid getting into difficult situations healthwise.  For instance, give away or throw away the remains of that Halloween candy now, before you eat it all.  Don’t leave bowls of goodies (candies and cookies) sitting out in your house because  “it’s that time of year”; put them out only when company is coming.  Look at your schedule closely: be realistic about all you have to do and the time it takes, and make a place for exercise.

·        Advocate for yourself. Don’t get that fattening holiday drink when you’re out with friends just because they insist that you do; stick with your regular skinny latte.

JH: Those are great. We’ll give more as these holiday weeks arrive.  In the next blog, we’ll talk about some recent studies about docs prescribing placebos, more on exercise and breast cancer, and about an interesting study about which diets work the best.

Yes, we do strongly believe in the necessity of exercise to maintain our health, and this particular exercise - that of exercising the right to vote - is no exception. No matter what your beliefs are or which candidates or party you favor, your vote is crucial not only for the health of our country and of democracy in general, but for your own sense of wellbeing. This coming Tuesday, don’t forget to do all of your exercises - including voting!

More discussion on recent medical studies right after the election.

October is National Breast Cancer Awareness Month. This important initiative, and organization by the same name (NBCAM), was started over two decades ago to raise awareness about breast cancer in all women and their families. Over the years, the organization has evolved and made all issues related to breast cancer of year-round importance. NBCAM is comprised of professional medical associations - such as the American College of Obstetrics and Gynecology, the American College of Radiology, and the American College of Clinical Oncology; government agencies – such as the Centers for Disease Control and Prevention; and national public service organizations, such as the American Cancer Society, working together to increase the awareness of breast cancer, provide access to screening services, and share information about all aspects of breast cancer.

Encouraging women to increase their knowledge and to take control of their own health, NBCAM wants women to make sure to schedule an annual mammogram, practice regular self-breast exams, and take the prescribed treatment, including that for prevention and treatment, of breast cancer. The fact that this organization and the increased awareness of breast cancer has had a positive effect is shown by recent studies in which not only death rates from breast cancer have decreased, but also the number of new cases diagnosed with breast cancer has decreased in recent years. Most experts believe that these significant decreases are due not only to improved treatments, but also to the increased awareness by patients of their risks for this cancer; this has lead to more women getting screened regularly, and in cases where breast cancer may be present, having it detected at an early stage when there is the highest chance for a cure.

Robin and I agree completely with the philosophy of NBCAM. Please visit NBCAM’s website, a wonderful resource about your breast health throughout the entire year, and not just in October.  http://nbcam.org/index.cfm

In addition to the stress due to what’s going on in this country, I have had a fair amount of personal stress in my life lately. My dad recently died, my youngest son has gone to college and the nest is now empty and my job is changing and getting a whole lot busier. That has led me to this current blog topic….STRESS!

Stress is one of those things that is a natural part of life. And one of those things that can show up physically with new, or worsening, symptoms. Some of us handle it better than others. There are various types of stress. There is acute stress that you feel when you are in danger and that provokes a “fight or flight” response, otherwise known as an adrenaline rush. There is intermittent acute stress that is a hallmark of those with the type A personality. These are people who are stress junkies and thrive on deadlines and rushing around. Finally, there is continuous or chronic stress. This can be seen in people who are oppressed either by a job, relationship or a government.

The most dangerous form is chronic stress. After time, those with this type of stress get so used to it they don’t even notice it. The continuous outpouring of stress hormones can lead to obesity, diabetes, heart disease, stroke and even cancer.

It is important that you recognize stress in your life and that you do something about it, especially since there are so many ways to relieve stress. I advise starting with a healthy diet (avoid the urge to devour carbs), exercise is key, and then find ways to relax: read a lighthearted book; listen to soothing music; lay on the sofa holding your dog, and pet her nonstop. There are also complementary medical therapies (CAM) such as massage and acupuncture that can help. Meditation and yoga are great ways to relax and manage the stress response. Some may need the help of a therapist. There are chapters in our book, which go into much greater detail about all of these stress-busters including diet, exercise, and CAM therapies

Regardless of which route you choose, it is important to pay attention to your body and if you are chronically or even intermittently stressed get help and stay healthy.