Happy, Productive, Satisfying  and of course HEALTHY NEW YEAR!!!!

See you in 2010!!

J&R

I always think of this week – the one between Christmas and New Year’s Day – as a time for reflection about my life in general as well as about the past year. And what always come to mind this time of year, particularly since I’ve gotten older and it is more of an issue, is health and health habits. So, in the spirit of this time of year and the wish to reflect on your life, the last of our blogs of 2009 will review some of the important health issues that we women in midlife and beyond must generally be concerned about, as well specific issues from this past year.  First, the general issues…

Most of us believe that the health worries of kids no longer apply to us as we get older.  We think that one of the advantages of reaching midlife is that we are finally finished with all those issues that make childhood and adolescence such a pain in the neck, such as needing set bedtimes as well as  regular dental and eye checkups; having to worry about using protection during sex and about cigarette smoking; getting all those shots to prevent diseases and wearing helmets to prevent sports injuries; needing to eat all our vegetables and avoid sugar as well as not missing gym class. What a relief to let these issues fade right along with our memories of tetherball on the school playground!

Not so fast. Would it surprise you to know that you still have to be aware of each and every one of the above so-called “child/adolescent” health issues? 

For instance, what about set bedtimes? The obvious reason that we needed enforced, regular  bedtimes each night was so that we would get enough sleep. Being tired and sleepy the next day in school caused everything from lousy concentration to crabby moods. Now that we’re in midlife, many of us believe that sleep is no longer an issue. This is not the case at all. It’s still essential to our health and wellbeing. Recent studies have shown that not only do sleep disturbances often indicate a serious health problem, but that lack of sleep can actually cause health problems, such as weight gain. Polls have shown that nearly two thirds of adults over the age of sixty-five have sleep complaints, but that less than 15 per cent of them have been formally diagnosed with a sleep problem. Why? Because we don’t mention sleep problems to our health care providers. Our mothers were right — we still need to be concerned about our bedtimes.

Once we’ve gotten the glasses we need and all our baby teeth are gone, we no longer need to get regular eye and dental checkups as we did in our younger years, right? Again — no. Although our vision does remain stable from young adulthood until we need bifocals, there are common eye diseases that begin to occur in midlife, and that can lead to blindness if not diagnosed.  And even though we no longer have our baby teeth,  other dental issues take the forefront upon reaching midlife, such as gum inflammation which has been shown to be associated with diabetes and heart disease. So, continued regular dental and eye checks are as important as in our younger years.

And what about sex at midlife and beyond?  We’ve moved from groping and being groped in the backseat of the car to more sophisticated maneuvers in a comfortable bed, and finally, finally no longer have to worry about pregnancy. So we don’t need protection; or so many of us think. Although it’s true that once menopause arrives one can’t get pregnant (warning: make sure you have completed menopause before assuming this as diagnosing menopause can be tricky),  protection is still needed during sex because of sexually transmitted infections (STIs). Yes, we can still get those, and in some cases are even more prone to becoming infected after menopause, even after a hysterectomy. And even though we’re past the childbearing years and our reproductive organs seem to have no further use, we still need regular pelvic exams and Pap smears. It is also important at that exam to discuss with our healthcare providers the need for testing for STIs; if there is a new partner or the worry that the current partner is not monogamous, this testing is a must.

STIs are not the only threat held over from our adolescent years; so is cigarette smoking. Many women in midlife think that there is no reason to stop smoking cigarettes at this age, since they wrongly assume that the damage is already done from all the prior years of smoking. This is not the case. No matter how many years one has smoked, stopping can prevent further damage to the heart, blood vessels, and lungs, and in some cases can reverse some of that damage. 

Also relevant to the lungs is the fact that asthma can begin in midlife, where once it was thought to only begin in childhood.  The two major causes seem to be occupational exposure to substances that damage the lungs, and the recreational exposure to air pollution by adults who run predominantly outside. So, a new onset of shortness of breath at this age — even if it occurs only with exercise — does not necessarily mean heart disease; remember that we can develop asthma now.

Did you think you were finished with all those horrible shots you had to have in childhood and adolescence? Sorry, you’re not. There is a recommended immunization schedule for adults in midlife and beyond, just as there are for children. At certain ages over 50 and at certain intervals, you’ll need shots against the flu, certain types of pneumonia, tetanus, and in some instances, shingles and hepatitis.  Ask your primary care provider about these.

