Real Health Summer 2015

REALHEALTH YOUR GUIDE TO BLACK WELLNESS

Actress

S.Epatha Merkerson Manages Her Diabetes By Knowing Her A1C Number

Activities That Burn The Most Calories

50+

The Age Of More Than Half Of Americans Living With HIV Hard Evidence Links Concussions And Youth Incarceration

Seeing Red?

Take These Steps To Control Your Anger

SUMMER 2015 $2.99 US REALHEALTHMAG.COM

CONTENTS this month on REALHEALTHMAG.COM If you suffer annoying hot flashes, don’t believe you have to just sit there and take it. Many options are available for you to experiment with.

Health Basics A—Z

9 5

editor’s letter

6

buzz

Want to lose weight, exercise smart, eat right, find good health care, sleep better or just get healthy? For tips, click on “Health Basics A–Z” on the realhealthmag.com home page.

Time to Plan Life

Today, women have many effective options for birth control, including intrauterine devices, or IUDs, and other long-acting reversible contraception (LARC).

Ask Dr. Dee a Question Many people find it difficult to negotiate condom use with a sexual partner. Check out these tips from Dorothy Horton, PsyD.

Digital Real Health

Read Real Health magazine online exactly as it appears in print. Go to realhealthmag.com/ digital to view the current issue and the entire Smart + Strong digital library.

16

A common health care mistake

Prison and public health; HIV and bone strength; older folks and HIV risk; ingrown toenails; hep C cure concerns; when to worry about a rash; anti-cancer diets; MSG’s many names; caffeine is a drug

10

fitness

11

sex

Some people think calisthenics is still the best way to build your body; check out which workouts burn the most calories

Vaginal dryness is a common problem for many women that doesn’t get discussed too often; Ask Doctor Dee: Faking orgasm can affect a couple’s relationship

20 16 COVER STORY

percentage points

Actress S. Epatha Merkerson learned how to use A1C testing to manage her diabetes.

20

transformations

24

making headway

28

a hidden behavior

32

thoughts

How chef Leticia Moreinos Schwartz changes ethnic meals into diabetes-friendly dishes

It’s time to discuss the connection between concussions and the incarceration of minority youth.

All about trichotillomania, an impulse control disorder that causes folks to pull out their hair

Tips on controlling your anger

Real Health Question of the Month

What key piece of advice do you have for caregivers?

Make sure to take time out for you, and take opportunities to breathe and honor your own needs, or you risk not being here to give your loved ones the care they need.

—Terrie Williams, CEO, The Terrie Williams Agency

reach out & click!

At realhealthmag.com, you can read more articles; access exclusive, online-only special reports; meet other health-minded black singles; and subscribe ($9.97 for four quarterly issues; you can also call 800.973.2376). Plus, sign up for the Real Health email newsletter to get the latest black health news!

(COVER) COURTESY OF MERCK/LISA BERG PHOTOGRAPHY; (MEDITATING, CONTRACEPTION AND VEGETABLES) THINKSTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD; (MERKERSON) COURTESY OF MERCK/ AP/JASON DECROW;(ARROZ CON LECHE) COURTESY OF LETICIA MOREINOS SCHWARTZ; (WILLIAMS) DWIGHT CARTER

Feeling the Heat?

EDITOR’S LETTER

REAL HEALTH

Medical Mistakes Happen

R

ecently, I visited my gynecologist for a health issue. After I signed the logbook, I sat down to wait. About 15 minutes later, the receptionist called my name and I returned to the receiving window. To my surprise, she asked me for my health insurance information. This struck me as strange; I had just visited my gynecologist two weeks earlier and confirmed that my insurance information was current. Why did I need to do this again, I wondered. But instead of asking the receptionist, I passed her my insurance card and sat down. The reason was soon made clear to me.

After a medical assistant called me into an examination room, she placed a folder with my name on it on the gray countertop in the small, windowless space. Another medical assistant entered the room to take my blood pressure and note my chart in the folder.

As I watched her flip through the papers in my folder, she frowned as she stared hard at the white sheets she’d rustled through. “You’re 71?” she asked.

My ears perked up. “Me, 71? No,” I said.

“What’s your name? You are Catherine Ferguson, aren’t you?”

“Yes, I’m Catherine Ferguson,” I replied. “But I’m not 71.”

In response, she stared down at the folder hard enough to burn holes through

EDITOR-IN-CHIEF

Kate Ferguson MANAGING EDITOR

Jennifer Morton DEPUTY EDITOR

Trenton Straube COPY EDITOR

Meave Gallagher EDITORIAL ASSISTANT

Casey Halter ART DIRECTOR

Mark Robinson ART PRODUCTION MANAGER

Michael Halliday LEGACY ADVISOR

Megan Strub

ADVISORY EDITOR

Sean Strub

ADVISORY BOARD

Lee SaintMartin, MS, IIPA, CN, ND, naturopath; Goulda Downer, PhD, RD, CNS, and Nutrition Services, Inc.; Yuan Wan, licensed acupuncturist and doctor of traditional Chinese medicine; Dorothy Horton, PsyD, clinical psychologist; Lovell Harris, MD, internist; Terrie Williams, mental health advocate; Xavier Artis, campaign creator, Stay Strong: Healing Starts With Us (HSWU)

SMART + STRONG PRESIDENT AND COO

Ian Anderson

CHIEF DIGITAL STRATEGIST

John La

VICE PRESIDENT, SALES/PUBLISHER

Susan Mary Levey CONTROLLER

Joel Kaplan INTEGRATED ADVERTISING COORDINATOR

Jonathan Gaskell

CDM PUBLISHING LLC CHIEF EXECUTIVE OFFICER

Jeremy Grayzel SALES OFFICE

212.938.2051

Here’s to your health, JOAN LOBIS BROWN

Issue No. 42. Copyright © 2015 CDM Publishing LLC. All rights reserved.

No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. If you are an individual or organization and would like to subscribe to Real Health, go to real healthmag.com or call 800.973.2376.

Send feedback on this issue to info@ realhealthmag.com or Real Health, c/o Smart + Strong, 462 Seventh Ave., 19th Floor, New York, NY 10018.

Smart + Strong® is a registered trademark of CDM Publishing, LLC.

the paper. “Oh!” she exclaimed. “You’re not white, either!”

Finally, her brow smoothed out.

“You’re the wrong Catherine Ferguson,” she explained. “This isn’t you.”

Well, it couldn’t be me—I certainly wasn’t white and I wasn’t 71.

Then the young woman sighed and shook her head. “She gave me the wrong Catherine Ferguson’s chart,” she muttered.

“I’m sorry, ma’am. I’ll be right back.”

And with that she turned and left the examination room.

Now I knew why the receptionist asked me for my health information: My doctor has two Catherine Fergusons as patients, and the other Catherine’s chart was missing her insurance information.

As I waited for the health care worker to return, I thought about how mistakes like these are probably made every day.

Mine was a harmless case of mistaken identity. But, I wondered, suppose I was billed for the other Catherine Ferguson’s medical care? What a total disaster that could be!

A worse-case scenario would be suffering harm in a hospital because of a more serious medical mistake, which has happened to an estimated 210,000 to 440,000 patients each year, according to findings from a study of this problem published in a recent issue of the Journal of Patient Safety. What’s more, no one knows for sure exactly how many patients suffer “preventable harm” from hospital mistakes, said study authors.

Scary? Sure. But, fortunately, a number of doctors are working on preventing medical mistakes like the one I experienced. It’s a simple fix: These docs either snap a patient’s photo to include in their file folder, or their offices require patients to present a photo ID when they check in for appointments.

Maybe I’ll suggest this to my gynecologist next time.

