Dr. Weil's Whole Life Health

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Andrew Weil, MD

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Before embarking on any health-related regimen, beginning any exercise program, taking any herbs, drugs, supplements or other health-related items, seek the care and advice of a qualified doctor or health professional.

The content in Dr. Andrew Weil’s Whole Life Health Advisor is intended to inform, not prescribe, and is not meant to be a substitute for the advice and care of a qualified health professional.

Dr. Andrew Weil, MD, is an internationally recognized leader in integrative medicine and expert in medical education, medical botany, and mind-body interactions. He earned an AB degree in biology (botany) from Harvard College and an MD from Harvard Medical School.

He is a best-selling author of books on health based in integrative medical philosophy, along with the popular Self Healing newsletter. Dr. Weil holds the Jones/Lovell Endowed Chair in Integrative Rheumatology at the University of Arizona College of Medicine, where he is also Clinical Professor of Medicine and Professor of Public Health. He is the founder and director of the Arizona Center for Integrative Medicine, a Center of Excellence at the University of Arizona.

Copyright 2017 by Five T2 Ventures, LLC. All rights reserved. This publication is a production of Five T2 Ventures, LLC, Dayton, Ohio.

Dr. Andrew Weil’s Whole Life Health Advisor

In these pages, you’ll discover the latest information about living well throughout the many stages of life. Because the topic is lifelong and family health, this guide is designed to be meaningful to everyone, whether that’s a 40-year-old mother, her 75-year-old father, or her 10-year-old son. You might find yourself drawn to read the sections of this guide that are most applicable to you right now, or discover that you look ahead with the goal of staying healthy as you get older. However you use it, we hope that Dr. Andrew Weil’s Whole Life Health Advisor becomes a trusted resource in your home library for years to come.

AN INTERVIEW WITH DR. WEIL

In this exclusive interview, Dr. Weil shares why he’s passionate about helping everyone achieve optimal health, no matter their age.

Q. WHY FOCUS ON FAMILY HEALTH?

A. Families are the foundation of community, a concept interrelated not only with the health of individuals, but also with the health of the planet and a sense of purpose greater than ourselves. The goal is to create a healthy lifestyle that works for everyone and everything.

Q. WHAT ARE THE MOST IMPORTANT THINGS WE SHOULD DO TO STAY HEALTHY THROUGHOUT OUR LIVES?

A. I believe that everyone should understand the concept of health as its own state of vitality and not just the absence of disease. In general, you should learn the principles of healthy eating, get regular physical activity, learn and practice methods of neutralizing the harmful effects of stress, get adequate rest and sleep, cultivate emotional wellness, use preventive medical care judiciously, and learn to breathe properly. To foster

optimal health in your family, it pays to teach these approaches to your loved ones, too. I cover all of these crucial areas in this guide.

Q. WHAT’S THE RELATIONSHIP BETWEEN FAMILY HEALTH AND INTEGRATIVE MEDICINE?

A. Integrative medicine views patients as whole persons who live in families and communities. It focuses on health promotion and disease prevention and pays attention to all aspects of lifestyle that influence health, including the support of family in times of illness and the stressors that can accompany family discord or crisis. Integrative medicine is appropriate for people of all ages.

Q. HOW HAS YOUR APPROACH TO YOUR OWN HEALTH CHANGED OVER THE YEARS?

A. I continually modify my diet and supplement regime as I learn new scientific findings. For example, as I’ve learned more about the importance of the microbiome, I’ve made more effort to eat fermented foods regularly. I’ve also modified my exercise routine to adapt to changes in my body.

Dr. Andrew Weil’s Whole Life Health Advisor

Everyone’s definition of “family” is different, but for many people, the concept of family isn’t complete without children. For those who are able to conceive, pregnancy can be a busy and joyful time, full of plans for the future. In spite of its timelessness across generations, however, it’s likely you and your partner have a lot of questions about ensuring a healthy pregnancy and childbirth. Much of the information in this section of Whole Life Health Advisor comes from my colleague Victoria Maizes, MD, executive director of the University of Arizona Center for Integrative Medicine and author of Be Fruitful: The Essential Guide to Maximizing Fertility and Giving Birth to a Healthy Child.

MAXIMIZE YOUR FERTILITY

Unless you pursue in-vitro fertilization (IVF) or other fertility treatments, the process of conception is the same: Each month, in one of a woman’s two ovaries, a group of immature eggs begins to grow and become follicles. Typically, one of the follicles matures and suppresses the development of the others. The mature follicle releases its egg, a process known as ovulation that occurs about two weeks before a woman’s next menstrual period starts. Following ovulation, the follicle changes into the corpus luteum, and begins to produce progesterone and estrogen. Progesterone prepares the uterus for pregnancy by thickening the endometrium, the inner layer of the uterus where the egg will attach if it is fertilized. After the egg is released from the ovary, it travels through the fallopian tube where it remains for about 24 hours, and where it may or may not be conjoined with a sperm. When you’re trying to prevent pregnancy, you might worry that this process will occur all too easily. While it’s not uncommon for couples to get pregnant on the first try, others struggle with infertility for years. For most women under age 35, however, it’s normal for conception to take up to about six months of trying. Age is certainly a consideration: At 40, the average woman has a five percent chance of conceiving in any given month, compared to 20 percent at age 30. A variety of other factors also reduce fertility, including irregular ovulation, scarring of the female reproductive organs (from pelvic inflammatory disease, for example), and, in men, the number, shape, and movement (motility) of their sperm.

“ For most women under age 35, it’s normal for conception to take up to about six months of trying. ”

There are many other influences on the ability to become and stay pregnant, some of which are under your control. When you’re trying to conceive, the most important thing you can do to boost your fertility is to prepare for pregnancy by leading a healthy lifestyle. To improve the odds of conception, try the following natural fertility boosters.

Get to Know Your Body

First, start paying attention to your cycle so that you understand and can predict when your body has the conditions necessary to conceive. Determine when your next period is due to start and count back 12 to 16 days. This will give you a range of days when you will likely be ovulating. (For women with a 28-day cycle, the 14th day is often the one.) To use this method, you need to know the length of your cycle. The best way to find your most fertile time is to monitor your body closely and learn to recognize the signs that ovulation is imminent.

You will want to watch for three different signs of ovulation. The first is a change in cervical mucus. As your cycle progresses, this increases in volume and changes texture. The greater volume and changes in texture signify your body’s increasing levels of estrogen. You are considered most fertile when the mucus becomes clear, slippery, and stretchy, similar to a raw egg white. The role of mucus is to nourish, protect, and propel the sperm on its way up through the uterus and into the fallopian tubes to meet the egg.

A few days after ovulation, your body temperature can increase by 0.5 to 1.6 degrees. You won’t notice the difference,

PHOTO JENNA NORMAN

but you can detect it with a basal body temperature (BBT) thermometer. This temperature spike indicates that you have ovulated. (Release of an egg stimulates the production of progesterone, which raises body temperature.) You are most fertile in the two or three days before your temperature hits its high point. A few experts think you may have an additional half-day to one-day window of fertility after you first notice the temperature rise, but most say at that point it is too late to conceive. Fertility specialists advise charting your temperature every morning for a few months to detect a pattern and pinpoint your likely ovulatory date. Then you can plan to have sex during the two to three days preceding the day your temperature normally rises.

Approximately 20 percent of women actually feel ovulatory activity, which can range from mild achiness to twinges of pain The physical symptoms, called mittelschmerz, may last anywhere from a few minutes to a few hours.

You can streamline things by using an ovulation prediction kit. Available without a prescription, these kits detect the surge in luteinizing hormone (LH) just before ovulation. They are easier to use and often more accurate than the BBT method, and they can predict ovulation 24 to 36 hours in advance, and thus aid in increasing your chance of conception the very first month you use them. But they are not foolproof. They can measure LH (you get either a positive or a negative result, not a number to quantify it) but are not able to indicate whether you ovulate after a positive response; LH can surge with or without the release of an egg.

False LH surges can also take place before the real one. For maximum accuracy, follow the kit’s directions closely. (However, if the instructions say to test your first urine of the day, you may want to test your second catch instead. Overnight urine can be concentrated and might give you a false-positive result.)

Your cycle starts on the first day you have your period. If you have a 28-day cycle, begin the test on day 11 and use it for six days (or however many days the kit recommends). If your cycle is longer, for example 35 days, start on day 14 and test for nine days. If you have an irregular cycle, you may find that this is the least convenient way to detect ovulation, because you will have to buy multiple kits to use over a long period of time. If your cycle runs between 28 and 40 days, your ovulation may occur between days 14 and 26. Because the kits (which range in price from $20 to $50) usually provide only five to nine days’ worth of tests, you may need to buy two of them per month.

Clean Up Your Act

In the past, couples were less aware of the negative consequences of unhealthy behaviors such as using tobacco or drinking alcohol excessively while pregnant. Now, many expectant mothers view pregnancy as an opportunity to eliminate risky behaviors and commit to a healthy lifestyle. And these days, that goes beyond quitting smoking and taking prenatal vitamins, although those choices are certainly important. As we learn more and more about the effects of common chemicals on health, it pays to be mindful of your dayto-day exposures—even before you conceive.

There are several reasons to pay attention

to your environment and, especially, chemical exposures when you’re planning a pregnancy, says Dr. Maizes. First, many such compounds are endocrine disruptors, which means that they affect levels and actions of estrogen and other hormones that play an integral role in both fertility and pregnancy. While more research is needed, there’s compelling evidence that exposure to endocrine disruptors may interfere with the ability to conceive. For example, studies suggest that bisphenol A (BPA)—a chemical found in some types of plastic, including food and beverage packaging—is associated with decreased fertility. One small study even found that high levels of BPA in women’s blood were linked to a 50 percent reduction in normal fertilization of eggs retrieved for in-vitro fertilization. (The good news: BPA is rapidly eliminated from the body if you avoid further exposure.)

If you do get pregnant, your baby will likely be exposed to a multitude of chemicals even before birth: One analysis detected an average of 232 chemicals in babies’ umbilical cord blood—possibly setting the stage for later problems like learning disabilities, reproductive abnormalities, cancer, heart disease, and diabetes. Those are good reasons

to go green, but don’t despair if the idea of eliminating toxins seems overwhelming. Dr. Maizes recommends starting with some simple steps.

Get personal. Before anything else, assess your exposure to environmental toxins by asking yourself questions about your diet, home, and habits. For example, do you purchase organic produce? Do you use “natural” cleaning products? Are you exposed to chemicals at work? For a free selfassessment, visit victoriamaizesmd.com.

Target the big guys. It’s unrealistic to expect that you can completely clear your life of toxic chemicals. Instead, try to avoid those that you encounter most often. If you enjoy gardening, for example, use only nontoxic pesticides and herbicides. If you’re a cosmetics lover, check the labels of your products for questionable ingredients at the Environmental Working Group’s Skin Deep site (ewg.org/skindeep).

Clean the kitchen. Your kitchen is one of the easiest places to go green. Swap plastic storage containers for glass, make sure your water is free of contaminants, and use cookware that won’t leach chemicals into food.

“ As we learn more and more about the effects of common chemicals on health, it pays to be mindful of your day-to-day exposures—even before you conceive. ”

Feed Your Fertility

Obviously, what you eat and drink can also be a source of unwanted toxins, so it makes sense to choose organic options when possible. But that’s only one aspect of the role that nutrition plays in your fertility. In fact, specific foods can help raise—or lower—your odds of getting pregnant.

Choose whole foods. Dr. Maizes recommends a diet rich in vegetables, fruits, eggs, vegetable-based protein, and omega-3 fatty acids in the form of low-mercury fish— like wild salmon and sardines—and low in processed foods, meat, and high-glycemic carbohydrates. The anti-inflammatory diet I recommend (outlined in Section Three of this magazine and described in detail in my books and newsletter) meets these requirements. So does the Mediterranean diet, which has been linked to a 40 percent reduction in the risk of infertility.

Go fish. Fears about mercury and other pollutants have led many women of childbearing age to reduce—and sometimes almost eliminate—fish from their diet. Yet oily, cold-water fish are excellent sources of omega-3 fats, which may benefit fertility and are critical for a growing fetus. Dr. Maizes recommends choosing fish that are high in omega-3s and low in mercury, such as wild salmon, sardines, herring, and trout. For more on selecting healthy seafood, check seafoodwatch.org.

Shun soda. Need another reason to ditch soft drinks? Research shows that the more soda a woman consumes, the longer it takes her to conceive. In general, carbohydrate foods that rate high on the glycemic index (a measure of how quickly they raise blood sugar) have been found to

interfere with fertility.

Take a multi. There’s good evidence that taking a daily multivitamin can help boost fertility, protect against birth defects, lower the risk of miscarriage, and reduce the odds of having a child with autism or other learning disabilities. Dr. Maizes recommends that all women who are contemplating becoming pregnant supplement with a multivitamin that contains vitamins A, B12, D, and E, as well as iron, iodine, and at least 400 mcg of folic acid.

A Word About IVF

If you’re struggling with getting pregnant, there are other options for conceiving, including in-vitro fertilization (IVF), in which egg and sperm are combined in a laboratory petri dish and the resulting embryo implanted in the woman’s uterus. Success with this approach increases with the number of cycles attempted, up to four cycles. According to the American Society for Reproductive Medicine (ASRM), a woman under the age of 35 has a 25 percent chance of conceiving and having a baby via IVF as long as her male partner has no fertility problem. The odds are lower for women in their forties. To optimize your chances for success with IVF, I recommend consulting a traditional Chinese medicine specialist in fertility: Acupuncture may improve the blood supply to reproductive organs, decrease stress, and positively influence sperm quality and count in men. Mind/body techniques such as guided imagery or hypnosis may also help.

Should You Freeze Your Eggs?

Oocyte cryopreservation is the technical term for freezing a woman’s eggs for future fertilization. This procedure is available to

women who want to have children eventually but worry that by the time they’re ready, the odds that they’ll be able to conceive will be low. After age 35, fertility declines, and a woman’s eggs become more susceptible to chromosomal abnormalities, increasing the risk of birth defects.

While oocyte cryopreservation can be appealing for some couples, there are significant drawbacks. First of all, in order to produce eggs that are to be frozen, women must take two weeks of treatment with drugs to stimulate the ovaries so that they’ll produce multiple mature eggs, rather than the one (or possibly two) released during the normal menstrual cycle. The drugs can cause very unpleasant side effects, including depression, hypertension, chest pain, thyroid abnormalities, night sweats, muscle pain, joint and bone pain, and loss of libido. Between 10 and 20 percent of women develop ovarianhyperstimulation syndrome, which in its mildest form causes nausea, vomiting, and diarrhea. More severe forms can be lifethreatening.

Once eggs have been produced, they’re removed via a needle inserted through the

vaginal wall and then frozen. That’s not as simple as it sounds: Eggs are harder to freeze than either sperm or embryos. They contain a lot of water, which makes them vulnerable to formation of damaging ice crystals. Because of this, chances are low that eggs will survive freezing and eventual thawing. When a couple is ready for pregnancy, eggs are thawed and fertilized with the partner’s sperm. Fertilized eggs, if any, are then implanted into the uterus.

Apart from the unpleasantness and potential danger of the ovarian stimulation, oocyte preservation has another big downside: The ASRM warns that for every 100 eggs that are extracted and frozen, only two will survive the process, and these may or may not result in live births. And then there are the costs, upwards of $10,000 for the ovary stimulation and extraction procedure—and that doesn’t include annual egg storage fees. None of this is typically covered by insurance for healthy women. Given the dismal success rates of today’s oocyte cryopreservation and implantation, the odds of a woman conceiving in her thirties and even her forties actually seem much better with Mother Nature.

PHOTO CHI-N-PH-M

Can Your Diet Influence Baby’s Sex?

It’s been said that we are what we eat, but does what you eat help determine whether you’ll have a boy or a girl? Some research suggests that diet may indeed influence sex, but the impact seems weak at best. For example, one study showed that women who had the highest caloric intake before they got pregnant were more likely to have boys than women who consumed fewer calories. But the researchers found no link between food consumption after or during pregnancy and the babies’ sex.

Of course, these findings reflect the fact that the contribution of either an X or Y chromosome by the father’s sperm genetically determines the sex of the child. If the findings of this study hold true, the influence of diet would be to create conditions in the mother’s body prior to fertilization that favor sperm carrying a particular chromosome and successful development of one sex over the other. If you’re planning a pregnancy, be sure to eat a healthy, balanced diet and take folic acid before trying to conceive and during pregnancy, to lower the risk of certain birth defects. Your diet prior to pregnancy might influence whether you have a boy or girl, but I wouldn’t count on it.

A HEALTHY PREGNANCY

If you’ve successfully conceived, congratulations! You’re about to embark on the exciting journey to parenthood. That said, you’ll want to do everything you can to ensure a healthy pregnancy. No woman who is, or may soon become, pregnant should be oblivious to potential hazards, but feeling overwhelmed by the impossible task of avoiding every health risk isn’t wise either. Pregnancy should, to the maximum extent possible, be a happy and relaxed period in a woman’s life. Make a few low-stress, prudent choices each day, and you’ll greatly increase the odds of enjoying a successful pregnancy and delivering a healthy baby.

Go Green for Baby’s Sake

Dr. Maizes points out that some 87,000 synthetic chemicals are registered for use with the Environmental Protection Agency (EPA), yet only about 200 have been studied for health effects on human beings in general, let alone on a developing fetus. Of those, only five have been removed from production. With such lax regulations, it’s no surprise that these chemicals, which range from pesticides in foods to plasticizers in packaging, are making their way into the womb. One study of 10 babies born in five states between December 2007 and June 2008 found an average of 232 different environmental chemicals in the babies’ umbilical blood. This is an important and sobering finding, because research clearly indicates that fetal exposure to toxins can raise risks that a child will suffer from learning disabilities, cancer, diabetes, and heart disease as he or she grows.

PHOTO BEN WHITE

Fortunately, in 2013, the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) took an important step in raising awareness. They issued a Joint Committee Opinion stating, “Patient exposure to toxic environmental chemicals and other stressors is ubiquitous, and preconception and prenatal exposure to toxic environmental agents can have a profound and lasting effect on reproductive health across the life course.” The opinion goes on to assert that ACOG and ASRM “join leading scientists and other clinical practitioners in calling for timely action to identify and reduce exposure to toxic environmental agents while addressing the consequences of such exposure.” This frank recognition by mainstream physician groups of these potential hazards could provide much-needed leverage in creation of tougher environmental protection regulations. In the meantime, there are simple, practical steps nearly any woman can take to lower the chance that her fetus will suffer significant exposure. I recommend the following tips. Banish bad habits. If you smoke or drink alcohol on a regular basis, quit and do your best to stay away from secondhand smoke. Drink up. Test your home water supply and, if necessary, install a water filter that removes any harmful compounds present. Visit NSF International (nsf.org) for information about different types of waterfiltration systems.

Clear the air. Consider placing a highefficiency particulate air (HEPA) filter in your bedroom. Further limit your exposure to air pollution by observing air advisories; visit AirNow (airnow.gov) for air-quality reports.

Be picky about plastic. Avoid plastic-wrapped and canned foods; these can contain plasticizers and bisphenol A, respectively, which can leach into the food.

Shop around. Use the EWG’s Skin Deep database (ewg.org/skindeep) to find safer versions of shampoo, sunscreen, makeup, and other personal-care products. And employ nontoxic cleaners: Make your own, or buy environmentally friendly brands at natural-foods stores.

Make a fresh start. When you begin decorating, paint the baby’s room with low- or no-VOC (volatile organic compounds) paint, and use hardwood or washable area rugs instead of carpeting. For additional practical advice on avoiding toxic chemical exposures while pregnant, see Dr. Maizes’s website at victoriamaizesmd.com.

PHOTO LONDON SCOUT

Eat for Two

Remember that what you put on your plate affects your growing baby, too. Focus on eating whole, unprocessed foods with minimal additives, as well as brightly colored vegetables and fruits, which are natural sources of antioxidants. Opt for organic or locally grown produce whenever possible. You can find guidance from the Environmental Working Group (ewg.org) on the foods you should always buy organic.

Fishing for advice. When it comes to fish consumption in pregnancy, confusion abounds. The dilemma: The omega-3 fatty acids in cold-water fish such as wild salmon, sardines, herring, and black cod are vital for healthy development of a baby’s brain and nervous system. At the same time, seafood can contain high levels of mercury and other harmful heavy metals. In my opinion, you certainly should eat fish while pregnant. Research now suggests that the benefit to a baby’s neurological health from omega-3s appears to far outweigh the potential for harm from small amounts of mercury that you might ingest.

For instance, one study compared the children of women who ate no fish in pregnancy to those who ate up to 12 ounces per week and to those who ate more than 12 ounces per week. Researchers found that the children whose mothers avoided fish had nearly double the risk of a low IQ at age eight. This was measured very carefully in tests designed to focus on the amount of fish in the mothers’ diets, not on their social or economic status or educational levels. The children who did the best in the IQ testing were those

whose mothers ate more than 12 ounces of fish per week while pregnant.

That makes sense, since the benefits of the omega-3 fat docosahexaenoic acid (DHA) include improvements in visual, cognitive, motor, and behavioral skills in newborns that last into childhood and may impact lifelong health and mental capacity. Ocean fish, including salmon, herring, sardines, and mackerel, meet the need for DHA and another omega-3 fat known as eicosapentaenoic acid (EPA) in pregnancy. I suggest avoiding swordfish, marlin, shark, and bluefish because they’re more likely than other species to contain dangerous levels of toxins. I recommend albacore over other species of tuna. Use the Natural Resources Defense Council’s Consumer Guide to Mercury in Fish (nrdc.org/health/effects/mercury/guide.asp) to make wise seafood choices.

Considering caffeine. Many women wonder whether it’s safe to continue drinking coffee or tea while pregnant. The answer is yes, but not too much. The concern focuses on the potential adverse effects of caffeine. Researchers have found that consuming the amount of caffeine in five or more cups of coffee per day doubles the risk of miscarriage.

However, there’s no evidence that moderate caffeine consumption of 200 mg daily from coffee, green tea, or other beverages increases the risk of miscarriage. (One-and-one-half to two cups of brewed coffee contains about 200 mg of caffeine; you would get half that amount in two cups of brewed tea.) When estimating your daily caffeine intake, remember to add in other sources of caffeine in your diet, such as soft drinks and energy drinks. I suggest

“

The omega-3 fatty acids in cold-water fish such as wild salmon, sardines, herring, and black cod are vital for healthy development of a baby’s brain and nervous system. ”

PHOTO MARCELO MATARAZZO

limiting your consumption of coffee or tea to one to two cups per day, especially during the first trimester. Fortunately, no studies have found any connections between caffeine and birth defects, low birth weight, or a baby’s motor development or intelligence. But because caffeine can enter breast milk, you’ll also need to watch your coffee and tea consumption if you plan to breastfeed your baby. In that case, limit your caffeine intake to 300 mg daily.

On the Move

Just because you’re pregnant doesn’t mean you can’t keep up a regular exercise routine. In fact, I recommend that you stay physically active during pregnancy as long as you’re in good health and your physician approves. Exercise can help you balance your mood, maintain a healthy weight, and speed your recovery after your baby is born. If you are accustomed to working out, you should be able to continue with your regular exercise program, providing that you have no complications. However, even early in pregnancy you may find that you tire more easily during exercise than you did previously.

Walking, low-impact aerobics, and yoga are good choices for pregnant women as long as they are comfortable. Indoor stationary cycling and aquatic exercises in a swimming pool are excellent nonweight-bearing exercises during pregnancy. (Riding a bike outdoors isn’t a good idea since pregnancy-related changes in weight distribution, balance, and coordination

can increase your risk of falling.) The American College of Sports Medicine also recommends the following tips.

• Avoid exercising while lying down on your stomach or your back after the first trimester of pregnancy.

• Make sure that you are well hydrated and drink plenty of fluids before, during, and after exercise.

• Avoid high heat and humidity, especially during the first trimester when the fetus is undergoing its most important growth.

• Stop exercising if you’re fatigued, develop persistent pain, or experience any vaginal bleeding; check with your doctor if regular contractions occur more than 30 minutes after exercise (possibly a sign of preterm labor).

• Avoid heavy weightlifting and any activities that require straining.

• Avoid exposure to extremes of air pressure, as in high-altitude exercise (unless you’re accustomed to it) or scuba diving.

• Don’t increase the intensity of your workout beyond pregnancy levels.

• Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you’re physically active, your caloric needs will be higher to make up for the calories burned up during your workout.

Managing Morning Sickness

Nausea and vomiting can be unwelcome side effects of pregnancy in many women, particularly during the first trimester, and these symptoms aren’t just limited to the morning hours. Here are my top three recommendations for managing morning sickness. Be sure to discuss any changes in your supplement regimen with your physician first.

GINGER. This spice (Zingiber officinale) is very effective for morning sickness. In scientific studies, the amount of dried ginger used to quell the nausea of morning sickness was about 1,000 mg per day, taken in two to four divided doses. You can take up to 1,000 mg of ginger daily in any form, including tea, candied slices, pickled slices, powder, or capsules. If you take capsules of ginger, keep in mind that many of the ginger supplements on the market are highly concentrated extracts. With these products, when the label says 250 mg, it means 250 mg of the extract. The equivalent of dried ginger root could be anywhere from 2,500 to 5,000 mg.

ACUPRESSURE WRISTBANDS. These bands apply pressure to acupressure points on the inner surfaces of your wrists and have been found to help ease motion sickness and morning sickness. They are available at most drugstores and health-food retailers. Proper placement of the wristbands is critical. Follow the package directions carefully so you’ll know how to locate the pressure points.

EAT SOMETHING. The traditional advice to keep your stomach partially full is simple and effective. Eat crackers, dry toast, or dry cereal before you get out of bed in the morning, and snack on dry, starchy foods later in the day. You should also sip clear liquids between meals. You’re more likely to feel nauseous if your stomach is empty or full, so aim for in-between.

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FCHILDBIRTH: SPECIAL DELIVERY rom hospitals to home births, expectant mothers run the gamut in their views on the ideal setting for childbirth. You should always discuss your birth plan with your partner and healthcare team, weighing the pros and cons of different options. Here are my thoughts on some frequently asked questions about childbirth and delivery.

Hospital or Home?

Out-of-hospital births, including home births, have been increasing slowly and steadily, but according to the U.S. Centers for Disease Control and Prevention (CDC), these deliveries still represented only 1.5 percent of all births in the United States in 2014, the last year for which the CDC’s National Center

for Health Statistics National Vital Statistics System has data. Of all the out-of-hospital births, 63.8 percent were home births and 30.5 percent took place in birthing centers.

According to the American Pregnancy Association, home births can be an option for women who are experiencing healthy, low-risk pregnancies. On its website, the association lists conditions that argue against home births: women who are diabetic, those who have chronic high blood pressure or toxemia (also known as preeclampsia), and those who have experienced preterm labor in the past or are considered at risk of it. The association also rules out home births when a woman’s partner doesn’t support her desire for one.

As you might expect, there is a fair amount of controversy about out-of-hospital births. A study presented at the February 2014 meeting

PHOTO THIAGO CERQUEIRA

of the Society for Maternal-Fetal Medicine found that babies born at home with midwives in attendance have a risk of neonatal death four times higher than that seen in babies delivered by midwives in hospitals. The same study found that the risk increased to about sevenfold if the pregnancy was the mother’s first and by about tenfold in pregnancies beyond 41 weeks, now considered “late term.” For this study, neonatal deaths were defined as those that took place up to 28 days after delivery. The study authors said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest and to recommend strongly against it.

That report was challenged, however, by the American College of Nurse-Midwives, which questioned the accuracy of the CDC data used in the study and maintained that the birth certificates the researchers relied upon in compiling their data are not always the most accurate source of information on home births. For example, you cannot learn from a birth certificate whether or not a woman planned to have her baby at home or in the hospital. Some may have intended to go to the hospital but gave birth at home unexpectedly, and some women who planned to give birth at home may have been transferred to the hospital if complications developed or if the midwife could not reach her in time.

The conventional medical community offers only grudging support for home births. The American Pediatric Association and the American College of Obstetricians and Gynecologists maintain that the safest settings

Lactation Tea

Traditional medical systems have long recommended certain herbs to help increase breast milk production. Most lactation teas contain fenugreek seed ( graecum), which is widely used to enhance the production of breast milk. Fenugreek is quite safe at the amounts used in tea or capsules. The dose is generally three grams per day (two capsules, three times per day) or one cup of tea three times per day. To make the tea, use 30 to 50 g of fenugreek seeds to one cup of boiling water; strain out the seeds, sweeten, and drink three to four cups a day. If you don’t like the taste of this drink, capsules might be a better option. You should see an increase in milk production within 72 hours after starting to consume fenugreek.