And did you pack away your helmet when you gave away your bike with training wheels? Probably ok to have done this since now you will need a bigger size helmet. But you do need a helmet. A recent report by the U.S. Consumer Product Safety Commission stated that sports-related injuries in the Baby Boomer population was on the rise, with over 1 million injuries in this age group in 1998 alone, most of the injuries being due to bicycling and basketball.  The same report said that the many head injuries associated with bicycling were probably due to the fact that Baby Boomers use helmets less than younger people do.

The fact that exercise and proper nutrition are as important in midlife and beyond as in childhood may not come as a surprise. Regular exercise at this age has been shown to increase longevity and wellbeing, postpone and possibly prevent dementia, strokes, heart disease, and diabetes, and aid in the treatment of depression. Important to know as well is that several different types of regular exercise are recommended at this age, including aerobic (cardio) exercise, weight-bearing exercise or strength training, and exercises to improve balance and flexibility.

What we eat as we get older is every bit as important as it was in our younger years. One particular healthy way of eating, the Mediterranean diet, has been shown to stave off dementia, prevent heart disease and diabetes, maintain a healthy cholesterol level, and improve longevity. One study showed that this diet even improved sexual function in certain women! This diet is exactly as expected given its name: lots of natural whole foods, like vegetables, fruits, and nuts, lots of fish and olive oil, moderate amounts of wine, and limited amounts of foods containing refined sugar. Controlling the portions of the foods we eat is even more important at this age. Our metabolic rate decreases with age, making it easier to gain weight while eating the same amounts of food as in our younger years. 

So, as you are rummaging through your mother’s attic looking at your old dolls, baseball bat and Ouija Board, and breathing a sigh of relief that you no longer have to worry about being picked for a baseball team or that your best friend copied your paper doll’s dress, don’t get lulled into complacency about your health. Although you once may have thought that taking care of yourself  health-wise would get easier as you get older, you know now that that’s not true.

Now that it’s that time of year to make resolutions: make your appointments for regular checkups, get more than 5 hours of sleep a night, use protection when having sex, particularly with a new partner, stop smoking no matter how old you are, get the recommended immunizations, be careful and wear your helmet and seatbelts, and exercise regularly and eat well. Your mother’s recommendations from your childhood continue to apply!

It dawned on me the other day – after a specific incident I’ll mention in a moment – that despite all the joy and exhilaration of this season, it’s also one that can be loaded with danger if we’re not careful. And that’s exactly what we’re NOT during this month because there’s too much to do and because we’re rushing to get it all done.  

Let me backtrack. I’m terrified of falling. You already know that if you’ve read our book or have seen prior blogs (http://www.smartwomanshealth.com/horn_miller_blog/?p=282). Because of this, I am extra cautious about watching where and how I walk when doing stairs, and of course, when there’s been rain or snow or ice. We had a huge snowstorm over the weekend; in fact, it set a record for December snowfalls in Baltimore (a bit over 20 inches).Despite thinking I was being careful yesterday on the first day out after the snowstorm, I missed seeing a patch of ice as I was coming out of the grocery store, and the next thing I knew, I was flat on the ground with the hot tea from my cup spilled all over me. The only thing good about it was that it happened so fast that I didn’t have time to get that awful feeling you get AS you are falling.

That fall started me thinking that perhaps I had NOT been as cautious as I usually am, or that I had been in such a hurry because of all the things I had to do, that I was distracted. And this led me to the realization that distraction – due to rushing and being more overprogrammed than usual – can cause many unforeseen dangers during this busy and harried season.  

So, I made a list of these potential hazards that may occur because we are too busy, rushing too much, or overtired.

·        Falling or having an accident (car or other)

·        Overeating

·        Eating too much sugar

·        Drinking too much alcohol

·        Smoking too much or starting to smoke again

·        Spending too much money

·        Not getting enough sleep

·        Not getting enough exercise

·        Being emotionally raw and losing your temper unnecessarily

·        Getting depressed and not realizing it

·        Completely missing the joy of the season

Now, doing any of the above for a short period of time may not be harmful, but the Holiday Season generally lasts at least one month or more for all of us. And so does the rushing around and the lack of attention to our routine daily lives. Doing any or all of the above for a month or so can be devastating to our health, especially since it can lead us to break all our good habits from the prior ten or eleven months.