Kate Ferguson, Editor-in-Chief katef@realhealthmag.com realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 5

BUZZ

A Sick System

A

growing body of evidence suggests that crime and incarceration are associated with severe physical and mental strain, including stress, trauma and high rates of chronic illnesses such as diabetes, asthma and hypertension, according to Columbia University’s Mailman School of Public Health.

Public health experts increasingly stress that mass incarceration is a public health issue. They believe addressing it requires more and better communication between policymakers in the criminal justice system and those in public health institutions whose job it is to safeguard the health and well-being of our communities.

“Mass incarceration is not just 2 million people who go to prison in a year,” explains Ernest Drucker, PhD, an adjunct professor of epidemiology at Mailman and author of A Plague of Prisons: The Epidemiology of Mass Incarceration in America. “It’s the phenomenon that 2 million people out of a population in which mass incarceration

6 REAL HEALTH S U MME R 2015

I

is concentrated go to prison and what that means not only for them, but their families, their communities and the society as a whole.”

While individuals are incarcerated, they also risk acquiring infectious diseases that may be transmitted to members of their families and, by extension, the communities to which they return. In addition, “the criminal justice system may also undermine other social determinants of health and healthy behaviors, such as school completion and substance use,” says Mailman’s public There’s a health crisis health initiative. growing Indeed, those who behind bars are incarcerated may that affects all of us. be out of sight and out of mind to many in our society. But prisoners do come home.

Every prisoner is an individual who faces the personal risks and consequences of incarceration. But those who are incarcerated are also members of a larger population group that includes family, social networks and communities.

realhealthmag.com

“Because they’re not just the only person in prison on their block, the effects of incarceration extend beyond the individual,” Drucker says.

The United States has the largest prison population in the world. The upward trend in U.S. incarceration rates began in the 1970s and continued through the 1980s, fueled by arrests and convictions for drug offenses.

Interestingly, according to a recent report published by the National Research Council and Institute of Medicine, high incarceration rates offer opportunities to treat and care for vulnerable people who might not otherwise seek medical services or have access to health resources. But prisons aren’t the ideal settings for medical care and treatment.

“Prisoners, as well as jail inmates, are more likely than the general U.S. population to be unemployed, poor, black or Hispanic, homeless and uninsured,” according to the report. “And these social variables are all strongly associated with poor health.”

BOTH IMAGES: THINKSTOCK

Some experts believe it’s time to make crime and punishment a public health issue.

BUZZ

Cracking Up

For those living with HIV, keeping bones strong means taking no breaks.

BOTH IMAGES: THINKSTOCK

Recent findings show that low bone mineral density, or osteopenia, and fragility fractures from low-height falls occur more frequently in people living with HIV. Studies show that HIV-positive people are 60 percent more likely to suffer a spine, hip, or wrist fracture. Is it the virus that causes the bones to lose minerals, or is it antiretroviral (ARV) treatment that creates this problem?

Doctors don’t yet know the answer.

But what’s known is that in the first two years after beginning ARVs, people tend to lose between 2 and 6 percent of their bone mineral density. Although you may not give your bones a second thought, this rock-hard living tissue is what allows the body to retain its structure. Without bones, notes one online biology encyclopedia, our bodies would “just collapse like a big glob of jelly.”

The importance of our bones may be what prompted health experts to generate improved guidelines for people living with HIV, especially those moving into middle age. The guidelines suggest this population group undergo a standardized program of screening, monitoring and management to minimize or prevent bone fractures.

The program includes DEXA screening of men age 50 and older and postmenopausal women, who are at high risk of fragility fractures. In addition, the guidelines suggest that men ages 40 to 49, and premenopausal women ages 40 and older, get assessed every two to three years for fracture risks using a scoring system based on their lifestyle and medical history.

But doctors also suggest that people living with HIV should exercise regularly, not smoke, reduce their alcohol intake and get an evaluation of their ARV regimen if they already suffer from osteoporosis (extremely thin bones).

What’s more, including fruits and veggies, calcium-rich foods and enough vitamin D in the diet are smart moves that can make a big difference in keeping the bones of those living with HIV strong for life.

A LOVE LESSON

Sexually active older Americans also face risk factors for HIV.

THE ESTIMATED PERCENT OF PEOPLE LIVING WITH HIV IN THE UNITED STATES IN 2015 WHO WILL BE 50 AND OLDER.

Source: Centers for Disease Control and Prevention

According to recent findings, more than half of men and almost a third of women older than 70 reported they were still getting busy, with a third of all respondents reporting having frequent sex.

But many older folks believe that because of their age, they’re not at risk of sexually transmitted infections. Not so, caution officials at the Centers for Disease Control and Prevention (CDC).

“The reality is that Americans aged 50 and older have many of the same HIV risk factors as younger Americans,” says the CDC. This means some older folks also aren’t well informed about HIV or how to prevent transmission, use condoms inconsistently, and may have multiple partners.

The agency reports that 217,300 of the estimated 1.1 million people living with HIV in the United States in 2010 were age 55 and older. In addition, the CDC states that “older Americans are more likely than younger Americans to be diagnosed with HIV infection later in the course of their disease.”

The statistics were alarming enough for researchers to stress that health professionals should become more open to discussing sexual health with their older patients.

Say infectious disease scientists, when it comes to older folks and HIV transmission, doctors can’t simply assume that seniors are no longer engaging in sexual activities.

realhealthmag.com

I

SU M M ER 2105 REAL HEALTH 7

BUZZ

IT’S FLIP-FLOP TIME

Therapy’s Done, But...

How do you know you’ve kicked hep C to the curb?

In 1991, the Food and Drug Administration approved the first-ever treatment for the hepatitis C virus, or HCV. The results were dismal; very few people cleared the virus. Since then, researchers have developed increasingly more effective drugs with fewer side effects to treat hep C. Today, the latest treatment meds aren’t injected, they’re swallowed, and they can clear HCV from the blood within four to 12 weeks.

Once people suffering from hep C undergo these oral drug treatments and the virus is undetectable in their blood for six months after they’ve completed therapy, doctors say they’ve achieved a sustained virologic response (SVR) and they’re considered cured.

But some doctors warn that re-infection can occur after a patient achieves SVR if the person engages in high-risk activities, such as injecting drugs or getting a tattoo with a dirty needle. Also, recent study findings show that in some people, HCV can remain dormant in the body for a long time before waking up and causing a patient to relapse.

Says Theo Heller, MD, a researcher at the National Institutes of Health and one of the study’s authors, “We already know it can and does occur.”

When baseball star Bryce Harper, an outfielder for the Washington Nationals, tweeted a picture of his bloody big toe and a piece of the ingrown toenail that was removed from it, some cringed at the sight.

But this commonplace foot problem affects about 18 percent of U.S. adults age 21 and older—that’s about 40 million folks. Ingrown toenails happen when the corner or side of the nail grows into the soft flesh of the toe. More often than not, it’s the big toe that suffers.

To treat an ingrown toenail, the Institute for Preventive Foot Health suggests you soak your feet in warm water for 15 to 20 minutes several times a day to reduce swelling and relieve tenderness. Next, clean the area with alcohol.

Next, use a clean file to lift the nail up and slightly away from the skin. Place cotton under the edge of the nail to separate it from the skin.

(Change the cotton each day.) Finish by swabbing again with alcohol. This will train the nail to grow back above the edge of the skin.

To avoid the problem, cut nails straight across, and don’t wear tight-fitting shoes or footwear that squeezes your toes together.

THE PERCENT OF PEOPLE LIVING WITH HEP C WHO DEVELOP CHRONIC INFECTION Source: Centers for Disease Control and Prevention

Rash Action Itchy skin? When should you zoom to the doc?

Just thinking of the embarrassment unsightly, bumpy, blister-covered, itchy skin eruptions can cause may make us cringe.

But apart from the cosmetic conniptions caused by the appearance of a skin rash, these signs of inflammation may occur because of viral, fungal or bacterial infections, heat, allergens, immune system disorders, and medications.