K eep in mind that fenugreek has a maplelike flavor and can make your baby’s urine smell like maple syrup. This is n’t a problem, but you should be sure to tell your pediatrician that you’re taking fenugreek, so the doctor doesn’t worry about the odor. If you develop diarrhea while taking the capsules or drinking the tea, reduce the dose.

I n order to support your milk production, be sure to eat a variety of fruits and vegetables every day, which can help you to avoid fatigue and maintain your energy. Watch your fluid intake, too, because drinking more liquids than you need to quench thirst can suppress milk production. And don’t overdo the use of parsley, sage, and peppermint, all of which may reduce your milk supply.

for births in the United States are hospitals and birthing centers, but both organizations acknowledge the right of women to make medically informed decisions about delivery. All things considered, I think home births are just fine for women experiencing lowrisk pregnancies, as long as they and their caregivers take adequate precautions, have medical backup (an obstetrician who works with the midwife), and good prenatal care.

Do You Need a Doula?

Doula is a Greek word that means “women’s servant,” although in today’s parlance it refers to a professional who helps women through labor, childbirth, and the initial stages of motherhood. The role of the doula is to facilitate a positive childbirth experience. She isn’t a substitute for a doctor or a midwife: You still need one or the other for medical care during pregnancy, and one or the other will need to be present when you give birth. However, a doula can enter the picture at any stage of pregnancy or the birth process to answer your questions and provide support and reassurance. Studies have shown that when doulas are present, women are less likely to require pain medications, less likely to have a caesarean delivery, and more likely to report a positive childbirth experience.

You can use a doula at the hospital, as well as at home, and many experts highly recommend having a doula present for the birth, especially if you’re a first-time mother. Check to see if your hospital has nursemidwives as well as doctors on staff. If so, you can be in the hospital but still create a more intimate, home-like delivery. If your pregnancy is low-risk and you are in good

health, giving birth at home can be beautiful, but you will need a qualified midwife in addition to a doula. Before hiring a doula, be sure to ask about her education and experience and check to see if she has been certified by a reputable national organization.

What’s Up with Water Births?

Some parents find the concept of a water birth—laboring and delivering in a tub or pool of warm water—very appealing. Indeed, my own daughter was born underwater, because I am convinced that water birth is a safe, nontraumatic experience. First introduced in the 1970s, water births have been gaining in popularity, particularly in Europe. In fact, a recent study from Italy found that in uncomplicated deliveries they may even shorten the first stage of labor. On the other hand, doctors in New Zealand have reported on four cases where newborns inhaled water after underwater delivery, developed respiratory distress, and required oxygen for anywhere from five minutes to six hours after birth. Some needed antibiotics as well.

Unfortunately, water births have not been widely studied so that no one can assure women that labor and delivery are equally as safe for both mother and baby as conventional births. However, a recent national surveillance study in Great Britain found a mortality rate of 1.2 per 1,000 live births of babies born in water compared to 1.4 per 1,000 among a comparable group of low-risk women having conventional births.

Immersion in warm water during labor relaxes muscles, reportedly leading to less painful uterine contractions and shorter

“ Immersion in warm water during labor relaxes muscles, reportedly leading to less painful uterine contractions and shorter labor. ”

labor. The Italian study I mentioned above found that water birth was also associated with a lower episiotomy rate and less need for pain relief compared with other methods of delivery. Although I’ve heard claims to the contrary, this study found no difference in the length of the second stage of labor (when the baby is moving through the birth canal).

Water births are usually considered suitable for women with low-risk pregnancies. Some hospitals now offer water birth facilities, and you can rent or buy inflatable tubs for water births via a number of Internet sites that also provide referrals to water birth practitioners.

If you’re considering a water birth at home, I urge you to work with a midwife or

practitioner with experience in this mode of labor and delivery. You should also become familiar with safety considerations, including temperature control of the water, the cleanliness of the tub, and a plan to deal with unexpected complications.

A Placenta on Your Plate?

Eating the placenta or afterbirth—a practice known as placentophagia—seems to be a trend among some new mothers these days. Actress January Jones discussed taking pills made from her placenta with People magazine. In a New York Times blog, author Nancy Redd wrote that even the hospital birth class she took suggested the practice. The hype for

placentophagia holds that it can improve breast milk supply, increase energy, ward off fatigue and postpartum blues, replace nutrients lost during pregnancy, and even prevent aging.

There’s not a shred of scientific evidence behind any of this. It’s true that almost all nonhuman mammals eat the placenta and amniotic fluid, but regardless of culture, humans don’t, according to Mark Kristal, PhD, professor of psychology and neuroscience at the University of Buffalo, who has been studying placentophagia for more than 20 years. Kristal reports that in nonhuman mammals, eating the placenta is believed to stimulate an increase in mother-infant interaction, boost the effect of pregnancy-mediated painkillers, and activate circuits in the brain that set in motion caretaking behavior and suppress postpartum pseudopregnancy, thereby increasing the possibilities for fertilization. More importantly, it gets rid of tissue that might attract predators to the birth site.

Dr. Kristal has suggested that eating the placenta might provide human mothers with substances that could help them avoid postpartum depression, failure to bond with their babies, or maternal hostility toward the infant. But there’s no proof that these substances exist or would work as Dr. Kristal suggests, and no study has tested this theory. Dr. Kristal emphasizes that any benefits claimed by women (and some of their husbands) who have eaten placentas are neither reliable nor valid as scientific evidence.

The lack of formal clinical investigation hasn’t dampened enthusiasm for the practice. In response to this trend, some states have passed laws allowing women to take their placenta home from hospitals. (Otherwise, they’re disposed of or kept for research.) And some enterprising women have built flourishing businesses on the preparation of placentas for ingestion by new parents or on “placenta encapsulation”—drying and grinding the placenta into a powder to be put into capsules that mothers can swallow— which is easier than eating cooked placenta or drinking it blended into smoothies.

In her New York Times article, Redd writes that taking encapsulated placenta turned out to be “a terrible idea” for her. Shortly after swallowing the first two pills, she reported feeling “jittery and weird.” After taking eight placenta pills, she said she was in “tabloidworthy meltdown mode, a frightening phase filled with tears and rage” that lasted a few days until she stopped taking the pills and immediately felt better. She wrote that she is still not sure what was in the “cleansing herbs” included in her placenta pills and wonders how many women are taking them for postpartum depression “when it very well may be a cause of their mama drama.” Of course, her experience proves no more about placenta-eating than the testimonials of women who say that doing so boosted their moods, relieved fatigue, and otherwise smoothed the sometimes rocky road of new motherhood.

OH, BABY: INFANCY AND BEYOND

If you’ve got a newborn, baby, or even young toddler, you doubtless have a lot of concerns about keeping your child well. After all, these early years lay the foundation for optimal health later on in life. From breastfeeding to vaccination, here are my thoughts on some common controversies and concerns.

Breast Is Best

Breast milk is the absolute best food you can give your baby during the first year of life. It provides all of an infant’s nutritional needs and transfers from mother to baby antibodies that protect against a long list of infectious diseases. Over time, breastfed babies are less likely to develop such chronic conditions as diabetes, high cholesterol, asthma, and allergies. And breastfed babies are less likely than their bottle-fed counterparts to become overweight children. The American Academy of Pediatrics recommends breastfeeding infants for at least the first year of life and, after that, for as long as is “mutually desirable.” La Leche League International maintains that the health benefits to babies will continue as long as they are breastfed. My feeling is that you should continue to breastfeed for as long as you (and your child) feel comfortable. You can begin to introduce solid foods at six months, but if you stop breastfeeding before your baby’s first birthday, be sure to switch to formula, not cow’s milk.

Children younger than one year old should not be given cow’s milk; they can’t process the proteins. And if there is a family history of allergy, autoimmunity, eczema, asthma,

bronchitis, or chronic sinusitis, I strongly recommend holding off on cow’s milk until at least two years of age. I never gave my daughter cow’s milk. Instead, she drank soy milk and rice milk, and unlike her siblings, never had an ear infection. But note that milk substitutes made from rice, oats, or potatoes don’t provide protein, so your baby will need an alternate source.

The latest development in formula has been the addition of two fatty acids found in breast milk: docosahexaenoic acid (DHA) and arachidonic acid (AA), both supplied to the fetus during pregnancy through the placenta. Babies who are breastfed continue to receive these two essential nutrients (especially when mothers eat a diet rich in omega-3 fatty acids). Some research suggests that DHA and AA are correlated with higher IQ scores and that deficiencies may be linked to slow growth, skin problems, and poor visual development. While formulas supplemented with DHA and AA are relatively new in the United States, they’ve been available in Europe for years.

Here’s an additional factor to consider: It appears that the more babies a woman has and the longer she nurses them, the lower her risk of breast cancer. One study showed that if women in developed countries had the same number of babies and breastfed them for as long as women in less developed countries, the risk of breast cancer would drop by more than half. Almost two thirds of the reduced risk would stem from breastfeeding alone. We’ve known for a long time that breastfeeding is good for babies. Now we know that it’s good for mothers, too.

“ Over time, breastfed babies are less likely to develop such chronic conditions as diabetes, high cholesterol, asthma, and allergies. ”

PHOTO TIM BISH

Ready for Solids

Surprisingly, the research is unclear on what foods are best to introduce to babies, or even if it really matters. I believe that parents should offer organic foods whenever possible, and give babies a wide variety of choices. As for what food to start with, vegetables are a good option, followed by fruits and then grains. It is much harder to get babies to accept vegetables than fruits, and it’s possible that starting with them is a good strategy.

Something else to bear in mind when you’re introducing babies to solids: pesticide residues in some baby foods. In 2012, for the first time since 1991, the U.S. Department of Agriculture (USDA) began to look at the pesticide content of baby foods. The Environmental Working Group released some of those results, and they are shocking. For example, the USDA found that green beans tested positive for five pesticides, including the organophosphates methamidiphos, found on 9.4 percent of samples, and acephate, on 7.8 percent of samples. These pesticides are associated with neurodevelopmental effects in children. Pears also tested positive for at least one residual pesticide 92 percent of the time. In addition, 26 percent of samples contained five or more pesticides. Three samples of pear baby food contained iprodione, which the EPA categorizes as a probable human carcinogen. The only tested baby food samples in which the USDA found virtually no pesticide residues were sweet potatoes.

Federal testing for pesticide residue in baby food was long overdue, as infants are especially vulnerable to toxic compounds. The initial results are disturbing; that pears intended for babies contain a likely carcinogen is an outrage. I recommend that parents purchase organic

baby foods or, better yet, prepare their own by putting organic foods through a simple hand-turned food mill. (Search the Internet for “baby food mill.”) It is vital that an infant’s developing brain and nervous system receive only uncontaminated, nutrient-dense foods.

Teething Troubles

In many infants, the process of teething is painless, causing only some increased drooling and a desire to chew. However, some infants develop tender, swollen gums; may not sleep or eat well; and may run a low fever (under 100 degrees). A fever above 100 degrees or diarrhea suggests problems unrelated to teething. Here are some recommendations to keep a teething baby comfortable:

• Wipe the drool off your baby’s face with a soft cloth to prevent rashes.

• Rub the baby’s gums with a clean finger.

• Let your baby chew on a wet washcloth that has been placed in the freezer for 30 minutes (wash it after each use). Alternatively, use a cool spoon or rubber teething ring. (Take it out of the freezer before it gets so hard that it can bruise the tender gums.)

• Never tie a teething ring around a baby’s neck—it could get caught on something and strangle the child. The same goes for amber teething necklaces, which are worn around the neck or as a bracelet by teething children. Proponents claim that they stimulate

the thyroid gland (to control drooling) and improve the ability of the immune system to reduce inflammation in the ears, throat, stomach, and respiratory system, but modern science does not support these beliefs. The necklaces have the same potential risk of choking that any jewelry poses, including hazards from swallowing a bead if the necklace is broken.

• Homeopathic teething tablets are a good option. Many parents tell me they have used them successfully to relieve the minor discomforts of teething in their babies.

Coping with a Cranky Baby

Crying, fussy, colicky babies have stolen many a night’s sleep from new parents, but the good news is that this behavior is usually quite normal. The first thing parents of a fussy newborn should do is to exclude other explanations for the baby’s crying. Make sure the infant isn’t running a fever, isn’t lethargic, is eating normally, and isn’t having any trouble breathing. Your pediatrician will also want to exclude gastroesophageal reflux disease (GERD), which can occur among babies, although it is much more common among adults.

The good news about colic is that what you see is what you get: a fussy, crying, but otherwise perfectly healthy baby. Some doctors think that this irritating phase may be part of normal development. Between five and 28 percent of infants develop colic, usually between the ages of two to six weeks. Most outgrow it by the time they’re three to four months old. Here are suggestions for dealing

PHOTO CENGIZHAN KONUS

with colic—and with the frustration it can breed among parents:

• Try massage therapy, a great way to enhance bonding between parent and child at a time when colic may be interfering with the bonding process.

• Rock your baby rhythmically.

• Turn on music or try the clothes dryer or vacuum cleaner. Sometimes the white noise they produce helps.

• Try cranial osteopathy or homeopathy; both may help and are safe forms of treatment.

• Try herbal remedies such as cooled chamomile or fennel tea. You can get tea bags at the health-food store and give the baby one to two ounces at a time, no more than three to four ounces per day.

• Ask your pediatrician about treatment with probiotics such as L. reuteri. One study showed that probiotic therapy may help relieve colic in some children compared with others treated with simethicone.

• Switch to a cow’s milk-free formula; or, if you’re breastfeeding, change your diet to affect what is entering breast milk (in some cases, a food sensitivity may play a role).

• Swaddle your baby, which provides a nice, snug feeling.

• Find a way to relax. Try breathing exercises or other relaxation techniques to help reduce tension and address frustration.

Should You Circumcise Your Son?

Many parents wonder whether circumcision is the right decision for their son. Opponents of the practice believe it does little, if any, medical good and can impair a child’s sense of sexual self. They also say it harms men’s ability to enjoy sexual sensation, but I don’t know if there is any way of measuring this.

Overall, circumcision does appear to have some health benefits, including fewer genitalurinary problems and slightly lower risk of cancer of the penis (which is fairly rare). Research also suggests that circumcision helps prevent transmission of HIV, syphilis, and gonorrhea. What’s more, female partners of circumcised men have a lower risk of cervical cancer.

Two recent scientific studies have bolstered the case for medical benefits. One, from the National Institutes of Health, reported on

two trials in Africa involving more than 7,500 men and found that circumcision reduces a man’s risk of contracting HIV through heterosexual sex by 51 to 60 percent. The studies were halted ahead of schedule because the preliminary results were so striking. The other study, which followed 510 New Zealand newborns until age 25, found that circumcision reduced the risk of contracting sexually transmitted diseases by about half. Interestingly, two new medical reviews of circumcision came to opposite conclusions about the benefits of the practice. One analyzed studies of both infant and adult circumcision and concluded that the risk of major complications ranges from two percent to 10 percent and noted that there’s a lack of consensus and robust evidence on the medical benefits. The authors took note of the African studies linking circumcision

in adult men to lower rates of HIV and other sexually transmitted diseases, but argued that only future studies will show if those findings hold true in the Western world where AIDS is less prevalent. The review’s author wrote that circumcision may lead to “significant anger of feeling incomplete, hurt, frustrated, abnormal, or violated.” The second review examined three studies and found that risks of complications from circumcision are less than one percent, and that serious long-term complications are extremely rare.

The American Academy of Pediatrics has maintained a neutral position on circumcision but is reviewing the issue. My view is that there is no justification for circumcision without appropriate anesthesia. Beyond that, it’s up to you to assess the medical evidence and the familial, religious, and cultural issues that you may have to factor into your decision.

“ The good news about colic is that what you see is what you get: a fussy, crying, but otherwise perfectly healthy baby. ”

PHOTO ANDREW BRANCH

was an unpleasant childhood rite of passage; the advent of the varicella vaccine has made it far less common these days. Chickenpox typically causes itchy red blisters all over the face and body, along with fever, headache, and sometimes a stomachache. It is extremely contagious and spreads in the air through coughing or sneezing, as well as by touch.

Chickenpox doesn’t usually leave scars unless a blister becomes infected or you pick at it. The disease tends to be much more severe in adults. Rarely, it may cause complications like dehydration, pneumonia, and other serious secondary infections, and death. As with other viral infections, you should never treat children with aspirin, as it increases their risk of developing a serious condition called Reye’s syndrome. About one in 10 adults who have had chickenpox will later develop shingles (herpes zoster), a painful, burning skin rash that can last several weeks or months.

VACCINE: The CDC recommends two doses of varicella vaccine for children, teens, and adults. These doses are reported to be 98 percent effective at preventing chickenpox. The vaccine isn’t recommended for pregnant women or people who have an allergy to neomycin or gelatin. Some parents eschew the vaccine and prefer that their children develop immunity to chickenpox by contracting the disease through playing with other infected kids (known as “chickenpox parties”). While this practice is relatively safe, chickenpox does have a small rate of complications. On the other hand, having had chickenpox confers lifelong protection against the disease, while the vaccine may not.

INFLUENZA

Flu is a viral respiratory infection that can cause a broad range of symptoms such as cough, sore throat, fever and chills, muscle aches, and fatigue. Complications include pneumonia, ear infections, dehydration, and death. Children, the elderly, those with weakened immunity, and those with chronic conditions like diabetes, congestive heart failure, and asthma are at higher risk for complications.

VACCINE: The best way to prevent this serious disease is to get a flu shot every year, preferably in October before flu season starts. I agree with the CDC, which recommends that both children and adults of all ages receive the flu vaccine.

MEASLES

A highly infectious viral illness, measles typically causes a rash, bloodshot eyes, runny nose, fever, sore throat, cough, and muscle pain. Complications can include ear infections, bronchitis, pneumonia, encephalitis (inflammation of the brain), hearing loss, and death. Before immunization was widespread, most people had developed measles by age 20. As mentioned earlier, measles is on the rise again, despite the availability of an effective vaccine.

VACCINE: The measles, mumps, and rubella (MMR) vaccine is credited with dramatically decreasing the number of measles cases and deaths in the U.S. When administered in combination with the varicella vaccine, MMR vaccines may rarely cause febrile seizures, which—while frightening for parents—usually cause no

lasting problems. The risk is lower when the MMR vaccine is given separately from the varicella vaccine. Despite fears to the contrary, there’s no good evidence that the MMR vaccine can cause autism or other disorders.

MUMPS

Mumps is a painful swelling of the salivary glands that’s spread through the air by sneezing or coughing. It can also cause a sore throat, headache, fever, and, in males, swelling of the testicles and scrotum. Complications are rare but can include seizures, paralysis, hearing loss, encephalitis, and sterility in males. Mumps is most common in children under age 12 who have not been vaccinated against the disease. Complications are worse in adults.

VACCINE: The MMR vaccine is effective at preventing mumps.

PERTUSSIS

Also known as whooping cough, pertussis starts with a runny nose, low-grade fever, and mild cough but eventually progresses to rapid, severe coughing that creates a loud “whooping” sound as you gasp for air. It can also lead to pneumonia, brain damage, seizures, and mental retardation, and can be life-threatening in infants and young children.

VACCINE: Since the 1990s, U.S. physicians have administered the acellular diphtheria, tetanus, and pertussis (DTaP) vaccine to infants and children. It is less likely than the previous “whole cell” DTP vaccine to cause side effects and complications, and is about 80 to 90 percent effective in infants and children, providing the best protection in the first two years after administration and waning over time.

MY TAKE

One major reason for the return of infectious diseases once thought to be relegated to the past is the choice by some parents not to immunize their children. As a parent myself, I understand that subjecting your child to multiple shots can be distressing. However, my daughter received all of her recommended vaccines as a child, because I know that the benefits of vaccines far outweigh any side effects or risks.

Unfortunately, the storm of misconceptions and the manufactured crisis perpetuated by the popular press that surrounds vaccines has many people confused about their safety. For example, research suggests that fewer parents in the United States vaccinated their children in the wake of concerns about a purported link between the MMR vaccine and autism, yet a comprehensive 2011 report by the Institute of Medicine concluded that while vaccines are associated with a small risk of seizures, fainting, and other issues, there’s no link between vaccines and autism or type 1 diabetes.

Indeed, declining to immunize can do more harm than good, says my colleague Sanford Newmark, MD, head of the Pediatric Integrative Neurodevelopmental Program at the UCSF Osher Center for Integrative Medicine. “I believe that being totally ‘antivax’ is a dangerous attitude,” he explains. “We do not want to see a return to the polio epidemics of the last century, or of widespread measles infection.”

That said, it’s okay to be somewhat flexible with the pace at which you vaccinate

your child. If you adhere to the CDC’s recommended vaccine schedule, your child will have up to 24 injections in the first two years of life. These include vaccines to prevent diphtheria, tetanus, whooping cough, polio, hepatitis A and B, influenza type B, measles, mumps, rubella, pneumonia, and meninigitis. The advantage of adhering to the schedule is that kids get full protection from these diseases early in life. The downside is the need to follow a complicated and sometimes confusing schedule, yet youngsters who don’t follow the immunization schedule tend not to catch up.

“The current immunization schedule doesn’t have to be written in stone,” says Dr. Newmark. “As a general rule, I prefer spreading out the vaccinations where possible. There are certain vaccines that are given in infancy that I feel may be delayed in many cases, such as the hepatitis B vaccine.” If you decide to space out your child’s vaccinations, speak with your pediatrician about an alternate schedule.

You can also reduce the risk of vaccine reactions by making sure your child has a clean bill of health first. Children with certain immune deficiencies, for example, should not receive any of the live vaccines (MMR, chickenpox, nasal flu vaccine). Kids who have had concerning reactions to a particular vaccine should not have the vaccine repeated. And children who are ill should not have any vaccine until they are well. If you’re still concerned, your doctor can further help you weigh the risks and benefits for your child.

Childhood and adolescence are times of considerable change. The hormonal shifts of puberty contribute to growth spurts, mood swings, and concerns such as acne. Some developmental conditions, including autism and attention-deficit/hyperactivity disorder (ADHD), are first diagnosed during these years. Kids have other special needs when it comes to health and wellness, too: They tend to be more prone to problems like ear infections and colds.

This is also an opportune time to establish healthy habits in nutrition and physical activity that will last a lifetime, and to help ward off “adult” diseases such as heart disease, diabetes, and obesity that have their roots in childhood. Much of the information in this section of Whole Life Health Advisor comes from my colleague Sanford Newmark, MD, head of the Pediatric Integrative Neurodevelopmental Program at the UCSF Osher Center for Integrative Medicine.

PHOTO AMY TREASURE

PHOTO ANTON DARIUS SOLLERS

RAISING HEALTHY EATERS

Children learn by example, and eating habits and nutrition are not exceptions. Your kids are more likely to eat well—and less apt to demand high-calorie, low-nutrient fare—if they see you enjoying a wholesome diet. They’ll also lower their risk of childhood (and adult) obesity.

There is no magic formula for raising a healthy eater. Simply put, you should eat as you would like your child to eat. That means eliminating processed, junk, and fast foods and focusing on choices that are high in fiber, such as fruits, vegetables, whole grains, whole soy products, nuts, legumes, and seafood. Don’t just micromanage your child’s diet: Change the way your entire family eats. Here are some additional tips for encouraging healthy eating in kids.

Build boundaries. Children are less likely to ask for pizza, chicken nuggets, burgers, and other such fare if they learn to avoid them early on. According to one recent study by researchers at the University of Buffalo, children whose parents set restrictions on what and when they could eat at age two had healthy eating habits by age four.

There’s no harm in the occasional treat in the context of a well-balanced diet, but try to encourage snacking on healthier foods—fresh or dried fruit; a small handful of raw, unsalted nuts such as cashews and walnuts; a piece of flavorful, natural cheese; or a piece of dark chocolate.

Watch what they drink. Kids may crave sugar-sweetened beverages like soda, chocolate milk, and fruit juice—drinks that provide a surprisingly large number of calories per day. For instance, the average 20-ounce soft drink contains 15 to 18 teaspoons of sugar and more than 240 calories. A 64-ounce cola may have as many as 700 calories. That can translate to heavier kids: A well-publicized study by Harvard researchers found that children’s risk of obesity significantly increased with each daily serving of sugar-sweetened beverage they consumed. Studies have found that reducing consumption of sugary drinks can help children control their weight.

Share family meals. Busy schedules can make finding time for family dinners difficult, but your effort to make it a priority will pay off. Eating meals together gives you more control over what your child eats and allows you to make sure that everyone gets at least two nutritious meals per day. According to one recent study, sharing just a couple of family meals a week may have lasting effects on weight. Among teens who reported that they never ate meals together with their family, 60 percent were overweight and 29 percent were obese 10 years later. Even having one or two family meals each week during adolescence was linked to lower odds of being overweight or obese within 10 years.

Preventing Picky Eating

It’s a common problem for parents: Their child favors only plain or buttered pasta, macaroni and cheese, cheese pizza, French fries, or grilled cheese sandwiches and typically eats a very small number of foods. If your child eschews most edibles, don’t despair. You may be frustrated now, but most kids outgrow such habits as they get older. In the meantime, follow these steps for dealing with a picky eater.

Don’t force it. It’s natural to worry about your child’s nutrition, but forcing meals or using bribery or punishment with food isn’t the answer. Such tactics may lead to a power struggle and reinforce his or her feelings of anxiety about food.

Be patient. Let your child experiment with food without insisting he or she eat it. You can talk about the color, shape, smell, and feel of the food at first—without the pressure to taste it right away.

Have fun. Make mealtime more enjoyable by serving a variety of brightly colored foods, cutting them into fun shapes, and serving produce with a dip or sauce that your child likes. Engaging your child in the process of growing, shopping for, and preparing food also builds enthusiasm. Indeed, research suggests that kids who help tend an edible garden are more likely to choose healthier foods such as produce.

Approaches like these may not transform a picky eater immediately, but they can go a long way in setting your child up for a lifetime of healthy eating when he or she is ready to expand their diet. If you’re concerned that picky eating may be negatively affecting your child’s growth and development, consult your pediatrician.

Are Supplements Necessary?

I’m often asked whether children should take supplements regularly. In 2013, the National Institutes of Health noted that about one in four children take a daily multivitamin/ mineral supplement and that adolescents are least likely to take them. The information about many “required” micronutrients at these ages can be confusing and is still evolving, but some suggestions are straightforward. For example, the American Academy of Pediatrics and the Institute of Medicine recommend a daily intake of 400 IU per day of vitamin D during the first year of life beginning in the first few days after birth, and 600 IU for everyone over age one.

I recommend that children take a daily multivitamin/mineral supplement to cover nutritional gaps, but it shouldn’t be regarded as a substitute for eating whole foods, especially fruits and vegetables. You may want to wait until children are at least four years old before giving them vitamin or mineral supplements (other than the vitamin D they already should be taking). It isn’t always easy to find a quality child’s multivitamin that doesn’t contain sugar or artificial colorings. Kids who take chewable “gummy” vitamins should get additional dental attention. Supplements for children between the ages of four and 12 should provide no more than 50 percent of the adult RDA of the major vitamins and minerals, especially the fat-soluble ones (A, D, E, and K). After age 12, kids can safely take the adult dosage. Be sure to keep all vitamins out of the reach of young children. Because some supplements for kids taste and look like candy, there is a danger of overdosing, especially when supplements contain iron.

KIDS ON THE MOVE

As with optimal nutrition, encouraging regular exercise early on can help set the stage for a lifetime of healthy habits. Once again, you should set a good example. For instance, studies have found that children are more likely to be physically active if their parents and siblings are active, and if they’re encouraged to take part in physical activities. Take family walks, hikes, or bike rides on a daily basis, if possible, or simply play outside with your child. Kids should get at least 10 to 15 minutes of vigorous exercise a day and an hour or more of overall physical activity.