The simple remedy? SLOW DOWN and FOCUS.  Be aware that rushing and being distracted and trying to do too many things can put you at risk for an accident or worse.  Tell yourself that it’s ok if: 1) you don’t get your Holiday cards out until after Christmas or 2) you’re late to a holiday party or 3) you give someone on your list a gift card to Amazon instead of picking out the perfect present or 4) you send store-bought cookies to the school party instead of baking them yourself , and so forth. You get the picture.  Remember that all the perfectly-chosen gifts and home baked cookies in the world are not worth anything if they cost you your good health habit,  and thus, your good health.

Wishing you and yours a joyful and slow upcoming holiday weekend – Merry Christmas and Happy Kwanzaa! And hope your Chanukah was wonderful.

If you’re feeling blue right about now, and wondering why, you’re not alone. The holiday season is well known for bringing on sadness, or for worsening a depression that was present previously.  There are many reasons for this, but the most obvious is that holiday time is usually family time – at least it is as portrayed in the advertisements in all forms of media. And whether you’re missing family members who are no longer here, or remembering past Decembers that were happier than this one, this time of year can be one of sadness.

There is also another important reason that the December holidays can make you feel down, and that is the time of year itself. These are the shortest days of the year, which obviously means that our exposure to sunlight at the lowest of the year. What’s the connection? You’ve probably heard of “seasonal affective disorder” (also referred to as “SAD”).  This is a type of  depression that occurs in some people at the same time(s) every year, and that is related to the seasons – more specifically it is related to the lessening amount of daylight.

What are the symptoms? They can be identical to other forms of depression and can include everything from increased fatigue to extreme moodiness to irritability to social withdrawal to full blown anxiety and hopelessness. And like other types of depression, you can actually get physical symptoms including sleeping too much, a change in appetite, decreased ability to concentrate, and even weight gain.

What makes SAD different from other depressions is that the symptoms can come out of the blue, with no real reason. What I mean by that is that usually with SAD, you cannot figure out why you feel so blue since it seems that everything else in your life is ok for the moment. In addition, if you were already suffering with depression, you can still get SAD. This can translate into worsening of your symptoms, even if you are on antidepressants. Although this can happen with other forms of depression, with SAD, it is more common that there is no precipitating cause of your feeling down.

People with SAD are thought to produce too much melatonin in their bodies which then causes a disruption in our internal clocks. In addition, whether or not you will get SAD is related to genetics and to age. The most common time of the year for people to suffer with SAD is right now – during the shortest days of the year. But it is not uncommon for people to get SAD and its symptoms at other times of the year when the seasons, and thus the amount of daylight, change; these include late August- early September, and March-April.

How is it treated? Some experts feel that antidepressant medications (or increasing the dosage if you are already taking them) is enough to treat SAD. But many others feel that the best way to treat it is by what is called “light therapy.” Now this is not, as it sounds, just turning on all the lights or staring into your lamps.  Light therapy for SAD must include a very specific type of light, from which you sit at a very specific distance for a prescribed amount of time daily.  For instance, the light must be of adequate intensity; if you use a light of 10,000 lux, you must be exposed to it for 30 minutes daily. If your light is of 5000 lux, then you have to use it for a full 60 minutes daily. The prescribed distance you should sit from the light is 12-18 inches. It is usually recommended that you use it in the mornings.

Yes, you can get your own light and use it without a prescription. BUT, it is always a good idea to let your clinician know you are doing it, especially because the therapy can have side effects such as eyestrain and headaches. And, your clinician should also know about your symptoms, as you may need medication in addition. Lastly, since some insurance companies will pay for the light itself, you should let your clinician know so that he/she can give you a prescription so that the light will be covered by insurance.

SO, if everything is going well in your life – except for the crazy schedules of the season-  and you suddenly are feeling like you don’t want to go to those holiday parties or even get out of bed,or, if you’ve been mildly blue, but it has increased recently, then consider that you may have SAD.  The good news is that SAD can be treated and in some cases, light therapy brings about improvement even more quickly than do antidepressant medications.  Talk to your clinician about your symptoms, and don’t just assume that you’ve become a Holiday Grinch.

For further information on light therapy, go to: http://www.mayoclinic.com/print/seasonal-affective-disorder-treatment/DN00013/METHOD=print

There are many foods we hear about that are considered junk food and often on the “forbidden” list, but they really aren’t bad for you. Here are a few that may surprise you – just in time for the holidays!

