Real Health Winter 2015 by Smart + Strong

REALHEALTH YOUR GUIDE TO BLACK WELLNESS

How To Eat Smarter For The Holidays

Actor

Rockmond Dunbar

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Caring For Kids With Sickle Cell Disease

More About The Little Pink Pill For Women

On Dyslexia A Misunderstood Learning Disability

Homelessness Hurts Health

速

New Genvoya is now available

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Actual Size

Onepill pill contains One contains elvitegravir, cobicistat, emtricitabine, elvitegravir, cobicistat, emtricitabine, and tenofovir (TAF). and tenofoviralafenamide alafenamide (TAF). Ask your healthcare provider Ask your healthcare provider if GENVOYA is right for you.

if GENVOYA is right for you. To learn more visit GENVOYA.com To learn more visit

GENVOYA.com

Please see Brief Summary of Patient Information with important warnings on the following pages.

11/17/15 3:24 PM

Brief Summary of Patient Information about GENVOYA GENVOYA (jen-VOY-uh) (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide) tablets Important: Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA. There may be new information about GENVOYA. This information is only a summary and does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is the most important information I should know about GENVOYA? GENVOYA can cause serious side effects, including: • Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis may happen in some people who take GENVOYA. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms, which could be signs of lactic acidosis: • • • • • • •

feel very weak or tired have unusual (not normal) muscle pain have trouble breathing have stomach pain with nausea or vomiting feel cold, especially in your arms and legs feel dizzy or lightheaded have a fast or irregular heartbeat

• Severe liver problems. Severe liver problems may happen in people who take GENVOYA. In some cases, these liver problems can lead to death. Your liver may become large and you may develop fat in your liver. Call your healthcare provider right away if you get any of the following symptoms of liver problems: • your skin or the white part of your eyes turns yellow (jaundice) • dark “tea-colored” urine • light-colored bowel movements (stools) • loss of appetite for several days or longer • nausea • stomach pain • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking GENVOYA for a long time. • Worsening of Hepatitis B infection. GENVOYA is not for use to treat chronic hepatitis B virus (HBV). If you have HBV infection and take GENVOYA, your HBV may get worse (flare-up) if you stop taking GENVOYA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. • Do not run out of GENVOYA. Refill your prescription or talk to your healthcare provider before your GENVOYA is all gone. • Do not stop taking GENVOYA without first talking to your healthcare provider. • If you stop taking GENVOYA, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking GENVOYA.

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What is GENVOYA? GENVOYA is a prescription medicine that is used without other HIV-1 medicines to treat HIV-1 in people 12 years of age and older: • who have not received HIV-1 medicines in the past or • to replace their current HIV-1 medicines in people who have been on the same HIV-1 medicines for at least 6 months, have an amount of HIV-1 in their blood (“viral load”) that is less than 50 copies/mL, and have never failed past HIV-1 treatment HIV-1 is the virus that causes AIDS. GENVOYA contains the prescription medicines elvitegravir (VITEKTA®), cobicistat (TYBOST®), emtricitabine (EMTRIVA®) and tenofovir alafenamide. It is not known if GENVOYA is safe and effective in children under 12 years of age. When used to treat HIV-1 infection, GENVOYA may: • Reduce the amount of HIV-1 in your blood. This is called “viral load”. • Increase the number of CD4+ (T) cells in your blood that help fight off other infections. Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your blood may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak (opportunistic infections). GENVOYA does not cure HIV-1 infection or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. Avoid doing things that can spread HIV-1 infection to others: • Do not share or re-use needles or other injection equipment. • Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. • Do not have any kind of sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your healthcare provider if you have any questions about how to prevent passing HIV-1 to other people.

Who should not take GENVOYA? Do not take GENVOYA if you also take a medicine that contains: • alfuzosin hydrochloride (Uroxatral®) • carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) • cisapride (Propulsid®, Propulsid Quicksolv®) • ergot-containing medicines, including: dihydroergotamine mesylate (D.H.E. 45®, Migranal®), ergotamine tartrate (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), and methylergonovine maleate (Ergotrate®, Methergine®) • lovastatin (Advicor®, Altoprev®, Mevacor®) • midazolam, when taken by mouth • phenobarbital (Luminal®) • phenytoin (Dilantin®, Phenytek®) • pimozide (Orap®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • sildenafil (Revatio®), when used for treating lung problems • simvastatin (Simcor®, Vytorin®, Zocor®) • triazolam (Halcion®) • the herb St. John’s wort or a product that contains St. John’s wort

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What should I tell my healthcare provider before taking GENVOYA? Before taking GENVOYA, tell your healthcare provider if you: • have liver problems including hepatitis B infection • have kidney or bone problems • have any other medical conditions • are pregnant or plan to become pregnant. It is not known if GENVOYA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking GENVOYA. Pregnancy registry: there is a pregnancy registry for women who take HIV-1 medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry. • are breastfeeding or plan to breastfeed. Do not breastfeed if you take GENVOYA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. – At least one of the medicines in GENVOYA can pass to your baby in your breast milk. It is not known if the other medicines in GENVOYA can pass into your breast milk. – Talk with your healthcare provider about the best way to feed your baby. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how GENVOYA works. Some medicines may interact with GENVOYA. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. • You can ask your healthcare provider or pharmacist for a list of medicines that interact with GENVOYA. • Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take GENVOYA with other medicines.

How should I take GENVOYA?

• Take GENVOYA exactly as your healthcare provider tells • • • • • • •

you to take it. GENVOYA is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection. GENVOYA is usually taken 1 time each day. Take GENVOYA with food. If you need to take a medicine for indigestion (antacid) that contains aluminum and magnesium hydroxide or calcium carbonate during treatment with GENVOYA, take it at least 2 hours before or after you take GENVOYA. Do not change your dose or stop taking GENVOYA without first talking with your healthcare provider. Stay under a healthcare provider’s care when taking GENVOYA. Do not miss a dose of GENVOYA. If you take too much GENVOYA, call your healthcare provider or go to the nearest hospital emergency room right away. When your GENVOYA supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to GENVOYA and become harder to treat.

What are the possible side effects of GENVOYA? GENVOYA may cause serious side effects, including: • See “What is the most important information I should know about GENVOYA?” • Changes in body fat can happen in people who take HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk). Loss of fat from the legs, arms and face may also happen. The exact cause and long-term health effects of these conditions are not known. • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider right away if you start having any new symptoms after starting your HIV-1 medicine. • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking GENVOYA. Your healthcare provider may tell you to stop taking GENVOYA if you develop new or worse kidney problems. • Bone problems can happen in some people who take GENVOYA. Bone problems may include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. The most common side effect of GENVOYA is nausea. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. • These are not all the possible side effects of GENVOYA. For more information, ask your healthcare provider or pharmacist. • Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of GENVOYA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use GENVOYA for a condition for which it was not prescribed. Do not give GENVOYA to other people, even if they have the same symptoms you have. It may harm them. This Brief Summary summarizes the most important information about GENVOYA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about GENVOYA that is written for health professionals. For more information, call 1-800-445-3235 or go to www.GENVOYA.com. Keep GENVOYA and all medicines out of reach of children. Issued: November 2015

EMTRIVA, GENVOYA, the GENVOYA Logo, GILEAD, the GILEAD Logo, GSI, TYBOST, and VITEKA are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. © 2015 Gilead Sciences, Inc. All rights reserved. GENC0001 11/15

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CONTENTS this month on REALHEALTHMAG.COM A unique plastic surgery technique helped restore this beautiful fitness model’s appearance after a car accident left her face horribly scarred.

Health Basics A—Z

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.

Eye On the Needle

Vaccines don’t just help ward off childhood infections; these immunizations may also protect your kids from the risk of early heart attack as adults.

Breast Cancer Screenings Once again the guidelines have changed for when women should get a mammogram to check their breast tissue for abnormalities.

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.

7 5

editor’s letter

buzz

14 COVER STORY

very misunderstood

Human condition vs. health issue

When Rockmond Dunbar got his dyslexia diagnosis, it motivated him to fight misconceptions about this common learning issue.

