YOUR GUIDE TO BLACK WELLNESS
Oscar Winner
Viola Davis How a Prediabetes Diagnosis Changed Her Life
Women’s Reproductive Rights Are Under Siege
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The Rise of Plant-Based “Meat” Breast Cancer and Reconstructive Surgery Is Endometriosis Causing Your Pelvic Pain?
When Is Inflammation Good for You?
IMPORTANT FACTS FOR BIKTARVY®
(bik-TAR-vee)
This is only a brief summary of important information about BIKTARVY and does not replace talking to your healthcare provider about your condition and your treatment.
MOST IMPORTANT INFORMATION ABOUT BIKTARVY
POSSIBLE SIDE EFFECTS OF BIKTARVY
BIKTARVY may cause serious side effects, including:
BIKTARVY may cause serious side effects, including: } Those in the “Most Important Information About BIKTARVY” section. } 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 BIKTARVY. } Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. } Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. } Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain. } The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%).
} Worsening of Hepatitis B (HBV) infection. If you
have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.
ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: } dofetilide } rifampin } any other medicines to treat HIV-1
BEFORE TAKING BIKTARVY Tell your healthcare provider if you: } Have or have had any kidney or liver problems,
These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY.
including hepatitis infection. } Have any other health problems. } Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. } Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
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.
Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.
HOW TO TAKE BIKTARVY
Tell your healthcare provider about all the medicines you take:
Take BIKTARVY 1 time each day with or without food.
} Keep a list that includes all prescription and over-the-
counter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.
} BIKTARVY and other medicines may affect each other.
Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.
Get HIV support by downloading a free app at
MyDailyCharge.com
GET MORE INFORMATION } This is only a brief summary of important information
about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.
} Go to BIKTARVY.com or call 1-800-GILEAD-5. } If you need help paying for your medicine,
visit BIKTARVY.com for program information.
BIKTARVY, the BIKTARVY Logo, DAILY CHARGE, the DAILY CHARGE Logo, KEEP MOTIVATING, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. Version date: December 2018 © 2019 Gilead Sciences, Inc. All rights reserved. BVYC0102 01/19
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KEEP MOTIVATING.
Because HIV doesn’t change who you are. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS.
Ask your healthcare provider if BIKTARVY is right for you. To learn more, visit BIKTARVY.com.
Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com.
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CONTENTS
this month on REALHEALTHMAG.COM The R&B legend told fans during a tour that he’s taking a break from performing to prepare for a kidney transplant this fall.
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.
This Is Sick!
Diagnostic errors are associated with a number of serious ilnesses that account for nearly three fourths of all medical problems. Do you know what these diseases are?
Good Morning, World!
If you’re one of those individuals who tends to wake up early in the morning, your love affair with the sunrise might offer you and your health really great benefits, according to recent findings published in The British Medical Journal.
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.
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14 COVER STORY
3 editor’s letter
alarming statistics
Mood mathematics
When actress Viola Davis learned she had prediabetes, she heeded her wake-up call.
5 buzz The Handmaid’s Tale today; is generic PrEP in 2020 too good to be true?; HIV and psoriasis; paying for cancer; diabetes and liver disease; signs of mental illness in kids
10 fitness Build muscle as you reduce fat; what’s the best time to exercise?
18 protein substitutions Plant-based burgers and hot dogs are becoming staples of the American diet.
22 when healing goes
haywire
Inflammation that persists can lead to a greater risk for other health issues.
11 nutrition Cancer-fighting greens; seafood fraud; ways to tame a sweet tooth
26 affordable options
12 sex
Financial help may be available for breast reconstruction surgery.
Get checked for endometriosis; is your partner living a double life?
30 thoughts
13 stuff we love A roundup of health products
On using drugs to enhance people’s cognitive abilities
REAL HEALTH Question of the Month What do you think of the explosion of CBD-related products now flooding the market for different health-related issues?
Cannabis is a natural, healing herb with many medicinal uses that offers benefits to many people. It’s great to be able to replace conventional painkillers and over-the-counter drugs with something natural and healthy. —Beatrice Feliu-Espada, founder & CEO, The Honey Pot Company
reach out & click! At realhealthmag.com, you can read more articles; access exclusive, online-only special reports; and subscribe ($9.97 for four quarterly issues; or call 212.242.2163). Plus, sign up for the Real Health email newsletter to get the latest news on issues relating to Black health!