Often a rash can disappear without treatment. But if the unpleasant eruption doesn’t go away or show signs of improvement, this is when it’s time to go to the doctor.

8 REAL HEALTH S U MME R 2015

I

realhealthmag.com

The same advice holds if the rash is accompanied by other symptoms, such as joint pain, difficulty breathing, fever, headache or body aches, and swelling, or if the rash spreads, is painful and shows signs of infection.

Really, even if none of these symptoms accompanies your rash, if you’re concerned, see a doctor. After all, it’s always better to be safe—not sorry— and totally rash-free too!

ALL IMAGES: THINKSTOCK

If an ingrown toenail isn’t too painful or severe, try treating this common condition at home.

NUTRITION Enjoy Responsibly Many people don’t consider caffeine a drug, but it is.

Food Shopping Let’s eat to prevent cancer.

Findings show certain substances in different foods—including catechins found in green tea, genistein found in soybeans, resveratrol found in mulberries and grape skins, and plant pigments such as lycopene and flavonoids—may be able to control blood vessel growth that leads to the development of tumors.

“What we eat, and how much, clearly impacts cancer,” says William Li, MD, an expert on maintaining health and fighting disease through diet, lifestyle and treatments that control the formation of blood vessels, or angiogenesis, in the body.

The substances in the foods previously mentioned stop or slow the growth of tumors by preventing the formation of new blood vessels that can feed cancers.

These substances are called angiogenesis inhibitors, and they fight cancer.

According to recommendations from the American Cancer Society, World Cancer Research Fund and American Institute for Cancer Research, breast cancer survivors should eat a healthy diet of more plant-based foods, such as fruits, vegetables, beans, peas, nuts, seeds and whole grains. What’s more, experts suggest that cancer survivors eat at least five servings each day of fruits and vegetables in a variety of colors, and that they limit their intake of red meat (fewer than 18 ounces per week) and processed meats.

(VEGETABLES AND COFFEE) THINKSTOCK

Alias MSG This common food additive uses many different names.

One woman discovered she was allergic to monosodium glutamate (MSG) when she ate Chinese food containing the substance, an ingredient the Food and Drug Administration classifies as generally recognized as safe.

After the meal, the woman’s face swelled, itchy hives and welts erupted on her skin and her air passages closed, stopping her breathing.

Emergency room doctors diagnosed her with “Chinese food syndrome.” Although doctors didn’t name MSG as the substance at that time, the woman later identified the culprit after

she suffered another allergic reaction of the same kind. This time she’d cooked with ingredients she thought contained no MSG. “But I learned that monosodium glutamate can be present in any number of foods without ‘MSG’ appearing as an ingredient anywhere,” she says.

The lesson here? MSG is also naturally present in other ingredients. Here are a few of them: Autolyzed yeast extract, hydrolyzed vegetable protein, plant protein extract, caseinate, textured vegetable protein, natural flavor and vegetable powder.

Americans consume gallons of coffee, tea, soft drinks and other caffeinated beverages each day. Caffeine is widely used, inexpensive and readily available; it’s found in more than 60 plants and provides the kick in many foods and drinks. But the bitter substance is also an addictive drug.

When you chug down a caffeinated drink, how it affects you depends on the amount of the stimulant you regularly consume, your size, diet and type of exercise you do.

In general, caffeine works by stimulating the central nervous system to increase your heart rate and boost energy and alertness. But caffeine may also cause side effects such as headaches, anxiety, dizziness, jitters and heart problems, especially in those sensitive to the substance.

“For healthy adults, the [Food and Drug Administration, or FDA] has cited 400 milligrams a day—that’s about four or five cups of coffee—as an amount not generally associated with dangerous, negative effects,” explains R. plains Michael Mic Taylor, deputy commissioner for foods and veterinary medicine at the FDA. As such, the FDA discouragess consumingg more thann 400 milligrams igrams of caffeine a day.

THE MILLIGRAMS OF CAFFEINE CONSUMED PER PERSON EACH DAY IN THE UNITED STATES. Source: Food and Drug Administration

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 9

FITNESS

REVVED UP!

What cardio workouts burn the most calories?

Remember when people used just their bodyweight to train?

On one popular fitness website, members on the site’s forum debated the benefits of calisthenics versus lifting weights. The discussion continued until it became clear that both approaches to exercise worked. The main difference between the two? Calisthenics doesn’t require using added weights.

Common calisthenic exercises include push-ups, pull-ups, sit-ups, crunches, jumping jacks, squats and dips. These fitness moves are just a few of the exercises you can do using your bodyweight to build and sculpt the body you want—no gym membership needed.

Below are some additional benefits of these time-tested physique builders: ■ Calisthenics can be done anywhere and anytime; all you need is enough space to work out.

■ Almost anyone in reasonably good health can perform calisthenic exercises.

■ No equipment is needed to do calisthenics.

■ Calisthenics can improve overall body strength.

■ Calisthenic exercises can work several muscle groups at once.

■ Like most fitness activities, calisthenics can improve mental health.

■ Calisthenics can relieve minor aches and pains.

■ Calisthenic exercises can improve the health of your heart and reduce your risk of cardiovascular disease.

NUMBER OF CALORIES BURNED IN ONE HOUR BY A 200-POUND PERSON JUMPING ROPE Source: Centers for Disease Control and Prevention

1 0 REAL HEALTH S U MME R 2015

I

realhealthmag.com

Moderate-intensity aerobic activity, like brisk walking, is generally safe for most people.

ALL IMAGES: THINKSTOCK

Simple Moves

Here it is, fast and simple: Any form of exercise that is repetitive, long and hard enough to challenge the heart and lungs to use oxygen for fuel qualifies as an aerobic workout. These workouts burn more calories so you lose weight.

During aerobic exercise, oxygen, fats and carbohydrates combine to produce the fuel cells needed so we can run, jog, swim, cycle, dance, or do whatever other activity we choose that’s challenging enough for us to break a sweat.

In general, a few of the cardio workouts that burn the most calories per hour, depending on a person’s weight and the intensity of the exercise, are running, rollerblading, tae kwon do, rope jumping, swimming, tennis and cycling and the ol’ reliable: clocking miles on a treadmill.

If you’re not sure how to start a cardio workout, simply follow the Centers for Disease Control and Prevention guideline below that gets you off your duff and ready to torch those calories:

SEX Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.

How can faking orgasm affect a couple’s relationship?

Keeping the Bloom on Your Rose Don’t let moisture-starved vaginal tissues ruin sex for you.

(ROSE) THINKSTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD

In general, there are many causes of vaginal dryness. “Medication can cause it, as well as sensitivity to birth control pills,” says Hilda Hutcherson, MD, a clinical professor of obstetrics and gynecology at Columbia University in New York City. “But this can also happen to women when they become perimenopausal or menopausal and their estrogen levels go down.”

For many women who suffer from a dip in their estrogen levels, vaginal dryness can cause itching, burning or pain during intercourse. This is

THE PERCENTAGE OF MALE VERSUS FEMALE SEXUALLY EXPERIENCED COLLEGE STUDENTS WHO RESPONDED TO A POLL ADMITTING THEY FAKED AN ORGASM WITH A PARTNER Source: Journal of Sex Research, Volume 47, Issue 6, “Men’s and Women’s Reports of Pretending Orgasm”

because losing estrogen can thin the vaginal walls and make tissues less elastic and less lubricated.

Also, less lubrication can cause bleeding and tearing of thinned-out vaginal tissues during intercourse.

“No one seems to talk about this,” says one 59-year-old woman who is two years postmenopausal. “I was totally unprepared when this happened to me.”

But vaginal dryness is a normal and common problem for many women.

Sexual health experts suggest women speak to their doctor if they get any signs of the condition because there are treatments. Therapies include using vaginal lubricants and moisturizers, or low-dose vaginal estrogen therapy in cream, ring or tablet form.