Homeless and ill; from HIV to AIDS and back; HIV ABCs; facts about frostbite; the return of heroin; high rates of undiagnosed hep C in ERs

holiday feasting

kids in crisis

hair growth news

thoughts

nutrition

Hot, spicy foods and health; water is the stuff of life; picky-eater kids

fitness

Thoughts about whether to eat before exercising; ever consider some ballet moves for your joints?

sex

All about that controversial little pink pill for women; Ask Doctor Dee: the concerns about doctors prescribing a drug to women who have low sexual desire

Make healthier meal choices at home and when dining out.

Researchers are studying ways children with sickle cell can get proper care as adults.

RH investigates the greenhouse effect, a hair care method some say helps tresses to grow.

Transitions can be challenging; here’s how to curb your fears.

Real Health Question of the Month

What’s the best way to handle holiday sadness from having lost a loved one? Instead of trying to hide your grief, try talking about your lost loved one during the day, or do something your loved one enjoyed. Be gentle with yourself. Simply say a prayer, or maybe donate to charity in their memory. —Sherre Hirsch, rabbi and author

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) DIMITRI CROWDER; (JACKSON) COURTESY OF LISA JACKSON; (HIRSCH) COURTESY OF SHERRE HIRSCH; ALL OTHERS: ISTOCK

Facing Up to Fears

EDITOR’S LETTER

REAL HEALTH

This Is Sick

EDITOR-IN-CHIEF

ecently, I noticed a number of news stories online that seemed to address a similar theme: Everyday human experiences are being culturally defined as pathological and, therefore, treatable as medical conditions, a process called medicalization. Certainly, some of these experiences do come with unpleasant or distressing problems attached. For example, many women don’t feel a great desire for sex. This state of low libido is now classified as “hypoactive sexual desire disorder.” Then there’s menopause with all its attendant symptoms, such as hot flashes, night sweats, painful sex, weight gain and many others too numerous to mention. And not only women are affected by the medicalization of ordinary human problems. For men, there’s impotence, or erectile dysfunction, with symptoms that include lagging libidos and weaker climaxes. What’s more, researchers who conducted one recent neuroscience study claimed to find two areas of the brain in people who hold sexist attitudes, which showed these folks have different levels of gray-matter density than people who said they believed in gender equality. What concerns me is that, often, these types of study findings can later be used as a reason for scientists to seek a medical intervention, such as drug therapy, to

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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)

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Issue No. 44. 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.

change these negative social attitudes. Here’s my opinion: Why pop a pill for something like this when sensitivity training might be a safer, more effective remedy to the problem? In Shyness: How Normal Behavior Became a Sickness, professor Christopher Lane, the book’s author, criticizes this growing trend. “To put it bluntly, this process of pathologizing has gotten out of control,” he wrote. “It’s become a juggernaut that no one seems able to stop.” He gave examples about how bad breath became halitosis and people who overdo plastic surgery are now classified as suffering from body dysmorphic disorder. But other voices are speaking up to suggest medicalization may not necessarily signal dire consequences ahead because of this trend. Some doctors note there are complexities involved that require we distinguish between good and bad forms of medicalization. These health experts believe there are times when it’s appropriate to resort to medical solutions as a way to prevent suffering and promote well-being, even when the source of a problem isn’t a disease. But I must confess that I’m a little skeptical and very uncomfortable with this way of viewing the issue. Today, people are used to taking a pill for everything, even issues that may have nothing to do with treating an illness. As I write this, I’m thinking in particular about nootropics, the so-called “smart drugs,” that are already being popped by some people who may want their cognitive function to reach superhuman levels. According to an article on medicalization in Mens Sana Monographs, a series devoted to the understanding of medicine, “the lines between natural and artificial, normal and pathological, treatment and enhancement, are increasingly blurred.” As technology advances, where this process will lead is sometimes a very scary thought to me.

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

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BUZZ

Gimme Shelter

Sustainable housing is a must for sick people to get and stay healthy.

ISTOCK

hen Brenda Owens (not her real name) feels a tingle on her upper thigh during the day, she knows what’s coming. By the next morning, she can count on finding the beginning of a raw, open wound that looks like someone pressed a lit cigarette into her flesh. Owens has lupus and lives in dread of the autoimmune disease’s unpredictable flare-ups that precipitated her plunge into recurring periods of homelessness that she continues to battle. Two years ago, Owens got very sick. Frequent hospitalizations caused her to lose several jobs. Without a regular income to pay her bills, she was evicted. The domino effect followed, swift and hard. “I had no health insurance,” Owens says. “Health workers got me on Medicaid. But I’d be on Medicaid for six months, and then for the next six months I wouldn’t have any health care. At the ER, they’d give me meds to hold me for several days until I got

to a doctor. But you can’t get to see a doctor without insurance.” Like Owens, many homeless people lack access to basic health care services, food, shelter, a way to communicate and means of transportation. When she’s homeless, Owens’s health suffers. Without money to buy nourishing foods, she eats cheap, unhealthy meals from fast food restaurants that wreak havoc on her health. One day her blood pressure shot up. She passed out in the train station, and paramedics rushed her to the hospital. “It was scary,” she says. Currently, Owens is unable to hold a job because of her chronic illness. She’s The streets are mean had to rely on charity indeed for from family and friends people who for a place to stay while are ill and homeless. she negotiates the lengthy process to secure Social Security disability beneﬁts. In the meantime, her treatment plan consists of her “getting sick and going

back to the emergency room and letting them give me more medication,” she says. “Ultimately, the loss of housing combined with poor health, no income, and limited personal support leads to homelessness,” conﬁrms the National Health Care for the Homeless Council, a network of more than 10,000 doctors, nurses, social workers, patients and advocates whose mission is to eliminate homelessness. Meanwhile, Owens’s troubles continue to multiply. Her mental health is also under siege. Doctors diagnosed her with depression, and she’s on meds to lift her mood. She admits she has dark days, but so far she’s been able to remain upbeat. “I’m hopeful that something’s going to work,” she says. “Because of the lupus, there’s a lot of things I can’t do anymore, so I’m trying to reinvent myself in other areas.” Now, if she could just get permanent housing in a place to call her own. realhealthmag.com

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BUZZ

HERE’S A QUESTION If antiretroviral treatment can stop HIV transmission, why is the virus still spreading?

Can you return to just being HIV positive after progressing to AIDS? OK, so you’re healthy again after being diagnosed with AIDS. Are you now just someone living with HIV? First, it’s important to know there are three stages of HIV infection. The first is acute infection, when the body produces large amounts of the virus and triggers flu-like symptoms in many, but not all, people. The second is when the body reproduces very low levels of HIV, a stage called clinical latency. “During this period, you may not have symptoms,” explain HIV experts, and “with proper treatment, people may live with clinical latency for several decades.” Without treatment, HIV progresses to AIDS. This is the third stage, when the body’s infection-fighting CD4 cells (a.k.a. T-cells) dip below 200.

THE ESTIMATED NUMBER OF PEOPLE IN THE UNITED STATES WHO CONTRACT HIV EACH YEAR Source: Centers for Disease Control and Prevention

8 REAL HEALTH WINT E R 2015

“This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections,” experts explain. What’s more, if you develop one or more of these opportunistic infections, you are considered to have progressed to AIDS regardless of how high your CD4 count is. In addition, sometimes an HIVpositive person can be diagnosed with AIDS if his or her immune system becomes severely weakened, even without one of these infections, or certain cancers, occurring. But to answer the opening question, public health ofﬁcials at the U.S. Department of Veterans Affairs say, “Once a person has been diagnosed with AIDS, she or he is always considered to have AIDS, even if that person’s CD4 count goes up again or they recover from the disease that deﬁned their AIDS diagnosis.” Still, perhaps what’s worth stressing isn’t the previous discussion. What’s even more key is that if you’ve been diagnosed with HIV, you see a doctor and get into care. When it comes to HIV, doctors stress antiretroviral (ARV) therapy to stop the virus from progressing to AIDS. Say the experts, ARVs help “control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others.”

realhealthmag.com

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Back and Forth

According to statistics, each year the number of people in the United States who contract HIV remains virtually unchanged at 50,000. Now, recent findings published in the medical journal JAMA Internal Medicine explain why this happens. Simply stated, these findings show that more than half of people living with HIV in the United States have been diagnosed with the virus. But many of these folks don’t get into care and on treatment with antiretroviral medicines that would lower the amount of virus in their bodies and reduce the chance they’ll transmit HIV to others. Researchers estimate that more than 60 percent of those in this group account for the largest number of new transmissions. What this means is that if more people who are diagnosed with HIV could get into care and treatment, then fewer folks would acquire the virus, and these straightforward interventions “would have a substantial effect on HIV transmission in the United States,” scientists conclude. How about that? Despite the complexity of the virus, reducing HIV transmission really isn’t rocket science.