Sour Cream

It is true that sour cream is 90% fat. However, it is usually only eaten in small quantities. A serving of sour cream is two tablespoons and is only 52 calories. This is less saturated fat than is in a 12-ounce glass of 2% milk.

Coconut

Coconut is packed with saturated fat. However half the fat is lauric acid. A recent review has found that lauric acid can increase the LDL or “bad” cholesterol levels, but it boosts the HDL or “good” cholesterol more. The rest of the fat is made up of medium chain fatty acids, which are neutral. A pinch of unsweetened shredded coconut can make a nice snack, or at least can add some flavor to another snack. Just don’t overdo it as it is high in calories.

Chocolate

Chocolate has been given a bad rap in the past. However, dark chocolate is rich in flavonoids. These compounds (also found in green tea and red wine) have been found to reduce inflammation and relax blood vessels, improve blood flow, and even improve your mood. Three ounces a day can decrease blood pressure. Once again, moderation is the key when it comes to eating chocolate. The recommended amount is the equivalent of 2 Hershey kisses a day.

Pork Rinds

Pork rinds are made from fried pigskin. Sounds fatty?! However, a one-ounce serving contains 9 grams of fat, 17 grams of protein and NO carbohydrates. Almost half the fat is unsaturated and in the form of oleic acid (the same healthy fat found in olive oil); the rest is saturated fat that is in the form of stearic acid and considered harmless. The key, if you like these, is not to go overboard.

Beef Jerky

Beef jerky is often thought to be high in preservatives and not particularly healthy. However, it doesn’t have to be unhealthy if you get the right brands. It is a great high protein snack that won’t raise your insulin levels. The key is to find it with all natural ingredients (without MSG, sodium nitrate and chemicals). For variety and omega-3 fatty acids, make sure to get grass-fed beef or give salmon jerky a try!

Taking a folic acid supplement has long been recommended to pregnant women to lower the risk of low birth weight, preterm delivery, and defects in the development of the baby’s neurologic system.  In fact, in 1998, the U.S. required that flour and other whole grains be fortified with folic acid for this very reason.

 Taking it as a supplement is also recommended to adults in midlife and older for specific medical problems in which folic acid deficiency is playing a role. Some of these include: 1) a certain type of anemia (low red blood cell count)  related to Vitamin B12 deficiency;  2) liver disease; 3) alcohol abuse or overuse;  4) kidney dialysis;  5) problems with absorption in the gastrointestinal tract; and 6) in people on certain drugs such as antiseizure medications, among others.

In recent years, folic acid supplementation for older adults has been in vogue for prevention of heart disease, though no studies have shown such a benefit, and more recently, for stroke prevention. In fact, a study showing that folic acid was effective in preventing strokes was released just as we were writing our book, although appropriate dosages were unknown.

 Now comes research from Norway (Ebbing M et al. JAMA 2009 Nov 18.)* in which the results of two separate trials of folic acid supplementation were combined, and included nearly 7000 people.  (Of note, Norway does not mandate folic acid fortification of foods.) Study participants received either folic acid plus Vitamins B12 and B6; folic acid plus B12 only; B6 alone ; or placebo.

After following the patients for an average of 6 years, it was found that those who took folic acid had a 21% greater risk for developing cancer than those who did not take folic acid.  Interestingly in another study in 2009, it was shown that folic acid supplementation increased the risk of prostate cancer.  Since it is known that folic acid can impair the immune system’s surveillance of cancer cells, and may even stimulate growth of already established cancer cells,  these findings are not all that surprising from a biologic point of view.

So, where does that leave us adults in midlife and older with respect to folic acid supplementation? Do we take it and possibly prevent heart disease or strokes, but risk an increased chance of cancer? The answer is not simple; as with all good medicine, it involves taking a personal approach and weighing the risks vs. the benefits in terms of  your particular case given your health profile.  The best answer is definitely not the same one for everyone.

Since we now know that there may be a risk in taking folic acid in amounts over what we get in our diets, and the benefits of it in terms of cardiovascular disease and strokes are not definite, the safest approach – based on our CURRENT knowledge – is NOT to take extra, or supplements of, folic acid unless you have a specific medical reason, or a folic acid deficiency. Unless you have one of the conditions that lead to folic acid deficiency mentioned above, you should be able to get all you need in your diet. 

What foods naturally contain folic acid? Leafy green vegetables (like spinach and turnips), citrus fruits, and dried beans and peas. Should you avoid whole grains and foods containing flour since they are fortified with folic acid – so that you can avoid getting too much? Most experts believe that even with the fortification in these foods, the American population is still within safe limits in terms of the amount of folic acid in the diet.