(COVER) COURTESY OF VIOLA DAVIS; (WONDER) SHUTTERSTOCK.COM; (FELIU-ESPADA) COURTESY OF BEATRICE FELIU-ESPADA; (DOCTOR/PATIENT, WOMAN, PILL, GREENS AND BONES) ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)
Stevie Makes Surgery Plans
EDITOR’S LETTER
EDITOR-IN-CHIEF
Kate Ferguson MANAGING EDITOR
Jennifer Morton DEPUTY EDITOR
Mood Mathematics
Trent Straube SCIENCE EDITOR
Liz Highleyman
New algorithms make machines more human than ever.
COPY CHIEF
Joe Mejía ASSISTANT EDITOR
Alicia Green INTERN
Caroline Tien ART DIRECTOR
Mark Robinson ART PRODUCTION MANAGER
’ve read a number of interesting articles recently about devices that use artificial intelligence (AI) to assess people’s emotions. We’re talking wearable tech that can determine whether a person is happy, sad, aroused, bored or experiencing some other state of being. How cool is that? Or is it? Maybe, like me, you’re not sure whether this is a good or bad thing. A lot of companies are intrigued by the edge this technology might give their businesses. After all, compiling and evaluating consumer data is key to reeling in more customers and racking up more sales than the competition. In law enforcement, hypothetical devices that can read thoughts, faces, body language and other clues conjure up visions of a future where crimes might go uncommitted because the perpetrators would be busted before they even broke the law. (Does this possibility ring a bell? Think of Minority Report, the film in which Tom Cruise played a cop in a futuristic police unit that uses AI to help stop crimes before they occur.) Interestingly, in this make-believe version
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of society, technological advances in surveillance rendered privacy obsolete. AI was responsible for the safety and security of residents of the state. Currently in its infancy, artificial intelligence is already having marked effects on the world as we know it. Digital assistants such as Amazon’s Alexa and Google’s Assistant now share our homes alongside our family members. Duplex, a chatbot by Google now in limited public testing, can even realistically mimic human speech. Will Duplex one day assume our identity and deceive others? No one really knows, but it’s enough of a possibility that Google has promised to build disclosures into Duplex to ensure that people will know they’re speaking to a robot. And here’s another thing. What will happen to our privacy? Alexa and Assistant are already like strangers living in our homes. Then again, at some point, people may start to think of them as invisible friends who are at their beck and call 24/7. Might they take the place of human companions? At least there’d always be someone—a voice? a presence?— to talk to. Maybe these assistants could help ward off the loneliness and isolation some folks feel when they lack family or friends in their lives. Taking things one step further, perhaps the day will come when machine learning allows AI to evolve to such a degree that these high-tech companions can actually compete with human beings for space on this planet. Right about now, maybe you think I sound crazy. But just let me know whether you agree that the possibilities are indeed mind-boggling.
Kate Ferguson, Editor-in-Chief katef@realhealthmag.com
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Living with a lung disease can be easier.
“I value the fellowship, education and support this group offers.” — Better Breathers Club member
American Lung Association Better Breathers Clubs are welcoming support groups offered at no charge for individuals living with lung disease – such as COPD, pulmonary fibrosis and lung cancer, and their caregivers. Led by a trained facilitator, learn better ways to cope with your diagnosis and live life to the fullest with chronic lung disease during these regularly scheduled educational programs. Plus, it’s fun and enriching to connect with others. Find a Better Breathers Club near you at Lung.org/better-breathers or by calling 1-800-LUNGUSA.
Lung HelpLine 1-800-LUNGUSA | Lung.org/better-breathers
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BUZZ
The Handmaid’s Tale Today
BOB ANDRES/ATLANTA JOURNAL-CONSTITUTION VIA AP
What would happen if women lost their say-so regarding reproductive rights?