BUZZ

EMERGENCY HELP ERs may help slow the rising rates of undiagnosed hepatitis C.

Frozen Solid Protect extremities exposed to this cold-weather threat. Although many of us don’t think much about frostbite during the winter, the fact is that plunging temperatures and icy winds can create the perfect storm for this most common type of freezing injury. According to the National Weather Service, “as wind speed increases, your body loses heat more rapidly, making the air feel colder than it really is. The combination of cold temperature and high wind can create a cooling effect so severe that exposed flesh can freeze.” In general, frostbite can occur in minutes in extreme cold. But the American Academy of Orthopedic Surgeons also cautions that you can get frostbite when temperatures are above freezing if there is a strong wind blowing. Interestingly, frostbite is the body’s way of ensuring that our central organs—the heart and lungs—get the blood they need by drawing blood away from our extremities: the hands, feet, nose, cheeks and ears. When blood-drained extremities are exposed to icy winds, frostbite may follow. Experts also say that if you remember only one thing about this freezing injury, let it be this: Frostbite is easier to prevent than to treat. Generally, to avoid losing any of your body parts to frostbite, pay attention to weather forecasts and wind chill warnings, dress properly for the cold by wearing layers of loose-fitting, warm clothing, and wear mittens instead of gloves.

Many public health officials expect hepatitis C virus (HCV) rates will spike because of a rise in the number of people injecting heroin. The assumption makes sense because intravenous drug use is one of the primary ways hep C is transmitted. What’s more, this rate will also be bumped up by baby boomers (those born between 1945 and 1965) who test positive for HCV. It’s not completely understood why baby boomers have high rates of hep C. But most boomers are believed to have become infected in the 1970s and 1980s when rates of hepatitis C were highest. There was also no test for hep C, so people could get it from surgeries and blood transfusions. But the good news is, findings show urban ERs can help health officials identify people who aren’t yet diagnosed with hep C. Doctors say this can help slow the spread of this potentially deadly blood-borne disease. Says Douglas White, MD, a doctor in the ER at Highland Hospital in Oakland, California, and the study’s lead author, many of the 3 million people who are infected tend to be heavy emergency room users already, so this will be a chance to connect them to “ongoing care at HCV clinics or elsewhere in the health care system.”

THE NUMBER OF PEOPLE WHO DIED IN 2013 FROM OVERDOSE RELATED TO HEROIN USE Source: Centers for Disease Control and Prevention

ENTER THE DRAGON

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Why is heroin use on the rise? If you’ve been watching the news lately, you may have noticed that opioid drug abuse is being scrutinized by both law enforcement and health professionals. Now, research suggests one reason for concern is that abuse of these medications may lead to heroin use, especially once access to the prescription med ends. According to three recent studies, almost half of young people surveyed who inject heroin say they abused prescription opioids, such as codeine and oxycodone, before graduating to the street drug. The ill effects of heroin on health are numerous. Besides addiction, the laundry list of threats to wellness includes the risk heroin users face of developing infectious diseases, such as HIV and hepatitis B and C viruses, collapsed veins, bacterial infections, abscesses, infection of heart lining and valves, arthritis and other rheumatologic problems, and liver and kidney disease, as well as lung complications, mental disorders, sexual dysfunction and cell death in vital organs. realhealthmag.com

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NUTRITION

Time to Get Sneaky Read this if your child is tight-lipped come mealtime.

Aqua Vita

Often, kids are turned off by how a

Cool, clear and key to our bodily functions Maybe you’ve heard this factoid before: The body can last weeks without food, but only days without water. In general, human beings are primarily composed of H2O. Water is of major importance because it regulates a number of essential functions in the body. That said, depending on age and gender, each of us is composed of different percentages of water, according to Jeffrey Utz, MD, a pediatric neuroscientist, who posted this information on Madsci Network online. What’s more, each day we must consume a certain amount of water to survive. Adult males need about 3 liters of water each day while adult females need 2.2 liters each day, according to the U.S. Geological Survey. This is because water is vital to the life of each cell in our bodies. Water also regulates our internal body temperature when we sweat and breathe, breaks down and transports the nutrients in food through the bloodstream, and flushes waste out of our bodies. Also, water helps us produce saliva for digestion, acts as a shock ock absorber for our organs and lubricates our joints. No wonder so many people call this thi his clear l and colorless liquid a basic necessity that’s really the “stuff of life.” e.”

food looks, tastes or smells. But there is one method that’s been very successful in getting children to eat foods they might not want to try: Just sneak them into meals they already like, say nutrition experts. Young picky eaters can be persuaded to try even veggies many kids hate, such as cauliﬂower, says best-selling author Missy Chase Lapine. Lapine wrote the popular Sneaky Chef series of cookbooks that show how she mixes veggie and fruit purees into recipes for kids’ favorite fa foods. Says Lapine, “Here’s my big secret: Taste rules!”

HOT NEWS If you’re like one woman’s dad, maybe you don’t think your food is packing enough heat unless your meal is ﬁery enough to send tears rolling down your cheeks. But hot pepper lovers may be on the right track to health. Several studies suggest turning up the heat in your diet might trigger all kinds of health beneﬁts. Findings from the most recent study focused on the dietary habits of more than 500,000 men and women in China, where fresh chile peppers rule in kitchens preparing spicy cuisines. For the study, researchers questioned participants about what they ate each day and

1 0 REAL HEALTH WINT E R 2015

followed them from 2004 through 2008. Scientists found that those who ate spicy foods once or twice each week enjoyed a 10 percent lower risk of death than those who didn’t. In addition, those who ate spicy foods six or seven days each week scored a 14 percent lower risk of death than others who didn’t eat peppery meals. Researchers suggest that the protective effects come from capsaicin, the main active component in chile peppers. Here’s another hot tip: For the best protective boost, use only fresh peppers.

realhealthmag.com

THE PERCENT OF THE T HUMAN BRAIN THAT’S WATER Source: So U.S. Environmental Protection Agency

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Spicy foods may lower a person’s overall risk of death.

FITNESS

WHAT’S BEST? To eat or not to eat before exercising

Joint Action

Raising the barre

Some people believe that if you’re suffering from arthritis, the last thing you should do is exercise. But not so, say health experts. Regular physical activity is one of the best things you can do to relieve this leading cause of disability in the United States. And some types of exercises are better than others to relieve the pain, swelling, stiffness and decreased range of motion that are common symptoms of arthritis. A ballet barre routine is a great low-impact exercise for people who have arthritis, especially when they also alternate this dance-related workout with exercises designed to strengthen the muscles surrounding a problem joint, say exercise physiologists. Ballet barre exercises are performed slowly, without sudden movements to create stress on your joints. What’s more, these movements are designed to improve flexibility and increase muscle mass while supporting the joints nts and relieving pain. Where do you find these ballet-inspired regimens? Check around your our city for fitness centers that offer ballet barre classes, or get them on DVDs. Ds.

Some experts claim exercising before you eat primes the body to burn more fat. Others, such as TV fitness expert Jillian Michaels, say, “This is a big, fat lie. Starving yourself before exercising can actually be detrimental to your body.” Also, while not eating before exercising might burn more fat, burning fat differs from losing fat. This is because to lose fat you must create a calorie deficit by eating fewer calories than you use. Indeed, the biggest disadvantage to exercising on an empty stomach is you may not have enough energy to get through a workout. This is why Bostonarea sports nutritionist and member of the American College of Sports Medicine Nancy Clark, MS, RD, encourages her clients to fuel up with a little pre-exercise food to enhance performance and, thereby, their ability to burn more calories. Michaels agrees with Clark. “I’m not suggesting you pig out,” she says. “A small healthy snack consisting of carbohydrates and protein will properly fuel your body for a killer workout.” “Each person has a different tolerance for pre-exercise food,” says Clark, author of the Sports Nutrition Guidebook. She suggests folks choose a small (100to 300-calorie) snack, such as “a few pretzels, crackers or other fuel that will enhance stamina, endurance and enjoyment of exercise.” Still, experts also suggest that since you know your body best, do what works for you.