Doctors may also suggest hormone replacement therapy (HRT) if a woman is a likely candidate.

Other ways to treat vaginal dryness, according to some experts, are as close as your kitchen and bedroom.

Drink more water and include more good oils in your diet, suggests one health practitioner.

Additionally, regular sexual activity or stimulation also helps to keep vaginal tissues from drying out.

But, advises Hutcherson, a woman may need many minutes of foreplay with her partner “to get things going.”

Remember the scene in the movie When Harry Met Sally when actress Meg Ryan faked an orgasm in a deli? The scene sparked a lot of talk. One reason might have been because it made people wonder whether someone had faked an orgasm with them.

Have you ever done this, or had it done to you? Deception is not a good thing for an intimate relationship. Faking an orgasm to lead your partner to believe you’ve reached a climax when this hasn’t happened is just dishonest. It’s like you’ve lied to your partner, and there’s nothing like lying to erode the trust in your relationship.

Sex is an amazing and beautiful experience that allows couples to release their inhibitions and become more vulnerable in their relationship. The sexual act is not only physical, it’s also an emotional and mental experience that helps couples build a bond.

Once trust is broken, it’s very difficult to re-establish and a couple’s relationship may suffer irreparable harm from this kind of sexual subterfuge.

Even worse, if the truth is ever revealed, imagine how betrayed and hurt your partner will feel.

Would you like to feel that way?

If your answer is no, then just don’t do it—ever.

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 1 1

1 6 REAL HEALTH S P R ING 2015

I

realhealthmag.com

(POGUE) DUSTIN FENSTERMACHER; (CHILDREN) COURTESY OF ERIC POGUE

CRUNCHING THE NUMBERS

The challenge for actress S. Epatha Merkerson and many others living with type 2 diabetes is to control their blood sugar level so they can better manage the disease.

By Kate Ferguson

realhealthmag.com

I

SP RIN G 2015 REAL HEALTH 1 7

to have her life change so dramatically one day about 12 years ago. The award-winning actress was asked by NBC to be a representative at the TV network’s health convention. The event was a huge affair that offered cooking lessons, a space for exercising,

She went to see her physician to talk about what she needed to do. When she thought about her diagnosis, she realized that type 2 diabetes ran in her family. Merkerson lost both her father and grandmother to complications of the disease, and her brother also has diabetes. “I think there’s something about not registering those things,” she says. “You know that they’re happening, but you don’t register them, so when this happened it was completely shocking.”

Nearly 30 million people in the United States have diabetes; most have type 2 diabetes. Once Merkerson was diagnosed, she worked with her doctor to create a plan to lower her blood sugar.

That meant Merkerson had to make certain lifestyle changes, such as finding the right diet, exercising and taking meds, to help her meet her A1C goals.

S. Epatha Merkerson gets the word out about knowing your A1C number in Philadelphia (left, right) and Atlanta (top center). Arpa Garay (bottom center) is the U.S. marketing leader of Merck’s diabetes franchise.

and a clinic where students and doctors from Howard University’s medical center tested attendees’ blood sugar levels. Merkerson also had her blood drawn for blood sugar testing. While cameras rolled, she smiled and talked about being proactive and taking care of yourself. After the cameramen stopped shooting, Merkerson was about to move on with the crew when a doctor approached. He asked her to come back when she was finished filming. “I was thinking, oh, he probably wants an autograph or to take a picture or something, so I told him I would come back,” she says. “When I returned, 1 8 REAL HEALTH S U MME R 2015

I

another screening tool, the A1C, or glycated hemoglobin test, measures what percentage of hemoglobin in blood has glucose attached to to it.

(A high number means more glucose is present.) Hemoglobin is the oxygen-carrying protein in red blood cells.

The American Diabetes Association (ADA) recommends that people with diabetes set an individualized A1C goal. The goal for many adults with diabetes is less than 7 percent. A higher or lower goal may be appropriate for some people, so you should speak with your doctor about what goal is right for you.

Merkerson took that doctor’s advice.

realhealthmag.com

“At 50, I was eating like a 12-year-old, so that was one of the first things I changed,” she says. “But what’s interesting is that during the years I’ve had to change my treatment plan as needed.

It’s not something you start with and always stick to. There are always going to be changes in the treatment.”

Merkerson changed her diet first, then

started exercising. “Doing television can be very sedentary, and I was put on medication,” she says. “Between those three things, we were able to find out what my A1C number should be and

PREVIOUS PAGES: (MERKERSON) JASON DECROW/AP IMAGES FOR MERCK; THIS PAGE: (MERKERSON IN PHILADELPHIA) LISA LAKE/AP IMAGES FOR MERCK; (MERKERSON IN ATLANTA) BERNARD MILLER PHOTOGRAPHY/COURTESY OF MERCK; (GARAY) LISA LAKE/AP IMAGES FOR MERCK

S. Epatha Merkerson wasn’t expecting

he told me he wanted to check my blood sugar again. It was over 300. He said, ‘Listen, I think you need to have a conversation with your doctor.’ That’s how I found out I had type 2 diabetes.

It was shocking.”

The test Merkerson took at that health convention was a blood sugar test that doctors use to diagnose diabetes from a blood sample. Regardless of when you last ate, a random blood sugar level of 200 or more milligrams of glucose per deciliter in the blood suggests diabetes.

Besides this common type 2 diabetes test, others include a blood sugar test that’s done after an overnight fast, and an oral glucose tolerance test that requires you to fast overnight and have your blood sugar level measured at intervals during a two-hour period after you drink a sugary liquid. In addition,

then set the goal to reach it.”

Merkerson is the spokesperson for a program called America’s Diabetes Challenge: Get to Your Goals. Merck, a pharmaceutical company, and the ADA launched the program to encourage people with type 2 diabetes to identify and meet their A1C goals, and learn how to control all aspects of their blood sugar level on a long-term basis.

For example, many people with diabetes are aware of the importance of controlling high blood glucose, but they may not know that blood sugar levels can also dip too low, a condition called hypoglycemia. If severe, this drop can cause accidents, injuries, coma and, possibly, death.

“We’re actually thrilled to be working with S. Epatha Merkerson primarily because we share a common goal,” says Arpa Garay, the U.S. marketing leader

IF PATIENTS’ NEEDS CHANGE, SO SHOULD THEIR DIABETES TREATMENT. for Merck’s diabetes franchise. “She is extremely passionate about working with diabetes patients to help educate them about how to better manage their disease.”

Merkerson is also working closely with the company to promote another ADA initiative, the Live Empowered program. This program reaches out to African Americans using diabetes workshops and activities to stress why everyone should know their A1C number and work with their doctor on a management plan to set and reach their A1C goal.

“This is a disease that really impacts

the African-American community,” Garay says. “African Americans are twice as likely as non-Hispanic whites to have diabetes.”

At these workshops and during the program activities, Merkerson shares her personal story about living with type 2 diabetes, how she works with her doctor on structuring the best treatment plan so she can reach her A1C goal, and the need to get the disease regularly assessed to control her diabetes and blood sugar.

The most difficult part of Merkerson’s treatment plan is managing her diet. “I come from a family of folks who are intimate with the kitchen, but I’m not,” she says. “I don’t cook, so it was important for me to figure out how to prepare meals for myself.”

When Merkerson finally figured out what kind of meals she should be eating, she cut back on red meat and fried foods. But doing so was tough. “One of the things I can do in the kitchen is fry a mean batch of chicken, but I had to give up on that,” she says with a laugh.

“Instead, I’ve been making salads and eating fresh vegetables. It’s very difficult and I’m constantly struggling with it.”