WHEN WOMEN BEGAN DRESSING IN flowing red robes and demure white bonnets à la the handmaids in Margaret Atwood’s book The Handmaids Tale to protest anti-abortion laws in different states, the media took notice. The costumes helped draw attention to the ongoing war against women’s reproductive right to legally terminate a pregnancy. During some protests, the women filed into legislative buildings en masse— sometimes holding signs—and sat or stood silently. At one event, they chanted their response to anti-abortion laws with a chorus of “We do not consent!” The message was clear: Women demand control over their own bodies. On January 22, 1973, the U.S. Supreme Court affirmed in Roe v. Wade that access to a safe and legal abortion is a constitutional right. Almost immediately, the ruling faced political efforts to overturn the decision; such challenges have persisted ever since. Currently, a slew of states—including Alabama (which bans all abortions with no exceptions), Georgia, Kentucky, Missouri, Louisiana and Ohio—significantly restrict women’s ability to get an abortion. Roadblocks to abortion in these
states take the form of doctor and hospital requirements, time limits on a woman’s stage of pregnancy, the viability of the fetus, state constraints on funding, rules for private insurance coverage, compulsory counseling, waiting periods and special guidelines that necessitate parental consent and notification for minors to undergo the procedure. Now, these limitations have become commonplace. Could they one day give men in power mastery over women’s reproduction? Interestingly, Atwood’s book was published in the 1980s, a time when states were passing anti-abortion laws. In Missouri, the ruling handed down in Webster v. Reproductive Health Services in 1989 upheld a state law that severely limited women’s access to an abortion and established a precedent that states could restrict care for this medical procedure. Through the years, attempts in other states to erode Roe v. Wade have achieved vary- More restrictive ing degrees of success. abortion In 2017, Representative laws keep Justin Humphrey (R–OK) coming. introduced a bill stipulating
that no abortion would be performed in the state “without the written informed consent from the father of the fetus.” Like the powerful men in Gilead—the fictitious city in Atwood’s novel— Humphrey views pregnant women as “hosts” for the embryos they carry. “The control of women and babies has been a feature of every repressive regime on the planet,” Atwood wrote in an essay published in 2017 in The New York Times. “Of those promoting enforced childbirth, it should be asked: Cui bono? Who profits by it? Sometimes this sector, sometimes that. Never no one.” Many draw a parallel between the social order oppressing women in Gilead and what America might be like should Republican lawmakers succeed in rolling back all the legislation that has passed thanks to Roe v. Wade. When asked whether The Handmaid’s Tale is a prediction, Atwood preferred to describe the book as an “antiprediction,” writing, “If this future can be described in detail, maybe it won’t happen.” But, she cautions, we also can’t depend upon such wishful thinking. —Kate Ferguson realhealthmag.com
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BUZZ
Skin Issues HIV and psoriasis
Is generic PrEP in 2020 too good to be true? WHEN GILEAD SCIENCES ANNOUNCED that a generic version of its HIV prevention pill, Truvada as pre-exposure prophylaxis (PrEP), would be available in 2020—a year earlier than expected— folks got excited. After all, a month’s supply of PrEP now costs between $1,600 and $2,000 in the United States. Since generics are cheaper than brand-name drugs, more people at high risk for HIV will be able to access PrEP next year, right? Not quite, say some activists, who point out that under the deal Gilead struck with Teva Pharmaceuticals, which is set to manufacture the generic, Teva may enjoy exclusive rights to PrEP for a year. That’s because Truvada contains two drugs, emtricitabine and tenofovir disoproxil fumarate, or TDF, and only the patent on TDF has expired.
(Emtricitabine’s patent expires in 2021.) Without any competition, Teva will have no incentive to lower the price of its generic PrEP. And although Gilead offers a co-pay assistance program for PrEP, Teva is under no obligation to do the same, which means many of those who could most benefit from PrEP, including Black men and transgender women, may still be unable to afford the drug. That’s why W. David Hardy, MD, chair of the HIV Medicine Association, says, “More immediate actions also are needed to significantly reduce the price and associated medical costs of PrEP, in addition to investments in provider education and capacity building in medically underserved urban and rural areas—particularly in the Southern region of the country.” —Joe Mejía
THE CURRENT COST OF A ONE-MONTH SUPPLY OF TRUVADA AS PrEP IN THE UNITED STATES COMPARED WITH ITS COST IN SOME OTHER COUNTRIES Source: Henry J. Kaiser Family Foundation
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Deal or No Deal?