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52.5 million

THE ESTIMATED NUMBER OF U.S. ADULTS WHO REPORT HAVING BEEN DIAGNOSED WITH ARTHRITIS Source: Centers for Disease Control and Prevention

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W IN TER 2015 REAL HEALTH 1 1

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

In the Mood for Love After a long wait, now there’s a little pink pill approved to treat low levels of sexual desire in certain women. Recently, the Food and Drug Administration gave the nod to the drug Addyi (ﬂibanserin). Doctors can prescribe the pill to premenopausal women to treat a condition called hypoactive sexual desire disorder, or HSDD. Many smiled in anticipation, but some frowned in concern. Was this med a good thing or a bad thing for women? Low sexual desire in women is a complex issue. But is this a disorder? Some women are not distressed by their lack of interest in sex. “One of the distinguishing features regarding low sexual desire being a disorder and something that requires treatment is whether or not a woman is bothered by it,” says Nanette F. Santoro, MD, a professor at the University of Colorado at Denver and chair of the department

of obstetrics and gynecology. But for women who are bothered by zero thoughts of sex with their significant other, Addyi may be a way to reignite the fires of physical desire. These ladies, however, must fit within certain prescription guidelines. Women’s low sexual desire can’t be due to a co-existing medical or mental health issue, relationship problems, or side effects of other drugs. In addition, some critics of the drug believe low sexual desire in women may really not require a drug treatment because so many variables can be responsible for the condition. But, says Santoro, “A pill seems like a much more attractive option for most people, so that’s what the drug companies want to provide.”

45 to 64

THE MOST COMMON AGE RANGE OF WOMEN REPORTING SEXUAL PROBLEMS AND SEXUALLY RELATED PERSONAL DISTRESS Source: “Sexual Problems and Distress in United States Women: Prevalence and Correlates,” Obstetrics and Gynecology

1 2 REAL HEALTH WINT E R 2015

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My biggest concern is that attempting to treat low sexual desire with Addyi (flibanserin), or any other drug, negates the reality that women’s sexual desire is deeply affected by issues in their lives that create stress and distance between them and their partners in intimate relationships. Despite flibanserin’s ability to improve a woman’s desire for sex, reduce her distress from the loss of sexual desire and boost the number of sexual episodes that she may have, women’s sexual desire is a very complex response. There are many variables responsible for a woman wanting physical intimacy with her partner. A quick fix may overlook underlying issues that contribute to a lack of sexual desire for her partner. What’s more, flibanserin doesn’t address cultural values that promote ignorance and shame in women about their sexuality, and that create unrealistic expectations about what women should want by legislating how they should participate in sex. Also, I think many times women may feel less desire because they’re plagued with anxiety and guilt because of so many societal expectations about sex. If they lose interest in sex with a partner who used to excite them, this can become a chronic psychological condition that just taking a pill— with worrisome side effects to boot—won’t cure in the long-term.

(FACE AND PILL) ISTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD

As a mental health professional, do you see any reason for concern about doctors prescribing a drug to women who have low sexual desire?

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Today, Rockmond Dunbar is the picture of success. But ﬁrst he had to learn his dyslexia wasn’t a showstopper.

READING

MINDS DYSLEXIA IS DESCRIBED AS A LEARNING DISABILITY, BUT THIS DEFINITION ADDS TO MISUNDERSTANDINGS ABOUT THE CONDITION. By Kate Ferguson

about dyslexia, he was a freshman at Morehouse College. He’d landed a role in a play called Blue Vein Society, and he and other cast members were doing a read-through of the script. Suddenly, his theater coach stopped the reading and focused on him. She asked him if he had dyslexia. Dunbar says he didn’t know what to say because, at the time, he had no idea what this common learning disability was. “It was very embarrassing,” Dunbar says. “You know, you’ve got cute girls in the class; I don’t know what dyslexia is and she’s calling me out in front of the class.” To save face, all Dunbar could think to do was say, “No, I don’t have dyslexia.” Dunbar’s seemingly insensitive acting coach explained to him that his reading reminded her of the way her

embarrassment, his curiosity drove him to Morehouse’s office of student and academic affairs. There he asked to be tested for dyslexia. “About a month later, I found out that I was a classic dyslexic,” Dunbar says. “It was devastating because, at that time, I didn’t know too much about learning disabilities. I felt I was duped in some way, like something was off, like I wasn’t taken care of when I was younger.” Often dyslexia slips by unnoticed because

those with the disability can be very bright and “gifted in areas that don’t require strong language skills, such as art, computer science, design, drama, electronics, math, mechanics, music, physics, sales and sports,” says the IDA. Interestingly, when Dunbar took the test, his IQ scores were above average,

PEOPLE WITH DYSLEXIA MAY FEEL THEY MUST KEEP THEIR LEARNING ISSUE A SECRET BECAUSE MANY MISCONCEPTIONS ABOUT THIS CONDITION ABOUND. son, who had dyslexia, read, so she suggested he get tested. Without his coach’s suggestion, Dunbar’s dyslexia might have gone unnoticed for many more years. “For some people, their dyslexia is identified early in their lives, but for others, their dyslexia goes unidentified until they get older,” says the International Dyslexia Association (IDA), an advocacy group composed of professionals who partner with people who have this learning disability and their families. After Dunbar recovered from his 1 6 REAL HEALTH WINT E R 2015

which is the case for many people who have dyslexia. The test Dunbar took was given by Landmark College, the first institution of higher education to pioneer a college-level curriculum for students with dyslexia. “After I was diagnosed, I got the opportunity to study that summer at Landmark College,” Dunbar says. There he learned more about dyslexia and how his brain works to process language. “I’m a kinesthetic learner,” Dunbar explains. “I’m tactile; I need to touch and feel and maybe be emotional about whatever I’m putting into

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my brain. Without learning these things, I’d have to say I don’t think that I would be a decent actor.” Dunbar’s speculation is echoed by experts such as Sheldon H. Horowitz, EdD, director of learning disabilities resources at the National Center for Learning Disabilities. According to Horowitz, dyslexia affects not only someone’s ability to learn to read and how they learn to read, but also their ability to recognize words at a glance and sound them out. “So even if a person with dyslexia learns how to read, the rate of reading and the fluency with which he or she reads are going to be somewhat slow,” he says. “Think about it: If you’re in a college class and you need to read a hundred pages each night, that’s going to be tough for you. Your fluency will be slower, and the extent to which you can grab information and run through it will be definitely delayed. People with dyslexia struggle with vocabulary, and they struggle with reading comprehension.” In addition, while dyslexia speciﬁcally

affects reading, the condition influences the ability to process information in many other areas. “You don’t necessarily associate math and reading, but kids have to do math word problems,” Horowitz says. “There’s math and reading and note-taking and summarizing and graphing and charting, so individuals with dyslexia are often not just challenged in the area of reading but in how reading affects their abilities to do other kinds of things, such as going shopping, reading a label, picking out the ingredients for a recipe, or fi lling out a college application and reading between the lines about what they’re really asking you to write about in your essay. Dyslexia is a lot of different things as it evolves over the course of the lifetime of the reader.” But these difficulties don’t reflect on the intelligence of someone who has dyslexia, Horowitz stresses regarding one of many misconceptions that make this learning disability so misunderstood. In school settings, people with dyslexia face many challenges besides their struggle with language skills. The competitiveness inherent in academic environments can trigger

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The ﬁrst time Rockmond Dunbar heard

frustration in someone who has dyslexia, and this can chip away at a person’s self-esteem. “This can impact a person’s sense of how much they can achieve,” Horowitz explains. “Also, this can cause teachers to have lower expectations for that student, given that he or she is a poor or slow reader. Th is is very bad because the student might have the knowledge but just can’t express information given the transition readers must make between printed text and oral reading.” Another misconception about dyslexia is that those who have this learning disability also have behavioral problems. “There’s no scientific evidence that people with dyslexia have behavioral disorders,” Horowitz stresses. But “there’s a much higher incidence of attention deficit disorder in those kids than in the general population, so there’s an overlap.” According to Horowitz, children with

dyslexia may be very inattentive because they’re not following along with what’s going on in class. “So they’ll cre-

ate a distraction, such as knocking over their desk, or they’ll do something to get disciplined to avoid having to read,” Horowitz says. “This is a way they can avoid being embarrassed. But there is no direct correlation between behavior problems and dyslexia.” Of course, stigmatizing stereotypes about dyslexia can be dispelled with education and awareness. This is why 15 nonprofit organizations teamed to create Understood.org, an advocacy group that offers support to millions of parents whose children struggle not only with dyslexia, but other learning and attention issues. Dunbar is a spokesperson for the organization, which launched a public service advertising campaign last year in partnership with the Ad Council. If parents and kids log onto the site, they’ll find information to help them find out whether they have any type of learning or attention issues. And if they do, the site can connect them with people who “are of a like mind and circumstances, so they don’t feel alone,” Dunbar says.