For Merkerson, joining the program is a way to help other people who also have to struggle with making the same lifestyle changes she did. She explains that the program’s user-friendly website, AmericasDiabetesChallenge.com, is a great resource of information for people with type 2 diabetes, their loved ones and caregivers.

Merkerson says the website has questions people with diabetes can ask their doctors that will help them and their docs work together to manage their diabetes. In addition, there’s a pledge on the website asking users to become proactive in their health care.

As part of her commitment, Merkerson tracks her blood sugar levels and works closely with her doctor to reach her A1C goal.

“The one thing that I so appreciate about being a part of this campaign is that it’s an education for me as well,” Merkerson says.

She pauses for a few seconds, then adds, “And if I can be a part of helping someone else through this disease, that really is extraordinary.” ■

WHY CHECK YOUR A1C? THIS BLOOD TEST CAN HELP YOU MANAGE DIABETES. Although home blood sugar testing is very useful to manage your daily blood glucose levels, doctors suggest people living with diabetes also take the A1C test, which measures their average blood sugar levels during the previous two to three months. This screening tool also helps people know if their diabetes management plan is working.

According to the National Institutes of Health, people should aim for their own unique A1C target number. This is because individuals have different A1C targets depending on their diabetes history and general health.

Diabetes patients should discuss their A1C target with a health care provider because findings show that if they can keep their A1C level below 7 percent, they can reduce the risk of suffering diabetes complications.

What’s more, maintaining good blood glucose control can benefit those with new-onset diabetes for many years to come. But an A1C level that is safe for one person may not be safe for another. For example, keeping an A1C level below 7 percent may not be safe if it leads to problems with hypoglycemia, also called low blood glucose.

Less strict blood sugar control, or an A1C between 7 and 8 percent—or even higher in some circumstances— may be appropriate in people with the following health problems: ■

Limited life expectancy

■

Long-standing diabetes and difficulty attaining a lower goal

■

Severe hypoglycemia

■

Advanced diabetes complications such as chronic kidney disease, nerve problems or issues with cardiovascular disease

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 1 9

Spicy Moroccan meatballs are served in a sauce avored with ginger, saffron and cumin.

2 0 REAL HEALTH WINT E R 2014

I

realhealthmag.com

COOKING

CHALLENGE

101 Diabetes dishes that are healthy for everyone

By Jeanette L. Pinnace

realhealthmag.com

I

W IN TER 2014 REAL HEALTH 2 1

When Leticia Moreinos Schwartz committed to being a spokes-

person for a health education campaign called “Desafiando La Diabetes,” to educate Latinos about type 2 diabetes, she relished the opportunity to also transform traditional recipes into more diabetes-friendly dishes.

Pharmaceutical company Merck sought out the Brazilian chef, teacher, food stylist and cookbook author who specializes in Latin cuisine for the campaign. Merck wanted Moreinos Schwartz because of her culinary expertise and passionate commitment to educating Latinos about managing type 2 diabetes.

Type 2 diabetes is the most common form of diabetes.

The illness causes blood sugar levels to rise because the body is unable to properly use insulin, a hormone that regulates the amount of glucose in the blood.

After struggling with the disease for many years, Moreinos Schwartz’s grandfather died of a stroke, one of many serious

for some people.) However, nearly half of people with diabetes don’t have an A1C number that’s below 7.

Better management of Moreinos Schwartz’s grandfather’s A1C number might have added years to his life. Instead, his death dealt the family a blow. They were shaken and saddened not only by his passing, but also because “we started to realize that maybe this could have been avoided if we had more information about the disease and a better comprehension of it,” she says. “That’s when we started to really pay a lot of attention to our lifestyle and to exercise a lot more; our minds became very conscious about healthy living.”

As in many families, food plays an important role in the social dynamics of Moreinos Schwartz’s family. But when her grandfather died, they looked harder at their food choices. “We were eating traditional Latin foods, and all of a sudden we had to modify,” she says. “I was always into the food, and I thought I would have to stop eating meals with ingredients that are really iconic to us in Brazil—the same ingredients we share with the rest of South America.

But I knew I’d have to modify my diet in order to take good care of my health.”

Diet modification is also the solution the Centers for Disease

Control and Prevention (CDC) offers to address statistics showing that diabetes disproportionately affects African Americans and Latinos. When Merck requested Moreinos Schwartz’s support on its campaign, she was eager to help educate others about the importance of understanding how high blood sugar levels can eventually lead to serious long-term health problems.

Also, being a chef, Moreinos Schwartz was excited to take on the culinary challenge of creating dishes that are not only healthy and nutritious for those living with diabetes, but also tasty and enjoyable recipes for the whole family.

Experts have long stressed that diabetes doesn’t mean you must deprive yourself of all your favorite foods. Many flavorful substitutions can be made to excite the taste buds and satisfy your appetite. In Moreinos Schwartz’s cooking classes, she stresses how to season food properly.

“When you know how to season and you use salt and pepper and herbs and spices from the very beginning, you don’t need that much extra salt to flavor the food, which is huge,” she says.

Moreinos Schwartz also uses chicken stock to add flavor to food, bypassing the butter, cream, cheese or any of “those things that aren’t really good for you,” she says. She encourages folks to make their chicken stock at home or buy some of the low-sodium brands, which are healthier.

Indeed, learning what to eat and making healthful choices can make you feel better. But not only that: Modifying your diet can help you lose weight and lower your risk of some of

complications type 2 diabetes can cause. “I was probably 15 or 16 at the time,” she recalls. “I noticed that my grandmother wasn’t completely educated about how to treat diabetes and how to help my grandfather control his A1C number. Also, she didn’t know what types of foods she should prepare for him and the family.”

The A1C number is derived from a test that measures the average

amount of glucose, or sugar, in your blood for the previous two to three months. Guidelines for the American Diabetes Association suggest many people with diabetes should have an A1C number of less than 7 to help reduce the risk of complications, such as heart disease and stroke. (Remember, everyone is different, and a higher or lower A1C goal may be appropriate 2 2 REAL HEALTH S U MME R 2015

I

realhealthmag.com

ALL IMAGES: COURTESY OF LETICIA MOREINOS SCHWARTZ

DESPITE WHAT MANY PEOPLE THINK, DIABETES-FRIENDLY MEALS DON’T HAVE TO BE BLAH, BLAND, BORING AND BASIC.

the scarier complications caused by diabetes, such as heart disease, stroke, kidney problems, blindness and amputation.

“Knowledge is power. Learning how the foods you eat affect your health and well-being gives you the power to become healthy, live longer, and feel better every single day,” says Joel Fuhrman, MD, author of the best-selling book The End of Diabetes.

“When you eat a diet rich in healthy, natural foods from the earth, you give your body the nutrients it needs to heal and protect itself,” he continues. Fuhrman also believes that type 2 diabetes is a disorder triggered by not making the proper food choices that could help extend our lives and prevent many of the diseases that we face.

But there’s more to controlling and managing diabetes besides choosing healthier foods and changing the way they’re prepared. “We can’t emphasize enough the importance of people talking about nutrition, knowing their A1C number and developing a personalized plan with their doctor,” Moreinos Schwartz stresses.

What’s more, a diabetes-friendly diet isn’t only a good idea for those living with the disease. Experts at the Mayo Clinic believe a healthy eating plan that is rich in nutrients found in fruits, vegetables and whole grains, which is automatically low in fat and calories, is the most nutritious diet for almost anyone.

“Choose recipes that are good for the whole family,” Moreinos Schwartz suggests. “Make it a family affair. When the family is involved, this tends to lead to a more successful outcome for a family member with diabetes.”

But what about dessert? Sweet treats at the end of a meal are

also a traditional part of many families’ dining experience.

Moreinos Schwartz agrees, but she stresses that for those with diabetes, allowing themselves sweets is part of a discussion to be had with their doctor. “It’s more appropriate that each person develop a plan with their doctor to control diabetes, and that will include the consumption of sweets,” she advises.