You should also consider encouraging your child to play a sport. Team sports offer the advantage of motivating kids and supporting

Heading Off Concussions

them through coaching and interaction with peers. Playing team sports also shows children where they may need improvement and how to achieve it. That said, team sports may be too competitive for some people, including parents. Some kids thrive under pressure and some don’t. There are many benefits if your children are on a team that provides just the right amount of competition to get them excited but not stressed. In addition to the obvious health benefits of exercise, the social aspect of team activity helps kids forge friendships. To find the right team for your child, ask what kind of sports he or she likes. It could be swimming, basketball, football, dancing, or something else. Ask other parents for recommendations and talk to coaches until you discover the right fit.

Historically considered an inevitable part of contact sports, we’re now learning more about the consequences of concussions, and the news is troubling. When you experience a violent blow to the head, neck, or upper body, the force of acceleration on the brain can temporarily disrupt its function. (In more severe trauma, the brain can impact the inner wall of the skull, causing potentially fatal bleeding in or around it.) Immediately following a concussion, you might lose consciousness briefly and experience a headache, dizziness, confusion, and ringing in the ears. It may take hours or even days for other symptoms to develop: memory problems, personality changes, and impairment of smell and taste.

As an increasing number of professional athletes have come forward about their health struggles following multiple concussions, doctors are now warning of the long-term effects of this type of traumatic brain injury. These include permanent and progressive cognitive impairment, as well as a higher risk of epilepsy. “Second impact syndrome”—sustaining another concussion before the first has healed—can lead to fatal brain swelling. As you might imagine, anyone who plays football, hockey, soccer, or another contact sport is at greater risk for second impact syndrome, especially if he or she continues to participate before a doctor gives a clean bill of health.

I’m concerned about the cumulative effects of concussions, particularly in younger people. Worse, a recent study in Neurology found that even traumatic head injuries that don’t result in concussion can negatively affect verbal learning and memory—over the course of just one season. I generally encourage children to pursue safer, non-impact sports and to always wear proper equipment while doing so.

ADDRESSING STRESS

Stress may seem like a grown-up problem, but even the littlest members of your family can feel frazzled. Childhood isn’t all fun and games: These days, a kid’s calendar can be just as full as yours. Factor in a heavy homework load, friendship ups and downs, the challenges of puberty, and stressors like moving, divorce, or the death of a loved one, and you can see that children aren’t free from anxiety.

The American Academy of Pediatrics (AAP), which represents the nation’s pediatricians, has urged parents to lighten their children’s loads and give them more time to just be kids. The organization has said that packed schedules and a fast-paced lifestyle can create stress for both kids and parents and can even cause depression in some children. It notes that play is recognized as a right of every child by the United Nations High Commission for Human Rights. I’m afraid that right is often neglected when parents focus on giving their children a full complement of the “advantages” they hope will ensure success in school and in life.

Experts agree that children need time to exercise their imaginations in playing with “true toys” such as blocks and dolls. Unstructured playtime can be just as beneficial as the enrichment programs, videos, and computer games designed to give children an academic edge from babyhood on. Left to their own devices, children can tap into their own creativity, develop problem-solving skills, learn to

relate to others, and discover their own passions. And while parents should play with their children, parental participation can also cramp a child’s style: When children play by adult rules, they lose some of the benefits of informal play, including the creativity, leadership, and group skills it can foster. I don’t believe that parents should completely abandon enrichment programs and extracurricular activities. But I do favor unstructured, “non-screen” time for play.

Here are some other suggestions to help keep a lid on stress.

Talk about it. Ask your children if they feel overworked or stressed because they are doing too much after school. You can suggest one day a week with no mandatory activities when they just stay at home or hang out with their friends. If they insist that they don’t feel overworked, don’t push them. Trust them and let them make their own decisions.

Keep the pressure off. It’s fine to put a little pressure on getting your kids to be active. But too much pressure will likely make your kids not want to do anything after school but lie on the couch watching TV.

Practice stress management. Teach your kids a relaxation technique such as breath work, progressive muscle relaxation, yoga, or guided imagery to practice when they’re stressed, and also practice it together often. Children may be particularly suited for guided imagery, since it harnesses the power of their imagination.

Dr. Weil’s Whole Life Health Ad

PHOTO JOSEPH GONZALEZ

CURBING SCREEN TIME

Overall, American kids age eight to 18 spend 4.5 hours per day watching television, and an estimated 70 percent have television sets in their bedrooms. Research shows that having a TV in the bedroom can have negative health effects. For example, in one study, researchers analyzed data collected from 369 children and adolescents ages five to 18 for waist circumference, resting blood pressure, fasting triglycerides, HDL (“good”) cholesterol, blood glucose, fat mass, and stomach fat. They then correlated these physical attributes with the children’s social histories. Results showed that children with TV sets in their bedrooms were fatter and had a greater waist circumference compared to kids without bedroom TVs. The youngsters with bedroom TVs, as well as those in the study who watched television for more than two hours a day, had 2.5 times the odds of having the highest levels of fat mass. The study also found that watching five or more hours of television daily was associated

with double the odds of being in the top quartile for visceral fat located deep in the abdomen surrounding internal organs. This type of fat is associated with higher risks of diabetes, cardiovascular disease, and certain types of cancer. Kids with television sets in their bedrooms had three times the normal risks of diabetes and cardiovascular disease. The researchers also observed that having a bedroom TV correlates with less sleep and fewer regular family meals, both of which are associated with weight gain and obesity. The study was published in the American Journal of Preventive Medicine.

To me, the overall exposure of children to electronics is already much too high. Having a television in the bedroom only increases this exposure. It also decreases possible time that you and your family can watch a television show or movie together, ideally a stimulus for some useful discussion and positive social interaction. Plus, the more time kids spend in front of the television, the less time they have for interacting with others, which means that they’re not learning social skills or how

PHOTO ALEXANDER DUMMER

to resolve conflicts. Indeed, research from Johns Hopkins University has linked having a TV in the bedroom at 5.5 years of age with behavioral problems, poor social skills, and poor sleep.

An increasing amount of research has also shown a link between time spent watching television and the risk of childhood obesity. For example, one study of 13- to 15-yearolds found that those who spent the most time watching TV, playing video games, and using computers were more likely to be obese than those who had less screen time. This relationship doesn’t appear to be based solely on the fact that screen time is passive and replaces healthier activities like exercise. There’s evidence that screen time also means snack time for many kids: One study found that every hour of TV a child watches is associated with the consumption of an extra

167 calories, particularly in the form of fast food, salty snacks, and sugar-sweetened beverages. It’s no wonder, since children are exposed to constant commercials for these unhealthy options. Screen time also crowds out sleep, which can influence appetite and hunger.

I’m not against spending a few leisure hours in front of the television. I often watch movies on television in the evenings, but enjoyable as that can be, it is no substitute for the relaxation techniques that I recommend to help manage stress. Television can be much too stimulating, and stimulation is an obstacle to relaxation. Kids are unquestionably at greater risk from overdosing on TV. Limit the time your child spends in front of the television, computer, and other gadgets, and encourage active play instead.

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SWEET DREAMS

Children need optimal sleep and should have a regular bedtime. Sleep provides a bevy of benefits: The brain is active and dreaming during rapid eye movement (REM) sleep, while during deep, non-REM sleep the body is busy increasing the blood supply to muscles and restoring energy. During the latter state, tissue growth and repair occur, and hormones that are needed for growth and development are released.

We evolved as a species to fall asleep soon after sundown, so it is probably better for children to have a relatively early bedtime. If your child’s bedtime is 9 pm instead of 7 pm, that shouldn’t be a problem. But if he or she is going to bed at 10 or 11 pm, try to make it a little earlier.

Recent research from the UK has found that children with regular bedtimes, regardless of whether they were early or late, had fewer behavioral problems compared to kids whose bedtimes were irregular. In fact, the researchers from University College London found that the longer irregular bedtimes persisted, the more severe the kids’ behavior problems were. They gathered their information by interviewing mothers when their children were ages three, five, and seven. Both mothers and teachers completed questionnaires about the children’s behavioral problems. The researchers reported that almost 20 percent of three-year-olds had no regular bedtime, compared with 9.1 percent of five-year-olds and 8.2 percent of seven-

year-olds. Commenting on the findings, the study’s lead author, Yvonne Kelly, a professor of epidemiology, said that “getting kids into a regular bedtime routine does appear to have important impacts on behavioral development,” but she made the point that lots of other practices have beneficial effects and that regular bedtime is only one of them.

For the record, according to the National Sleep Foundation (NSF), parents should expect preschoolers to sleep 11 to 13 hours per night and not expect most to nap after five years of age. The NSF notes that difficulty falling asleep and waking during the night are common in this age range and that with normal development of imagination, preschoolers commonly experience nighttime fears and nightmares. Sleepwalking and sleep terrors also peak during preschool years.

Kids ages five to 12 need 10 to 11 hours of sleep a night, but in this age range they are also dealing with increased demands on their time from homework, sports, and other extracurricular activities, as well as television and computers, all of which can cause difficulty falling asleep, nightmares, and sleep disruptions. The NSF warns that watching television close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep, and sleeping fewer hours. What’s more, the foundation notes that poor or inadequate sleep in kids this age can lead to mood swings, behavioral problems such as hyperactivity, and cognitive problems that impact their ability to learn in school.

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STEMMING THE TIDE OF CHILDHOOD OBESITY

In 2009, President Barack Obama established a national Task Force on Childhood Obesity aimed at reducing the rate of childhood obesity to just five percent by 2030—the same rate as before the problem began to increase in the late 1970s. It was an initiative driven by sobering statistics: According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 10 percent of children age five and younger, 18 percent of children ages six to 11, and 21 percent of adolescents ages 12 to 19 are obese. The numbers are even higher when taking overweight youths into account—all told, about a third of kids and teens are either overweight or obese.

The effects of childhood obesity extend far beyond self-esteem issues and bullying. The condition can have both immediate and longterm consequences that take a toll on health. For example, a large population study by UCLA researchers found that obese children have twice the risk of developing a wide range of physical and mental conditions, including bone, joint, and muscle problems; attention-deficit/ hyperactivity disorder; learning disabilities; asthma; allergies; ear infections; and headaches. For example, a large population study by UCLA researchers published in Academic Pediatrics found that their hearts are also in peril: Research suggests that about 70 percent of obese kids already have at least one risk factor for cardiovascular disease, such as high cholesterol, high blood pressure, and pre-diabetes. Indeed, there’s evidence that type 2 diabetes appears to progress more quickly in obese children and becomes much more difficult to treat.

Obesity in childhood can have lasting effects as well. Obese kids often grow into obese adults and have a greater chance of developing all of the health complications that come with extra pounds, including cardiovascular disease, type 2 diabetes, metabolic syndrome, stroke, sleep apnea, infertility, osteoarthritis, and many different types of cancer. Worse, they tend to develop these problems much earlier than people who didn’t become obese until adulthood. Ten years ago, a troubling report in The New England Journal of Medicine made headlines when it predicted that being obese during childhood could shave an estimated two to five years off a person’s life. It seems that little has changed in the decade since that study.

The good news is that childhood obesity is completely preventable—but tackling it can be quite challenging. Perhaps more than any other time in history, parents and kids alike are faced with enormous obstacles to maintaining a healthy weight. From the constant onslaught of advertisements for junk food, to the decline of recess and other physical fitness programs in schools, to limited time and financial resources, a number of daily influences can conspire against healthy habits. Childhood obesity is particularly problematic in certain racial, ethnic, and socioeconomic groups: African Americans, Native Americans, and Latinos have higher rates of it, as do lower-income communities.

Clearly, telling parents to feed their children healthy food and encourage more physical activity isn’t enough. “We need to look at the issue of childhood obesity from every level— kids, parents, schools, communities, and policy makers,” says Dr. Newmark. “It’s not just about what one person should do.”

Prevention: The Sooner, The Better

With all of the serious negative complications associated with childhood obesity, it makes sense to start preventing the problem as soon as possible. That means addressing it even earlier than you might think, advises Dr. Newmark. Indeed, a growing body of evidence shows that childhood obesity begins during pregnancy before a child is even born. Some research suggests that many of the racial and ethnic disparities in childhood obesity appear to occur early in life. One large study found that black and Hispanic children were more likely than white children to have gained weight rapidly during infancy. These babies spent less time breastfeeding, were introduced to solid foods sooner, consumed more fast foods

and sugar-sweetened beverages, slept less, and had television sets in their bedrooms during the first three years of life—all risk factors for childhood obesity. Black and Hispanic moms were also more likely to begin their pregnancies while overweight or obese.

The exact reasons for these differences are still unclear, but researchers do know that the choices a woman makes during pregnancy and in the first several months of her baby’s life can have a dramatic affect on that child’s risk of obesity. Here are some of the most important factors, according to recent research.

Healthy mother, healthy baby. Research demonstrates that children born to women who were overweight while pregnant are at higher risk of gaining extra pounds themselves. One study found that children of mothers who

PHOTO ALEXIS BROWN

had gained excessive weight in pregnancy had about four times the risk of being overweight by age three. More recently, a study of more than 41,000 mothers and their children showed that high pregnancy weight increases the risk of childhood obesity all the way until age 12. Other evidence suggests that children whose mothers smoked while pregnant have twice the risk of being overweight by age three than those whose mothers did not smoke.

Delivery makes a difference. According to one study, three-year-old children who had been born by Caesarean section were twice as likely to be obese as those who had been delivered vaginally. Differences in the microbiome—the collection of trillions of bacteria and other microbes that populate our bodies soon after birth—may be responsible. Researchers believe that babies born by C-section have a different microbial makeup than those born vaginally, which might affect energy balance and metabolism.

Breast is best. A number of studies suggest that children who are breastfed are less likely to be overweight or obese. That may

be because breastfed babies learn to better regulate their appetite and food intake by responding to hunger rather than other cues. Meanwhile, one study found that children who were introduced to solid food before four months old were six times more likely to be obese by age three, compared to those who didn’t receive solid food until at least four to six months of age.

Sleep more, weigh less. Research suggests that adequate sleep during infancy and childhood can help protect against extra pounds. One study found that babies who slept less than 12 hours a day were twice as likely to be obese by age three than those who slept more. Another showed that children who consistently had reduced sleep in early childhood had increases in obesity by age seven. It makes sense: The hormones produced during a good night’s sleep help regulate appetite.

Antibiotics may add pounds. I’ve long warned against the overuse and misuse of antibiotic medications, which can lead to the rise of drug-resistant bacteria. Now, two

“ It’s ideal to start preventing childhood obesity very early in life. ”

PHOTO SEAN GORMAN

recent studies suggest that antibiotics may have even more insidious effects. In the first, Pennsylvania researchers reviewed electronic health records from more than 64,500 children to determine the incidence of obesity in kids ages two to five years old. They found that 69 percent of the children had been given antibiotics before age two, and that there was an increased risk of childhood obesity among those who were exposed to broad-spectrum antibiotics, particularly among children who had been prescribed antibiotics on four or more separate occasions.

Likewise, a study by Columbia University researchers found that children who were exposed to antibiotics in utero during their mother’s second or third trimester of pregnancy had an 84 percent higher risk of childhood obesity at age seven. In both cases, antibiotics may alter the children’s microbiota, leading to imbalances between beneficial and harmful bacteria and increasing the likelihood of obesity.

What You Can Do

While it’s ideal to start preventing childhood obesity very early in life, many parents may not even consider it a problem until their child begins to gain noticeable weight. Still, there’s much you can do to help kids achieve and maintain a healthy weight, no matter what their age. Follow the advice in this section on healthy eating, physical activity, stress reduction, and other lifestyle changes to help your child keep off extra pounds.

A Group Effort

They say that it takes a village to raise a child, and the same certainly holds true for raising a healthy child. While there’s plenty that parents can do at home to help kids maintain an optimal weight, I agree with experts who believe that we must also address childhood obesity at a policy level. For instance, schools should receive better funding for physical education classes and healthier lunch programs, and city planning boards should address the lack of “green space” for outdoor activities in many communities. I’d also like to see Congress work with the U.S. Food and Drug Administration and Federal Trade Commission to regulate food marketing aimed at children. And our government needs to revamp the Farm Bill, which currently doesn’t subsidize foods like fruits and vegetables.

T hese and other changes would go a long way toward making healthy foods more accessible and affordable, while encouraging exercise and limiting kids’ exposure to junk food. Other policy changes could also help reduce rates of childhood obesity, say experts. For an analysis in the November 2014 issue of the American Journal of Preventive Medicine, researchers examined the potential effects of three policy initiatives on childhood obesity: after-school physical activity programs, a $0.01-per-ounce sugarsweetened beverage excise tax, and a ban on childdirected fast food TV advertising. They predicted that a tax on sugar-sweetened beverages such as sodas, energy drinks, sweet teas, and sports drinks would reduce obesity in adolescents more than the other policies, and would also generate significant revenue for additional obesity prevention strategies.

You can make your voice heard by contacting your state and local representatives about childhood obesity and joining advocacy groups such as the Center for Science in the Public Interest (cspinet.org) and the Environmental Working Group (ewg.org).

COPING WITH COMMON CONCERNS

Children and teens are more prone to certain disorders, from the mild (ear infections) to the serious (meningitis). Here’s my advice for preventing and treating some common conditions in kids.

Acne

Acne often has a hormonal basis, which is why it’s so prevalent in adolescents. Stress, a family history of acne, and use of certain hair and skin products or medications can also contribute to acne.

In general, diet doesn’t cause acne, but it may play a small part in its development. In the large Nurses Health Study II, Harvard researchers found that women who consumed more than three servings of milk products a day when they were teens were 22 percent more likely to report having acne than those who drank milk just once a week or less. Those who drank skim milk had an even higher risk of developing acne. Although more research is needed, it may be worth eliminating dairy from your child’s diet to see if it helps. I also recommend following an anti-inflammatory diet that is rich in fruits, vegetables, and fish.

As for treating pimples, over-the-counter products that contain benzoyl peroxide can be effective. You might also experiment with calendula products (made from an ornamental flower) or tea tree oil, both of which may benefit skin. And consider consulting a practitioner of traditional Chinese medicine: This healing system can be very successful at treating acne with herbs and other measures.

ADHD

“I won’t apologize for having ADH—Oh, look: A squirrel.” So goes a popular Internet joke that satirizes people with attention-deficit/ hyperactivity disorder (ADHD). These days, it’s almost trendy to say you have the condition, whether you have trouble juggling tasks at work or would rather watch a mindless reality show than read a book. For many adults struggling with concentration and attention, the cause may not be ADHD but rather a normal reaction to an overload of information and an increasing amount of digital distraction. Children believed to have ADHD may instead have other issues, such as learning disabilities or simple immaturity: Studies have found that the youngest children in a kindergarten class are significantly more

likely than the oldest to be diagnosed with the condition. It’s possible that some students said to have ADHD are simply too young for their grade level. (For more on getting an accurate diagnosis, see “Is It ADHD?” on page 52.)

That said, ADHD is a very real condition that can be quite challenging for those who suffer from it. According to the U.S. Centers for Disease Control and Prevention, an estimated 11 percent of American children have been diagnosed with the condition—a number that has steadily risen over the last decade. And it isn’t a disorder of childhood that necessarily goes away with time: A study published last year in Pediatrics found that only about a third of people who had ADHD as children were free of symptoms by adulthood.

That’s not surprising, as there appears to be many contributing factors. While the primary cause remains elusive, the condition is likely the result of a combination of genetics and environmental influences. For instance, there’s evidence to suggest that exposure to pesticides and other toxins may play a role. Studies show that children who have high urinary levels of organophosphate pesticide metabolites are twice as likely to have ADHD as those with lower levels. Other research has linked exposure to cigarette smoke, alcohol, lead, and even certain food additives and dyes to a greater risk of ADHD.

Conventional doctors typically use stimulant medications such as Ritalin and Adderall to treat ADHD. Despite its designation, this class of drugs can have a calming effect, improving the ability to focus and reducing hyperactivity. ADHD drugs

“ Research has linked exposure to cigarette smoke, alcohol, lead, and even certain food additives and dyes to a greater risk of ADHD. ”

PHOTO EZRA JEFFREY

can be very effective in some people. But they aren’t right for everyone—and they aren’t benign.

All of them can cause side effects, including insomnia, anxiety, irritability, decreased appetite, and physical or verbal tics. It’s still not clear how, or if, their long-term use affects a child’s developing brain. We don’t know how effective they are in the long run, either. Studies have found that the majority of children who take medication to treat their ADHD still have clinically significant symptoms. I believe that ADHD drugs are grossly overprescribed, and recent research appears to support my concern: One study found that 90 percent of medical specialists who diagnose and treat the problem in preschoolers aren’t following the American Academy of Pediatrics (AAP) guidelines for the disorder. In fact, one in five specialists prescribe medication as a first-line approach for ADHD, even though the AAP recommends behavioral therapy as the initial treatment.

Is It ADHD?

AN INTEGRATIVE APPROACH

Fortunately, ADHD often responds very well to integrative approaches. The following measures have been found to be helpful for kids diagnosed with ADHD and can be used in conjunction with prescription medications and individual or family therapy. Some of the strategies may even benefit those without ADHD who simply have difficulty focusing.

Diet. Dietary changes can have a profound effect. Junk food—especially high-sugar items—spike blood glucose levels and may make symptoms worse. Many patients have dramatic results when they start eating a healthy diet or avoid foods they’re sensitive to. One major culprit: artificial dyes and other food additives. Studies show that even kids without ADHD tend to exhibit hyperactive behavior after consuming foods that contain artificial colors.

Some experts also believe that ADHD is the result of an allergy or sensitivity to certain foods, particularly dairy products, wheat,

Symptoms of ADHD include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity. But be aware that a slew of other issues, including anxiety, depression, boredom, learning disabilities, undetected vision or hearing problems, and difficulties at school can be mistaken for ADHD. For this reason, it’s imperative that your child receives a thorough examination and diagnosis from a pediatrician, neurologist, or psychiatrist. (Although an evaluation for ADHD should take up to two hours, some providers prescribe medication after just 15 minutes of an initial visit, says Dr. Newmark.)

If your child is diagnosed with ADHD, ask about the integrative approaches in this article. I also urge you to ensure that your child’s needs are being addressed appropriately at school. Sometimes relatively simple school interventions can make a pronounced difference. Above all, employ consistent and positive behavior management at home. Children with ADHD are often subject to almost constant and ongoing criticism. Focus on what they do well, not just the areas of difficulty.

corn, soy, eggs, and peanuts. While there’s no evidence that a diet free of these substances can consistently help with the condition, it may be worth eliminating them for a period of time to see if symptoms lessen or resolve. One recent study of 100 children, published in The Lancet, found that those who followed an elimination diet for five weeks showed improvement. For best results, work with your doctor or a nutritionist.

Exercise. Regular physical activity has a natural calming effect; it also raises levels of the neurotransmitters norepinephrine and dopamine, which are involved in focus and attention. In fact, research suggests that kids with ADHD who exercise several times a week gain improvements in their motor skills, behavior, and ability to process information. Martial arts (such as tai chi and karate) may be especially beneficial. These techniques can improve self-discipline, boost concentration, and slow the restless cascade of intrusive thoughts. Outdoor activities can be helpful, too. Some studies link exposure to “green space,” such as parks, forests, and other natural settings, to improved concentration.

Mindfulness. If focusing on the here and now seems like an impossible goal, it’s probably because your child is already trying to pay attention to several different things at once. Information overload from computers, television, video games, smartphones, tablets, and other technology forces us to attend to more than one thing at a time, to multitask. The supposed ability to multitask—rapidly switching from one activity to the next, then back again—is a badge of honor for many people, but it may be doing more

harm than good. Investigators now believe that multitasking may seem efficient, but the practice of concomitantly addressing tasks actually takes more time, and results in more mistakes, than simply focusing on and completing one task at a time.

Mindfulness-based stress reduction (MBSR) can help retrain our brains to stay focused. The term refers to the various forms of practice that involve cultivating a calm awareness of one’s body and mind— in other words, keeping your attention on your experience of the present moment. Preliminary research suggests that mindfulness can help increase the ability to concentrate, even when other stimuli are competing for our attention. For more information, I recommend Wherever You

PHOTO BEN WHITE

Go, There You Are by Jon Kabat-Zinn, PhD. I also like Kabat-Zinn’s Guided Mindfulness Meditation Series 1 CDs.

Neurofeedback. Not surprisingly, study participants with ADHD have been found to exhibit patterns of lower activity in regions of the brain associated with attention, alertness, and self-control. To help address these abnormal patterns, some therapists use a technique called EEG neurofeedback in both children and adults. In this approach, kids perform various tasks while their brainwave patterns are monitored via sensors and translated into tones, lights, or other cues. They then try to influence their brainwaves and other nervous system activity to yield the desired cue, usually by playing a computerbased game.

Research shows that kids who receive neurofeedback training have improved attention, and some studies suggest that it may be as effective as stimulant medications at reducing symptoms of ADHD. One downside: This technique can be time-consuming and expensive (up to $150 per session), and in many cases is not covered by insurance. For more information, visit the website of the Association for Applied Psychophysiology and Biofeedback (aapb.org).

Supplements. I believe that every child and adult with ADHD can benefit from taking a daily omega-3 fatty acid supplement (1 to 2 g a day). Deficiencies of the minerals iron, zinc, and magnesium have also been linked to ADHD, so it’s prudent to check blood levels of zinc and iron and supplement on a physician’s recommendation if necessary. A daily multivitamin may be helpful as well.

Allergies and Asthma

Allergies and asthma are quite common conditions in children. The good news: They respond well to integrative approaches and lifestyle changes. Asthma is a chronic inflammatory condition characterized by repeated episodes of airway obstruction and associated with an exaggerated airway response to a variety of inhaled stimuli. Although the cause is unknown, such factors as allergies, increased stress, respiratory infections, and exercise can worsen asthma. It can also occur without any obvious triggers.

Allergies are due to misplaced immunity against an irritant that’s not really a threat to health. Allergic responses are learned responses that can be unlearned. The goal of treatment should be to convince the immune system that it can coexist peacefully with the substances it is reacting to. In young children, it’s important to try to limit exposure to potential irritants of the immune system.

My principal recommendation for patients with asthma and allergies (or both) is to follow an anti-inflammatory diet: Increase organic fruits and vegetables, and stay hydrated with lots of water. Avoid cow’s milk and cow’s milk products, processed foods, partially hydrogenated oils, white sugar, and white flour. I also recommend using standard medical treatment selectively and trying to avoid suppressive medications (such as oral steroids) as much as possible. Use mind/body approaches such as guided imagery or clinical hypnosis and experiment with homeopathy as well, since children respond favorably to this nontoxic form of treatment.

Autism

Autism is a spectrum of developmental disorders characterized by behavior limitations that include impaired social interaction, problems with spoken and unspoken communication, and unusual, repetitive, or severely limited activities and interests. These problems can range from mild to disabling. Related conditions include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Between three and six children out of every 1,000 are estimated to have autism. Boys are four times more likely to be affected as girls.

The hallmark of autism is impaired social interaction. You might notice during infancy that your baby is unresponsive to people or will focus intently on one item to the exclusion of others for long periods of time. Sometimes, a child with autism may appear to be developing normally and then withdraw and become indifferent to others.

Is It a Food Allergy?

An estimated one in 13 children has a true allergy to a particular food. Common food allergens include milk, eggs, peanuts, tree nuts, shellfish, soy, and wheat. When true food allergies occur, the immune system reacts to a benign substance as if it were a harmful one and produces antibodies against it, releasing histamines and other compounds in the process. This causes symptoms such as a tingling mouth, hives, swollen tongue and throat, a drop in blood pressure, or even anaphylactic shock.

Food intolerance is much more common and may produce less serious but still uncomfortable symptoms (diarrhea, gas, headaches, or flushing). It may be due in part to a lack of enzymes needed to break down food. If you feel your child has a true food allergy or experiences symptoms of food intolerance, talk with your pediatrician about your concerns; he or she can arrange tests and offer advice.

PHOTO CLARISSE MEYER

These children may not respond to their names and may avoid making eye contact with others. They may not recognize social cues such as tone of voice or facial expression and, as a result, don’t grasp what others are thinking or feeling. They might not watch other people’s faces for clues to appropriate behavior and may not know how to play with other children. Many of these children engage in repetitive movements (rocking or twirling) or may hurt themselves by biting or by banging their heads. They tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Some speak in a sing-song voice only about a narrow range of topics.

Many children with autism have a reduced sensitivity to pain but are abnormally sensitive to sound and touch. As a result, they may resist being cuddled or hugged. They appear to be at higher-than-normal risk for epileptic seizures, Tourette syndrome, learning disabilities, and attention-deficit disorder.