“I wonder what it would have been like if I knew I had a learning issue when I was younger,” he continues. “If there would have been a website like Understood.org that I could go to just to ask questions and be heard and supported, I think I would be in a much better position now.” But there’s something else Dunbar

considers when he thinks about educating people about dyslexia. “What we’re trying to do now is drop the word ‘disability,’ because dyslexia isn’t really a disability,” he says. “How we use the word ‘disability’ is hindering and it doesn’t fit.” Experts may or may not agree with Dunbar, but there are those who prefer dyslexia be viewed as simply a different way some people’s brains learn and process information. Some others prefer dyslexia be called “a gift.” After all, many famous people who had dyslexia, such as Steve Jobs, Albert Einstein, Leonardo da Vinci, Pablo Picasso and Thomas Edison, were considered geniuses. ■

FOR CONCERNED PARENTS HELPING A CHILD WHO HAS DYSLEXIA CAN BE A CHALLENGE, BUT THERE ARE WAYS TO BE SUPPORTIVE. Actor Rockmond Dunbar speaks highly of Understood.org, a website created to educate children and their families about dyslexia and other learning and attention issues. Dunbar suggests that the ﬁrst thing a parent who has a child with dyslexia should do is visit the site. “For parents who don’t have dyslexia themselves, it may be hard to understand what their child is experiencing,” he says. “On the Understood.org website, there’s a section called ‘Through Your Child’s Eyes’ that allows you to experience some of what it must be like for a child that some people may believe is

lazy or not trying hard enough. This is an eye-opener for lots of parents.” Understood.org has information about some common myths concerning dyslexia as well. “There’s so much misinformation about what causes or what contributes to or what’s associated with dyslexia and learning disabilities,” Dunbar says. “This is the mythology that a parent needs to get on the other side of.” Parents who have children with dyslexia must become educated consumers. “Know enough about your child and, speciﬁcally, be a good observer of your kids,” Dunbar

suggests. “Also, know enough about dyslexia to know what it is and what it isn’t, and then know how to request information from schools and how to work with other professionals.” When parents visit Understood.org, the website offers them targeted information that can answer many questions about dyslexia. Dunbar also suggests parents get their child evaluated if they think he or she might have learning issues. Understood.org offers invaluable resources to help parents “unpack what’s really going on with their child,” Dunbar says.

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How to enjoy holiday meals and still stay healthy By Gerrie E. Summers

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During the holidays, eating is a huge part of celebrating the season. But neither home-cooked feasts nor gourmet meals have to mean giving up on eating healthy food. You can certainly make healthier choices without sacrificing flavor or satisfaction, whether you’re sharing a meal with loved ones at home or dining with friends at a fancy restaurant. whether the goal is to lose weight or to simply make healthy food choices, the holiday season is a minefield of tempting morsels that requires smart decision-making. From mouthwatering displays of holiday candy and desserts at grocery and department stores to office party spreads, food is everywhere and the urge to binge is hard to fight. “With this in mind, it becomes important to think of outings at restaurants and holiday parties as a break from the usual but not an excuse to splurge on anything we see,” says Liz Weinandy, MPH, RD, an outpatient dietitian at Ohio State University’s Wexner Medical Center. Certainly that’s difficult to do when buffets and plates piled high with delicious-looking food beckon and friends and associates indulge in merry munching. “We may feel like we shouldn’t be eating that way, but it’s easy to get caught up in the ‘everyone else is doing it’ attitude,” Weinandy continues. “The fact is, almost 70 percent of all Americans are overweight or obese, and at holiday time, plates overflowing with food isn’t uncommon; in fact, that is more the norm. But as a nation, we can’t keep eating this way because our health will really continue to deteriorate.” To resist the temptation to overeat

during the holidays, nutrition experts offer the following guidelines: Eat regular meals. Getting ready for the holidays often leaves little time 2 0 REAL HEALTH WINT E R 2015

for meal preparation. This results in missed meals and can lead to overeating at the next meal. Regular meals provide energy throughout the day and ensure that you’ll choose more balanced and nutritious foods. Drink water 30 minutes before eating. “Always start your meals with

YOU CAN EAT HEALTHY AND STILL ENJOY THE HOLIDAY SEASON. a glass of water,” advises Shane Allen, certified weight loss specialist, sports nutritionist and personal trainer for PersonalTrainer.com. Allen’s advice is sage because, according to recent findings published in the journal Obesity, having a couple glasses of water before your holiday meal could help

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you lose weight. “This makes sense because water fills up your stomach, helping you feeling more satiated,” Allen adds. “The key in this experiment was that the test group drank water 30 minutes before each meal. Researchers think this time between drinking and eating helps you feel full while giving you time to shape better decisions about what you eat.” Don’t shop while hungry. Whether you’re stopping at the grocery store to buy necessities or browsing for party gifts, shopping on an empty stomach might lead you to fuel up on fast food and quick, high-calorie snacks. Then there are major diet sabotagers

lying in wait on those groaning, food-laden holiday tables. The following waist-expanders are foods the experts advise you skip. Casseroles. According to Allen, “Calories don’t create fat; starchy carbs and sugars do, and many of those starchy carbs live in casseroles. Even green bean casserole has fried onions on top. Broccoli-cheese casserole has rice. And stuffing? Keep that bread in the bird.” Sugary extras. “Sugars are in the same boat as starchy carbs when it comes to fat gain. But sugars pack on pounds much quicker, and with greater side effects,” Allen says. “Spikes in your blood glucose levels can cause you to crave more carbs and then give you that ‘crash’ feeling later. Keep that gelatinous cranberry sauce in the can and push those pies away.”

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OK, so you’re watching what you eat—

There is one—just one—sugar allowance, Allen says: “That’s apples. They’re high in fiber and low glycemic, which means the sugar in them is released into the bloodstream slowly, so your body goes through less of a sugar spike and energy swing when you eat them. For a great fat-busting, guilt-free apple dessert alternative to help lose weight over the holidays, coat four granny smith apples with 1 tablespoon of cinnamon, 1 teaspoon of nutmeg and 2 tablespoons of Splenda or stevia. Bake them in a shallow dish with ¼-inch of water for 30 minutes at 350 degrees, or until the apples are soft. You can even melt a little butter over them before you dig in.” In addition, leave the fried foods, sodas and fruit juices alone. But even if you make it past those

holiday standards, it’s not easy avoiding festive treats because those are often what we crave. Still, don’t beat yourself up for taking pleasure in the festivities. “The holidays are meant to be enjoyed,” says Kristen Trukova, MS, RD, a staff member at the Cancer Treatment Centers of America at Midwestern Regional Medical Center. “While overeating at one holiday party will not cause a 10-pound weight gain, overeating at several holiday parties might. Choose one or two events where you eat what you enjoy, and focus on moderation and limits at the others.” Trukova also suggests you plan ahead and involve a friend. “Decide what cocktail or beverage you enjoy most, and choose one,” she advises. “Perhaps you can start with sparkling water or a fruit spritzer. You and your friend can keep each other on track to avoid overindulging.” Also, watch portion size. “If a person is a volume eater and likes very large portions, it’s important they fill up on mostly low-calorie foods such as vegetables,” Weinandy says. “If the person really likes quality cuisine or how foods taste, then small portions become key since these foods generally will be higher in calories.” She suggests taking your plate and dividing it in half. “On one half put