Still, the chef does agree that sweet treats can also be modified and made more diabetes-friendly, even rich and creamy Latin desserts such as arroz con leche. “This is another traditional Latin dish that we have adapted with a lot less sugar,” she shares. “When we give a tasting of that, people go crazy.”

If you want to see for yourself, check out Moreinos Schwartz’s recipe for this crowd-pleaser in the sidebar on this page. This sweet treat is one of Moreinos Schwartz’s diabetes-friendly recipes that she created to be generally lower in sodium, carbohydrates, saturated fat, trans fat and cholesterol, and higher in fiber than its traditional counterpart.

But portion control is also part of the equation. “We try to encourage people to eat a lot less,” she cautions. That means enjoying just a tablespoon or two of the creamy creation instead of scarfing down a whole bowl.

Says Moreinos Schwartz, “Again, I think a successful way for someone with diabetes to go about including sweets in a meal plan is to really talk to their doctor.” ■

Craving Something Smooth, Sweet, Rich and Creamy?

Check out this diabetes-friendly dessert!

Arroz con Leche Serves 10 Ingredients Two 3-inch (8-centimeter) cinnamon sticks 4 cups (1 liter) whole milk, divided ½ cup (100 grams) Arborio rice 2 tablespoons (30 grams) sugar One 14-ounce can (396 grams) sweetened condensed milk 2 egg yolks Ground cinnamon to garnish Directions Lightly punch the cinnamon sticks on a cutting board with the flat side of a chef’s knife to break them up.

In a large saucepan, combine 3 cups of the milk with the rice, sugar and cinnamon sticks. Bring to a boil, then reduce the heat. Simmer uncovered, stirring occasionally with a wooden spoon and making sure none of the rice is stuck on the bottom, until the rice is cooked, about 20 minutes.

Remove from the heat.

In another saucepan, simmer the sweetened condensed milk and the remaining cup of milk.

In a medium bowl, whisk the yolks. Add a little of the condensed milk to temper, whisk well, then return everything to the saucepan. Cook on low heat, stirring slowly and constantly with a wooden spoon, until the mixture just begins to boil, about 5 minutes.

Combine the contents of both pans and continue to cook, stirring constantly with a wooden spoon, without letting it come to a boil, another 5 minutes.

Transfer the rice pudding to a bowl. You’ll be tempted to taste it now, but if you do, the rice will seem slightly sweet and too loose. Chill for at least 6 hours. The cinnamon sticks will continue to impart flavor; remove them just before serving. Pour the pudding into a serving bowl or divide among individual bowls, lightly sprinkle ground cinnamon on top, and serve.

Nutrition information (1 serving): Calories 247; fat 7 g; saturated fat 4 g; cholesterol 57 mg; sodium 84 mg; carbohydrates 38 g; fiber 0 g; protein 7 g Recipe courtesy Leticia Moreinos Schwartz

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 2 3

To visualize a concussion, imagine this ball is someone’s head.

TAKIN’ HITS FALLS, BUMPS, BLOWS AND JOLTS TO THE HEAD AND BODY CAN CAUSE CONCUSSIONS AND A HOST OF OTHER ILLS.

By Gerrie E. Summers

When Lindsey Carfagna played soccer in college, she suffered

back-to-back concussions during her first season. The second time she was hit, she hadn’t yet healed from the first incident.

“I learned later that’s when you can have a catastrophic outcome,” she says.

Doctors diagnosed Carfagna with “second-impact syndrome,” a rare condition that happens when a second concussion occurs before the first concussion has properly healed. The result is rapid and severe brain swelling. During that time, Carfagna was depressed and suffered from anxiety.

“I lost a lot of friends because I couldn’t play with my team anymore,” she recalls. “For me, it went as far as having to go on medication. Prior to that, I was a happy-go-lucky, very capable person. But a brain trauma can really make you not recognize yourself.”

In general, the brain is cushioned from normal bumps and jarring movements by cerebrospinal fluid in the skull.

But violent and severe blows or falls that affect the head, neck and upper body can slam the brain against the inner walls of the skull. This damages brain cells as well as creates chemical changes in the brain that may cause a number of symptoms associated with traumatic brain injury (TBI) (see sidebar).

According to the Centers for Disease Control and Prevention (CDC), an estimated 5.3 million men, women and children are living with permanent TBI-related disability in the United States.

The condition is highest among adolescents, young adults and adults older than 75. But research also shows that minorities are at a particularly higher risk of TBI. What’s more, aspects of the condition, such as cognitive, emotional, sensory and motor impairments, can be missed or ignored. That’s why TBI is often called the “invisible epidemic.” The condition can negatively affect employment, social activities and family dynamics, and

it can create a burden of financial debt from medical care that’s necessary for treatment.

But this isn’t all. Research suggests there is a relationship between these injuries and the onset of criminal behavior in youths and adults. The findings also show that kids from minority populations are at a decided disadvantage when it comes to recovering from severe brain injury. This is one of the reasons Carfagna, who today is a certified personal trainer with the National Academy of Sports Medicine (NASM) and a doctoral student in sociology at Boston College, advocates for concussion awareness.

“Folks that have concussions are likely to be very irritable, anxious, depressed and sad, and to experience outbursts of rage,” she says. “Despite all the anti-violence therapy I’ve done and with all the resources I can access to avoid a bad outcome, I have a really hard time cooling myself back down after something sets me off.”

Continues Carfagna, “Imagine being a 15-year-old kid and having no skills to pull yourself out of those feelings of rage. I can absolutely tell you that you’ll be hard-pressed to find somebody who has suffered a concussion who won’t tell you that you experience personality changes.”

Indeed, a recent study published in the medical journal NeuroRehabilitation found that, when compared with Caucasians, minorities experience lower rates of success after undergoing long-term treatment for TBIs. In addition, despite lots of information that shows minority populations are at a significantly higher risk of TBI, the current treatment system seems to lead to notable disparities in outcomes.

The youth population outside of sports that is most dramatically

affected by head injury is that of incarcerated youngsters, particularly males. In a report published in the journal

2 6 REAL HEALTH S U MME R 2015

I

realhealthmag.com

Pediatrics, researchers found that kids convicted of a crime were more likely to have self-reported their TBI. “Some suffer concussion while in the custody of juvenile centers,” Carfagna says. “Concussions can cause changes in mood, anger, moments of oubursts, depression, suicidal thoughts, and a host of other cognitive and behavioral side effects. For a middle-class kid with a strong support system, these things

(PREVIOUS PAGES) THINKSTOCK

FINDINGS SHOW THERE’S A LINK BETWEEN TRAUMATIC BRAIN INJURY AND THE ONSET OF CRIMINAL BEHAVIOR IN YOUNG MALES OF COLOR.

are challenging but not typically life-threatening. In addition, they don’t exist alongside existing stereotypes and bias as they do for poor kids, particularly youth of color.”

Carfagna says that she’s been a bit frustrated with the conversation about concussion awareness and youth safety. “It’s awesome that we’re giving attention to this important issue,” she says. “But if I were a sociologist, I’d be doing a poor job if I didn’t also note that there are youth populations who suffer from head injuries at a higher than average rate. There’s very few people talking about this particular aspect of the issue.

“I’m passionate about issues of social justice, and I tend to bring that lens to whatever I do,” Carfagna continues.

“But this isn’t always welcome in the health, fitness and sporting realms.”

Carfagna adds that, for poor kids, particularly poor young people

of color, the side effects of a concussion can push them into the school-to-prison pipeline, or fuel the perception that minority youth have violent tendencies. “I think it is very important that more people are aware of the relationship between concussions and youth incarceration, or at least how the concussion awareness movement misses major pieces of our youth populations,” she says.

Indeed, a number of findings target TBI as a chronic condition with long-term health issues that must be addressed if incarcerated offenders are to be successfully rehabilitated.