The cause of autism is still unclear, but researchers suspect that both genetics and environment contribute to the disorder. They have identified a number of genes associated with it, and studies have found irregularities in several regions of the brain in autistic people. Some research suggests part of the problem may be abnormal levels of serotonin or other brain chemicals. If so, this could mean that autism stems from disruption of fetal brain development due to defects in genes that control brain growth and regulate how neurons communicate with each other. But these are theories that have yet to be proved. In-utero exposures to harmful chemicals may

be a factor. Although the age of the parents, and especially the age of the father, has been recently linked to increased rates of autism, research has confirmed that parental practices after birth are not to blame.

There is no cure for autism. Instead, treatment focuses on helping children develop social and language skills and on family counseling for parents and siblings coping with an autistic child. Sometimes, physicians prescribe antidepressants to treat symptoms of anxiety, depression, or obsessivecompulsive disorder that can occur among autistic youngsters. Other drugs that may be useful are antipsychotic medications for severe behavioral problems, anticonvulsants to treat seizures, if any, and stimulant drugs (used to treat attention-deficit disorder) to help lessen hyperactivity and impulsiveness.

INTEGRATIVE APPROACHES

Some studies suggest that autistic behavior may stem from allergies or intolerances to the proteins in milk (casein) and in wheat and other grains (gluten). Possibly, some children with autism can’t completely break these proteins down into amino acids. Instead, fragments of these proteins (peptides) get into the bloodstream and central nervous system before eventually being eliminated from the body. Several groups of researchers have identified these peptides in urine samples from children with autism. Some are chemically similar to morphine and, in theory, may be the agents that cause or contribute to autistic behavior. It is well worth trying a gluten-and-casein-free diet to see if it helps. Ample anecdotal evidence attests to marked

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improvement in some youngsters after foods containing gluten and casein were removed from their diets.

I also recommend making sure that children with autism get sufficient omega-3 fatty acids. Recent research indicates that supplementing the diet with these essential fats can help address autism as well as depression, bipolar disorder, and attention-deficit/hyperactivity disorder. Dietary sources of omega-3s include wild salmon, mackerel, herring, sardines, and sablefish (as well as specially fortified eggs). Omega-3 sources other than fish are few: walnuts, flaxseeds, hemp seeds, and the oils extracted from them and, to a lesser extent, soy and canola oils. But vegetarian sources alone cannot provide what the body needs.

Children with autism can also benefit from probiotics, products containing the helpful bacteria that normally inhabit the human digestive tract. Probiotics can help decrease leakage of peptides and other large molecules from the gut, thus potentially lessening the triggers for immune reactions that might have effects on brain function.

Colds

While there is no cure for the common cold, there are several things you can do to help make your young children more comfortable while the virus runs its course:

• To relieve a stuffy nose, use saline-only nose drops. Ask your pediatrician which ones to use, and never use over-thecounter nose drops that contain any medication.

• Clear a baby’s nose with a suction bulb.

Squeeze the bulb, gently put the rubber tip into the baby’s nostril, and slowly release the bulb. This works best for babies younger than six months.

• Use a cool-mist humidifier in the child’s room to moisten the air and clear nasal passages. Clean the humidifier often. (I recommend using distilled water, which has less potential to aerosolize contaminants and makes maintenance easier.)

• To relieve fever, use acetaminophen or ibuprofen. Ask your pediatrician for the correct dosage for you child’s age and weight. Don’t give aspirin, as it has been associated with Reye’s syndrome, a disease that affects the liver and brain.

• Make sure the child drinks plenty of fluids to prevent dehydration.

• If a cold does not go away or seems to worsen, call your pediatrician.

Echinacea has proven very helpful in adults but has been less well studied in children. Dr. Newmark recommends treating colds in kids with echinacea and zinc lozenges if they are old enough to suck them without swallowing or chewing them. (Some kids may not go for the way they taste, and they can cause nausea.) He also recommends extra vitamin C: 125 mg three times a day for children who weigh 20 to 29 pounds, 250 mg three times a day for those who weigh 30 to 59 pounds, and 500 mg three times a day for those who weigh more than 60 pounds. Effervescent, powdered forms of vitamin C can be dissolved in water to create pleasant-tasting drinks. Give the supplements at the first sign of a cold. Read product labels

carefully and completely—avoid any products that contain artificial colors or sweeteners.

Keep in mind that otherwise healthy kids are pretty good at shaking off colds. Sometimes, all the medicine needed is extra sleep and plenty of vitamin-C-rich fluids. And remember that the best treatment for a cold is prevention. Make sure your children wash their hands regularly and avoid direct or indirect contact with people who have colds or fevers.

Ear Infections

In young children, middle-ear infections (otitis media) are so common as to be accepted as a normal part of growing up. They are also the bread and butter of allopathic pediatricians, who treat them with frequent courses of antibiotics and decongestants and

sometimes with surgery. I prefer to take a more natural route. When performed by a trained practitioner, I’ve seen a simple osteopathic technique called cranial therapy end recurrent ear infections in children. In addition, I suggest eliminating all milk and milk products from the diet for at least three months to see if any benefits result. That means avoiding all dairy products as well as breads and other foods containing milk in any form. You can use soy, rice, and nut milks instead. Children who are old enough to gargle should be encouraged to do so frequently when they first notice the pain of an ear infection. Warm saline solution works fine; it promotes healing by bringing more blood to the Eustachian tube, which connects the ear with the throat.

“ I recommend making sure that children with autism get sufficient omega-3 fatty acids. ”

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One of the benefits of adulthood is the freedom to make decisions about our lives. Along with that autonomy comes the responsibility to make prudent choices—in what we eat, how we stay active, and how we manage stress, for example. For some people, healthy living comes naturally. Enjoying fresh, wholesome foods and a daily brisk walk are second nature. For others, practicing these positive approaches can be a struggle. For most, it takes time and a little discipline to establish healthy habits. In this section, you’ll learn how to achieve and maintain vibrant health through simple lifestyle changes. Incorporating these common-sense strategies can make a tremendous difference in your daily energy and outlook, and help ward off common health concerns, no matter what your current state of wellness.

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EATING FOR OPTIMAL HEALTH

There’s no doubt that nutrition plays a powerful role in shaping our health and protecting us from disease. Unfortunately, the typical American diet tends to eschew antioxidant-rich fruits and vegetables, fish, and whole grains in favor of foods with higher calories but emptier nutritional profiles. The effects of our eating habits—particularly on our risk for chronic conditions—occurs through two major biologic pathways: inflammation and a related process called glycation. A diet high in manufactured and highly processed foods, fast foods, refined carbohydrates, and red meat and other animal-based products can intensify both pathways, in turn raising your odds of developing disease.

Putting Out the Fire

Once a novel concept, the risks and effects of chronic, inappropriate inflammation are now well known. A wealth of research suggests that a broad range of common conditions are rooted in chronic inflammation, which predictably occurs when your body’s equilibrium of pro- and anti-inflammatory forces is out of balance.

Inflammation isn’t always a negative thing: In fact, it’s the cornerstone of the body’s healing response, allowing the immune system to deliver more blood, nourishment, and defensive activity to an area that is injured or under attack. And while this inflammatory reaction can produce painful symptoms, it’s necessary for repair and regeneration. If you can’t

produce enough inflammation when it’s needed, you are vulnerable to infection; if you produce too much, you suffer from allergy and autoimmunity as well as the long-term problems associated with chronic inflammation that serves no purpose. Left unchecked, such purposeless chronic inflammation appears to be the primary contributor to many serious conditions, including cardiovascular disease, cancer, and Alzheimer’s disease. It is even associated with obesity.

Chronic inflammation is largely tied to lifestyle, and one of the strongest correlations is with food choices—particularly consumption of fats and carbohydrates.

When you eat certain essential fats, your body produces hormones called prostaglandins, which help regulate inflammation. Some

fats, such as omega-6 fatty acids and trans fats, induce the production of prostaglandins that can increase inflammation, while others, like omega-3 fatty acids, decrease it. Both types are necessary to keep the potential for inflammation in proper balance. Unfortunately, most Americans choose to eat a diet that promotes chronic inflammation— and their health suffers.

Not So Sweet

Your choice of fats isn’t the only dietary factor you should focus on. Glycation, an intricate chemical reaction that occurs when sugars and proteins interact with each other, also promotes inflammation. When sugar bonds with lipid (fat) or protein molecules, it triggers a reaction that forms compounds called advanced glycation end products, or

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AGEs. This process can be observed outside the body during high-temperature cooking of fats and sugars, resulting in browning or caramelizing. As you might imagine, these foods—such as donuts, French fries, and barbecued meats—tend to be unhealthy. But what happens when AGEs are formed inside your body is even more disturbing.

Glycation is the first step in a series of chemical reactions that are set into motion when you consume rapidly digesting carbohydrate foods that quickly raise blood sugar. Whenever blood sugar spikes or remains high, glycation reactions occur and AGEs form. AGEs promote inflammation directly and also indirectly, by cross-linking (deforming) proteins and turning them into pro-inflammatory agents. Along with diabetes, glycation and AGEs have now been implicated in a host of chronic diseases, such as Alzheimer’s disease, cardiovascular disease, and stroke. Fortunately, there’s much you can do to stem glycation and inflammation, chiefly by making intelligent food choices.

Choose the right fats. Opt for extra-virgin olive oil (EVOO) and other sources of monounsaturated fat, which counteract inflammation, as your main fat. (High-quality EVOO also contains a unique anti-inflammatory agent, oleocanthal, which gives a peppery bite.) Increase your consumption of omega-3 fatty acids, which are found in some varieties of oily, cold-water fish; freshly ground flaxseed; walnuts; hemp; and fortified eggs.

Eliminate unhealthy fats. Polyunsaturated vegetable oils (such as safflower, sunflower, corn, and soy oil) are rich in omega-6 fatty acids, which promote inflammation, as do the trans fats in margarine, vegetable shortening, and partially hydrogenated oils. Avoid them and any manufactured foods containing them. We need both omega-6 and omega-3 fats to keep

pro- and anti-inflammatory forces in balance, but most of us are getting far too much of the former and not enough of the latter.

Color your world. The colorful hues of fruits and vegetables serve as visual cues to the protective phytonutrients they contain. These include antioxidants, which help neutralize free radicals, the highly reactive byproducts of metabolism that may contribute to inflammation. Choosing fresh produce in a variety of colors is the best way to take advantage of these

health-protective compounds.

Limit refined carbohydrates. Foods made with flour and sugar can cause rapid increases in blood sugar, which favors the abnormal reactions between proteins and sugars that result in pro-inflammatory AGEs. Eliminate refined carbs in favor of whole grains whenever possible.

Focus on plant-based protein. Red meat and dairy products tend to be high in unhealthy saturated fat, and regular consumption of these American favorites has been linked to a number of diseases. Along with chicken, red meat and dairy are also high in arachidonic acid, a pro-inflammatory fatty acid.

The Anti-Inflammatory Diet Pyramid (included in my books) does not exclude high-quality cheeses and yogurt but stresses the importance and benefits of plant-based sources of protein, such as whole soy and other legumes. Spice things up. Using turmeric, ginger, and some types of peppers can add depth of flavor to your meals and provide natural anti-inflammatory protection.

Wet your whistle. Sip pure water, or drinks that are mostly water (tea, very diluted fruit juice, sparkling water with lemon), throughout the day. Avoid sweetened and artificially sweetened beverages. Use filtered water, or install a home water purifier or distiller if your tap water tastes of chlorine or other contaminants.

ON THE MOVE

atients often ask me, “How much exercise do I need? How often should I get moving?” The simplest answer is that you should engage in some form of aerobic activity every day that makes your heart beat faster. For maximum benefit to your cardiovascular system, this should be continuous and sustained for more than a few minutes. My recommendation is to work toward the goal of performing 30 minutes of aerobic activity at least five days a week. If 30 minutes seems like a lot, compare it to how much time you spend each day sitting and being inactive.

There’s good reason to do aerobic exercise. It conditions our heart and arteries and our respiratory systems. It increases stamina and general fitness. It promotes cleansing of the blood by stimulating circulation and perspiration. It gives a sense of strength, capability, and well-being, in part by releasing feel-good endorphins. Aerobic exercise increases the flow of oxygen to all organs, enabling them to work more efficiently; burns calories; strengthens the immune system; lowers serum cholesterol; and tones the nervous system. It is the type of exercise most people neglect and need to concentrate on first.

Yet despite the undeniable benefits of exercise, too many people quit, become injured, or simply find the process unenjoyable. Here’s how to make aerobic exercise an ongoing, safe, and rewarding part of your life.

• Any aerobic exercise is better than no aerobic exercise. I would be happy to see you doing even a few minutes of it on a regular basis, but if you want to experience all the benefits, please try to perform some

continuous aerobic activity for 30 minutes a day, on average, five days a week.

• Work up to this level gradually and at your own pace, especially if you have not been exercising.

• Remember also that I am recommending an average amount of activity over time. It is not the end of the world if you miss a day or two here and there. You can make it up later. Feeling bad about missing exercise isn’t productive—I’d rather you use a missed day to strengthen your resolve to get back in the game.

• Find other ways to fit physical activity into your day, such as using stairs more often and parking farther from your destinations to walk more.

• Always warm up before you get into the full swing of aerobic activity. The best warm-up is a slowed-down version of the activity you are about to perform. For example, walk, run, or cycle in slow motion. You will see many people stretching as a warm-up, but this does not prepare muscles for aerobic exercise as well as slow movement does. Stretching should be done after exercise.

• Give yourself a few minutes to cool down at the end of the activity. Repeat the same movements in slow motion.

• If you have never exercised, get a medical checkup before you start an exercise program. If you have a history of heart trouble or high blood pressure, or a strong family history of such problems, a cardiac stress test may be in order.

• Stop exercising immediately if you develop dizziness, lightheadedness, fainting, chest pains, or difficulty breathing. Get a medical checkup promptly.

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Work toward the goal of performing 30 minutes of aerobic activity at least five days a week. ”

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Walk This Way

Walking is an ideal form of aerobic exercise. It offers the great advantage of requiring no skill or practice. Everyone knows how to do it, and the only equipment you need is a good pair of shoes. You can walk outdoors or indoors (in shopping malls, for example). It is probably the safest option of all, with the least chance of injury. The main drawback is that you can easily fail to do it strenuously enough to get the conditioning benefits of exercise. Aerobic walking cannot be casual or intermittent, and it takes a little more time than the other options. You should be able to walk about three miles in 45 minutes. If, after building up to that, you still do not get a good workout, you will have to walk faster, do some uphill walking (long, gradual hills are best), or carry hand weights. (Never use ankle weights, which can stress joints and lead to injury.)

It’s important to maintain good posture during walking exercise, and swinging the arms opposite to the movement of the legs makes for a better stride. Walking with special poles (like ski poles) is another option. Athletic supply stores can give you advice about good walking shoes. The right shoes are as essential for aerobic walking as for running. If you become accomplished at walking, you can join walking tours throughout the world or look into race walking, an advanced technique taught at some fitness clubs.

Run for Your Life?

Running has become very popular in our society in recent years. The main appeal of this form of exercise is its intensity. It promotes fitness quickly and efficiently and burns more calories than other activities, making

it attractive to people who want to control their weight. Because of its intensity, running releases endorphins in many people, creating the so-called runner’s high.

However, running has some potentially serious disadvantages that you should consider before choosing to do it on a regular basis. Running traumatizes the body, especially joints in the legs, knees, and back, as well as the kidneys. You can minimize this possibility by taking several precautions. Never run on concrete, for example. If possible, run on cinder tracks or dirt paths. Asphalt is not as bad as concrete but not as good as dirt. Always wear well-made running shoes designed to minimize shock to the joints, and get a new pair whenever your present ones start to wear out. Women should wear athletic bras or other breast supports. Warm up before you start a run, not by stretching but by running in slow motion.

Above all, listen to your body. If you develop pain in any joints, stop running or cut down on it until you determine the reason for the pain. I have seen too many people who ignored warning signals of this sort and now are unable to run at all because of damage to vertebrae, hip joints, and knees. Of course, this caution applies to any form of physical activity, but because running subjects the body to so much trauma, it is of special importance.

Running also seems more open to abuse than other forms of aerobic exercise, probably because of its stressful nature and consequent effect on the endorphin system. Many people run addictively—that is, with a compulsive quality that takes over their lives. In Tucson during the burning hot days of May and June,

I often see middle-aged men running on city streets in the midday sun with looks of agony on their faces. They must believe they get more benefit from an aerobic workout if they make it as torturous as possible. I should not have to tell you that this idea is foolish. The extreme stress of running in heat can damage the body, especially the cardiovascular and urinary systems. Be sure to replace fluids if you run in hot weather and sweat a lot. Also try not to run on streets with heavy traffic. You can inhale a lot of exhaust fumes, especially when your breathing is stimulated by aerobic exercise.

If outdoor running is not an option, you can run indoors on an automatic treadmill. Fitness clubs usually have these machines, and you can buy one for the home. Many models allow you to vary speed and incline and give you continuous information about

your work output on a video display screen. Treadmills greatly reduce the possibility of injury, because the running surface has the proper springiness for safety. I find them quite boring, though, and it’s often an effort to entertain myself while using them. Try listening to music or audiobook to keep yourself engaged.

Stay Strong

Strength training works muscles against resistance, either with machines or with free weights. It increases muscle bulk by a simple physiological principle: Use any muscle more, and it will increase in size; stop using it, and it will decrease. If I find myself in a health club, I usually perform a circuit of the weight machines and some work with free weights, because this activity feels good to me. You might want to do the same.

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One benefit of working muscles against resistance is that it will increase your bone density, providing an antidote to the hormonal and metabolic changes that can cause calcium loss and development of osteoporosis. Women become susceptible to this debilitating disease earlier than men, but women who have good habits of weight-bearing exercise have more protection than those who do not. Weight lifting is only one kind of weightbearing exercise; aerobic activities like running, dancing, and brisk walking also strengthen bones while they condition your heart and lungs. Another benefit of strength training is that increased muscle mass correlates with increased metabolism and the ability to burn calories.

That’s a Stretch

Stretching is a totally natural conditioning exercise that improves the tone and health of muscles; limbers up tendons, ligaments, and joints; changes the dynamics of the nervous system; and just feels good. You can learn a lot about our need to stretch by watching dogs and cats do it. All of us tend to stretch after being in one position for a long time, and students of the human body tell us we ought to make a habit of stretching in opposite ways from the positions we spend the most time in during the day. For instance, if you work leaning over a desk, when you get home you should spend a few minutes with your head, neck, and shoulders arched backward.

Muscles contain stretch receptors, special groups of cells that inform the central nervous system about their state of tension. This may be why stretching can change our level of

arousal and mood. Stretching feels good, but it is a sensation that borders on both pleasure and pain. Although some kinds of formal stretching exercises, like yoga, may seem painful when you first try them out, your perception of the sensations will change fairly quickly if you practice.

Stretching is so natural that you can easily invent your own forms of it. If you feel the need to do it formally, you can find stretch classes at many fitness clubs (aerobics classes usually include some preliminary stretching, too), or you can learn from books. I strongly recommend that you stretch frequently, especially if you suffer from stiff muscles or spend a lot of time sitting or working in one position.

Yoga is one popular form of stretching, but it does much more for the body than just stretch muscles. In India, this ancient practice is a philosophical-religious system for attaining unity of consciousness. The physical aspect of it, known as hatha yoga, includes a number of asanas, or poses. These are what most of us think of when we hear the word yoga, and these are what most yoga instructors in the West teach. In the larger context, the yoga asanas are intended to facilitate concentration and meditation by quieting the body and nervous system. They are not meant to be an end in themselves, since it is possible to become very proficient at the postures without making any progress at the more important job of learning to still the mind. You can learn yoga from books, but it is easier to learn it from a teacher. Yoga classes are widely available through health clubs, community centers, and universities.

You can practice on your own once you learn the basics, and you do not need to spend any specified amount of time at it.

Making Exercise a Habit

No matter how much you try to make it fun, and no matter what the experts tell you about how great you will feel, when you first start regular aerobic exercise, you will probably dislike it. Developing this healthy living habit takes time and effort. It will be difficult in the beginning, and time may move much more slowly than you’d like. You must force yourself to stick to your routine during this stage. A common pitfall is to forgo exercise on days when you feel tired and lethargic because you think you do not have enough energy for it. A secret, known to those who have become habitual exercisers, is that effort creates energy. Don’t wait for energy to come when you are tired; create it by expending effort. You can easily prove to yourself that this principle works. Just try it.

The inner voice that says you don’t have time for exercise is lying. You can make time for it once you realize its priority in an overall program of preventive health maintenance and healthy living. In fact, regular exercise, by giving you more energy and a greater sense of well-being, will help you work more efficiently so that you use your time better and have more to spare. I promise you that eventually you will move beyond the initial stage into a different relationship with aerobic activity. It will make you feel good both physically and mentally, at first after you finish exercising and later while you are doing it as well. Days without exercise will not feel quite right or complete. Then you will know that your good habit has begun to take solid form, and the chance of your abandoning the program will be much diminished.

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KEEPING STRESS UNDER CONTROL

We can no more eliminate stress from our lives than we can eliminate tension from our muscles. If muscle tension dropped to zero, we would fall to the ground in a shapeless heap. If all stress disappeared, we would not be alive. Stress is inherent in our interactions with the world around us and, unless it becomes overwhelming, it keeps us growing and developing. Stress really has two aspects: one external and one internal. The internal aspect of stress is our reaction to the obstacles and reverses of living. If we become anxious, fearful, angry, or depressed about them, those states can certainly do us harm. Internalized stress keeps the mind agitated, throws the nervous system out of balance, interferes with the functioning of the immune system, and fosters the many stressrelated disorders so common in our society.

The external aspect is what we see as the cause of tension. While it is always worth trying to change external situations that are destructive, keep in mind that you have a choice in how you allow situations to affect you. In time, you can learn to change your reactions to them. Simply making changes to what you see as the external aspect of stress (such as getting a new job, moving, or ending a relationship) does not necessarily help you develop the skills for managing future problems any better. Therefore, it is also important to learn how to relax and protect yourself from the harmful effects of stress. If you feel you experience a lot of daily stress, consider the following contributors— each can increase or prolong stressful reactions. Choose one, and try eliminating it for a period of time to see how the change affects your stress levels, then try eliminating another.

PHOTO NIK SHULIAHIN

Caffeine and Other Stimulant Drugs

Stimulant substances can often make us more jumpy, anxious, and fearful, and interfere with relaxation, rest, and sleep. Caffeine isn’t just found in coffee, energy drinks, and colas—it is an ingredient of many over-the-counter and prescription drugs. If you want to lower your level of internal stress and develop your ability to relax and let go of external annoyances, a good place to begin is to eliminate caffeine and its related compounds from your life. Because of their action on the sympathetic nervous system, all stimulants—whether natural or synthetic, or in the form of beverages or pills—are obstacles to relaxation.

Sound

With its profound influence on the nervous system, it is no surprise that some kinds of sound increase our level of arousal and make us tense and anxious. Music has special power to infiltrate and affect consciousness—it’s often difficult to ignore sounds that directly and forcefully push the nervous system away from calmness and centeredness. In a way, choosing which sounds to let into your consciousness and which to exclude is like making choices about your mental nutrition. If you want to be excited, stimulated, sexually aroused, or prepared for physical violence, by all means listen to the readily available sounds that move you toward those states. If you want to relax and dissipate the tension resulting from external stress, don’t make it harder by exposing yourself to those influences.

News

News reports can also profoundly affect your mental state. They are designed to increase anxiety, give you new possibilities for worry, and play on your desire for emotional stimulation. Notice the effect that news has on your mental equilibrium. Like caffeine addiction, news addiction is a major roadblock to learning to relax. Experiment with breaking the news habit, then use your power of choice to tune into news selectively and consciously.

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Like caffeine addiction, news addiction is a major roadblock to learning to relax. ”

Agitated Minds

Moods can be contagious, and being around individuals who are agitated will affect your level of agitation. A kind of resonance takes place in the realm of consciousness. If you are in the presence of calm, centered people, your internal tension often diminishes and allows you to let go of some of your stress without making any effort to do so. If you are in the presence of people who are excited, angry, or anxious, you will naturally move toward those states. Pay attention to your internal responses to the people you associate with. As much as possible, try to avoid the company of agitated minds.

Breathing Through Stress

In many languages, the words for spirit and breath are one and the same (Sanskrit: prana; Hebrew: ruach; Greek: pneuma; Latin: spiritus). Breathing is the bridge between mind and body, the connection between consciousness and unconsciousness, the movement of spirit in matter. Breath is the key to health and wellness, a function we can learn to regulate and develop in order to improve our physical, mental, and spiritual well-being. Breathing is special in several respects: It is the only function you can perform consciously as well as unconsciously, and it can be a completely voluntary act or a completely involuntary act, as it is controlled by two sets of nerves, one belonging to the voluntary nervous system, the other to the involuntary (autonomic) system. Breath spans these two systems.

PHOTO JIMMY CHANG

Most of us don’t breathe in a manner that takes full advantage of the nourishing, health-giving properties of the act. Knowing how to perform simple breathing techniques can help lower your blood pressure, calm a racing heart, or help your digestive system without taking drugs. Breathing has direct connections to emotional states and moods—observe someone who is angry, afraid, or otherwise upset, and you will see a person breathing rapidly, shallowly, noisily, and irregularly. You will find it difficult to be upset if your breathing is slow, deep, quiet, and regular. You cannot always center yourself emotionally by an act of will, but you can use your voluntary nerves to make your breathing slow, deep, quiet, and regular, and the rest will follow.

When learning how to breathe, begin by closing your eyes for a few minutes. Practice moving your breath. Keep your back straight. Begin with a deep, audible sigh, then quietly inhale and see how slow, deep, quiet, and regular you can make your breathing and still have it feel perfectly comfortable. You should feel that you are getting enough air with no sense of not getting enough air. Do this for at least eight breaths, then open your eyes and breathe normally. This is a simple exercise but an effective one, and you should perform it often.

Next, pay attention to your exhalation. If you watch people breathe, you will see that most of them use effort to inhale but none to exhale. Exhalation is usually passive and takes less time than inhalation. When you breathe this way, you do not move nearly as much air in and out of your lungs as you can. The more air you move, the more you promote health, because the functioning of all systems of the body depends on delivery of oxygen and removal of carbon dioxide. To get more air into your lungs, concentrate on getting more air out of them by attending to exhalation.

At the end of a normal breath, try squeezing more air out. You will be using your intercostal muscles to do this, and you will feel the effort as they compress the rib cage. Try to make your exhalation as long or even slightly longer than inhalation. Whenever you think of it, practice this technique of extending exhalation and developing your intercostal muscles.

“ Breathing is the bridge between body and mind.”

PHOTO DINGZEYU LI

COPING WITH COMMON CONDITIONS

Anumber of conditions become more likely to develop with age, so it makes sense to do all that you can to protect yourself against them now, whether you’re 25 or 45. Here’s how to harness the power of integrative medicine to ward off three common health concerns.

Help for Your Heart

Cancer may seem more frightening to many of us, but cardiovascular disease remains the leading cause of death for American men and women. I personally have some genetic susceptibility to the condition: My grandmother on my father’s side had coronary artery disease and angina. My father had a mild heart attack when he was 49 years old and his father died of a heart attack at 51. My father lived to be 81, but he

underwent two coronary bypass operations. He also smoked, ate a relatively unhealthy diet, and was fairly sedentary from middle age on.

This knowledge of my family history has made me more aware of my own cardiovascular health, and I do whatever I can to lower my risk of heart disease. I believe the root of coronary artery disease is chronic inflammation, which can, in turn, influence the major risk factors associated with cardiovascular problems, including high blood pressure, high cholesterol and high homocysteine, atherosclerosis (narrowing of the arteries), and insulin resistance. The same prudent lifestyle measures can moderate all of these risk factors, so protecting your heart and blood vessels is not as complicated as you might imagine.

“ You can harness the power of integrative medicine to ward off common health concerns. ”

PHOTO LUCAS FARVE

DIET

• Put out the fire. Because chronic inflammation appears to have a strong impact on cardiovascular health, I recommend that everyone follow the antiinflammatory eating plan outlined earlier in this section.