non-starchy vegetables, such as salad, cooked vegetables or some from the vegetable tray. On the remaining half, put protein and starch in equal, moderate amounts. This automatically helps to cut down on overall calories.” Another great tip, say nutritionists, is to bring your own meals to the celebration to enjoy and share with others. This is entirely appropriate if you have, for example, severe food allergies. If you’re hosting a holiday party or

dinner, make sure you have several dishes that involve fruits and vegetables, advises Trukova. In addition, Weinandy says, “Include a lot of healthy foods—vegetable dishes that aren’t too high in fat, fresh fruit, and then a nice mixture of higher-calorie indulgences with more sensible entrees and sides.” “Following a meal, plan to take a walk as a group,” Trukova adds, “or have a group sport or snowball fight to burn off a few extra calories.” If you’re dining out, avoid appetizers because they often have a surprising amount of calories. Share a large entree, or just eat half and put aside the rest to take home. Another tactic is to eat slowly and savor your food. “Not only does that increase your enjoyment of the meal, but the more slowly you eat, the less total food you are likely to consume,” Trukova says. One big no-no is going to a party when

you’re famished. “Eat a small snack or meal two to three hours beforehand,” Weinandy advises. “If you are really hungry and facing a lot of temptations, this will spell disaster.” But there’s also a less restrictive approach to holiday eating that can help to keep the health consequences of your indulging minimal. Splurge for a meal on the big day, “and then get back into the groove of healthy eating to balance out that large-calorie day,” Weinandy says. What’s more, try not to deviate from other healthy routines during the holidays. Continue being active by going to the gym or walking each day. Get plenty of rest, too, because findings show people who don’t get enough sleep tend to overeat. ■

It’s Holiday Party Time! Easy ways to negotiate bulging buffets, open bars and those decadent dessert platters Seasonal celebrations are particularly perilous for your healthy eating regimen. But you can enjoy the festivities without completely derailing your diet. Check out these tips from nutrition experts. Before the party starts, decide how many drinks, desserts and other foods you will eat. “For example, you may decide ahead of time you are going to drink no more than two alcoholic drinks, try one dessert and eat a small plate of hors d’oeuvres,” says Liz Weinandy, a registered dietitian. Don’t go to a party ravenous. To curb hunger, eat a small snack or meal two to three hours beforehand. Check out the spread or menu before diving in. “Decide what you would most enjoy eating, choose it in the appropriate portion and savor each bite,” says registered dietitian Kristen Trukova. Start with healthy foods first. Eat a salad to leave less room for more calorie-laden choices. Use a smaller plate and eat slowly. Try this tip from Weinandy: “Fill up half the plate with healthier food and then the other half with higher-calorie goodies, and you’ve just reduced your calorie intake by half.” Choose beverages carefully. Limit yourself to one or two alcoholic drinks each day. Also, balance alcohol intake with a glass of sparkling water to avoid dehydration. Drink flavored or infused waters and teas to keep calories low, says Trukova. Don’t stand near the food table during the party. Once you’ve fixed yourself a plate, move away from the buffet to avoid more temptation.

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W IN TER 2015 REAL HEALTH 2 1

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COMPLERA does not cure HIV-1 infection or AIDS.

To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them. It is not known if COMPLERA is safe and effective in children under 18 years old.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about COMPLERA?

COMPLERA can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. • Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

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Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. • Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones. • Changes in body fat can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. •

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What should I tell my healthcare provider before taking COMPLERA?

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

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Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information. What is COMPLERA? • COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. • COMPLERA is a complete HIV-1 medicine and should not be used with any other HIV-1 medicines. • COMPLERA should always be taken with food. A protein drink does not replace food. • COMPLERA does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses. • Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: • Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – having stomach pain with nausea or vomiting – feel cold, especially in your arms and legs – feel dizzy or lightheaded – have a fast or irregular heartbeat • Severe liver problems. Severe liver problems can happen in people who take COMPLERA. In some cases, these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis). Call your healthcare provider right away if you get any of the following symptoms of liver problems: – your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools) – loss of appetite for several days or longer – nausea – stomach pain • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

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• Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider. – Do not run out of COMPLERA. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone. – Do not stop taking COMPLERA without first talking to your healthcare provider. – If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA. Who should not take COMPLERA? Do not take COMPLERA if you also take any of the following medicines: • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) • Medicines used for tuberculosis: rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) • Certain medicines used to block stomach acid called proton pump inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) • Certain steroid medicines: More than 1 dose of dexamethasone or dexamethasone sodium phosphate • Certain herbal supplements: St. John’s wort • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) Do not take COMPLERA if you also take any other HIV-1 medicines, including: • Other medicines that contain emtricitabine or tenofovir (ATRIPLA, EMTRIVA, STRIBILD, TRUVADA, VIREAD) • Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Triumeq, Trizivir) • rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) COMPLERA is not for use in people who are less than 18 years old. What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects: • See “What is the most important information I should know about COMPLERA?” • Severe skin rash and allergic reactions. Skin rash is a common side effect of COMPLERA but it can also be serious. Call your doctor right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. Stop taking COMPLERA and call your doctor or get medical help right away if you get a rash with any of the following symptoms: – severe allergic reactions causing a swollen face, lips, mouth, tongue or throat, which may cause difficulty swallowing or breathing – mouth sores or blisters on your body – inflamed eye (conjunctivitis) – fever, dark urine or pain on the right side of the stomach-area (abdominal pain) • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA.

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• Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease. Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. • Changes in body fat can happen in people taking HIV-1 medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known. • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having any new symptoms after starting your HIV-1 medicine. The most common side effects of COMPLERA include: • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, depression Additional common side effects include: • Vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), pain Tell your healthcare provider if you have any side effect that bothers you or that does not go away. • These are not all the possible side effects of COMPLERA. For more information, ask your healthcare provider. • Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. What should I tell my healthcare provider before taking COMPLERA? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, mental health, bone, or liver problems, including hepatitis B or C infection. • If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child. – There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take COMPLERA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. – Two of the medicines in COMPLERA can pass to your baby in your breast milk. It is not known if this could harm your baby. – Talk to your healthcare provider about the best way to feed your baby.

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Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements: • COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. • If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV-1 infection. The HIV-1 virus in your body may become resistant to COMPLERA or other HIV-1 medicines that are like it. • Be sure to tell your healthcare provider if you take any of the following medicines: – Rifabutin (Mycobutin), a medicine to treat some bacterial infections. Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take. – Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. – Certain medicines to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. Some acid blocking medicines should never be taken with COMPLERA (see “Who should not take COMPLERA?” for a list of these medicines). – Medicines that can affect how your kidneys work, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte). – clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan) – itraconazole (Sporanox) – ketoconazole (Nizoral) – methadone (Dolophine) – posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider. Keep COMPLERA and all medicines out of reach of children. This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com. Revised: May 2015

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners.

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CRISIS INTERVENTIONS RESEARCHERS ARE SEARCHING FOR NEW WAYS TO HELP KIDS WITH SICKLE CELL DISEASE. By Jeanette L. Pinnace

Finally, when he was 7, a doctor diagnosed

him with sickle cell disease (SCD). That’s when Spates’s journey with this red blood cell disorder began. If someone has sickle-cell anemia, some of their normally O-shaped red blood cells are C-shaped. These sickled cells can cluster and create blockages in small arteries and capillaries, stopping blood flow and causing pain. “For seven years, all my parents knew was I was hurting,” Spates says. After his diagnosis, Spates continued living life normally. “At 7 years old I really didn’t think I was different from other children,” he says. “I still played and did the things that I loved to do; just sometimes I had to go to the hospital.” But as the years rolled by, Spates learned just how devastating SCD could be. As a teenager, he was an avid athlete. Spates ran track and played basketball and football. “But someone mentioned to the football team doctor that I had sickle cell, and he threw me off the team,” he says. “My only dream was to play in the NFL, and I had that snatched away from me because of sickle cell.” Spates sunk into a depression. “I was good at football and I just couldn’t understand why I couldn’t play anymore,” he says. “I didn’t go around the team anymore, I didn’t come out of my room, and I didn’t talk to my parents. I didn’t know what to do.” Keeping their son healthy also strained and finally derailed Spates’s parents’ marriage, further deepening his depression. He attempted suicide twice. But Spates rallied. “I really think about that moment and those days, and it keeps me going,” he says. “I don’t ever want to be in that mental state again. So I started educating myself about the disease. I told myself that I had to face my fears.” 2 8 REAL HEALTH WINT E R 2015