Antiretroviral medications, or ARVs, allow most people with HIV to live longer, healthier lives. But these drugs can also lead to the development of inflammatory conditions, such as psoriasis, in up to 20% of those managing the illness with these meds. (Interestingly, doctors also have noticed that ARVs can sometimes improve symptoms of psoriasis.) For these folks, treating psoriasis— which causes itchy, dry patches on the skin—can be difficult because the therapies for the condition can further inhibit their already compromised immune system. But it may be possible to reduce the chance you’ll develop the illness by frequently washing your hands and avoiding foods known to trigger allergies, heavy alcohol use and exposure to certain infections that weaken the immune system, such as strep throat, bronchitis and tonsillitis. In addition, get proper nutrition and avoid skin damage (from bugbites, sunburn or picking at the skin), smoking, stress, anxiety and certain medications used for malaria, high blood pressure and bipolar disorder. Note that changes in weather can also trigger a psoriasis flare. Over-the-counter or prescription skin creams and ointments may also be effective for people with HIV. These include antibacterial soaps, coal tar, corticosteroid creams, moisturizing lotions, salicylic acid, synthetic vitamin D creams and topical retinoid meds. Additionally, doctors recommend phototherapy with ultraviolet light, applying aloe vera gel or coconut oil on the skin and taking baths with colloidal oatmeal or Epsom salts for relief of symptoms. —KF
BUZZ
Worried and Sick
Hepatitis News The link between diabetes and liver disease
How to pay for cancer treatment and related costs FOR THOSE DIAGNOSED WITH CANCER who are experiencing financial woes, here are some ways to help yourself. First things first: Do your research. Plenty of resources are available for people with cancer, including the Cancer Financial Assistance Coalition and Cancer.net. If you need help getting started, ask your doctor, local health department or a social worker for information. Financial navigators are counselors who can help patients understand outof-pocket expenses, which services health insurance plans might cover and how to set up payment plans—as well as find cost-saving treatment methods and better access to health care. Next, gather the necessary paperwork, such as proof of your diagnosis, as well as paycheck stubs, tax filings and any other proof of income. This supporting documentation will come in handy when you apply for a grant, food stamps or disability benefits. In addition,
consider reaching out to pharmaceutical companies that offer patient assistance programs for folks who can’t afford to pay for their medicines. A diagnosis doesn’t have to shatter your whole world. Reach out to others, and tap into resources and services to help ease your burden. Doing so can do wonders for your wellness and recovery. —Alicia Green
Many of the 30 million Americans with type 2 diabetes may be at risk of developing liver cancer and cirrhosis, also known as scarring of the liver. In a recent study of 18 million adults in Europe, which is the largest investigation of its kind, scientists identified individuals with non-alcoholic fatty liver disease (NAFLD), the accumulation of liver fat in people who drink little or no alcohol, or non-alcoholic steatohepatitis (NASH), an advanced form of NAFLD that can lead to cirrhosis, liver cancer and liver failure. Researchers found that those with NAFLD or NASH who had a diagnosis of type 2 diabetes were more than two times as likely to develop advanced liver disease as those without the blood sugar condition. This suggests that diabetes may predict the progression of liver disease. The takeaway, experts say, is that efforts should focus on liver disease education and prevention—as well as monitoring organ function—among people with diabetes. —AG
THE ESTIMATED NUMBER OF CHILDREN IN THE UNITED STATES AGES 3 TO 17 WHO’VE BEEN DIAGNOSED WITH DEPRESSION
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Source: Centers for Disease Control and Prevention
What’s Wrong? Signs of mental illness in kids According to the 2016 National Survey of Children’s Health, one in six American children between ages 6 and 17 has a treatable mental health disorder. But such a condition can be hard for parents to identify. Warning signs of mental illness in children include mood and behavioral changes, intense feelings, difficulty concentrating and substance abuse. Kids suffering from a mental condition may also inflict self-harm, experience unexplained weight loss and develop physical symptoms, such as headaches and stomachaches.
If you’re concerned about your child’s psychological state, it’s best to consult a doctor. Kids diagnosed with mental disorders are often prescribed psychotherapy (talk or behavior therapy). In some cases, medications may be used to treat them. As a parent, you can nurture your children’s mental health by helping them to build strong, caring relationships and develop self-esteem. In addition, create a safe, positive home environment where you listen to your kids and respect their feelings so they feel understood and valued. —AG
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FITNESS
Time to Exercise Does it matter whether you work out in the morning or evening?