But before this happens, everyone must become educated about concussions and understand the full effect this type of TBI has on the body and the brain.

Many people believe that concussions only happen when an injury causes someone to lose consciousness, but this isn’t necessarily true. “I remember not hearing things correctly and feeling like things were incredibly slowed down,” Carfagna says. “Sometimes your ears might feel like they’re ringing, depending on where you got hit. Everything feels kind of slow and a little bit surreal. There’s a sensation of dizziness. A lot of people will vomit, or might feel like they’re going to throw up. You may also have trouble seeing, feel sensitivity to light and sound right away, and you may feel irritable. But sometimes these things don’t happen immediately. Also, depending on the severity of the blow, some people can heal within two weeks. But we still don’t know why some people don’t.”

Experts advise that if you don’t feel quite right for several days or weeks after you’ve sustained a TBI, check with your doctor, especially if your symptoms become worse. According to the CDC, most people fully recover from a concussion, but it can take some time. What’s more, rest is very important after a TBI so the brain can heal.

a concussion while playing a school sport, “pull your child out of play immediately,” she urges. Parents should also request baseline concussion testing. If a school doesn’t have access to baseline concussion testing, “advocate for it,” Carfagna suggests. After that, the next stop is a visit to the doc and a concussion-trained specialist. ■

HEADS UP! Contrary to popular belief, most concussions do not involve a loss of consciousness. Here are some signs and symptoms of this traumatic brain injury to watch for.

Physical ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

wanting to do the best thing for them, to keep them active, to socialize them,” Carfagna says. “But many of them also grew up in an era where [the attitude toward a child’s injury was] ‘You just got your bell rung, get back out there.’”

When a parent suspects that a child might have suffered

Headaches Nausea Vomiting Balance problems Dizziness Visual problems Fatigue Sensitivity to light Sensitivity to noise Numbness or tingling

Cognitive ■ ■ ■ ■ ■

■ ■

■ ■

■

■

■

■

■

■ ■ ■

■

■ ■ ■ ■

■

■

Irritability Sadness Depression Heightened emotions Nervousness Anger

Sleep ■

Drowsiness or an inability to wake up

realhealthmag.com

Sleeping more than usual Sleeping less than usual Trouble falling asleep

Seek medical help immediately if you notice these dangerous signs:

■

Feeling mentally foggy Feeling slowed down Difficulty concentrating Difficulty remembering Forgetting recent conversations or information Confusion about recent events Slow to answer questions and repeating questions

Emotional

■

“You have a lot of parents putting their kids into youth sports,

■

Loss of consciousness, even briefly Slurred speech or other changes in speech Weakness, numbness or decreased coordination Seizures, convulsions Vision or eye issues (pupils that are bigger than normal, or pupils of unequal size) Headaches that worsen and won’t go away Lasting or recurring dizziness Repeated vomiting or nausea Obvious difficulty with mental function or with physical coordination Unusual behavior Large bumps or bruises in areas other than the forehead in children, especially infants younger than 12 months

If you have suffered a concussion, you should not return to play (or vigorous activities) on the same day as the injury, or if you still have signs of a concussion. For more information, visit cdc.gov/traumaticbraininjury.

I

SU M M ER 2015 REAL HEALTH 2 7

TORN

APART THIS BEHAVIORAL DISORDER WREAKS HAVOC ON APPEARANCE AND SELF-ESTEEM.

By Kate Ferguson

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 2 9

(POGUE) DUSTIN FENSTERMACHER; (CHILDREN) COURTESY OF ERIC POGUE

Visit realhealthmag.com to see the video detailing Hannah’s story.

3 0 REAL HEALTH S U MME R 2015

I

realhealthmag.com

MINDING YOUR HAIR Trichotillomania is also emotionally painful.

Besides the physical and medical problems hair-pulling causes, those who suffer from this disorder also experience shame and isolation, as well as interference with intimate relationships, work and school. Many also avoid activities they previously enjoyed.

According to Mental Health America, trichotillomania is officially classified as an “impulse control disorder,” much like the uncontrollable urge to steal (kleptomania), light fires (pyromania) or gamble. Some mental health experts consider “trich” to be a type of obsessive-compulsive disorder that can trigger depression, guilt and lowered self-esteem because the behavior can be hard to stop.

Some mental health experts also believe that hair-pulling is a type of addiction, or a form of harming oneself.

In addition, guidelines for diagnosing the disorder are explored in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

A hairstylist or dermatologist may be more likely to uncover the physical damage trich causes, but mental health docs are the ones who make the diagnosis.

Sometimes physicians and mental health professionals may team up to diagnose trich and create a treatment plan. For those who have the problem, “You are not crazy, helpless, weak or out of control, even though you may feel like some or all of these things at times,” stresses the Trichotillomania Learning Center (TLC), a nonprofit organization that offers a wealth of information about the disorder.

The TLC and mental health doctors share a mission: To make people aware that although there isn’t a cure for trich, there are ways to treat the disorder so folks can recover from the mental and physical damage it causes.

PREVIOUS PAGES: THINKSTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

t the age of 13, Hannah, then a young girl in Sarasota, Florida, began to tear out her tresses. One morning, she woke up to find a pile of hair on her pillow: She’d pulled out a handful of her thick, beautiful hair during the night.

Hannah hid her behavior from her family for several years, until her mom finally noticed a bald spot on the front of her head.

If you search YouTube for trichotillomania, a.k.a. “trich” or TTM, you’ll find Hannah’s story among a number of videos about this disorder. Most of the videos show women or girls who compulsively pull hair from their scalp, eyelashes, eyebrows, legs or other parts of their body. But men also suffer from this disorder.

Although Hannah thought she was the only person “on the face of the planet” who did this, she later learned that she was not alone. According to estimates by the Trichotillomania Learning Center (TLC), a nonprofit organization that’s an educational resource about the disorder, about 2 million to 10 million Americans suffer from trich. What’s more, the disorder affects people of all ages, genders, ethnicities, nationalities and backgrounds.

There are many reasons why some people pull out their hair. Findings show that the disorder is neurological and may be genetic, so scientists are studying people who suffer from trichotillomania to isolate genes that may be at fault.

While some researchers focus on possible biological causes of trichotillomania, others continue to search for better ways to treat this disorder that has no known cure. Still, many treatments are available and have helped “thousands of people to become pull-free,” says the TLC. One effective treatment for trich is cognitive behavioral therapy (CBT), a method psychologists use to interrupt hair-pulling as a response to things that trigger the behavior. Another approach is drug therapy, which may be used along with CBT. But “there is no magic pill for the treatment of trichotillomania” because “people respond very individually to medications, so there will never be a single drug that helps everyone,” explains the TLC. Some trich sufferers report that alternative therapies have worked for them. Many of these unproven methods, such as diet changes, hypnosis, prayer, yoga and herbal remedies, often have no scientific support for their effectiveness. Therefore, the TLC suggests that those suffering from trich may do best to explore these therapies with an open, but also cautious, mind.

Additionally, trich sufferers may want to connect with a support group.

Because so often people feel isolated when they are suffering from a disorder, experts advise finding a support group that’s led by a therapist, or individuals who are members of a peer group.

For Hannah, the feeling that she was the only person suffering from hair-pulling caused her to believe she was crazy and strange for wanting to harm herself. When her mother learned about her hair-pulling episodes and took her to psychologists, Hannah was shocked to find that there was no name for this illness.

Indeed, it is only within the past two decades that trich and similar body-focused repetitive behaviors have gotten attention in mental health literature or skin and hair care circles, states the TLC. But, as Hannah and her mom found, help is available.

After she found a hair salon that helped her recover the tresses she lost to hair-pulling, Hannah decided to disclose her disorder to others. That’s when she joined other advocates who chose to reveal their personal stories about suffering from trich online. Many of the tales were heartbreakingly similar.