• Choose carbs wisely. Select foods that rank low on the glycemic index (GI), an indicator of how quickly carbohydrates are converted to blood sugar. Lowranking carbohydrates include sweet potatoes, winter squash, and beans. You should also be aware of glycemic load (GL), a measure closely related to GI that takes into account how many grams of carbohydrate a normal serving contains. Research shows that choosing foods with a low GL may prevent the development of type 2 diabetes, a major risk factor for heart disease. Be sure to eliminate sugary beverages, including soda and fruit juice; all sugars promote inflammation and obesity, and increase the risk of developing cardiovascular conditions.

• Eliminate trans fats. Found in many margarines and in most processed and junk foods, these heartdamaging fats can reduce levels of HDL (“good”) cholesterol and raise levels of LDL (“bad”) cholesterol. If you see “partially hydrogenated oil” listed in the ingredient list on any food label, find a healthier substitute.

• Say “yes” to soy. Consuming excessive animal protein has been shown to raise levels of homocysteine, a toxic amino acid linked to a greater risk of heart disease, while the protein contained in whole soy foods, such as tofu, tempeh, soy milk, and whole soy beans, can lower cholesterol levels. Try to incorporate two daily servings of whole-soy-based foods into your meals.

• Seek out seafood. Because of compelling evidence linking the omega-3 fatty acids in fish to a lower risk of stroke, arrhythmia, and heart attack, the American Heart Association recommends eating fish at least

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twice a week. Focus on wild cold-water fish that are high in omega-3 fatty acids, such as Alaskan salmon and sardines.

• Eat the rainbow. There’s good evidence that eating five or more daily servings of fruits and vegetables may significantly lower the risk of coronary heart disease, heart attack, and stroke, probably because of the phytonutrients they contain. Research also links produce consumption to lower blood pressure and a decreased risk of type 2 diabetes.

• Fit in fiber. Studies have shown that people who eat about three daily servings of whole grains have up to 30% lower risk of developing type 2 diabetes and coronary heart disease, and a greatly decreased risk of having an ischemic stroke, compared to those who rarely or never consume these foods. Other research shows that whole grains—such as oats, brown rice, bran, barley, bulgur, and kasha—can help lower total and LDL cholesterol and reduce the odds of developing atherosclerosis. Opt for products that contain actual whole or cracked grains rather than those made with flour, even “whole-grain flour,” which has a high GI rating.

Long-term studies also suggest that both men and women who eat beans (dried or fresh, not canned), peas, and other legumes at least four times a week have a significantly lower risk of coronary heart disease than those who consume only one weekly serving. Beans are rich in soluble fiber, which lowers cholesterol, as well as the B vitamin folic acid, which reduces levels of homocysteine, and magnesium

and potassium, which help maintain healthy blood pressure. The primary reason to avoid canned beans is that they tend to be high in sodium.

• Shake the salt. Excessive sodium intake has been linked to high blood pressure and heart disease. Avoid processed meals and canned foods, taste foods before you salt them, don’t add salt while cooking, pass over foods that are visibly salted, and read labels carefully, as salt is hidden in just about everything. Aim for no more than 1,500 mg of sodium per day.

• Get spicy. Salt can easily be replaced with herbs and spices that add both flavor and health benefits. For example, garlic has been shown to lower cholesterol levels. It also has a modest beneficial effect on blood pressure, potentially helping to relax blood vessels. Eat one or two raw or very lightly cooked cloves a day. (Mash them and let them sit for 10 minutes before using them to maximize their benefits.) And consider adding more chili peppers to your meals. Capsaicin, the fiery substance that gives peppers their heat, has been found to have a number of heartprotective properties: Research suggests that it may help reduce blood cholesterol levels and block the action of a gene that regulates the constriction of arteries. This allows more blood to flow through them.

EXERCISE

Regular exercise helps protect against cardiovascular disease in several ways: It decreases inflammation, improves cholesterol levels and insulin resistance, lowers blood pressure, helps maintain a healthy weight, and

keeps blood vessels flexible. All told, people who are physically active have a 45 percent lower risk of developing cardiovascular disease than do sedentary people. You can help prevent heart problems by following the fitness advice in this guide. Be sure to check with your doctor before beginning a new exercise problem, particularly if you already have heart disease.

MIND/BODY

Stress is a reality of life, but uncontrolled stress can raise blood pressure, as well as elevate cholesterol levels. Practice breath work, meditation, guided imagery, visualization, or another relaxation technique, and stay social.

SUPPLEMENTS

• Coenzyme Q10. This antioxidant helps prevent the oxidation of LDL cholesterol, maintain healthy blood vessels, protect against clots and plaque rupture, and support optimal functioning of the heart muscle. It’s a must if you take cholesterollowering statin drugs, which interfere with the body’s natural production of CoQ10.

• Fish oil. The omega-3 fatty acids in fish and fish oil supplements have been shown to help lower triglyceride levels, increase HDL cholesterol, decrease inflammation and blood clotting, and keep blood vessels healthy.

• Magnesium. Higher insulin and blood sugar levels are associated with low plasma magnesium levels, and animal studies suggest that adding magnesium to the diet can help decrease insulin resistance.

• Chromium. This micronutrient helps stabilize blood sugar, may improve serum lipid profiles, and also may help the body utilize glucose and burn fat. The most effective form to use is GTF chromium.

Memories Are Made of These

Perhaps more than any type of physical limitation, suffering from mental difficulties and deficits seems to be the most-feared aspect of getting older. The specter of Alzheimer’s disease and other types of cognitive decline is very real: According to recent estimates, about 5.1 million Americans have Alzheimer’s disease, and that number is expected to grow to 7.7 million by 2030. Some loss of memory function is normal as we age, but you shouldn’t confuse that with Alzheimer’s.

The two major categories of memory are short-term and longterm. Short-term memory includes remembering the names of people you recently met or where you just put your car keys. Information stored in long-term memory includes events that occurred years ago, such as the name of your third-grade teacher, what you wore to your prom, or where you worked during your summer breaks from college.

As we get older, we experience a gradual loss of brain cells. This can affect the efficiency of the way we store and retrieve information. Short-term memory progressively declines, sometimes causing difficulty in recalling details of recent events as well as a diminished ability to learn. Memory loss from aging— forgetting someone’s name or misplacing your car keys—does not necessarily get worse over time.

On the other hand, dementia is a progressive decline in mental ability, affecting memory, thinking, awareness, judgment, attention span, and learning. Although dementia usually develops after age 60, it is not a natural part of aging. Alzheimer’s disease is the most common form of dementia. Multi-infarct dementia, caused by successive “mini” strokes that gradually affect brain tissue, is also common. Alzheimer’s disease begins slowly, and gets progressively worse over time. There is a gradual decline in memory, the ability to keep track of time, and the ability to recognize people, places, and objects. It becomes more and more difficult to find and use the appropriate words. Often, there are also changes in personality. In contrast, multi-infarct dementia typically has a more predictable, step-like progression. The good news: A growing body of evidence suggests that we can protect our brain against memory loss.

DIET

• Quench inflammation. Chronic inflammation and oxidative stress appear to contribute to the risk of Alzheimer’s disease, and controlling inflammation may be protective. Recent research has found that older people with higher levels of vitamins B, C, D, and E and omega-3 fatty acids in their blood perform better on mental acuity tests and exhibit less of the brain shrinkage typical of Alzheimer’s. On the other hand, a higher intake of trans fats (found in baked and fried foods, margarine, fast food, and junk food) is associated with consistently worse cognitive performance. Follow the anti-inflammatory diet described earlier in this section, and try to cut back on sweets: Animal research has shown that a diet high in sugar may affect insulin receptors in the brain and worsen spatial learning and memory skills.

• Cook right. Opt for cooking methods that rely on lower temperatures, as highheat cooking such as grilling favors the formation of advanced glycation end products, or AGEs, carcinogenic compounds that have also been linked to Alzheimer’s disease.

• Go fishing. Research suggests that omega-3 fats may slow the growth of two distinct brain lesions that are hallmarks of Alzheimer’s disease: A study in mice found that the omega-3 fatty acid DHA can delay the development of protein “tangles” in brain cells. DHA also reduces levels of beta-amyloid, another protein that can cluster in the brain and form plaques. Wildcaught Alaskan salmon, sardines, herring, and sablefish are excellent sources of

omega-3s, yet are relatively low in potential environmental toxins.

• Pick produce. More research is needed, but recent studies in animals suggest that diets rich in fruits and vegetables may help protect against both Alzheimer’s disease and Parkinson’s disease. A large study of older Japanese Americans also found that regular consumption of fruit and vegetable juices was associated with a decreased risk of developing Alzheimer’s disease. Other research indicates that berries, and blueberries in particular, may help prevent the inflammation in the brain that can lead to neuronal damage, as well as improve motor skills, reverse age-related short-term memory loss, and protect the brain from stroke damage.

• Spice it up. Clinical research indicates that extracts of the yellow spice turmeric block the formation of beta-amyloid, the substance responsible for the plaques that slowly obstruct cerebral function in Alzheimer’s disease. And population studies have consistently found lower rates of the disease in India, where people consume turmeric (typically in the form of curry dishes) with most meals.

• Sip green tea. Recent studies suggest that regular consumption of green tea may help protect against Alzheimer’s and other forms of dementia. EGCG, a powerful antioxidant in tea, appears to enhance learning and memory by improving object recognition and spatial memory.

• Have a heart. What’s good for the heart is also good for the brain. Follow my advice for cardiovascular health to help keep both organs running smoothly.

PHOTO LAURA OCKEL

EXERCISE

Exercise is associated with better mental function overall, perhaps because it increases blood flow to the brain. Regular aerobic activity has been shown to lower the likelihood of Alzheimer’s disease in particular by 30 to 50 percent. Follow the fitness recommendations in this guide.

MIND/BODY

• Use it or lose it. In one study, researchers found that people who are cognitively active in old age are 2.6 times less likely to develop dementia or Alzheimer’s disease than those who are less engaged mentally. Clinicians from Rush University Medical Center tested more than 700 study participants, average age 80, every year for up to five years. Ninety seniors who were enrolled in the study developed Alzheimer’s disease during the investigation, and the odds of avoiding the disease correlated with levels of mental “workouts.” The benefits of continued mental stimulation held true even after the investigators controlled for past cognitive activity, socioeconomic status throughout life, and current social and physical activity. Stimulating activities include reading the newspaper or books, working crossword or Sudoku puzzles, playing chess, going to the theater, taking classes, and learning another language, as well as other mentally engaging pursuits.

• Look on the bright side. Studies show

that adopting a positive outlook may help ward off cognitive decline. Social ties, involvement in your community, and meaningful relationships all seem to be protective against dementia.

SUPPLEMENTS

• Add antioxidants. An antioxidant regimen that includes vitamins C and E, mixed carotenes, and selenium should provide you with the basic vitamins, minerals, and other micronutrients necessary to help protect against oxidative damage and age-related disease, including cognitive decline.

• Take B-complex. This supplement will provide adequate levels of folic acid and other B vitamins that help rid the body of homocysteine, a toxic amino acid that has been linked to an increased risk of Alzheimer’s disease, as well as heart attack and stroke.

• Fish oil. The omega-3 fatty acids in fish oil appear to help protect the brain against cognitive decline, depression, and other mental concerns. I recommend supplementing with two to four grams of fish oil a day.

• Phosphatidylserine. Also known as PS, this naturally occurring lipid is essential for the normal, healthy functioning of brain cells and may have positive effects on memory and concentration. Research suggests that it may help slow age-related cognitive decline.

Healthier Bones and Joints

Joints provide flexibility, stability, support, and protection to the skeleton, allowing movement of the limbs and locomotion of the entire body. Cartilage assists in these functions by coating the ends of the bones. Osteoarthritis, often described as “wear-and-tear” arthritis, affects more than 15 million Americans and results from the breakdown of cartilage in a joint, eventually leading to abnormal bone changes. In the early stages of osteoarthritis, the surface of the cartilage becomes swollen, forming tiny crevasses, which hinder normal joint functioning. Inflammation may also occur in the synovium, the soft tissue that lines joints and produces fluid that lubricates the joint

and nourishes cartilage. As cartilage loses elasticity, it becomes vulnerable to further damage from repetitive use, which can cause a great deal of pain and swelling. The joints most commonly affected are the knees, hips, spine, hands, and toes.

Osteoarthritis can result from injury or from repetitive use, although there is often no single cause. Primary osteoarthritis commonly occurs with aging, as the water content in the cartilage increases and the protein portion degenerates. Secondary osteoarthritis is usually due to another disease or condition that affects the joint, such as repeated trauma, infectious disease, gout, or surgery. Obesity is a frequent contributor, as excess weight puts additional stress on the cartilage, particularly in the knees and hips.

Osteoporosis refers to a loss of bone mass in which the bones become porous and fragile. Our bones are constantly being remodeled in response to use and mechanical stressors, with bone tissue being broken down and rebuilt on a regular basis. Bone density (the degree of mineralization of the bone matrix) usually increases until about the age of 30, but it declines after that. Osteoporosis is the result of more bone being lost than can be rebuilt. Eventually, bones become brittle and easily fractured.

Estrogen plays an important role in maintaining bone mass. Once women reach menopause and estrogen levels decline, bone loss escalates. Rapid loss continues for about five years during and after menopause, and can deplete three to four percent of total bone mass. This surge of bone loss eventually tapers off after a few years, and soon equals the amount in men of the same age. But the loss of bone minerals continues throughout the rest of a person’s life.

About one of every three postmenopausal women has osteoporosis to some degree, and even mild osteoporosis leads to an increased risk of fractures, particularly of the hip, vertebrae, and wrists. Fractures can have serious consequences. About 20 percent of elderly women who undergo hip replacement surgery due to a hip fracture die within one year (usually from pneumonia resulting from immobility). And half of those who survive will require full-time nursing care. Bone loss is more gradual in men, but once they reach age 70 their risk for osteoporosis increases significantly. Men in this age group are at increased risk for fractures, particularly if they are sedentary and have a low dietary

intake of calcium or do not have adequate levels of vitamin D. However, regardless of your age and gender, there is much you can do to keep your skeleton healthy.

DIET

• Fight inflammation. Focus on foods rich in omega-3 fatty acids, such as oily, cold-water fish like salmon and sardines, walnuts, freshly ground flaxseed, and spices like ginger and turmeric to help reduce inflammation in joints caused by arthritis.

• Consider calcium. Dairy products (such as yogurt and skim milk); non-dairy, calcium-rich foods such as sardines and canned salmon (with bones); dark, leafy greens; and calcium-fortified products such as soy milk and orange juice are good sources of this essential mineral. Aim for a total of 1,000 to 1,200 mg of calcium a day from all sources, which for women can include 500 to 750 mg in supplement form.

• Stay balanced. Spinach, tofu, almonds, broccoli, lentils, and pumpkin, sesame, and sunflower seeds are particularly rich in calcium.

• Get tested. Calcium is best absorbed in the presence of adequate vitamin D. A simple blood test can confirm that your blood levels of vitamin D are in the optimal range.

• Eat more fruits and vegetables. The phytonutrients and antioxidants found in fresh vegetables and fruit may help reduce tissue damage in joints caused by inflammation. Produce plays a role in healthy bones, too. Several studies have

PHOTO HENRI MEILHAC

reported that higher intakes of fruits and vegetables are associated with significantly higher bone mineral density and lower rates of bone loss in both men and women. Foods that are rich in carotenoid pigments (such as squash, carrots, and sweet potatoes) in particular have been linked to higher total bone mass. Leafy greens are high in vitamin K, which helps activate proteins involved in the structuring and remodeling of bone mass.

• Select soy. Evidence suggests that consumption of whole-soy-based foods may help protect bones and prevent fractures in postmenopausal women. For example, one large study found that the more whole soy foods a woman consumed, the lower her fracture risk—even after accounting for age, calorie intake, osteoporosis risk factors, and socioeconomic status. The study’s authors say that soy’s protective effect may be strongest within 10 years of menopause: Those in this group with the highest intake of soy protein (13 or more grams per day) had 48 percent fewer fractures than women whose soy intake was lowest (less than five grams per day). For women more than 10 years past menopause with the highest soy consumption, the risk reduction was 29 percent.

Try to get one to two servings of whole soy foods per day, an amount

equivalent to one cup of soy milk or one half cup of edamame, tofu, tempeh, or soy nuts.

• Watch protein and sodium intake. Excessive dietary protein can promote calcium loss from bone, and too much salt increases calcium excretion. Shun the salt shaker and read labels carefully—sodium hides in unlikely places.

• Try tea. Some studies have found that regular tea consumption is associated with higher bone mineral density, possibly because of the flavonoid compounds it contains. But don’t overdo it: Excessive caffeine can cause calcium to be excreted from the body (another good reason to avoid caffeinated sodas and energy drinks).

EXERCISE

Regular physical activity benefits both bones and joints as long as it doesn’t stress your skeleton. Strengthening surrounding muscles will support and protect joints, as well as improve and maintain joint mobility. Exercise can also help you shed pounds, alleviating stress on weight-bearing joints like the knees. Avoid intense physical activities that can injure or strain the joint cartilage. The gentlest activities are swimming and other water-based exercises, stationary cycling, and light weight training, all of which put minimal stress on the joints if performed correctly.

SUPPLEMENTS

• Consider calcium. Women may want to supplement their diet with calcium citrate, for a total of 1,000 to 1,200 mg of this mineral a day from all sources. (No more than 500 to 750 mg of that should be from supplements.) Because magnesium is also necessary for bone health (and offsets calcium’s constipating effects), take calcium in divided doses with half as much magnesium. Men should get this nutrient from diet alone, because calcium supplements may increase prostate cancer risk.

• Vitamin D. Research has shown that maintaining adequate levels of this vitamin may be just as important for skeletal health as calcium: Vitamin D facilitates the absorption and use of calcium, promoting bone mineralization. Both men and women should supplement with 2,000 IU of vitamin D (as D3, cholecalciferol) a day.

• Glucosamine and chondroitin. Glucosamine sulfate provides the joints with the raw material needed by the body to manufacture an essential component of cartilage. Chondroitin protects cartilage and attracts fluids that give the tissue its shock-absorbing

quality. If you weigh between 120 and 200 pounds, take 1,500 mg of glucosamine and 1,200 mg of chondroitin daily and expect to continue supplementing for up to two months before being able to assess results.

• Natural anti-inflammatories. Turmeric and ginger may work as well as aspirin and ibuprofen for addressing the inflammatory component of osteoarthritis. Choose a combination product standardized for curcuminoids and pungent compound content, follow package directions, and give it at least two months to fully work.

• SAMe. This naturally occurring molecule (S-adenosyl-L-methionine) is involved with the utilization of sulfur in cartilage to maintain strong joints. Research suggests that SAMe may be as effective as drugs like aspirin and ibuprofen at relieving joint pain from osteoarthritis and improving function. Take 400 mg twice a day for two weeks, then decrease to 200 mg twice a day thereafter. Choose enteric-coated products providing the tosylate disulfate form for best absorption. Take SAMe on an empty stomach and not too late in the day. (It can be stimulating.)

“ Studies have found that regular tea consumption is associated with higher bone mineral density, possibly because of the flavonoid compounds it contains. ”

Idon’t worry too much about getting older—there’s nothing to be done about aging itself. By leading a healthy lifestyle, I’m hoping to reduce the risks and delay the onset of age-related diseases, so that the time of illness and decline at the end of my life will be squeezed into the shortest period. Taking a proactive approach may not only help you live as long and as well as possible, it can also ease your mind. Rather than dwelling on the losses that time may bring, try to recognize and appreciate the benefits of aging, such as richness of experience, depth of character, a more serene disposition, and greater wisdom.

STUDYING CENTENARIANS

Healthy centenarians can serve as priceless examples of aging at its best. I’ve met a number of them during my visits to Okinawa, Japan, home to some of the world’s longest-lived people. Contrary to the notion that advancing age brings steadily declining health, I have seen men and women who have remained vigorous well into older age. According to the Census Bureau, there are currently 80,000 people aged 100 or older in the U.S., and there will be 580,000—a seven-fold increase—by 2040.

While genetics likely plays a significant role in the health and extreme longevity of centenarians, I’m inclined to believe that lifestyle factors are just as important. Centenarians are a diverse lot, and investigators have yet to find a single, specific formula for a long, healthy life. However, some common themes have emerged from centenarian studies in Georgia, New England, and Okinawa.

• Centenarians have either avoided or markedly delayed the onset of diseases normally associated with aging, such as Alzheimer’s disease, cancer, heart disease, and stroke.

• Few are obese, and many say their current weight is close to what it’s been for their entire adult lives.

• Very few smoke or have a significant history of smoking. They drink alcohol in

moderation or not at all.

• They have stayed physically active throughout life. For instance, older Okinawans garden, walk, typically practice some form of martial arts, and perform traditional Okinawan dance.

• Centenarians keep active mentally and are open to learning new things.

• Some studies show that centenarians eat plenty of fruits and vegetables and consequently have a high dietary intake of carotenoids, flavonoids, and other protective phytonutrients, which may help ward off age-related disease.

• They have strong social support networks and maintain close relationships with family and friends. Centenarians are almost never “loners.”

• They handle emotional stress very well. They tend to be optimistic, have a well-developed sense of humor, and are adaptable to change.

• They score low on measures of negative emotions, such as anger, fear, guilt, and sadness, and also have low rates of clinical depression. Many rely on spiritual beliefs and practices to cope with hardship and loss.

While emulating the lifestyle practices of centenarians won’t guarantee that you’ll live to 100, you may well prolong your years of enjoying good health.

KEYS TO LONGEVITY

From human growth hormone (HGH) to DHEA, so-called antiaging products abound. Supplement manufacturers, online retailers, and physicians who practice “anti-aging” medicine claim that men and women who take the latest pill or injection can slow, stop, or even reverse the aging process. However, there are no good long-term clinical trials to back up these claims. Worse, hormones like HGH and DHEA may actually increase the risk of heart disease and certain cancers.

Beyond the financial burden and potential dangers of such products, the entire concept of anti-aging is flawed. First, there is no Fountain of Youth. The myth of some magical substance that can turn back the hands of time or confer immortality has captivated human imagination throughout history, and continues to prove enticing in our youthoriented culture. However, the myth of the Fountain of Youth remains just that—a myth. In contrast to Internet marketing claims, there is no product on the market today that can stall or reverse the aging process.

Another issue with anti-aging remedies is that they are based on the false idea that aging is a disease. Rather, getting older reflects a natural breakdown in the efficiency of the body’s normal maintenance and repair processes. As you age, all the design flaws in the human body eventually become apparent. For this reason, longevity alone isn’t enough. Living to an old age isn’t necessarily better unless it includes staying relatively healthy. To me, it’s more important to maintain a

good quality of life and remain productive and engaged than to aim for extreme longevity.

Fortunately, there’s much you can do to add quality life to your years. Good health habits can’t stop the aging process, but they can help manage related problems, such as joint pain, osteoporosis, and cardiovascular disease. As you’ll discover throughout this guide, a wealth of research suggests that people who live long and healthy lives have a number of lifestyle strategies in common—particularly staying physically and mentally active, eating well, maintaining social connections, and not smoking. Attitude also makes a difference: Studies show that many centenarians have a good sense of humor and a positive outlook. Perhaps someday we’ll unlock the secrets of the biological clock and extend human lifespan. But I don’t think science or technology will ever be able to change the fact that all of us will eventually grow old and die. Aging is a natural process, and if you seek to deny it, you’re fighting a losing battle with an unrelenting and unassailable adversary. It saddens me to see the enormous amounts of money and mental energy that people put into trying to deny the clock, rather than trying to live well and age gracefully.

Nevertheless, I believe we should all do what we can to stay as healthy as possible for as long as possible. For those that can leave behind their denial of getting older, the path to optimal aging begins with basic preventive measures. These often simple steps help ensure that you are doing what you can to minimize risk factors for chronic disease, including staying on top of your health with regular visits to your doctor. The recommendations in this section may seem

like common sense—but they are absolutely crucial to healthy aging.

Keep Track

Your doctor’s office keeps your medical records on file, but you should maintain your own personal medical journal as well. This should include a record of any past illnesses and injuries, treatments you received, and hospitalizations; a list of current medications (both prescription and over-the-counter), as well as any vitamins, herbs, and other supplements you take; and your family medical history. Your family history will help reveal categories of age-related disease for which you are at risk, such as cardiovascular disease, cancer, diabetes, and Alzheimer’s disease. The preventive strategies described in this guide can help you ward off these conditions, which are responsible for most of the premature disability and death in our population.

Get Immunized

Make sure all of your recommended immunizations are up to date. Although the number of vaccinations now recommended for children may seem daunting, I firmly believe that the benefits of immunizing far outweigh the risks. In addition to boosters for immunizations received earlier in life, people age 65 and older should receive both of the pneumonia vaccines now available and an annual influenza shot. The Centers for Disease Control and Prevention has a current listing of all immunizations recommended for adults at cdc.gov/vaccines.

Have a Complete Physical

A comprehensive medical exam should include a thorough history that details your current health status, any symptoms that concern you, previous illnesses and hospitalizations, past medical tests and their results, medications and supplements you take, a description of any allergies you may have, and the health history of your parents and siblings. It should also include your travel and employment history. Your healthcare provider should ask you if you smoke or ever did; whether you drink alcohol and, if so, how much; and if you take any recreational drugs. This information is necessary to allow your doctor to objectively assess your risks of disease. It can also make it easier for you and others to track changes in your health over time, and help you avoid unnecessary medical tests and procedures. This information should mirror that in your own personal medical journal.

The actual physical examination should include measurement of your temperature, height, weight, pulse rate, and blood pressure. The physician should measure your waist circumference, listen to your heart and lungs, and examine your body, including a thorough look at your skin for any signs of skin cancer. Your exam should also include a urinalysis and complete blood work, as well as an electrocardiogram (EKG). A physical will screen for such common conditions as hypertension, diabetes, elevated serum cholesterol, anemia, and liver or kidney problems. Keep a copy of the results in your personal medical record.

As long as you’re healthy, you may not need a physical exam more often than every five years. But if you have a chronic health problem or a strong family history of heart disease, cancer, or other conditions, you should be examined more frequently. I do not routinely recommend annual medical examinations if you are in good health and have no new, persistent, or unusual symptoms. Discuss how often to have physicals with your healthcare provider.

Don’t Smoke

Tobacco use is unquestionably the single greatest cause of preventable illness. While it’s true that some very old people have smoked for years, they probably have rare genes that better help them detoxify the harmful combustion products of tobacco. Most people do not have that kind of genetic protection and are at risk for tobacco-related health problems, including cardiovascular disease, respiratory illnesses, and many forms of cancer.

Not smoking is the single most important thing you can do to promote healthy aging. Quitting reduces your risk of heart disease and lung cancer and may even add years to your life: Although smoking cuts at least 10 years off a person’s lifespan, recent research suggests that if you quit smoking before age 40, you won’t lose those years. Even older smokers who quit will likely see a benefit in terms of longevity.

One large study found that people who gave up cigarettes between the ages of 35 and 44 gained back about nine of the 10 years they would have lost if they continued smoking. Smokers who quit between ages 45 and 54 got back six years, and those who quit between ages 55 and 64 regained four years. The study also concluded that the former smokers retained an increased risk of lung cancer but that it was much smaller than it would have been if they had continued to smoke. The added risk of heart attack from smoking disappeared over time after the smokers quit. Other research has shown that people who quit smoking, even after age 50, lower their risk of heart attack and stroke by 40 percent within five years.

“ Not smoking is the single most important thing you can do to promote healthy aging. ”

Use Alcohol Wisely

While you shouldn’t start imbibing for health reasons if you don’t already drink, there’s reasonable evidence that moderate consumption of alcohol may help promote healthy aging. Research suggests that alcohol itself, as well as antioxidant flavonoids and other compounds like resveratrol (found in red wine), may have beneficial effects on health. For instance, people who regularly drink moderate amounts of alcoholic beverages generally enjoy up to a 50 percent lower risk of some of the most serious and common age-related conditions, including cardiovascular disease, heart attack, type 2 diabetes, stroke, and dementia.

Wine in particular also appears to have an anti-inflammatory effect. A small study in the American Journal of Clinical Nutrition found that women who drank two glasses of wine a day for four weeks had lower levels of C-reactive protein (CRP) and other inflammatory markers. Another study showed that, while both red wine and gin have antiinflammatory effects, people who drink red wine have lower levels of interleukin-1, a marker for inflammation.