Here’s the scientific formula: Build and shape muscle as you reduce fat. MANY WOMEN SAY THEY WANT TO GET TONED NOT BULKY. BUT WELLNESS journalist Lisa Elaine Held suggests that, on a physical level, there is no difference between the two. Both goals, she says, require muscular hypertrophy, the muscle growth that occurs when you work out regularly. Furthermore, solid scientific evidence backs her up. “Muscles are only able to grow, shrink or stay the same,” explains Brynn Putnam, one of the fitness experts Held interviewed. No matter the workout you do, how the body builds muscle doesn’t change. So, ladies, don’t shun the weight room. Whether you’re lifting hefty barbells for hours at a time or planking your butt off in Pilates classes, the end result will be the same. —Caroline Tien
THE NUMBER OF STATES THAT REQUIRE PHYSICAL EDUCATION BE TAUGHT IN EVERY GRADE Source: 2016 Shape of America Report
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Toning Up
Which is better for you: working out in the morning or working out in the evening? It’s a question that has nagged at the minds of many fitness enthusiasts at one time or another. Time magazine reporter Jamie Ducharme recently asked Anthony Hackney, a professor of sports science at the University of North Carolina at Chapel Hill, for an answer and got one. Although Hackney stresses that consistency is by far the most important element of any exercise regimen, he gives morning workouts the edge. “In the early morning hours, you have a hormonal profile that would predispose you to better metabolism of fat,” Hackney says. In plain English: You’ll burn more calories working out in the morning than in the afternoon or evening. But if you’re a night owl rather than an early bird, no sweat. Hackney says that in the end, any hour of the day or night is a good time to exercise. —CT
NUTRITION
Fishy Listings An update on a recent report about seafood fraud in the United States
Potent Produce Cancer-fighting greens
SCIENTIFIC EVIDENCE HAS ESTABLISHED that plant-based foods contain a rich supply of nutrients shown to reduce the risk for several types of cancer. Now, scientists from Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston, have identified a compound called indole-3-carbinol (I3C) in broccoli, kale and other cruciferous vegetables that stimulates the production of PTEN, a protein that restricts tumor growth. The next step for researchers is to use I3C to increase the potency of PTEN. “These findings pave the way toward a long-sought tumor suppressor reactivation approach to cancer treatment,” says Pier Paolo Pandolfi,
MD, PhD, the director of the hospital’s cancer center. William Li, MD, president and medical director of The Angiogenesis Foundation and the author of Eat to Beat Disease: The New Science of How Your Body Can Heal Itself, has for years stressed the key role that food— combined with drug therapies—can play in cancer treatment and prevention. But the team isn’t suggesting that eating lots of cruciferous vegetables could have the same effect. “For a start, a person would have to eat around six pounds of raw sprouts per day to reach an effective level of I3C,” Pandolfi says. —Kate Ferguson
Many seafood lovers worried about recent findings that showed the fish they buy at stores or restaurants may not be what’s advertised on the label or menu. But a follow-up study by the Marine Stewardship Council (MSC) that used DNA bar coding to confirm the fish species of products identified as “certified seafood” found that 99% of the labeling was correct. However, such DNA testing can’t determine whether individuals intentionally misidentify seafood or substitute one group of fish for another. MSC requires that every distributor, processor and retailer that sells certified seafood use a documented system that allows the agency to track fish from its source to the point of sale. But the effectiveness of this system in stopping fraud—whether deliberate or not—on a global level has yet to be determined. Still, scientists believe that genetic identification methods are key to resolving this issue. —KF
THE PERCENTAGE OF ADDED SUGAR IN OUR DIETS THAT COMES FROM SOFT DRINKS Source: New Hampshire Department of Health and Human Services
Sweet-Tooth Tamers
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Easy ways to handle our very human liking for sugary treats Findings show that newborns smile when they’re fed something sweet but respond negatively to sour or bitter tastes. “This suggests that children are born with an innate preference for sweetness,” explains Marion Hetherington, who is a biopsychologist at England’s University of Leeds. Still, too much sugar can be bad for both children and adults. But here’s good news: Experts have some tips for avoiding overindulging. For instance, eat only
a little of what you crave. Better yet, pair sweets with a filling healthier food (preferably, something rich in fiber and nutrients, such as a delicious fruit or high-protein fare). Alternatively, you can chew a stick of gum or get moving to distract yourself from the desire for something sweet. Whatever you choose to do, though, don’t wait too long to eat. Hunger can prompt you to quell belly rumblings with sugary or fatty foods. —KF realhealthmag.com
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SEX Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.
What are some signs that your significant other might be leading a double life?