This change in attitude helped Spates better manage his disease. He vowed to stay positive and to work with his doctors to improve his quality of life. “It’s so important that you understand you can have sickle cell and still live a full, quality life,” he says. When Spates was diagnosed with SCD in his hometown of Houston, like many states, Texas didn’t have mandatory testing of infants for sickle cell disease. But on May 1, 2006, the federal government required all states to conduct universal screenings of newborns for SCD. This paved the way for national health organizations to establish clinical guidelines to treat sickle cell disease in children. “By and large, the programs developed to manage children with sickle cell disease in this country are good,” says W. Keith Hoots, MD, director of the Division of Blood Disease and Resources (DBDR) at the National Heart, Lung, and Blood Institute (NHLBI). DBDR’s mission is to support and develop research and training programs on the causes and prevention of blood diseases and disorders, including SCD. Hoots says the multidisciplinary programs help children living with sickle cell disease and their parents manage the physical, psychological and social stresses caused by SCD. They help kids integrate into schools and other settings that are necessary for their growth. “All those things are part and parcel of what some of the best programs do for children,” he says. But Spates grew up during a time when

SCD was largely misunderstood. Doctors predicted he wouldn’t live past the age of 11. His response—with the love, commitment and understanding of his parents and a physician who was a friend of the family—was to prove

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them wrong. “My mama told me, ‘You can do anything you want to,’” he says. “I vowed never again to let sickle cell disease stop me from doing anything.” At age 19, Spates, who had a gift for making people laugh since he was a child, decided to become a comedian full-time. Today, the 37-year-old entertainer works on the popular syndicated radio program The Steve Harvey Morning Show. Spates is also the celebrity ambassador for the Sickle Cell Disease Association of America (SCDAA) and is a spokesperson for the agency’s “Rise Above” campaign. “Our goal is simply to raise awareness about sickle cell disease as much as we can and where we can,” he says. “As long as sickle cell has been around, understanding of the disease is still in its infancy, and we have to get people talking. We are the greatest country on Earth and it’s time for us to do something about this disease. My biggest goal is to draw as many people into this fight as I can.” Spates also launched his own foundation, Kier’s Hope, to help families dealing with sickle cell. Spates says the big goal for his foundation is to organize the first-ever “sickle-cell family reunion.” “I think it is very important that we treat this disease as a national issue, and we would like to call attention to it through this event, a family reunion in one city. We’re all bound by blood, and that makes us family,” he says. “People with SCD don’t get to have a lot of fun. We spend so much time in the hospital, in doctors’ offices, getting shots, giving blood, getting blood transfusions; wouldn’t it be nice to have a day where we can just sit back and relax and enjoy some music, socialize with each other and just have fun?” On the medical side, Hoots and other researchers are working hard to establish a continuum of health care for kids living with SCD as they transition into

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Comedian Kier Spates recalls being a sickly child. He was constantly ill, often wracked with pain, and sometimes he screamed all night long. But his parents didn’t know why. The pediatricians thought Spates was reacting to allergies.

adulthood. One huge concern he has is that as children age out of pediatric care, the support systems that help manage their sickle cell disease tend to disappear. In part, this is because of the way reimbursement for medical services is structured, and partly because the health system puts more responsibility on individuals with SCD moving into adulthood to manage their own care, he explains. “That’s appropriate, except when you

have a disease that must be managed every day,” Hoots says. “That’s not only exhaustive and exhausting from a health care perspective, but exhausting in terms of economics. Imagine explaining to everyone why you can’t show up to your job today because you’re in pain and just incapacitated. Just as these things can happen on the health care side, they can happen in the wider arena [of life].” Hoots believes one way to help kids with sickle cell prepare to manage the disease when they move into adulthood is to teach them how to effectively negotiate the health care system. “Teach them that if they don’t get the support they need in one place, they can reach out to get it elsewhere,” he suggests. “Another is to find ways to

IT JUST KILLS KIER SPATES THAT SOME PEOPLE THINK SICKLE CELL DISEASE IS CONTAGIOUS. IT ISN’T. change the paradigm for these kids’ care in an adult setting. How can we adapt strategies that may have worked well for children and make those more adaptable to adult needs?” As people living with SCD age, the

disease worsens as bodily systems break down. “How do you preempt some of those illnesses?” Hoots asks. “How do you get the person the services, the support, the medical access? How do you support them as they move back and forth between having to access health care and access their everyday life in terms of their work and their other colleagues in a broader way than just their health issues?” (These are just some of the questions the NHLBI is trying to answer.) Meanwhile, Spates and organizations such as SCDAA continue to push for more public awareness about sickle cell disease because there are many misconceptions about the illness. Spates says the craziest one he’s heard is that sickle cell is contagious. It’s not. Another misconception is that SCD is an African-American disease. This also isn’t true. Although in the United States most people with sickle cell are of African ancestry, or identify as black, people who come from Hispanic, southern European, Middle Eastern, or Asian Indian backgrounds can also suffer from the disease. “Sickle cell is a global disease,” Spates says. “Outside of America, there are people from all corners of the world who get this illness.” ■

CAN SICKLE CELL BE CURED?

COURTESY OF KIER SPATES/COREY REESE

THE SHORT ANSWER IS YES. BUT THE PROCEDURE ISN’T SUITABLE FOR EVERYONE. Currently, a stem cell or bone marrow transplant is the only way doctors can cure sickle cell disease (SCD). But, according to the National Heart, Lung and Blood Institute, not all people with sickle cell disease are suitable for a transplant. Today, doctors perform most sickle cell-related stem cell transplants on kids who have suffered certain complications from the blood disorder. The procedure requires that doctors use a matched donor from the child’s family, such as a sibling, who doesn’t have SCD. But only a small proportion of children will have a matched donor. That’s why so few people with sickle cell get stem cell transplants.

While the great majority of children who receive stem cell transplants from a matched donor will be cured, a small proportion will either reject the transplanted cells, or develop a problem known as chronic graft versus host disease, which can be fatal. Researchers are now looking for a way to use stem cells from a donor who isn’t related to the sickle cell patient, and a potentially safer way to destroy the stem cells that form sickle-shaped blood cells in bone marrow. One researcher at Boston Children’s Hospital says it’s not even necessary to replace all of a patient’s red blood cells to correct sickle cell disease.

Adults with sickle cell disease have not been considered to be good candidates for stem cell transplant, due to the increased risk of dying from the complications of the transplantation procedure. However, new regimens that are associated with fewer complications are being developed that have resulted in excellent disease conrol and fewer complications. Finally, scientists are also studying gene therapy, which requires they harvest blood-producing stem cells from a patient’s own body, then add a gene with anti-sickling properties. Doctors would place these altered genes into the patient so their bone marrow could produce normal blood cells, thereby curing SCD.

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W IN TER 2015 REAL HEALTH 29

GROWING

SEASON

IS THERE ANY SCIENCE BEHIND THE “GREENHOUSE EFFECT” THAT SOME SWEAR IS RESPONSIBLE FOR GENERATING LONG, LUSCIOUS LOCKS?

by Kate Ferguson

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W IN TER 2015 REAL HEALTH 3 1

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

Oh, and let’s not forget factors you can control, such as your nutrition and how well you take care of the tresses you already have on your head. Now, if you ever visit a greenhouse, the first thing you may notice is the heat and humidity that hits you as soon as you step inside. In these controlled indoor environments, plants grow in profusion; their health and vitality are easy to see. The theory behind the greenhouse effect (GHE) on hair growth is similar, except you’re re-creating a hot-

house environment atop your head to encourage your tresses to grow. In general, the hair growth cycle consists of three key phases: anagen, when hair grows; catagen, when hair follicles shrink and detach from the cells located directly under the outer layer of skin; and telogen, when old hair rests prior to falling out to make way for new hair. The greenhouse effect is used for hair growth and involves applying your favorite natural oil, blend of oils,

TAKE THE GREENHOUSE EFFECT CHALLENGE TRY THESE NATURAL PRODUCTS FOR YOUR OWN HAIR GROWTH EXPERIMENT. In general, the greenhouse effect is created using water, oils and butters as the go-to moisturizers to lavish on your hair. First, lightly mist your hair with water. Some folks might like to use rosewater or distilled water instead of regular tap water. Or you can skip this step and work on dry hair.