But overdoing it can have opposite effects. Research shows that binge drinking—consuming four (for women) or five (for men) alcoholic drinks in a two-hour period may contribute to clogged arteries. When fatty deposits build up on artery walls, the body activates immune cells called monocytes, which can in turn increase inflammation. If you drink, do so in moderation: That’s no more than one daily alcoholic beverage for women and people over age 65, and no more than two a day for men

under 65. For some people, the risks of alcohol outweigh the benefits. Strongly consider abstaining if you:

• Have or are at increased risk of breast cancer

• Are prone to depression or other mental illness

• Have liver disease or gastrointestinal problems

• Have a personal or family history of alcoholism or other addictions

• Are allergic to compounds in wine or other alcoholic beverages (symptoms include wheezing, hives, and chest tightness)

• Take medications that interact with alcohol

The Tests You Need

As you get older, a standard battery of medical tests can help you and your doctor gauge your risk of developing chronic, age-related conditions. I recommend discussing the periodic need for the following screening tests with your healthcare provider.

• Blood glucose and A1C: These tests examine how well your body utilizes sugar. They are used to confirm and monitor diabetes, as well as long-term control of blood sugar.

• Blood pressure: You should get this test every one to two years if your blood pressure is normal. If your test falls outside the normal range, your blood pressure should be checked frequently, especially if you start new medications.

• Bone density/DEXA scan: Anyone at high risk for osteoporosis (specifically, women who are light-boned and fair-skinned or whose mothers had osteoporosis) should have this test. It can help determine your bone mineral density and track how it changes over time. All women age 65 and over should have at least one DEXA scan to gauge the condition of their bones.

• Cholesterol: Have your cholesterol tested every five years. You want a complete lipid panel that measures

total cholesterol, LDL, HDL, cholesterol ratio (total cholesterol divided by HDL), and serum triglycerides. If you have high cholesterol, you should be tested yearly. You should also request measurement of serum homocysteine and CRP, which are clinically useful indicators of heart disease risk.

• Complete blood count (CBC): A CBC measures your red blood cells, white blood cells, and platelets and evaluates their size and shape. A low red blood cell count might indicate anemia, while changes in the number and types of white blood cells can signal problems in the bone marrow where these cells are made.

• Colonoscopy: You should get this test for early signs of colorectal cancer every 10 years starting at age 50, or earlier if you have a positive family history of the disease. If you have positive findings, such as polyps, it will need to be repeated more often.

• Dental exam: Everyone, regardless of age, should have a dental checkup once or twice a year.

• Eye exam: This test is recommended every two to four years between ages 40 and 65 and every one to two years after age 65. If you wear glasses or contacts, you should have your eyes checked annually, regardless of your age.

• Liver panel: This test measures your liver enzymes and indicates the general health and functioning of that organ. Be sure to ask for this panel if you’re taking any medication that might affect your liver.

• Mammogram: I agree with the U.S. Preventive Services Task Force, which now recommends that women delay getting regular mammograms until age 50. Women

at higher risk or with a family history of breast cancer should discuss earlier screening with their doctor.

• Pap smear: Women need Pap smears every one to three years to help detect abnormalities that may precede cervical cancer.

• PSA test: This test for prostate specific antigen (PSA), a protein produced by prostate cells, is best used to monitor for the recurrence of cancer after surgery. It can also be used as a screening tool to warn men of prostate cancer. False positives are common, however, and even when the test does detect cancer, it provides no information about how aggressive it is or how likely it is to spread. Until we have a reliable followup test to show whether or not a tumor is aggressive, I doubt the wisdom of using PSA as a screening tool, except for men at high risk of prostate cancer on the basis of family history or lifestyle. A newer test, the pro-PSA, may be better. Discuss prostate screening with your physician.

• Renal panel: This test tells you how well your kidneys are functioning. It includes measures of sodium, potassium, calcium, urea nitrogen, creatinine, carbon dioxide, chloride, glucose, and phosphate.

• Skin exam: Check yourself monthly for new moles or any changes to existing moles. I recommend having an annual skin exam by a physician regardless of your age. Follow your doctor’s recommendations for more frequent exams if you’ve had any type of skin cancer.

• Thyroid test: All adults, particularly women, should be screened for thyroid disorders at the age of 35 and every five years thereafter.

NUTRIENTS FOR HEALTHY AGING

There’s no doubt that nutrition plays a powerful role in helping determine whether you will remain healthy and energetic as you age. Along with physical activity (and not smoking), a wholesome, balanced diet is one of the key factors in achieving longevity and protecting against chronic, age-related diseases. By following the anti-inflammatory diet described in Section Three and outlined in detail in my books and newsletter, you can do much to improve your longevity.

As we get older, we don’t necessarily need different nutrients as much as we may need different dosages to compensate for some of the age-related changes in our bodies. For example, our skin is less able to synthesize vitamin D with aging, and we also may spend more time indoors. As a result, we may not get enough sun exposure to trigger adequate synthesis of vitamin D, a hormone that assists in the absorption of calcium and promotes bone mineralization. Another vitamin seniors may not absorb as readily as they once did is vitamin B12. The problem is that we need stomach acid for its optimal absorption, but as we age, our bodies often produce less acid. In addition, if you suffer from heartburn or acid reflux, you may be taking over-the-counter or prescription drugs called protonpump inhibitors or histamine-2 receptor antagonists. These work by inhibiting stomach acid production, raising the risk of vitamin B12 deficiency.

After menopause, as estrogen levels fall, so does a woman’s ability to absorb calcium. I recommend that women supplement with 500 to 700 mg of calcium citrate in two divided doses taken with meals for a total of 1,000 to 1,200 mg a day from all sources (including food). I do not recommend calcium supplements for men (except on the advice of a physician). Instead, I suggest that men try to get 500 to 600 mg of calcium daily from their diet. All men, and women that have reached menopause, should not take supplemental iron unless instructed to by a physician. The body stores iron readily, and the only way the body can rid itself of iron is through blood loss. In addition, some people have a genetic trait that makes them store iron excessively. As a strong pro-oxidant, too much iron in the body can increase the risk of cardiovascular disease and cancer.

Taking supplements does not excuse you from eating a healthy diet that emphasizes whole foods, including a variety of fresh fruits and vegetables. Think of them as insurance against gaps in your diet. Some have specific preventive or therapeutic effects when taken at doses higher than you can get from food. Here are the supplements every older adult should consider taking on a daily basis.

ACETYL-L-CARNITINE AND ALPHA-LIPOIC ACID

Also known as ALCAR, acetyl-L-carnitine was synthesized to provide a more bioavailable form of L-carnitine, a compound that is made naturally in the body by the liver and kidneys and is then transported to other organs, such as the brain and heart. Like L-carnitine, ALCAR functions as an antioxidant and promotes cells’ production of glutathione, a free radical scavenger. ALCAR also helps increase the efficiency of energy production in the mitochondria, the “power plants” of cells throughout the body, and has been shown in some studies to help protect against Alzheimer’s and heart disease.

Alpha-lipoic acid (ALA) is a manufactured version of lipoic acid, a naturally occurring compound produced in the body and synthesized by both plants and animals. Like ALCAR, this antioxidant is vital to cellular energy production, and helps to neutralize the damage caused by free radicals. ALA may help increase insulin sensitivity and defend against metabolic syndrome. It may also help improve memory via its protective effects on brain and nerve tissue.

Interestingly, when these two compounds are taken together, they may be particularly

effective at promoting healthy aging. In preclinical tests, renowned geneticist and biochemist Dr. Bruce Ames and his colleagues at the University of California, Berkeley, discovered that a combination of ALCAR and ALA appears to help maintain the health of mitochondria, effectively slowing the cellular aging process. (Over time, mitochondria become less efficient at converting fuel to energy.)

Food sources: The primary dietary source of ALCAR is red meat, particularly mutton. Very small amounts of lipoic acid can be found in plant-based foods, such as spinach. How to take: The easiest way to supplement with ALCAR and ALA is to take a combination product. UC Berkeley has patented the combination used in Dr. Ames’s research. I have been so impressed by the evidence to support it that I take this preparation myself and have made it available for sale on my website under the brand name Weil Juvenon. (I donate all of my after-tax profits from the sale of Weil Juvenon directly to the Weil Foundation, a notfor-profit organization dedicated to supporting integrative medicine through training, education, and research.) If you take Weil Juvenon, be sure to follow package directions. Alternatively, you could take both compounds separately: The dose for ALCAR is 500 to 1,500 mg daily, and the dose for ALA is 100 to 200 mg once or twice daily.

Keep in mind: Rarely, ALCAR and ALA can cause mild side effects, such as nausea, vomiting, abdominal cramps, headache, rash, and an increase in agitation or restlessness. ALCAR may also cause an increase in seizure frequency in people with seizure disorder.

ANTIOXIDANTS

If you are familiar with my books and website, you are probably already aware of the importance of a daily antioxidant regimen. Because our bodies use oxygen to burn fuel, normal metabolism produces highly reactive compounds that can damage structures within our cells. Humans have evolved natural defenses against these harmful free radicals, and antioxidants are a special class of micronutrients that can help prevent the oxidative damage caused by them. Over time, oxidative damage may be responsible for many of the degenerative changes of aging, as well as many age-related diseases. Vitamins C and E, selenium, and carotenoids are examples of antioxidants found naturally in many foods. Other antioxidants include catechins in green tea and resveratrol in red wine.

Food sources: Eating a wide variety of whole foods, especially fruits and vegetables—such as tomatoes, watermelon, papayas, blueberries, carrots, and leafy greens—as well as herbs and spices and drinking beverages like green tea will provide a wide range of beneficial antioxidants. However, even if you are conscientious about healthy eating, it can be difficult to consume optimum amounts of the major antioxidants on a daily basis.

How to take: I have long recommended that adults take four antioxidants in supplement form daily to promote good health: 200 mg of vitamin C, 400 IU of natural vitamin E (as mixed tocopherols, or at least 80 mg of mixed tocopherols and tocotrienols), 200 mcg of selenium, and 15,000 IU of mixed carotenoids (including lycopene and beta-carotene, a precursor to vitamin A, as well as lutein, alpha-carotene, zeaxanthin, and others.). You should take antioxidant supplements with meals to enhance absorption and to reduce the risk of an upset stomach. Selenium and vitamin E facilitate

each other’s absorption, so you should take them together if possible.

Keep in mind: When taking antioxidants, be mindful of selenium: Doses much higher than 400 mcg a day may cause hair loss, gastrointestinal upset, fatigue, irritability, and even cirrhosis of the liver. Taking high doses of beta-carotene has been shown to increase orange pigmentation of skin, although this is not harmful and often disappears after reducing beta-carotene intake for a few days. Smokers, former smokers, and those who are or have been exposed to asbestos may have an increased risk of lung cancer if they supplement with isolated beta-carotene, which I do not recommend taking.

B-COMPLEX

Many of the B vitamins are necessary for optimal aging: Vitamin B3, also known as niacin, helps protect against cardiovascular disease and high cholesterol. Vitamin B6 is necessary for strong immunity, particularly in older people, as well as for nerve function. Vitamin B12 also plays an integral role in our nervous system and supports adrenal function. Folic acid (vitamin B9), which appears to be especially important in our younger years for fertility and development of healthy babies, may help lower the risk of cardiovascular disease and cervical cancer as we get older.

Food sources: You can find vitamin B3 in salmon and tuna, eggs, leafy vegetables, broccoli, tomatoes, carrots, sweet potatoes, avocados, nuts, whole grains, legumes, and mushrooms. Leafy greens are also high in folic acid. Nutritional yeast, bananas, cereal grains, legumes, vegetables (especially carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, and sunflower seeds are rich in vitamin B6, while animal-derived foods are

the only reliable sources of vitamin B12, including dairy products, eggs, meat, fish, poultry, and shellfish. Some foods, such as orange juice and cereal, may be fortified with B vitamins.

How to take: To make sure you’re getting a full complement of B vitamins, I recommend taking a daily B-50 B-complex supplement that contains no more than 400 mcg of folic acid.

Keep in mind: High doses of vitamin B3 can cause flushing, itching, nervousness, headaches, gastrointestinal upset, and liver toxicity; doses in excess of 3 g a day should be used only under careful medical supervision. High doses of vitamin B6 (over 100 mg a day) can result in irreversible nerve damage or numbness and tingling in the extremities. Too much B6 can also cause oversensitivity to sunlight, which can lead to skin rashes and numbness, as well as nausea, vomiting, abdominal pain, loss of appetite, and abnormal liver function. Such problems are very unlikely if you limit yourself to one B-50 B-complex supplement a day.

CALCIUM

The most abundant mineral in the body, calcium is best known for its role in building and maintaining strong bones and teeth, but it is also required for proper functioning of the heart, muscles, and nervous system. It plays a major role in maintaining normal blood pressure, regulating blood clotting, and preventing cancers of the digestive tract.

Food sources: Dairy products are high in calcium: Two glasses of milk provide 1,000 to 1,200 mg of this mineral. However, you don’t need to consume dairy products to get adequate calcium. Non-dairy foods rich in calcium include greens such as collards, mustard, kale, broccoli, and bok choy; canned salmon (with bones) and

sardines; calcium-fortified soy milk, tofu, fruit juice, sesame seeds, and cereals; and blackstrap molasses. If you do choose to include dairy in your diet, make sure you use only hormone-free, organic brands to reduce your exposure to the antibiotics and hormones found in many dairy products.

How to take: If you eat a calcium-rich diet, you may not need to supplement at all. I recommend that women aim for a total of 1,000 to 1,200 mg of calcium a day from all sources, with no more than half of that amount coming from supplements. Calcium citrate is my preferred supplemental form, as it is more easily absorbed. Take it in divided doses with meals, and with half as much magnesium. I do not recommend that men take calcium supplements at all, as they have been linked to a higher risk of prostate cancer. Instead, men should try to get about 500 to 600 mg of calcium a day from their diet.

Keep in mind: Calcium supplements can be constipating, but taking them with magnesium can neutralize this effect. Because vitamin D is key to calcium absorption and utilization, an adequate D intake is critical to bone health. I recommend having your D levels checked (see below). Excessive amounts of calcium may cause nausea, vomiting, loss of appetite, and increased urination. More serious complications include kidney toxicity, confusion, irregular heart rhythm, and an increased risk of prostate cancer in men. Avoid bonemeal and dolomite as sources of calcium; the FDA has issued warnings about these products because they may contain lead.

COENZYME Q10

The body naturally produces this antioxidant, but our levels of coenzyme Q10 (CoQ10)

decrease over time—an 80-year-old person has far lower amounts of it than a 20-yearold. CoQ10 is beneficial for heart health in many ways: It assists in maintaining the normal un-oxidized state of LDL (“bad”) cholesterol, helps promote circulatory health, and supports optimal functioning of heart muscle. CoQ10 may help support the health of vessel walls. There is also some evidence that it can help lower blood pressure, reduce the frequency and severity of migraines, and slow the progression of Alzheimer’s and Parkinson’s disease. Statin drugs that lower cholesterol also suppress production of CoQ10, contributing to the fatigue and aching joints and muscles that can be side effects of those medications. If you are on a statin, you must take supplemental CoQ10.

Food sources: Foods such as fish and meats and oils from soybean, sesame, and rapeseed (canola) are good dietary sources of CoQ10. However, the typical American diet only provides approximately 10 mg of this compound daily, so supplementation is usually necessary to obtain the amounts required for maintaining cardiovascular health.

How to take: I recommend taking at least 90 to 120 mg of supplemental CoQ10 if you have a family history of heart problems, are at increased risk for cardiovascular disease, or are on a statin. This dose is also appropriate for healthy seniors as a preventive measure to help maintain a healthy cardiovascular system.

CoQ10 is fat-soluble, so take it with a meal containing some fat. Seek out softgel ubiquinol forms, as these may have the greatest antioxidant efficiency.

Keep in mind: There is limited research on the toxicity of CoQ10, but preliminary

evidence indicates that supplemental doses of up to 1,200 mg a day have no known adverse side effects and may be beneficial for those with Parkinson’s disease.

FISH OIL

Both omega-3 and omega-6 are essential fatty acids, which means the body cannot make them and must get them from foods. Although both fats should be consumed in roughly equal amounts, today’s modern American diet—full of refined vegetable oils, fried foods, and junk foods—provides a great overabundance of omega-6s. The result is an imbalance of these essential fats that drives inflammation and promotes agerelated disease.

Research indicates that the omega-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can contribute to optimal aging. EPA supports heart health, while DHA is believed to play an important role in normal brain development and function. Omega-3s also decrease inflammation and may thereby help reduce the risk and symptoms of a variety of disorders rooted in chronic inflammation, including heart attack, stroke, several types of cancer, and autoimmune diseases such as rheumatoid arthritis.

Food sources: Oily, cold-water fish such as wild Alaskan salmon, mackerel, sardines, herring, and sablefish are rich in omega-3 fatty acids. You can also find alpha-linolenic acid (ALA), a precursor to the essential omega-3s, in plant foods, such as freshly ground flaxseed, walnuts, hemp seeds, and the green vegetable purslane, but do not rely on vegetable sources alone, because the body’s conversion of ALA to EPA and DHA is inefficient.

How to take: I recommend eating oily fish and other sources of omega-3s two or three times a week. If you have or are at high risk for cardiovascular disease, consider supplementing with 2 to 4 g of EPA + DHA daily. Choose brands of fish oil that are molecularly distilled to be free of contaminants (such as mercury and PCBs), and include both EPA and DHA. Vegan omega-3 products made from algae are now available; they provide both EPA and DHA.

Keep in mind: Because they can affect blood clotting, use fish oil supplements cautiously if you’re taking anticoagulant drugs such as Coumadin (warfarin), have had a hemorrhagic stroke, or are scheduled for surgery. People with allergies to fish should avoid fish-derived omega-3 capsules.

VITAMIN D

Actually a hormone, vitamin D assists in the absorption and utilization of calcium and promotes bone mineralization, which may prevent or slow the progression of osteoporosis. Research suggests that vitamin D also helps to strengthen

the immune system; prevent hypertension, type 2 diabetes, and several autoimmune diseases (including multiple sclerosis and rheumatoid arthritis); and reduce the incidence of bone fractures. In addition, a growing body of evidence suggests that it benefits brain function and emotional health and may protect against cancer: Studies have linked vitamin D deficiency to as many as 18 different cancers.

Vitamin D may be particularly important as we get older. Researchers have found that people over the age of 60 only produce about one-third of the amount of vitamin D from sun exposure as they did in their 20s, possibly because the enzymes needed to synthesize this vitamin are less abundant. That’s a problem, since low levels of vitamin D have been linked with poor cognitive performance in seniors. On the other hand, research shows that getting adequate amounts of vitamin D is associated with significantly lower levels of inflammation and body stress, factors that can slow aging.

Food sources: Good sources of vitamin D include fortified foods, eggs, salmon, tuna, mackerel, and sardines. However, it is not possible to get enough vitamin D from diet alone. While fortified foods such as milk and cereals are available, most provide vitamin D2, a form that isn’t used as well by the body as vitamin D3.

How to take: Based on recent research, I recommend 2,000 IU of vitamin D per day. Look for supplements that provide D3 (cholecalciferol) rather than D2 (ergocalciferol). Get your blood level of vitamin D tested; if it is very low, your

Longevity in a Pill?

You may be familiar with claims that resveratrol, an antioxidant compound found in red grapes and other plants—as well as in red wine—may help slow the aging process. One well-publicized study at Harvard Medical School showed that resveratrol helped prevent the negative health effects of weight gain (enlarged liver, high insulin levels, and diabetes) in mice fed a high-fat diet—and reduced the animals’ risk of death by 31%. As they got older, the mice that received resveratrol also performed better on tests of balance and coordination than did their peers. Other research has shown that this antioxidant appears to mimic the effects of caloric restriction in extending longevity.

However, to get the dose of resveratrol used in this research (24 mg per kilogram of body weight), you would have to drink far more wine than is sensible, or even possible. If you do drink, switching to red wine might be a healthier option than other forms of alcohol, but if you don’t drink, resveratrol is not a good reason to start. You can get resveratrol in your diet simply by eating more fruits with deep red and purple hues, such as grapes, blueberries, raspberries, blackberries, and cranberries.

Ongoing toxicology testing should tell us how much resveratrol is safe for human consumption, particularly in supplement form. Yet these products may not be the way to go: One study found that resveratrol may block many of the cardiovascular benefits of exercise in older men. Researchers at the University of Copenhagen looked at the effects of supplemental resveratrol (250 mg a day) in 27 healthy sedentary men with an average age of 65. All of the men then performed high-intensity exercise training, while half received resveratrol and half received a placebo pill.

After eight weeks, although exercise improved heart health, resveratrol supplements appeared to blunt the expected benefits in several areas, such as blood pressure, serum cholesterol, and oxygen intake. These surprising findings contradict studies in animals that suggested an opposite effect. For now, I recommend getting your resveratrol from food, not supplements.

physician may prescribe higher doses initially. (No adverse effects have been seen with supplemental vitamin D intakes up to 10,000 IU daily.)

Keep in mind: Since sunlight stimulates synthesis of vitamin D in the skin, prudent daily sun exposure is helpful: Aim for about 10 to 15 minutes a day before you put on sunscreen. But remember, this is no guarantee that you’ll meet the recommended daily dose of vitamin D, particularly if you have dark skin, take medications such as corticosteroids, or live at higher latitudes where strong sunlight is limited for much of the year.

The Skinny on Calorie Restriction

You know that what you eat can influence whether you age gracefully or poorly, but could the amount you eat be even more important? Research has long shown that rats, mice, worms, flies, fish, and other creatures kept on low-calorie diets live longer and enjoy better health than those allowed to eat more food. This concept is known as caloric restriction, or consuming barely enough calories than necessary for weight maintenance while avoiding malnutrition. About a decade ago, a study by researchers at University College London found that restricting the diets of fruit flies beginning at two to three weeks into their lives (which is about middle age for them) doubled their life span to 90 days.

Since then, studies have found that calorierestricted animals are less likely to develop diabetes and heart disease. Researchers have

shown that caloric restriction may have more of an impact on lifespan than maintaining a healthy weight and exercising—at least in rats. Other research has produced conflicting results: Two recent long-term studies on the effect of calorie restriction in rhesus monkeys had opposite conclusions, with one finding that it does not affect mortality and the other finding that it does.

We still don’t yet know if what works well for mice and monkeys will also work for humans. Investigators at Harvard Medical School have found that the stress of caloric restriction appears to activate two genes (SIRT3 and SIRT4) that produce enzymes found in mitochondria, the tiny “powerhouses” in our cells that generate energy and regulate metabolism. This gene activation may help slow cell aging. And in 2006, researchers found that when overweight people cut their caloric intake by 25 percent (to 1,500 calories a day instead of 2,000, for example), their insulin levels and amount of DNA damage both decreased.

Such results are intriguing, but I remain skeptical about caloric restriction in general. We simply don’t know enough about its longterm consequences in humans, and there’s no guarantee that it will extend your life. The difficulties involved, such as frequent hunger and feeling deprived, may not be worth it. That said, I do think that modest caloric reduction—cutting out a few hundred calories a day—as well as intermittent fasting can be beneficial for health, especially if you are overweight or obese.

SWEAT EQUITY

The human body was made for movement throughout life, and to maintain optimal health as we age, we need to keep it moving. Yet in today’s world, it’s all too easy to remain sedentary, whether that means driving when you could be riding a bike or sitting on your couch when you could be walking outside. Physical activity affects every system of the body. It’s not surprising, then, that so many chronic, age-related diseases are on the rise.

If you need a reason (or several) to become more active, consider this: According to a recent review of 40 studies, published in the International Journal of Clinical Practice, apart from not smoking, being physically active is the most powerful lifestyle choice someone can make to improve his or her health. The authors note a broad spectrum of benefits conferred by exercise, including a lower risk of coronary heart disease, stroke, diabetes,

obesity, osteoporosis, and some types of cancer. Other studies suggest that regular physical activity may also lower the risk of falls and fractures and may help preserve memory and cognitive function.

Recent research shows that it’s never too late to reap the rewards of fitness. In 2010, four articles and a commentary published in the Archives of Internal Medicine highlighted the importance of exercise at any age: The authors found that physical activity is associated with a reduced risk or slower progression of several age-related conditions, less disability, and better overall health and longevity. Other evidence links exercise to the health of telomeres, the protective “caps” on the ends of chromosomes that are a barometer of cell health and age. Investigators at the University of California, San Francisco, have found that chronic psychological stress appears to shorten telomeres in cells, a problem associated with cardiovascular

disease, cancer, and other age-related diseases. The good news: Regular physical activity may moderate the impact of stress, protecting telomeres against damage.

Knowing the benefits of fitness is one thing, but taking advantage of them is quite another. Today, city streets are filled with joggers and cyclists, people flock to spas and health clubs, and whole new classes of professionals have sprung up, such as exercise physiologists, sports medicine doctors, fitness advisers and aerobics instructors, and personal trainers. Yet I still meet many people who think that exercise is only for athletes, and many others who go about exercise in ways more likely to harm them than to better their health.

Up until my late twenties I hated exercise. Since then, I haven’t felt right if I let a day pass without being physically active. In my experience, the key has been finding types of fitness that I truly enjoy, so that “working out” becomes less about work and more about fun. There is no shortage of options: Within the four recommended forms of exercise (aerobic, strength training, flexibility, and balance) there are seemingly endless choices to make your own fitness regimen anything but dull. Be sure to consult your physician when beginning a new exercise routine.

Aerobic Activity

You don’t need to run a marathon (or run at all, for that matter) to experience the beneficial effects of aerobics, but you should be moving at a sustained, continuous pace that challenges you and makes it difficult

to carry on a conversation. I agree with the recommendation of the Centers for Disease Control and Prevention that adults get 150 minutes of aerobic exercise a week, or 30 minutes five days a week. You don’t have to do all 30 minutes at once: Studies suggest that informal bouts of 10 minutes here and there throughout the day may be just as effective as longer sessions.

I tend to get bored doing any one aerobic activity and find that I am more likely to stick with my program if I make it as varied as I can. I like to walk, hike, cycle, swim, and dance, and I try to mix all of these up. Gardening, yard work, and housework can be aerobic, too, if you do them vigorously enough. Here’s more information about some of the most popular forms of aerobic exercise.

Aerobics classes. If you belong to a fitness club, you are probably familiar with these classes, which typically involve jumping, running, and dancing. To my taste, aerobics classes are less fun than spontaneous, freeform activity, but I recognize that they work well for many people: Because aerobics classes are organized and structured, they are often better suited for those who have a hard time committing to exercise. Be careful to start off at the level of difficulty you are comfortable with and seek out “low-impact” aerobics classes, which are meant to be less jarring. Water aerobics are a great alternative, because the buoyancy of the water takes the weight off your joints but still provides some challenging resistance—a good choice for people with arthritis and related conditions.

Climbing stairs. Although it looks simple enough, one of the most physically demanding

exercise machines is the stair climber. Look for it at fitness clubs and consider one for your home if you like it. Even using this machine at relatively slow speed, I am quickly drenched in sweat and obviously working hard during a 30-minute climb. Skip this exercise if you are significantly overweight; it can be too much effort for your heart and can traumatize your joints. A newer version, the elliptical trainer, gives a much smoother workout that is easier on knees and adds arm motion. Even climbing actual stairs can be surprisingly strenuous if you go up more than one flight at a time or do it many times a day, as I do. If you have stairs in your home, use them frequently. Whenever possible, walk up (and down) stairs instead of taking elevators and escalators.

Cross-country skiing. Rated as a best all-around aerobic exercise by many fitness experts, cross-country skiing works more muscles than other activities and is very efficient at conditioning the cardiovascular system. If performed properly, risk of damage to the body is low, and mastery of this sport can give you a great deal of pleasure. The disadvantages are obvious. You can do it on a regular basis only if you live in a suitable area, and then only seasonally. Most people have to learn how to ski, ideally from a qualified instructor. Even if you have a suitable outdoor environment, you still have to buy and maintain the necessary equipment. Indoor cross-country ski machines are available at many health clubs and can be installed in the home. They are slightly harder to learn to use than stationary bikes but somewhat less boring and give a better workout.

Cycling. This activity is growing in popularity, but to make it effective, you’ll need to cycle at a rate of at least 10 to 15 miles an hour, either on a bicycle or stationary bike. Cycling can provide an exhilarating feeling of speed and freedom and give you access to beautiful surroundings that will make your exercise time more enjoyable. It is also a good choice for people with bad knees, because it strengthens the muscles that support the knee without traumatizing the joint, leading to greater stability and a lesser chance of injury in the future.