There’s a good lesson in all this. Trends in nutrition and vitamin supplementation come and go. New information and scientific studies are constantly coming out. Speak to your clinician before you take supplements of folic acid, or anything else for that matter.  Remember: vitamin and herbal supplements can have negative effects too. Don’t go buying lot of vitamins and herbs in hopes of staying healthy or living forever. You will probably do better in the long run to simply eat a healthy diet.

*(Ebbing M et al. Cancer incidence and mortality after treatment with folic acid and vitamin B₁₂. JAMA 2009 Nov 18; 302:2119)

You know how every month of the year has been designated as “National Awareness Month” for a specific condition or disease? Just recently, The American Foundation for Paying Attention to Things (AFPAT) has declared this December as “National Awareness Month” in an effort to combat what they see as “the current epidemic of complete and utter obliviousness” in America.  They further say that not only are Americans suffering from an epidemic of general unawareness, but that Americans are even unaware that they are unaware!

As with all other awareness campaigns, especially those related to health, the National Awareness Month campaign includes a recommendation for screening, or self-exam, for the disorder. The suggestion is that at least once a year, you:  while making eye contact with yourself in the mirror, take 3-5 minutes to think about the fact that you are a human being. 

The AFPAT of course has many activities planned for this month, including  a charity walk, advertising campaigns, and the wearing of a 9 inch highly-reflective yellow ribbon.

So, what do you think? Do you have time for one more self-exam and one more thing to be aware of?!

Here’s a link for more info: http://www.theonion.com/content/news/december_named_national_awareness

Insomnia is becoming a cultural problem. In 1999 a survey found that 30% of American men and 20% of women used medication to help them sleep in the course of a year.

There are a variety of medications available. They may help for the short term, but it is really important to get to the root cause of the sleep problem. For some, it may be sleep apnea. For others, it may be anxiety or depression. There may be medical conditions that are causing sleep problems. If you have a problem sleeping, see your doctor. That said, I will run through the medical options for sleep. There are a variety of options.

Over The Counter Medications

Most of the over the counter medications contain antihistamines that cause drowsiness. These are medications such as Tylenol PM, Sominex, Unison, and Benedryl. These medications can cause dizziness, daytime sleepiness and dry mouth.

Natural Remedies

Melatonin is one of the more popular natural remedies. In studies, it has been found to help people fall asleep but may not increase the total sleep time or reduce daytime fatigue. It has been found to benefit the elderly who have low melatonin levels. It has helped people who are blind to maintain their circadian rhythm. It has been found to have benefit to some who are jet lagged. There is no set dose. Some recommend as little as 0.3 mg at bedtime for insomnia. High doses may actually keep people awake. Rozerem isn’t really natural, but it acts on the melatonin receptors and has a similar effect on sleep. It has the side effect of potential dizziness and daytime drowsiness. Valerian is an herb that can be helpful for sleep. It takes one to two weeks of continued use to work. The usual dose is between 300 and 600 mgs. It is relatively safe but can cause vivid dreams, and has been reported to cause abnormal heart rhythms in high doses. Chamomile tea is safe and relaxing and can be very helpful for those who have mild sleeping problems.

Prescription Drugs

Long acting drugs include Klonopin , Restoril, and Dalmane. These drugs are in the benzodiazepine family. They can cause depression, depressed breathing, memory loss (sleep walking), and overdoses can be fatal. These drugs should not be mixed with alcohol. They can become habit forming. Short acting non-benzodiazepines include Sonata, Ambien, and Lunesta. Sonata is very short acting and can be taken if you can’t fall back to sleep in the middle of the night. Ambien and Lunesta are better if you take them at bedtime as they are longer acting than Sonata. Ambien and Lunesta are particularly useful for people with jet lag. Side effects include dizziness, nausea, amnesia with sleepwalking and headache.

Other Prescription Drugs Chloral Hydrate is rarely used due to the risk of addiction. As we know from Anna Nicole Smith, when chugged from the bottle and mixed with other drugs it can be fatal. These medications and supplements are not meant to be used long term. Many can result in rebound insomnia when they are stopped. Some can interfere with the sleep cycle so that the sleep isn’t as restful a natural sleep.

If you have a sleep problem, it is important to consult your doctor and find ways to sleep without medication