Now it’s time to slather on the butter. Shea butter is favored by many people because this plant-based oil is an excellent moisturizer for the hair and skin. Some others include avocado, cocoa, illipe, mango, kokum and cupuacu butters.

Next, pour one of your favorite oils in a dish. Try extra virgin olive oil, avocado oil, coconut oil, grapeseed oil, or castor oil as a carrier oil. (Carrier oils, a.k.a. base oils, dilute essential oils and “carry” them onto the scalp.)

Next, section your hair and put tresses into two-strand twists, braids, bantu knots, or just pull your hair into a simple bun. Once you’re done, place a shower cap on your head, or cover hair with a close-ﬁtting plastic bag. Now, tie a scarf over your hair and the bag and pull on a comfortable cap to hold in that heat.

Tap in a few drops of essential oils, mix and rub into the scalp. Essential oils include rosemary, eucalyptus, tea tree, lavender, or lemongrass. They’re used to stimulate the scalp.

That’s it! Now you may be on your way to reaping the beneﬁts of the greenhouse effect. Keep track of your progress by doing length checks of your hair with a measuring tape.

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or hair butters to either dry or damp tresses. Next, you cover your hair with a shower cap or plastic bag, and put on a scarf or some type of close-fitting headgear, such as a beanie or knit hat. Covering the hair generates heat, which is supposed to encourage the body’s production of more of your hair’s natural oils, or sebum, to moisturize your tresses, along with the oils you’ve used. Many people also modify this routine by warming the oils and massaging their scalp to stimulate the hair follicles. Massaging any part of the body stimulates blood flow to that area. When blood flows to the scalp, this allows nutrients in the blood to nourish the scalp, and this helps hair to grow. On the Internet, there’s a wealth of information about the greenhouse effect. You can also find a host of videos demonstrating how folks put the GHE into practice. What’s more, many of the videos include before-and-after photos that show hair growth attributed to GHE challenges done over the course of months and, sometimes, years. One woman believes the warmth and humidity the GHE generates for her hair are comparable to the hot weather she swears helped her hair grow when she vacationed in the tiny tropical nation of Belize. Still, there aren’t any scientific studies about how the greenhouse effect influences hair growth. But a few hair study findings do seem relevant to this technique. Results from one study showed that human hair growth is affected by seasonal changes in temperature and humidity. Another study found that tresses shed at certain times of the year when follicles undergo changes in the hair growth cycle. In addition, other findings showed follicles entered certain phases of the hair growth cycle during seasonal variations triggered by temperature, sunlight and the body’s hormones. Still, it’s key to remember that hair growth doesn’t occur in a vacuum. Simply rubbing natural oils and butters on tresses and covering your hair with plastic and hats won’t help locks grow if your health is poor in general and your diet is lacking in nutrients. ■

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First, the science: The body has a hair growth cycle. Hair on the head grows on average one-half inch each month, growing faster or slower depending on your age, genetics and hormonal state.

GoMacro Macrobars (single bar, $2.89; tray, $34.68) Try these filling, wholesome and delicious organic, plant-based protein bars that are soy-, gluten- and dairy-free and packed with nutrients that come mostly from delicious combinations of tasty raw ingredients, gomacro.com.

Janes Wellness Gown (2 sizes, 8â&#x20AC;&#x201C;14, 16â&#x20AC;&#x201C;4X, $49.95, monogramming + $7) This wrap-front gown is comfortable, durable and fits women of all sizes who crave comfort and coverage during medical procedures and treatments at-home or in the spa. Great for nursing moms, and makes a great gift too, getjanes.com.

Stuff We Love A ROUNDU ROUNDUP OF THE LATEST MUSTMUST-HAVE FINDS SKIN, HEALTH, FOR HAIR, SK BEAUTY AND AN MORE. ARE THESE PRODUCTS PROD E WORTH EVERY EVE CENT.

Momentum Jewelry ($9.99 to $40) This line of really cool athletic jewelry includes shoe pendants, fabric bracelets, suede and leather cuffs, necklaces, earrings, and headbands, all with inspirational sayings on shiny, lightweight aluminum tags that can motivate you to meet your fitness and life goals, momentumjewelry.com.

Play Again Now (24 fl. oz., $49.95) This oral liquid gel with hyaluronic acid and MSM, a chemical compound, is for exercise enthusiasts of all ages and fitness levels to fight soreness and stiffness. Order at Amazon, GNC.com, playagainnow.com.

Stocking Stuffer Life-Savers 1. Blingsting Glammer Escape Hammer, $24; Ahh!-Larm, a 120-decibel alarm, $22; Pepper Spray, 1/2 oz., $22, blingsting.com 2. TP-Link 10400mAh Power Bank Dual-Port USB Charger, $19.99; TP-Link 150 Mbps Wireless N Nano Router, $19.99, tp-link.us 3. White Sands The Cure 24/7 hair serum, 1.7 oz., $29.99, whitesands products.com 4. U|R Powered Touchscreen Gloves for men and women, various styles, prices range from $30 to $75, urpowered.com.

THOUGHTS

Crossing a Threshold One woman’s difficult journey from Miss to Mrs.

Forge a New Path Negotiating life’s transitions

There’s a saying that nothing in life is constant except change. This is because change is a normal part of life. But changes can also be scary. Transitions are challenging, whether they’re positive or negative, planned or unexpected. But instead of viewing transitions as fearful upheavals that threaten you, try seeing them as opportunities to learn more about yourself and a path to new growth. In her book Thresholds: How to Thrive Through Life’s Transitions to Live Fearlessly and Regret-Free, Rabbi Sherre Hirsch likens transitions to crossing a threshold into something new and different. “When I talk about the thresholds of our lives, I am referring to those moments when we are in transition,” she says. “Those moments when we are standing between the way we were accustomed to living and a new way of thinking, feeling and being.”

Two years ago, I found myself at an unsettling turning point in my life. I’d decided that my boyfriend, whom I’d allowed to re-enter my life after a separation of eight years, was totally wrong for me. I’d resumed our relationship with high hopes. We’d talked about the problems that previously caused the relationship to fail, and felt ready for a redo. But one huge obstacle resurfaced: I still distrusted him and time wouldn’t change this. Once again, we ended the relationship. This was it for me. I’d decided that I was done with relationships. I was ready to ride off into the sunset—alone. I wasn’t looking for anyone and didn’t want a relationship. I just wanted to get on with my life. Then I met someone and fell in love. After a while, he asked me to marry him. Although I was convinced this was the right move, I balked. The truth is, I was afraid. But one day, I confronted my fears and set them aside. Now, I was ready to trust in love again. —As told to Kate Ferguson

The Expert Says Rabbi Sherre Hirsch, the author of Thresholds: How to Thrive Through Life’s Transitions to Live Fearlessly and Regret-Free, suggests effective ways to prepare for transitions in your life.

First, pause. Identify your fears. Realize feelings are not permanent. You may not be in control of your circumstances, but you are in control of how you choose to act going forward.

What is a simple way for us to overcome the fear of failing?

We fear failure when we believe that there is only one right outcome and, therefore, everything else is wrong. But perfection is not a destination, so we’ll always fall short of it. Don’t fear failing. Believe there are many possible outcomes—ones you may not 3 4 REAL HEALTH WINT E R 2015

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even know yet. This belief can allow your fear to transform into faith that you will land someplace that may be different, but that may also be even better.

How does the way we view our mistakes help us to negotiate transitions in our lives?

If we see our past choices as mistakes, we eventually view ourselves that way. Change the narrative and tell yourself a different story. Realize everything that happened in the past led you to this moment when you have more information and tools to forge ahead. One story weakens our resolve; the other strengthens it. You choose.

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When transitions come unexpectedly, what is the best way to regain a sense of control?

WE FOCUS ON HIV TO HELP YOU FOCUS ON

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Ask your doctor if a medicine made by Gilead is right for you.

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5/6/15 10:21 AM