If you decide to invest in a bicycle, test out different kinds first. Many that are designed for racing sacrifice comfort for a degree of speed you will never need. A cycle must be designed, sized, and adjusted correctly for your body, or it will soon cause you problems. Cycle seats are a particular difficulty. Uncomfortable ones can irritate your skin and leave your bottom very sore, and poorly fitted saddles can even injure nerves by compression. Even with the right bike and seat, jarring motion to the spine and pelvic area can exacerbate back problems and aggravate prostate trouble in men.

Although the actual physical activity of cycling is much safer than running, cycling itself can be more hazardous, depending on where you choose to ride. The main danger is from motor vehicles, which greatly detract from the pleasure of a ride if you always have to share the road (and air) with them. Not only do you have to keep most of your attention on the cars rather than on the scenery, you also have to breathe their fumes. Cycling is much more attractive as a regular exercise if you can enjoy it off road or have access to bike paths or roads with little traffic, but keep in mind that

the weather may ultimately dictate when and where you ride.

As an alternative, you can use a stationary bike in a health club or at home. These come in many models, some of them very expensive and with a lot of computerized gadgetry. Try putting it in front of the television (nature shows can be especially absorbing), or read a book while pedaling. Indoor group cycling has become immensely popular at health clubs. It uses specially designed stationary bikes and participatory coaching to give an intense workout, made more fun by performing it with others.

Dancing. This is one of the best aerobic activities of all, in my opinion, and perhaps also the most fun, a tonic for the mind and spirit as well as the body. Dancing can give as thorough an aerobic workout as any of the activities mentioned so far, is never boring, and definitely promotes health. Some of the healthiest seniors I see are those who dance regularly. Since dancing is traditionally a social activity, people are likely to forget that they can do it by themselves. Sometimes on badweather days I put on a favorite album and get my aerobic workout by dancing around my living room. If you decide to dance, whether at home or at a club, doing ballroom, salsa, Zumba, belly dancing, square dancing, or something else, you’re bound to enjoy it.

Jumping rope. Athletes have long used this activity as an efficient aerobic conditioning exercise. It has several advantages, among them extreme portability. Jump ropes are inexpensive compared to other exercise equipment, and you can take them anywhere. When I was younger, I used to jump rope in hotel rooms and roadside rest areas when I

was on the road, as well as inside and outside my house. (My knees no longer want me to do it.) The rhythm of this activity, when you become proficient at it, is hypnotic in a way that makes time pass quickly and smoothly, offsetting the monotony.

Rope jumping gives an excellent cardiovascular workout and uses both arm and leg muscles. Mastering it takes a bit of practice: You want to be able to sustain a steady rhythm and use a smooth dance step (one foot at a time rather than both together) without lifting your feet very high. You will probably not want to jump rope continuously for 30 minutes, but you can intersperse it with other exercise routines, such as jumping on a minitrampoline or dancing.

Running. This age-old aerobic activity has

become very popular in our society in recent years. The great advantage of this form of exercise is its intensity. It promotes fitness quickly and efficiently and burns more calories than other activities, making it attractive to people who want to control their weight. Because of its intensity, running releases endorphins in many people, creating the runner’s high that can lift mood dramatically. For more on this form of exercise, see Section Three of this guide.

Swimming. For most people, swimming is less convenient than running or walking because it requires access to a pool and some skill. However, exercise in water offers several advantages that other forms of aerobic activity cannot. Water neutralizes the force of gravity, allowing free movement of joints and muscles. This makes

swimming the activity of choice for anyone with musculoskeletal problems, such as arthritis or traumatic injury. Many people get into a desirable altered state of consciousness while swimming, brought about by the feelings of freedom and buoyancy water provides and by rhythmic breathing. Unlike walking and running, “treading water” uses the upper body as well as the lower, giving a more balanced muscular workout. It does not provide as intense a cardiovascular workout as running does; nor does it increase bone density, as it eliminates the weight bearing aspect of exercise.

To use swimming well as aerobic conditioning, you should develop good form—meaning good posture in the water, an efficient stroke, and breathing synchronized with movement. It may help you to work with a trainer for a while to improve your form if you intend to use swimming as your main exercise. The freestyle or crawl is the best stroke for aerobic swimming. Water aerobics, a combination of swimming, dance movements, and calisthenics, is taught in classes at many health clubs and can be much more interesting than swimming laps.

The disadvantages of swimming have to do mostly with pools. Unless you are lucky enough to live near a swimmable body of water in a favorable climate, a lot of your swimming will be done in public pools. These environments are often not inspiring, and chlorinated water can be very bad for your eyes, skin, and hair, as well as for the membranes of your nose, mouth, and upper respiratory passages. Be sure to wear goodfitting goggles or even a mask and snorkel,

which can also help you achieve better posture in the water.

Walking. One of my favorite forms of exercise, walking offers the great advantage of requiring no skill or practice. Everyone knows how to do it, and the only equipment you need is a good pair of shoes. You can walk outdoors or indoors (in shopping malls, for example). It is probably the safest option of all, with the least chance of injury. For more about walking, see Section Three of this guide.

Strength Training

Many older people avoid strength training, believing that it is a type of exercise only for the young. Nothing could be further from the truth: Also known as resistance training and weight lifting, strength training is an integral part of any well-rounded exercise program and has myriad benefits for young and old alike. For example, research links regular strength training to better balance, a lower risk of falls and fractures, better blood sugar control, reduced pain from arthritis, less depression, and improved cognitive function. Studies even show that people in their 90s can improve strength and walking speed through weight training.

The object of strength training is to work your body’s major muscle groups. Having your skeletal frame bear weight is an added benefit. When lifting weights, you must use proper technique and stance in order to avoid injuries and ensure you’re using your muscles correctly for each exercise you do. Hiring a trainer can be expensive but will pay off in the long run, if only by saving you from injury. Health clubs typically carry a wide range of free weights and weight machines. If you’re strength

training at home, you’ll need an exercise ball and some hand weights, from three to 12 pounds depending on your abilities. The American College of Sports Medicine recommends the following exercises:

• Upper body: Bicep curls, tricep extensions (for the arms); shoulder presses, bench presses, and bent-over row.

• Torso: Abdominal curls (sit-ups with arms folded across your chest); opposite arm and leg raises (positioning yourself on your hands and knees, lift the opposite arm and leg for five to 10 repetitions, then do the opposite arm/leg).

• Legs: Squats or lunges and heel raises.

Start out using light weights and do sets of 15 to 20 repetitions for every exercise. Your final daily routine should include two to three sets of eight to 12 repetitions each for every exercise. When working with weights, keep in mind these tips from the ACSM:

• Always exhale with the effort you’re making and inhale during the easier phase of the movement.

• Be sure to control your movements. Don’t swing the weights or let momentum move them, a sure set up for injury.

• Never lift with your back when picking up weights from the floor; use your legs instead.

• Allow 48 hours between strength training sessions for your muscles to rest and repair.

Flexibility Exercises

Activities that increase your flexibility can also improve your range of motion, as well as the tone and health of your muscles, tendons, ligaments, and joints—plus they just feel good. All of us tend to stretch after being in one position for a long time, and students of the human body tell us we ought to make a habit of stretching in opposite ways from the positions we spend the most time in during the day. For instance, if you work leaning over a desk, when you get home you should

spend a few minutes with your head, neck, and shoulders arched backward.

Yoga is a popular flexibility exercise, but it involves much more than just stretching. For more on yoga, refer to Section Three of this guide. You can learn to do yoga at any age, and while there are plenty of books, DVDs, and even smart-phone apps to guide you, it is easier to learn it initially from a teacher. Yoga classes are widely available through health clubs, community centers, and universities. You can practice on your own once you learn the basics, and you do not need to spend any specified amount of time at it to realize a benefit.

Balance Exercises

Maintaining good balance is our safeguard against injury from falls, especially as we get older. Getting in and out of a car, climbing stairs, and even walking all require proper balance, which is based on input from three sensory systems: visual, spatial, and vestibular. All three of these systems can lose efficiency with age, a problem compounded by hearing and vision difficulties, limited flexibility, slowed reflexes, and diseases that affect the nerves, such as diabetes and multiple sclerosis. The good news: You can improve your equilibrium at any age by practicing certain exercises. Commercial products such as balance boards and BOSU balls (available at health clubs and from online retailers) test your balance, but you don’t have to use any special equipment at all. Walking on uneven ground (such as when hiking), standing on one leg while brushing your teeth or talking on the phone, and standing on one or both legs with your eyes closed for 30 seconds are simple but effective ways to boost equilibrium.

I am also a fan of tai chi, an Asian-based martial arts practice that involves a formal series of flowing, graceful, slow-motion movements designed to harmonize the circulation of energy (chi) around the body. Like yoga, tai chi is an effective method of stress reduction and relaxation; it also promotes flexibility, balance, and helps develop body awareness. It is particularly beneficial for older people, because it significantly reduces risk of injury from falls. Indeed, there’s compelling evidence to suggest that it can help improve everything from balance to brain function. A growing number of health clubs, senior centers, and adult education outlets offer tai chi.

EMBRACING AGING

The very thought of getting older can be stressful for some people—and, in fact, stress itself can undermine health as we age. Chronic stress has a widespread impact, affecting every system of the body and the aging process, but the same general mechanism is always in play. When we’re under stress, the sympathetic nervous system prepares us for “fight-or-flight,” the body’s innate response to danger, whether that threat is real or imagined. When sympathetic nervous activity revs up, the heart beats faster, blood pressure rises, blood sugar increases, and digestion slows. Most importantly, the adrenal glands release cortisol. This hormone is crucial for mediating stress responses, but it also suppresses immune function and is directly toxic to neurons in the part of the brain responsible for memory and emotion.

Intense sympathetic nervous system activation can be life-saving, but like inflammation, it should only occur when absolutely necessary and end when it is no longer needed. When it becomes chronic, it can cause or aggravate a slew of diseases, from heart problems, to impaired immunity,

to digestive woes. Worse, a growing body of research shows that chronic stress and an overactive sympathetic nervous system are major impediments to healthy aging. Nearly 10 years ago, scientists demonstrated a direct correlation between stress (both objective and perceived) and cellular aging. They measured the length of telomeres, telomerase activity, and oxidative stress in the white blood cells of mothers with either a healthy or chronically ill child. The women who had experienced, and were experiencing, more stress in their lives as caretakers had shorter telomeres, lower telomerase activity, and more oxidative stress than their less-frazzled peers.

More recently, researchers at Boston’s Brigham and Women’s Hospital found similar results: They examined blood samples from more than 5,000 women ages 42 to 69 and compared them to survey answers regarding experiences with phobias (such as a fear of heights) and anxiety. Women who suffered from these problems had shorter telomeres than those who were less anxious—in fact, when considering the ultimate effects of cellular aging, the researchers estimated that stress and anxiety might shorten the women’s lives by six years. Another study found a

link between work-related exhaustion and shorter telomeres. Even the threat of stress— for instance, the anticipation of public speaking—has been associated with accelerated cellular aging.

What happens on a cellular level may seem abstract, until you consider the very real effects that stress can have on our risk of age-related diseases. Studies in both animals and humans suggest that chronic stress may contribute to the development of premature brain aging and Alzheimer’s disease, as well as cardiovascular problems, cancer, and hearing and vision loss. It can weaken bones, increase inflammation, dampen the immune response, contribute to depression and anxiety, and interfere with glucose regulation, setting the stage for diabetes. In addition, feeling overwhelmed can lead you to eat poorly, exercise less, abuse alcohol or drugs, and rely on other unhealthy habits that increase the odds of experiencing illness as you get older.

Keeping a Lid on Stress

I don’t often use the term “stress reduction,” because it is impossible to control all sources of stress in your life: Eliminating stress completely is not an option. That said, it is quite feasible to modify your experience of stress and change the way you react to it. Much of this involves the regular practice of relaxation techniques such as breathing exercises, meditation, and visualization. These simple approaches help encourage a shift from the sympathetic (“fight-or-flight”) to the parasympathetic nervous system. When the latter is dominant, heart rate slows, blood pressure drops, and digestion, metabolism, and immunity all work optimally. On an emotional level, you feel relaxed and connected.

For many people, the act of relaxing or unwinding involves a few glasses of wine or a session with the television remote. These are passive forms of relaxation that may help you feel mellow but do little to protect you in the long term. Instead, I recommend active relaxation techniques that, over time, can help transform the way your body and mind perceive and respond to stress. Here are three of my favorites.

BREATH WORK

Breath work is my preferred active relaxation technique. It’s free, simple, requires no equipment, and you can do it anytime, anywhere. There are scores of breathing exercises, many of which are taught as part of yoga or meditation. The Relaxing Breath that I recommend, also known as the 4-7-8 breath, is especially useful for instilling a sense of calm, both in the short and long term and for balancing sympathetic/parasympathetic tone:

• Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise.

• Exhale completely through your mouth, making a whoosh sound.

• Close your mouth and inhale quietly through your nose to a mental count of four.

• Hold your breath for a count of seven.

• Exhale completely through your mouth, making a whoosh sound to a count of eight.

• This is one breath cycle. Now inhale again and repeat the cycle three more times for a total of four cycles.

Note that you always inhale quietly through your nose and exhale audibly through your mouth. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply. Do this at least twice a day; although it calms you immediately, the long-term benefits in nervous system function become apparent after weeks of regular practice. (After a month of practice, you can increase to eight breath cycles, the absolute maximum.)

MEDITATION

Meditation is nothing more than focused attention, directed to the breath, to an external visual focus (such as a candle flame) or to a silently spoken word or phrase, for example. I have practiced sitting meditation for many years: After waking in the morning, I sit with my back straight and try to center my attention on my breathing and on body sensations for 15 to 20 minutes. I believe this approach has helped me control mood swings and neutralize the most harmful effects of stress. You can learn meditation from books and recordings or from a class. For those who have difficulty sitting and focusing, there are other forms of meditation worth trying, such as walking a labyrinth or even simply being mindful (“in the moment”) as you focus on a seemingly mundane tasks, like cooking or washing dishes. With whatever you choose, the key is to keep up a regular practice, even if it seems difficult or unnatural at first.

VISUALIZATION

A number of mind/body techniques, including guided imagery and hypnosis, harness the power of visual imagination to promote relaxation. These therapies take advantage of the connection between the visual brain and the involuntary nervous system. When this portion of the brain (the visual cortex at

“ Breath work is my preferred active relaxation technique. It’s free, simple, requires no equipment, and you can do it anytime, anywhere. ”

the back of the head) is activated, without receiving direct input from the eyes, it can directly influence physical and emotional states. Visualization typically involves imagining a place where you feel safe, secure, peaceful, and relaxed (say, a beach, a forest, or your childhood home). Simply picture yourself in that place, making all of your sensory impressions—the sights, smells, and sounds—as sharp as possible. Except for being mindful and purposeful, it’s really not much different from daydreaming or fantasizing. You might want to learn this technique with a trained professional at first, but you can also get started with books and audio programs.

Time for an Attitude Adjustment?

In my experience, people tend to have three general concerns about getting older: They don’t want to suffer from poor health, they don’t want to become a burden to their loved ones, and they want to make sure that the latter years of their lives are meaningful. Problems in these areas are common, but certainly not inevitable. You can address the first two now, by talking with your family, your doctor, a lawyer, and a financial planner. As for the third concern, in large part, adding meaning to your life involves shifting your outlook on the aging process from one of sadness, frustration, or resignation to one of excitement, engagement, and curiosity. This is the true definition of “aging gracefully”—and it begins with a positive attitude.

Indeed, research shows that people who take an upbeat view of getting older experience the process more positively. One study looked at measures of successful aging (including rates of chronic disease and disability, as well as social engagement and participants’ assessment of their own health) in more than 1,000 men and women between the ages of 50 and 99. Researchers found that a higher self-rating

of successful aging was associated with higher education and better cognitive function—but also with better perceived mental and physical health, less depression, and greater optimism and resilience. Even people who had poor physical functioning but high resilience had self-ratings of successful aging on par with those of healthy people with low resilience. This suggests that a good attitude can go a long way in helping you enjoy older age.

Other research suggests that fostering a positive perception of aging can prolong life expectancy, while having a negative one might actually diminish lifespan. In one study, researchers matched data from questionnaires collected some 20 years earlier with mortality rates for 660 men and women age 50 and over. They found that older people who responded more positively to survey questions about aging lived roughly 7.5 years longer than those who viewed getting older as a negative experience. The scientists suggested that a will to live only partially explains the longevity, while the impact of negative views of aging might influence self-perception for the worse and elevate stress levels. Likewise, a study that followed nearly 1,000 older adults for nine years concluded that people with high levels of optimism had a 23 percent lower risk of death from cardiovascular disease and a 55 percent lower risk of death from all causes compared to their more pessimistic peers. A positive outlook has also been linked to a faster walking pace, sharper memory, better immunity, and less frailty in older people.

Although you might expect that older age equates with crankiness, the stereotype of a grumpy old man (or woman) is often unfounded. There’s empirical evidence that we

actually become happier with age: Magnetic resonance imaging (MRI) scans show that middle-aged and older people tend to be less bothered by fear than younger people and have more control over negative emotions. With age, the amygdala—the part of the brain that processes emotion—becomes less reactive to fear, while the prefrontal cortex, which handles planning and judgment, becomes more active.

Of course, looking on the bright side is often easier said than done—and a relentlessly sunny disposition may not even be advisable. The poet Robert Frost once wrote, “Happiness makes up in height for what it lacks in length.”

I think that’s a fair description. Our society, and perhaps pharmaceutical companies in particular, sends the message that feeling down is abnormal, and prompts us to demand and expect perpetual happiness. Maintaining such a state of mind is impossible, and, I believe, sets us up for failure and disappointment. It’s healthier to have more realistic emotional aspirations.

In my book Spontaneous Happiness, I introduced readers to a Swedish concept that suggests a reasonable goal: lagom. It doesn’t have an exact English equivalent, meaning something like “just right” or “exactly enough.” It permeates the entire culture of Sweden: architecture, politics, economics, and every aspect of daily life. Contentment, serenity, comfort, balance, and resilience, together constitute a lagom version of positive emotionality—your emotional safe harbor, which you may leave for bouts of blues or bliss but to which you should be able to return easily and naturally. It should be more than enough to sustain us, and will not burn us out or condemn us to alternating cycles of ecstasy and despair. I

believe it can be cultivated until it becomes our default emotional state. That is what I try to do in my own life, and what I suggest that everyone strive for.

With that goal in mind, there are day-to-day strategies you can adopt to help brighten your outlook on getting older and improve your chances of aging gracefully. In addition to influencing your emotional health by practicing active relaxation techniques, I recommend the following approaches.

Get connected. A wealth of research suggests that people who are more socially connected tend to be healthier and happier than those who are isolated or lonely. Reach out to family and friends, spend time with people who make you happy, join community groups or clubs, and consider volunteering.

Stay young. Do your best to retain youthful characteristics like humor, curiosity, playfulness, and spontaneity. Take advantage of opportunities to connect with younger people when possible.

Find purpose. Identify things you enjoy doing, whether that’s cheering for a favorite sports team, pursuing a hobby, taking a ceramics class, or otherwise staying engaged with the world around you.

Build a legacy. Add meaning to your life—and to others’ lives—by keeping a journal or photo album, making a recording of old family stories, or sharing life lessons with loved ones.

Let the spirit move you. Regardless of any religious affiliation you might have, feeling a connection with nature, a higher being, or a purpose cultivates spirituality and facilitates graceful aging.

Accentuate the positive. Allow negative thoughts to come, but don’t dwell on them. Instead, practice substituting positive thoughts and images that evoke feelings of happiness and security. A therapist who specializes in cognitive-behavioral therapy can help you learn how to change problematic thought habits and your emotional reactions to them, even in just a few sessions.

“ Regardless of any religious affiliation you might have, feeling a connection with nature, a higher being, or a purpose cultivates spirituality and facilitates graceful aging. ”

Senior Housing Options

I’m a firm believer in the concept of community. Simply put, community is the sense of living and working together for common goals. We are naturally communal beings and derive great satisfaction from the experience of belonging to a group with a shared purpose. The strength and comfort of community come from the intuition that the whole is greater than the sum of its parts. Our society often fails to provide for this need, and unless we work to create community, these social connections are lost, or can form in an unhealthy way. You can define community any way you want, as long as it gives you a feeling of connectedness.

As I get older, I’m increasingly interested in the role that community can play in the lives and health of senior citizens. In many cultures, the elderly are revered as important members of society. They often live with extended family and are considered valuable resources and wellsprings of wisdom. In the United States, however, the tendency has been to view the aged as “less than”— burdens to be relegated to nursing homes. All that is beginning to change, though. As the 78 million members of the Baby Boomer generation age, people are increasingly demanding safe, comfortable, and enjoyable living options, whether that means joining a community for active seniors or remaining at home as long as possible.

My own preference would be to have my own space within a larger community, in which I could enjoy my privacy while still interacting with friends by preparing meals together or engaging in activities. Here’s a

roundup of some of the growing number of options for communities and living spaces geared to seniors.

Affinity communities. Also known as niche retirement communities, these living situations cater to active seniors with specialized interests. Perhaps the best-known example of an affinity community is the golf club, where members typically live in an over55 neighborhood set on a golf course. But there’s a wide range of such facilities. Some are exclusively for people who have worked in certain fields: For example, letter carriers for the U.S. Postal Service have their own Floridabased retirement community. Others are designed for people with particular hobbies, such as senior artists’ colonies that emphasize creativity, holistic living communities that promote wellness, and university-based senior communities that encourage lifelong learning. Still others are tailored to specific groups, such as LGBT people, Jewish Americans, or Asian Americans. In most affinity communities, members live in their own homes and socialize during activities.

Naturally occurring retirement communities (NORCs). This term, which was coined in the 1980s, describes an area that has naturally developed a high concentration (more than 50 percent) of older residents, because seniors tend to either remain in or move to these communities when they retire. NORCs aren’t created specifically to meet the needs of seniors, but rather tend to evolve naturally: People may move to the area when they are younger and then stay there, or they may be drawn to the community for various reasons. That said, NORCs may offer certain

social and healthcare resources and services targeted to the older demographic. According to the AARP, about a quarter of older Americans currently live in NORCs.

If you decide to remain in your home for as long as possible, you should consider making changes to it that promote safety and usability. For instance, you can install grip bars in showers or tubs and by toilets, move bedrooms and bathrooms to the first floor, and have wheelchair-accessible ramps built— all with the goal of keeping you mobile and preventing falls.

Long-term care. Once seen as a repository for the elderly in declining health, long-term care facilities are now focused on keeping seniors active and engaged. These are not your grandparents’ nursing homes. Instead, they aim to transform the culture of longterm care by improving quality of life. This can mean that pets are allowed, that more activities and social events are provided, and that the atmosphere is more visitorfriendly. Many revamped long-term facilities are changing their physical environments

as well, by including plants, gardens, and other natural elements, and fostering a better sense of community and home rather than a sterile, institutional setting. Examples of such long-term care options include Eden Alternative and The Green House Project.

Assisted-living communities are often considered the step before long-term care. In them, seniors stay as self-sufficient as possible in their residences (typically apartments or condominiums) while having access to 24hour supervision, structured social activities, and healthcare. Continuing-care retirement communities, a related concept, combine the benefits of living on one’s own with the resources of assisted-living and long-term care facilities. They can be quite expensive, however, and usually require a written contract in which you or your family are obligated to pay for specific services.

Remember that your living situation isn’t the only aspect of aging that contributes to your quality of life. Lifelong learning, volunteerism, leisure pursuits, second and third careers, and maintenance of physical and mental activity are also critical components of aging gracefully.

BOOST YOUR ENERGY

Watch any young child and you’ll get an excellent idea of what optimal energy looks like. The average kid comes rocketing out of bed, ready to hit the playground or the park. But for many adults, it’s a struggle just to stop hitting the snooze alarm in the morning. Constantly refilling their coffee cups, they plod about their day, only to collapse on the couch when work is done. Of course, not everyone suffers from an energy crisis: We all know “morning people” who practically glow with vigor as they bounce from one activity to the next.

Energy isn’t something that some of us are just born with and others lack. You shouldn’t feel more tired simply because you’re getting older, but a number of factors can sap your energy, including poor sleep, stress, and illness. The approaches I recommend are simple and commonsense—eat well, exercise, get enough sleep—but you have to stick with them to see real results. At the same time, I strongly advise against the regular or habitual use of coffee, energy drinks, and other stimulants that may give you a temporary lift but deplete your vitality in the long run. Try my 10-step plan for fighting fatigue and boosting your energy, naturally.

Step 1: Get a Clean Bill of Health

Most causes of low energy can be easily remedied by lifestyle changes, but if you suffer from severe fatigue that makes it difficult to go about your day, see your physician. A number of conditions can cause or contribute to the problem, including an underactive thyroid, cardiovascular and respiratory diseases, cancer, anemia, sleep disorders, and depression. The good news: Treating these conditions can often help restore your vitality.

Step 2: Eat for More Energy

The quest for optimal energy begins as soon as you wake up. Many people skip breakfast, making do with a latte. Others rely on highcarbohydrate offerings such as sugar-laden cereal and fluffy bagels. Refined carbs spike your blood sugar, giving you a temporary boost in energy—only to bring you crashing down a little while later.

Breakfast may well be the most important meal of the day. Opt for foods that fuel your body and brain for the day ahead: fruit, vegetables, whole grains, beans, nuts, yogurt, and eggs are good choices. And don’t be afraid to think outside the box—my preferred breakfast often includes salmon, soy foods, and other nontraditional morning fare. Follow these same guidelines when deciding on snacks, rather than feeding an afternoon slump with a vending machine candy bar.

Step 3: Wet Your Whistle

Dehydration is a common cause of both garden-variety fatigue and hunger. Instead of grabbing an unhealthy snack, drink a glass of water. Even better, replace your trips to the

coffee machine with visits to the water cooler to provide your body with a constant source of hydration. Add a squeeze of lemon or lime to water if you want a bit of flavor.

Step 4: Slip on Your Sneakers

When you’re feeling tired, the last thing you want to do is exercise. But the old adage still holds true: You have to expend energy to get energy. Being sedentary makes you lose muscle mass and causes energy levels to plummet, creating a vicious cycle of inactivity and fatigue. Regular physical activity raises your cardiac capability, improves sleep, and helps increase the number and efficiency of mitochondria, the tiny energy factories in your cells. Aim for at least 30 minutes of moderate aerobic activity most days of the week, such as swimming, cycling, and walking. Strength training and stretching exercises such as yoga can also be beneficial. If you feel your energy plummeting during the day, take a quick walk or do some chair-based stretches to give yourself a boost.

Step 5: Send Stress Packing

It’s impossible to avoid stress altogether, but your strategies for coping with it can make all the difference in your energy levels. Most of us will experience serious sources of stress at some time in our life, such as divorce, illness, and financial worry, and even small stressors like a grumpy boss or a looming deadline can play havoc on your mind and body. Feeling frazzled isn’t all in your head. It can have real physical consequences. Your adrenal glands release stress hormones, including cortisol and adrenaline, which impair mitochondrial function. You may eat more and sleep less, setting yourself up for low energy.

Find an active relaxation technique that works for you and practice it regularly. Options include breathing exercises (such as the 4-78 breath described on page 119), meditation, yoga, qigong or other physical activities, guided imagery or visualization, and creative approaches like drawing or journaling. And remember to cultivate a positive attitude. Anger, resentment, guilt, and fear are negative emotions that can deplete your energy. Instead of focusing your mind on the negative, look to the positive—surround yourself with uplifting art, inspirational people, and upbeat thoughts and experiences. On the flip side, breathing exercises can also give you a jumpstart. To energize your mind and body, consider the Stimulating Breath, also known in yoga practice as the Bellows Breath, which is a short version of the “breath of fire” in Kundalini yoga. For details, see “Breathing for Energy.”

Step 6: Mind the Gap

Even the most conscientious eaters can have nutritional gaps in their diet, which can contribute to an energy crisis. Your body depends on certain vitamins, minerals, and other micronutrients to support the chemical reactions responsible for energy metabolism. In particular, deficiencies of magnesium, vitamin B12, and vitamin D—nutrients that can be hard to obtain from food alone—may lead to fatigue. To help normalize energy and prevent deficiencies, take a daily multivitamin/ multimineral supplement that contains all the B vitamins as well as magnesium and vitamin D.