But so were the reasons these advocates had for speaking out.

“I knew that I couldn’t keep quiet about my secret anymore,” Hannah says. “I wanted to be able to help girls all over that were just like me, and I wanted to let them know they aren’t alone. There is hope, and there is help.”

SIGG Swiss Edition Color Block Series (33 fl. oz., $22.99 each) Pour your beverage in these sleek, sporty, lightweight, one-liter bottles you can tote anywhere, mysigg.com.

Belli Pure Radiance Facial Sunscreen (1.5 oz., $24) Protect your face with this broad-spectrum, oil-free, allergy-tested, moisturizing sun block that can be used alone or under makeup and blends with all skin tones, belliskincare.com.

CapriClear Spray-On Moisturizer (5.2 fl. oz. bottle, $19.99; 1.9 fl. oz. travel size, $10.99) This colorless, odorless treatment contains only pure fractionated coconut oil to soothe and hydrate even the most sensitive skin, capriclear.com.

Stuff We Love

A ROUNDUP OF THE LATEST MUST-HAVE FINDS FOR HAIR, SKIN, HEALTH, BEAUTY AND MORE. THESE PRODUCTS ARE WORTH EVERY CENT.

Oxygen Plus O+ Skinni (3-pack, $35.97) Press a button on the canister to inhale 95 percent pure oxygen for increased alertness, mental clarity, cognitive performance and recuperation after intense physical activity, oxygenplus.com.

Ultra CHI Flat Irons (patterns vary, $149.95 each) Style your hair fast and with minimal damage using one of these brightly colored, beautifully patterned flat irons with their quick-heating, 1-inch tourmaline ceramic plates; when done, stow in its matching tote bag, ulta.com.

South Beach Diet Good to Go Bars ($3.59 per box of five bars, variety of flavors) These rich, chewy, satisfying cereal bars feature extra protein and fiber, lower sugar, and healthy, tasty ingredients with no artificial flavors, sweeteners or sugar alcohols, southbeachdiet.com.

realhealthmag.com

I

SU M M ER 2015 REAL HEALTH 3 1

THOUGHTS

Cooling Off

How I tamed the raging tiger inside me

Steaming Mad?

Take a moment to think so you don’t blow your stack.

Several years ago, my sister and I took a walk near a park on our way to the library.

We were sharing a joke when out of nowhere, a teenage boy ran past and snatched my sister’s costly Italian gold chain from around her neck. For a moment, we stood silent and frozen in place. But after a few seconds, I felt overwhelmed by anger. Totally incensed, I took off after the boy, leaving my sister standing there dumbfounded.

When I couldn’t find the chain-snatcher, I returned to the corner where my sister waited. She looked at me in consternation.

“That was not a good idea, you running after that kid,” she scolded. “Suppose you’d found him; then what?”

My sister was right. Fortunately, I didn’t find the young man who’d stolen her necklace. As I reflect on this incident today, I realize that the time that passed while I was running after the thief was a godsend.

While I pounded the pavement looking for him, I’d cooled off and checked my anger without even knowing it.

It’s the same principle that applies when you count to 10 before you react to something that makes you angry.

If you could draw a picture of anger, what would it look like? Would you express this powerful emotion as a destructive explosion? Perhaps a volcanic eruption, or a fast-moving tidal wave towering high and ready to crash down on anything in its path? We all get angry sometimes. But if anger isn’t controlled, this feeling can escalate into rage and result in all sorts of unpleasantness. Happily, there are ways to outsmart this primal emotion and use it to our advantage.

Tom G. Stevens, PhD, a psychologist and professor emeritus Ever heard the phrase, “I was so angry, I could at California State University, Long Beach, and the author scream”? Many people assume that this is an effective of You Can Choose to Be Happy: “Rise Above” Anger, Anxiety way to release anger and avoid a more negative or violent emotional or physical reaction. But some and Depression, says that “every moment of anger is one studies show a far better way to “buffer and temper the less moment of happiness.” anger response,” say Joseph Shrand, MD, and Leigh What is the best way to regain control after becoming angry?

Devine, MS, authors of the book Outsmarting Anger: 7 Identify what’s driving your anger. Imagine anger’s consequences, find Strategies for Defusing Our Most Dangerous Emotion. “win-win” solutions, rethink the situation, distract yourself, or use con“Our anger can be transformed into much more structive, vigorous activity until your anger loses steam. productive power.”

The strategies the authors offer are brain-based How can we defuse the anger inside us when we make a mistake? techniques that train our prefrontal cortex, the part of Ask key questions to better see why you made a mistake. Maybe your goals the brain responsible for conscious reasoning, to first or expectations were unrealistic. View mistakes as opportunities to learn, identify angry feelings and then change our reactions become stronger and improve your chances of success in the future. to them.

What are some simple activities people can do to help reduce anger?

Here’s an exercise to try: The next time you’re in a There is no simple way or activity to get rid of a chronic anger-aggression heated argument with a loved one that seems on the problem. Rethinking and vigorous exercise are probably the quickest and verge of escalating, take a quick breather and ask if easiest ways to immediately realize short-term relief from anger. he or she would like some refreshments.

What happens next might surprise you!

3 2 REAL HEALTH S U MME R 2015

I

realhealthmag.com

THINKSTOCK

The Expert Says

READER SURVEY

SPEAK YOUR MIND! (And Win Free Stuff)

According to the Centers for Disease Control and Prevention, regular physical activity helps improve your overall health and fitness and also reduces your risk of many chronic diseases. Please take our survey below and tell us how much of a priority fitness is in your life.

Cardio workouts for big weight loss!

As a thank-you, we’ll select two winners at random from among the completed surveys we receive and send these readers a fitness DVD (suggested retail price $14.98). For official contest rules, please visit realhealthmag.com/survey/rules.

1. Do you exercise for at least 20 minutes each day?

12. What is your household income?

❑ Yes ❑ No

❑ $15,000–$34,999

❑ Under $15,000 ❑ $35,000–$49,999

2. Do you include any fitness activity, such as walking or cycling, in your commute to work?

❑ $50,000–$74,999

❑ Yes ❑ No

❑ $100,000 and over

3. Do you exercise only during the weekend?

13. What is the highest level of education attained?

❑ Yes ❑ No

❑ Some high school

❑ High school graduate

❑ Some college

❑ Bachelor’s degree or higher

❑ $75,000–$99,999

4. Do you engage in any fitness activities during your work hours?

14. What is your ethnicity?

❑ Yes ❑ No

❑ American Indian or Alaska Native ❑ Arab or Middle Eastern

5. Do you have a fitness goal you’re trying to reach?

❑ Asian

❑ Yes ❑ No

❑ Hispanic or Latino

❑ Black or African American ❑ Native Hawaiian or other Pacific Islander

6. Do you have a regularly scheduled workout time each week?

❑ White ❑ Other

❑ Yes ❑ No

15. Where do you get Real Health?

7. Do you exercise at least three times a week?

❑ I’m a subscriber

❑ Yes ❑ No

❑ My doctor’s office ❑ My church

8. Do you maintain your exercise schedule when you’re on vacation?

❑ A community or college organization

❑ Yes ❑ No

❑ Other:_______________________

9. Do you exercise if you suffer an injury?

16. Do you have Internet access?

❑ Yes ❑ No

❑ Yes ❑ No

10. What year were you born?_________

17. Name:___________________________________________ 18. Organization (if you represent one):______________________ 19. Street address:_____________________________________________ 20. City & state:________________________________________________ 21. ZIP code:____________________________________________________ 22. Email:_______________________________________________________ 23. Phone:_______________________________________________________

11. What is your gender? ❑ Female ❑ Male ❑ Transgender ❑ Other

❑ It was mailed to me

Summer 2015