Step 7: Let the Sun Shine In

Who doesn’t feel more energy when they go for a walk outside or even look out a window? Natural sunlight affects the production of melatonin, the neurotransmitter that controls your sleep cycle. Some sunlight every day also increases levels of vitamin D, which our bodies make with exposure to ultraviolet rays from the sun. To help moderate your sleep cycle and boost your energy levels, make it a point to get outside every day (or if you winter in northern latitudes, consider investing in full-spectrum lights that mimic natural sunlight).

Step 8: Take a Coffee Break

Whether you get your fix from an espresso maker, a teapot, or a vending machine, caffeine is what most people rely on for a quick jolt of energy. The drug stimulates the central nervous system and increases heart rate and blood pressure. But caffeine isn’t benign. It may make you feel jittery and anxious and sabotage your sleep. You may also find yourself using it as a crutch once its stimulating effects wear off, which can lead to dependence and addiction. Gradually decrease the amount you consume—drink one fewer cup of coffee every day, for example. Going cold turkey may cause withdrawal symptoms, including throbbing headache, nervousness, irritability, and severe fatigue. (These usually last for 24-48 hours.) If you still crave caffeine in the morning, have a cup or two of green tea, which provides a perk as well as beneficial antioxidants.

Step 9: Sleep on It

There’s no question that inadequate sleep can have a profound impact on your energy levels. Without rest, levels of blood sugar and stress hormones rise, slowing your metabolism and draining you of energy. As a result, you may have trouble waking up and getting through your day without relying on stimulants such as caffeine. In fact, getting enough good-quality sleep is the most important thing you can do to enjoy optimum energy. While the amount you get (including naps) is an individual matter, consider aiming for more sleep at night if you’re feeling tired during the day. On the other hand, too much sleep can result in a sluggish, dull feeling. Try different amounts to see what works best for you—most adults need about seven to eight hours of shuteye a night.

Step 10: Consider Supplements

Supplements should be low on your list for stabilizing energy levels—well behind the lifestyle approaches described here. That said, certain vitamins, herbs, and other natural products may be beneficial in reducing fatigue and increasing vitality. Along with a multivitamin, consider one or more of the following supplements (follow package directions):

Coenzyme Q10. This well-researched antioxidant is involved in cellular energy production throughout the body. Cordyceps. A traditional Chinese medicinal fungus that helps fight fatigue and boost energy levels, cordyceps also increases aerobic capacity and endurance.

Eleuthero. This woody shrub from northeastern Asia has properties similar to those of ginseng and a long history of use to maximize athletic performance. Studies suggest that eleuthero may help enhance mental activity as well.  Rhodiola. This adaptogenic herb helps prevent fatigue, stress, and the damaging effects of oxygen deprivation.

Breathing for Energy

The Stimulating Breath is a vigorous exercise that can quickly raise energy and alertness. It’s perfect for pulling yourself out of an energy slump.

• Inhale and exhale rapidly through your nose, keeping your mouth closed but relaxed. Your breaths in and out should be equal in duration, but as short as possible. This is a noisy breathing exercise.

• Try for three in-and-out breath cycles per second. This produces a quick movement of the diaphragm, suggesting the action of a bellows. Breathe normally after each cycle.

• Do not do this for more than 15 seconds on your first try. Each time you practice the Stimulating Breath, you can increase your time by five seconds or so, until you reach a full minute.

If you perform it properly, you should feel the effort at the base of the neck, the diaphragm, the chest, and the abdomen and get a sense of increased alertness and energy, like that following a good workout. Try this breathing exercise the next time you need an energy boost and feel tempted to reach for a cup of coffee.

BOOST YOUR IMMUNITY

The immune system helps protect your body from foreign or harmful substances, including bacteria, viruses, and antigens that can cause disease and infection. As we get older, however, the immune system becomes slower to respond, increasing the chances of getting sick and impairing healing. As a cornerstone of health, you should do everything you can to help fortify immunity and strengthen your body’s natural healing response.

• Keep moving. Exercise tones the immune system, in part by maintaining good circulation.

• Wash your hands frequently. One of the most important things you can do to prevent infectious disease is to wash your hands. Make it a point to scrub them thoroughly and often. Antibacterial soaps aren’t necessary; just use regular soap and water.

• Make time for rest. Inadequate sleep can sap your immune system, energy levels, and mental alertness.

• Put a lid on stress. Increased levels of stress hormones such as cortisol can dampen the immune system, creating opportunities for a host of health issues. Practice relaxation techniques such as breathing exercises and visualization.

• Eat well. A synergistic mix of antioxidants in fruits, vegetables, and other whole foods helps boost immunity and decrease the risk of illness. Garlic and cooked Asian mushrooms (shiitake, oyster mushrooms, maitake, and enoki) also support a healthy immune system.

• Watch your mouth. Cavities, gingivitis, and infections of the teeth and gums can divert and monopolize immune system resources. Tending to oral health can free up immunity and support the health of the entire body.

• Add astragalus. This root of a plant in the pea family has antiviral and immuneenhancing properties and a long history of use in traditional Chinese medicine to ward off colds and flu. Follow package directions.

SLEEP ON IT

Poor or unrefreshing sleep is a common complaint of older people. As you age, you may have trouble falling asleep and may wake up more often. Surprisingly, age doesn’t appear to affect the total amount of sleep we get (about 6.5 to seven hours a night on average), but as you get older, you may feel your sleep is lighter, leaving you less refreshed in the morning. Age-related issues such as chronic pain and urinary difficulties may cause you to leave your bed more often during than night. Get better shuteye with these tips.

• Make a routine. Take a warm bath, go for a relaxing stroll, or practice relaxation techniques as part of your regular nighttime ritual. Try to go to bed at the same time every night, and get up at the same time each morning, even on weekends.

• Stay active. Studies show that people who are physically active sleep better than those who are sedentary. The more energy you expend during the day

(preferably earlier in the day), the sleepier you will feel at bedtime.

• Look to your diet. Avoid large meals late in the evening, as digestion may interfere with sleep, and don’t consume alcohol or caffeine within several hours of bedtime.

• Use light wisely. Spend time outdoors during the day as often as you can to get exposure to bright, natural light. In the evening, dim lights before bedtime and avoid too much “screen” time, whether from TV, tablets, or smartphones. Sleep in complete darkness.

• Take a nap. Although longer daytime naps can interfere with nighttime sleep, 10 to 20 minutes of afternoon shuteye can be refreshing without contributing to insomnia.

• Consider short-term supplements. The two best natural sleep aid treatments I know are valerian and melatonin. With a long history of traditional use, the sedative herb valerian is readily available in standardized extracts. Take one to two capsules a half hour before bedtime. Melatonin is a neurotransmitter that regulates the wake/sleep cycle and other daily biorhythms. Try sublingual (under the tongue) tablets; take 2.5 mg at bedtime as an occasional dose, making sure that your bedroom is completely dark. A much lower dose, 0.25 to 0.3 mg, may be more effective for regular use.

Whether you’re setting off for a family vacation in July or gathering around the table to give thanks in November, certain seasons and circumstances can present challenges for maintaining optimal health. But integrative medicine can help. From warding off travel-related woes to coping with holiday stress, there’s much you can do to stay healthy all year-round.

HOME FOR THE HOLIDAYS

Chestnuts roasting on an open fire, sleigh bells ringing, Santa on the way, family gatherings, exchanging presents, singing carols, feasts, parties, ringing in the New Year, and a host of other rituals are associated with this joyous time. Our culture tells us that the winter holiday season is the most wonderful time of the year—and for some people, that’s true. But many others experience the holidays as a time of stress, tension, and even depression. It’s no wonder: We’re bombarded with impossible expectations for constant holiday happiness and family togetherness almost before the first leaf has fallen from the trees.

Some of the reasons for the holiday doldrums are obvious—the pressure of all the work and preparations involved, for instance. But there are many other factors that can make the end of the year difficult. From the improbability of finding parking at the crowded malls to the loneliness of spending the first Christmas without a departed loved one...feeling guilty about the gifts we cannot afford to give...feeling anxious about an alcoholic family member’s behavior... children shuttled between divorced parents or, worse yet, forgotten. The list of possible stresses goes on, but you get the idea. Holiday advertising adds to it. It narrowly portrays the spirit of the season through commercial messages designed to make you believe that joy is something you can buy, gift wrap, wear, pour, play with, or eat. Indeed, I believe that the discordance between expectations of happiness and the emotional impact of the reality of the holidays is a major reason for the high incidence of depression at this time of year.

Fortunately, there are many ways to reduce holiday stress, and they all involve making simple and prudent choices. For example, choosing to limit your commitments to those that you will have the time to enjoy can keep you from feeling rushed or pressured. Sticking to a reasonable budget can take the worry out of spending. Avoiding excessive drinking and eating and getting enough rest can help you overcome fatigue and provide you with a reserve of energy. Choosing to let go of negative thoughts about the holidays and giving yourself positive expectations might seem difficult at first, but the value of doing so will be well worth the effort.

A New Tradition

I have a holiday tradition that has served me well in enjoying time spent together with friends and family: reading stories to each other, after dinner, in front of a fire. I am passionate about reading and being read to, something that once was an evening ritual among many families but, sadly, has disappeared in the age of television and DVDs. I especially enjoy funny tales like those by Saki (H.H. Munro), an English author born in Myanmar who is known as the master of the short story. Saki’s writing is witty and often outrageous.

Another favorite of mine is Roald Dahl, a British writer born in Wales who wrote for both children and adults. Among his best-known works are the children’s classic Charlie and the Chocolate Factory and James and the Giant Peach, but I prefer his twisted tales with knockout endings. (A good collection is The Best of Roald Dahl.) I also enjoy fantastic stories, such as The Arabian Nights.

Storytelling stimulates the imagination and is a pleasurable and inexpensive way for family and friends to be together during the winter. And, it can have important health benefits as well. Increasingly, storytelling is used to comfort the sick and dying, promote healing, and create a more nurturing environment for people who are dealing with pain, suffering, and grief.

A Healthier Holiday Table

The first Thanksgiving was nothing like the holiday we celebrate today: More

of a political gathering between the Pilgrims and Native Americans, the feast centered on corn, beans, squash, turnips, venison, and fish, mainly cod. (Turkey didn’t become a traditional Thanksgiving staple until the 19th century.) My own Thanksgiving offerings may seem a bit unusual to those who associate the holiday with poultry and stuffing, but they’re just as tasty—and usually healthier. You can also use these suggestions as a menu guide for Christmas and other fall and winter holidays.

THE MAIN ATTRACTION

• Fish. Seafood—usually either salmon or trout—takes center stage at my holiday dinner. I typically coat a whole salmon or trout with extra-virgin olive oil; stuff it with lemon slices, shallots, and herbs (like tarragon or dill); and grill it. It may not have a wishbone for breaking, but it’s delicious, festive, and rich in healthful omega-3 fatty acids.

• Tofu turkey. My daughter, Diana, is a vegetarian. For her, I prepare this soy-based turkey substitute. There are a number of tofu turkeys on the market, or if you prefer to create your own, you can find recipes online.

SAVORY SIDES

• Roasted root vegetables. Root vegetables are nutritional powerhouses: They’re low in sodium and calories and high in fiber. I roast a mixture of sweet potatoes, carrots, parsnips, turnips,

rutabagas, and onions with some garlic for this simple side dish.

• Braised red cabbage. This dish is packed with anthocyanins, powerful antioxidants that give red cabbage its vibrant color. Like other cruciferous vegetables, cabbage provides fiber, vitamin C, and cancer-protective compounds called indoles.

• Sweet potato hash. Small cubes of sweet potato are sautéed with onion and garlic until browned, making a healthier alternative to candied sweet potatoes or mashed white potatoes.

JUST DESSERTS

• Squash pie. If you crave a traditional seasonal dish, try making a vegan pie made with winter squash (such as buttercup, butternut, kabocha, or banana), cashew milk, and raw sugar. Thicken it with arrowroot instead of eggs and flavor it with brandy, cinnamon, ginger, and cloves.

• Coconut black-rice pudding. This dessert may seem an unusual choice to serve on Thanksgiving, but it’s perfect for late fall and winter. Sweet black rice (available at gourmet shops and online) readily combines with light coconut milk, shredded coconut, and bananas for a comforting pudding with a tropical twist. Take it over the top with a scoop of coconut sorbet.

GOOD HEALTH ON THE ROAD

Vacations can be an opportune time to bond with your family but can also take a toll on your health. In addition to managing your luggage, you just might find yourself contending with travel-related woes such as respiratory infections, motion sickness, and gastrointestinal upsets. As a frequent traveler, I’ve come to rely on certain strategies to stay healthy on the road or in the air. Here’s how to protect yourself and your loved ones against four common problems when you’re on the move.

Colds. One of my main concerns about air travel is the risk of developing an upper respiratory infection. There’s no good evidence that the recirculated air in planes is to blame, although some research has linked recirculated air in office buildings to higher rates of the common cold. Most experts believe that, when it comes to air travel, simply sitting in the confined quarters of an airplane—in close proximity to coughing, sneezing fellow passengers—is enough to make you sick.

What to do: If you’re worried about catching a cold, you might wear a face mask that covers your nose and mouth. You should also wash

your hands frequently and avoid touching your nose, mouth, and eyes. Maintain good immunity by keeping up healthy diet and exercise habits (I also use Host Defense MycoShield, a throat spray containing a blend of medicinal mushrooms that help support the immune system). Since sinus trouble is another common consequence of air travel, be sure to drink plenty of water and consider using a hydrating saline gel (such as Ayr) to keep nasal passages moist.

Motion sickness. Motion sickness occurs when the brain receives conflicting signals from the inner ear, eyes, and other parts of the body that sense motion. For example, when you feel turbulence on a plane, your eyes don’t see what’s happening to cause the motion. Your brain gets one message from your inner ear, which senses the turbulence, and an opposing message from your eyes, which see only the apparently unmoving interior of the plane. The same thing happens when you’re sitting in the backseat of a car or are on a boat.

What to do: You may be able to prevent or at least reduce motion sickness by making sure your eyes see what your inner ear feels. When riding in a car, either drive or sit in the front seat. On board an airplane, choose a window seat over the wings, where you’re least likely to

feel motion. If you’re traveling by ship, request a cabin in the forward or middle of the ship or on the upper deck; spend as much time as possible on deck watching the horizon.

I’m subject to seasickness and have used acupressure wristbands with great success to avoid it. The wristbands are the modern version of an old Chinese fisherman’s remedy of stimulating the acupressure points that control nausea. They have plastic pegs that press on acupressure points on the inner surfaces of the wrists. Proper placement of the wristbands is critical, so follow package directions carefully. Another useful remedy is ginger, which is more effective than Dramamine for motion sickness and doesn’t cause drowsiness as a side effect. Take two capsules of powdered ginger about 20 minutes before travel, or chew on crystallized ginger throughout your trip. If you need something stronger, try over-the-counter meclizine, which will not make you groggy or drowsy. Constipation. Constipation can plague even the most “regular” of travelers. As you might suspect, travel-related constipation stems from changes in your normal routine as well as from jet lag—your interior body clock doesn’t always catch up immediately to local time when flying long distances. Changes in diet, the timing of meals, and less-thanideal access to restrooms can all play a role in traveler’s constipation (defined as fewer than three bowel movements a week), as can the stress involved in making the adjustment to new surroundings.

What to do: My recommendations for treating travel-related constipation are similar to those for coping with the problem at home. Make sure you’re getting enough

fiber by eating lots of vegetables, fruits, and whole grains, and drink plenty of water. Stay physically active to encourage regularity, and don’t ignore the urge to go when it hits: The longer stool stays in the bowel, the harder it gets, as more water is reabsorbed, and the more difficult it is to expel. You might also consider supplementing with powdered psyllium (such as Metamucil), as well as triphala, an Ayurvedic combination of three fruits that help tone the muscles in the large intestine and regulate the bowels. Follow package directions.

Jet lag. This sleep disorder can affect anyone who travels across multiple time zones. It occurs when your body’s internal clock (also known as circadian rhythms) gets out of sync with sleep-related cues in your new time zone, such as onset of darkness and timing of meals. For example, if you travel from New York to London, which is five hours ahead, you might have difficulty falling asleep at 11 pm (which would be only 6 pm in New York). The opposite problem can happen upon your return. Although jet lag is temporary, it can be debilitating, causing insomnia, daytime sleepiness, and difficulty concentrating.

What to do: When you arrive at your destination, expose yourself to as much natural daylight as possible to help reset your internal clock. Avoid substances such as caffeine and alcohol, which can play havoc with sleep, and drink plenty of water: Dehydration can exacerbate symptoms of jet lag. I also recommend melatonin. Take 2.5 mg of this supplement sublingually (under the tongue) for one or two nights at bedtime once you’ve reached your destination.

SECTION

ONE: Pregnancy and Childbirth

Tips on avoiding chemicals while pregnant and a free self-assessment of environmental toxin exposure: www.victoriamaizesmd.com

pages 9 and 13

Lists of potentially harmful ingredients used in cosmetics and other personalcare products: www.ewg.org/skindeep

pages 9 and 13

Advice for selecting healthy (lowmercury) and sustainably sourced seafood: www.seafoodwatch.org

page 10

Searchable database of tested, certified home water-filtration systems: www.nsf.org

page 13

Access to air-quality reports and health advisories in your area: www.airnow.gov

page 13

SECTION TWO: Children and Teens

A list of the “Dirty Dozen,” the 12 foods you should always buy organic, and additional information on pesticides and produce: www.ewg.org

page 14

Information about the specific mercury levels of your favorite fish: www.nrdc.org/stories/smart-seafoodbuying-guide

page 14

Childhood health and obesity advocacy groups, with information about the epidemic and opportunities to get involved in their work: www.cspinet.org and www.ewg.org

page 49

Searchable database of neurofeedback/ biofeedback practitioners in the U.S. and around the globe: www.aapb.org

page 54

Printer and mobile-friendly versions of healthcare professionals’ recommended immunization schedules: www.cdc.gov/vaccines

page 94

SECTION FOUR: Seniors

Acetyl-L-carnitine, 101

Acne, 50

Acupressure, 17, 139

Aerobic exercise, 16, 66-71, 84, 111-115, 129

Aging, 81-89, 90-133

Alcohol, 8, 13, 51, 92, 94, 96-97, 107, 119, 133, 135, 139 wine, 96-97, 102, 107

Allergies, 24, 31, 46, 52, 54-56, 63, 94, 97, 106

Alpha-lipoic acid, 101

Alzheimer’s disease, 63-64, 81-84, 92, 94, 101, 105, 119

Antibiotics, 48-49, 59

Antioxidants (see also entries for acetyl-L-carnitine, alpha-lipoic acid, coenzyme Q10, resveratrol, and vitamins C and E), 14, 65, 82, 84, 86, 96, 101-103, 130, 132, 137

Anti-inflammatory diet, 10, 50, 54, 62-65, 82, 100

Arthritis, see osteoarthritis

Assisted-living communities, 127

Asthma, 24, 31, 46, 54

Astragalus, 132

Attention-deficit/hyperactivity disorder (ADHD), 46, 50-54, 56-58

Autism, 10, 32-33, 55-58

— B —

Balance, 16, 107, 111, 115, 117

Basal body temperature thermometer, 8

Beans, 77-78, 129

Bisphenol A (BPA), 9, 13

Breast cancer, 25, 97-98

Breastfeeding, 16, 24-25, 28, 47

lactation tea, 19

Breath/breathing techniques, 28, 40, 74-75, 79, 115, 119-120, 130-132

Caesarean section, 20, 48

Caffeine (see also green tea), 14-16, 73, 88, 130-131, 133, 139

Calcium, 70, 86-89, 100, 104, 106

Calorie restriction, 107-108

Cancer, 9, 12, 28, 42, 46, 63, 92-95, 98, 100, 103-104, 106-107, 110-111, 119, 129, 137 breast, 25, 97-98 cervical, 28, 98, 103 prostate, 89, 98, 104

Carbohydrates, 10, 62-65, 77, 129

Cardiovascular disease, 9, 12, 42, 46, 63-64, 76-79, 82, 92-96, 98, 100-101, 103, 105-108, 110, 119, 123, 129

Centenarians, 92-93

Cervical cancer, 28, 98, 103

Chickenpox, 30-31, 33

Childbirth, see labor

Cholesterol, 24, 42, 46, 66, 76-79, 94, 97-98, 103, 105, 107

Chondroitin, 89

Chromium, 79

Circumcision, 28-29

Coenzyme Q10 (CoQ10), 79, 104105, 131

Colds, 58-59, 132, 138

Colic, 27-28

Colonoscopy, 98

Concussions, 39

Constipation, 89, 104, 139

Cosmetics, safe choices, 9, 13

Cranial osteopathy (therapy), 28, 59

Cycling, 16, 66, 88, 111, 113, 129

Dancing, 39, 70, 111, 113-114 DEXA scan, 97

Diabetes, 9, 12, 24, 31, 33, 42, 46, 64, 77-78, 94, 96-97, 107-108, 110, 117, 119

Diet (see also entries for specific foods and food categories), adults and, 77-78, 82, 86-88

anti-inflammatory, 10, 50, 54, 6265, 82, 100

PHOTO DANIELLE MACINNES

bone/joint health and, 86-88

calorie restriction, 107-108

cardiovascular disease and, 77-78

childhood conditions and, 50, 5254, 56-59

fertility and, 10

holidays and, 136-137

memory and, 82

picky eating, childhood, 38

pregnancy and, 12, 14

seniors and, 92, 100-109, 130, 133

Doulas, 20 — E —

Ear infections, 25, 31, 46, 59

Echinacea, 58

Energy, aging and boosting, 128-131

Exercise,

adults and, 66-71, 78-79, 84, 88

aerobic, 16, 66-71, 84, 111-115, 129

balance, 117

bone/joint health and, 70, 88

cardiovascular disease and, 78-79

children/adolescents and, 39, 43, 49, 53-54

cycling, 16, 66, 88, 111, 113, 129

dancing, 39, 70, 111, 113-114

flexibility, 116-117

memory and, 84 pregnancy and, 16

running, 66, 68-70, 111, 114-115

seniors and, 107, 110-117, 129, 132

strength training, 69-70, 111, 115116, 129

stretching, 66, 68, 70-71, 116-117, 129

swimming, 16, 39, 88, 111, 114115, 129

tai chi, 53, 117

walking, 16, 66-68, 70, 111-112, 114-115, 117, 123, 129

yoga, 16, 40, 70-71, 117, 129-130

Extra-virgin olive oil, 64, 136

Eye health, 98, 115, 119 — F —

Fats, dietary, 63-65, 77, 82, 107

omega-3/omega-6 fatty acids, 10, 14, 25, 54, 58, 63-64, 77-79, 8284, 86, 105-106, 136

Fertility/infertility, 6-11, 46, 103

Fiber, 37, 78, 136-137, 139

Fish, 10, 14, 50, 58, 62, 64, 77-78,

82, 86, 103-106, 108, 136

Fish oil, 79, 84, 105-106

Flexibility, 111, 116-117

Flu, see influenza

Garlic, 78, 132, 137

Ginger, 17, 65, 86, 89, 137, 139

Glucosamine, 89

Glycation/advanced glycation end products (AGEs), 62-64, 82

Glycemic index, 10, 77

Grains, 26, 37, 58, 62, 65, 78, 103, 129, 139

Green living (see also organic foods), 8-9, 12-13

Greens, leafy, 86, 88, 102-104

Green tea, 14, 82, 102, 130

Guided imagery (see also visualization), 10, 40, 54, 79, 120, 130 — H —

Heart disease, (see cardiovascular disease)

High-efficiency particulate air (HEPA) filter, 13

Holidays, 134-137

Home births, 18-20

Homeopathy, infants/children, 27-28, 54

Meditation, 53-54, 70, 79, 119-120, 130

Melatonin, 130, 133, 139

Organic foods, 10, 14, 26, 54, 104

Osteoarthritis, 46, 85, 89

Ovulation, 6-8

Immunity, boosting, 66, 103, 106-107, 119, 123, 132, 138

Immunizations, (see vaccines)

Inflammation, common conditions, (see also anti-inflammatory diet), 76-79, 82, 85-86, 105-107, 119

Influenza, 31, 94, 132

In-vitro fertilization (IFV), 6, 9-10

Memory, aging and (see also Alzheimer’s disease), 81-84, 101, 110, 123

Menstruation (see also ovulation), 6-8, 11

Mercury, fish and, 10, 14, 106

Midwives, 19-20

Milk, cow’s, 86, 103-104, 107 childhood conditions and, 50, 54-56, 59

Infants and, 24-25, 28

— P —

Pap smear, 99

Pertussis, 30, 32

Pesticides, baby food and, 26

Phosphatidylserine (PS), 84

Physical examination, 94-95

Picky eating, childhood, 38

Placentophagia (placenta-eating), 22-23

Pregnancy, 6-23, 47-49

Jet lag, 139 — L —

Labor, 18-23

home births, 18-20

water births, 20-22

Lactation tea, 19 — M —

Magnesium, 54, 78-79, 89, 104, 130

Mammogram, 98

Measles, 30-31, 33

Meat, 10, 62-65, 101, 104-105

Medical tests, seniors and, 94, 97-98

Mindfulness-based stress reduction (MBSR), 53-54

Morning sickness, 17

Motion sickness, 17, 138-139

Multivitamin, 10, 38, 54, 130

Mumps, 30-33

— 0 —

Obesity, 63, 77, 85, 108, 110, 112

childhood, 24, 37, 42-43, 46-49

Omega-3/omega-6 fatty acids, 10, 14, 25, 54, 58, 63-64, 77-79, 82-84, 86, 105-106, 136

Oocyte cryopreservation, 10-11

postpartum depression, 23

Probiotics, children and, 28, 58

Prostate cancer/health, 89, 104, 113

PSA test, 98

— R —

Resveratrol, 96, 102, 107

Retirement, 126-127

Running, 66, 68-70, 111, 114-115

— S —

SAMe, 89

Screen time, 40, 42-44, 47, 53, 73, 133

Seafood, (see fish)

PHOTO FRANK MCKENNA

Senior housing, 126-127

Sex, of baby, 12

Sleep, aids, natural, 133

children/adolescents and, 26-27, 42-44, 48, 52, 59

jet lag, 139 seniors and, 128-133

Smoking, 8, 13, 48, 51, 92-95, 100, 103, 110

Soda, 10, 37, 49, 77, 88

Sodium, 78, 88

Sound, stress and, 73

Soy foods, 25, 37, 53, 55, 58-59, 64-65, 77, 86-88, 104-105, 129, 136

Sperm health, 6, 10

Sports, childhood/adolescent team, 39

Strength training, 69-70, 111, 115-116, 129

Stress, 10, 135

adulthood and, 72-75, 79 children/adolescents and, 39-40, 43, 49-50, 53-54

seniors and, 92, 110-111, 117124, 129, 131-132

Stretching, 66, 68, 70-71, 116-117, 129

Sugar, 52, 54, 63-65, 82, 129

Sugar-sweetened beverages (see also

soda), 37, 43, 47, 49, 77 Supplements (see also entries for specific supplements), adults and, 79, 84, 86, 89 bone/joint health and, 89 cardiovascular disease and, 79 children and, 38, 54, 58 memory and, 84 pregnancy and, 10, 17 seniors and, 94, 100-108, 130-131

Swimming, 16, 39, 88, 111, 114115, 129

Visualization (see also guided imagery), 79, 119-122, 130, 132

Vitamins,

B family, 78, 82-84, 100, 103104, 130

multivitamin, 10, 38, 54, 130

vitamin C, 58-59, 82-84, 102, 137

vitamin D, 38, 82, 86, 89, 100, 104, 106-108, 130

vitamin E, 82-84, 102 vitamin K, 88 — W —

Tai chi, 53, 117

Tea, green, 14, 82, 102, 130

Teething, 26-27

Television, (see screen time)

Thanksgiving meal, 136-137

Thyroid health, 11, 98, 129

Toxins, environmental, see entries for green living and pesticides

Traveling, 138-139

Turmeric, 65, 82, 86, 89 — V —

Vaccines, 30-33, 94

Valerian, 133

Walking, 16, 66-68, 70, 111-112, 114115, 117, 123, 129

Water births, 20-22

Water filtration, 13, 65

Whooping cough (see pertussis)

Wine, 96-97, 102, 107 —

Yoga, 16, 40, 70-71, 117, 129-130 —

Zinc, 54, 58