Book a doctor’s visit ASAP to get checked for endometriosis. NEARLY 10 YEARS AGO AT THE FIRST Annual Blossom Ball fundraiser for the Endometriosis Foundation, actress Whoopi Goldberg declared that she thought everyone knew about endometriosis, or endo for short. This common pelvic disorder occurs when tissue that usually lines the uterus grows in other areas where it doesn’t belong. The painful condition affects an estimated 176 million women worldwide but isn’t well known or understood by either females or health care providers, say health care agencies. Goldberg said she had experienced endo about 30 years prior to her addressing the crowd at the Prince George Ballroom in New York City that evening of April 20, 2009. She said
THE PERCENTAGE OF MEN COMPARED WITH WOMEN WHO SAID THEY OFTEN LIE TO THEIR SIGNIFICANT OTHER Source: Credit Donkey survey
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she was lucky to have been treated by a doctor who knew about the condition and “cleared it up” for her. But many women endure years of painful periods and ovulation, pain during or after sexual intercourse, heavy bleeding, chronic pelvic pain, fatigue and infertility before they’re diagnosed with endometriosis. When patients are Black women, doctors sometimes link these symptoms of endo to other pelvic problems they commonly experience, such as pelvic inflammatory disease, uterine fibroids or a pelvic infection, says Idries J. Abdur-Rahman, MD, a boardcertified ob-gyn and contributor to BlackDoctors.org. He advises women with ongoing pelvic pain who are unsatisfied with their doctor’s assessment to get a second opinion. There’s no cure for endometriosis, but hormonal meds and surgical procedures, such as laparoscopy, which is used both to diagnose the condition and remove affected tissue, and hysterectomy, which removes the uterus, can relieve pain. Recently, however, the Food and Drug Administration approved the new drug Orilissa (elagolix) for treating the moderate to severe pain caused by endometriosis. —Kate Ferguson
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Despite always “working overtime,” your partner’s paycheck shows no increase. Your calls go unanswered, or are returned only when it’s convenient for your partner. When asked about his or her whereabouts, your mate can’t give logical answers. (Often an individual will attempt to distract, criticize or flirt with a significant other to avoid questions.) Your partner is disinterested in you and avoids closeness. Your loved one’s personality changes abruptly. Credit card statements show items or services purchased that you know nothing about.
Certainly, there can be many more signs that your partner is leading a secret life. But in a happy and healthy relationship, there is no room for lies and deception. For relationships to grow and get stronger, there must be true commitment, effective communication, respect, trust, honesty and genuine love between two people.
(GIRL ON COUCH) ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY); (HORTON) COURTESY OF DOROTHY HORTON, PSYD
Pain in Your Pelvic Area?
Human beings lie for a multitude of reasons. But when individuals in romantic relationships deliberately deceive their partners to lead a double life, chances are that they’re dropping clues here and there that can expose their lies. Of course, when the truth surfaces, the consequences of their actions affect both parties in the partnership. Here are several warning signs that you might be dealing with a “double-lifer,” according to relationship experts:
STUFF WE LOVE
OreganKnow Healing Ointment (1 fl. oz., $5.95) Keep this ointment—which contains an oregano extract—on hand to treat skin burns, ulcers, abrasions, superficial wounds, surgical sites and inflammation from insect bites. oreganknow.com
Grow Gorgeous Scalp Detox Exfoliating Pre-Wash Treatment (6.4 fl. oz., $34) Remove buildup with exfoliating castor oil beads and pomegranate enzymes while moisturizing the scalp and absorbing excess sebum to extend the time between hair washes. growgorgeous.com
The Honey Pot Company (Organic Cotton Tampons, 24-count, $7.99; Soothing Body Balm, 2 fl. oz., $45.99; Moisturizing Water-Based Lubricant With Kiwi Vine Extract, 3 fl. oz., $19.99; and Mommy-to-Be Wipes, 30-count, $9.99) This line of plant-based feminine care products features healthy alternatives for women that are free of chemicals, parabens, carcinogens and sulfates. thehoneypot.com
A ROUNDUP OF THE LATEST MUST-HAVE FINDS FOR HAIR, SKIN, HEALTH, BEAUTY AND MORE. THESE PRODUCTS ARE WORTH EVERY CENT.
Teslar Watches (Men’s and Women’s Collections, from $595 to $2,695) These Swiss-made timepieces contain nanotech chip technology that has been designed to resist the harmful waves of electromagnetic radiation. teslarwatches.com
Vegamour CBD + Biotin Vegan Gummies (60 gummies, $68) These supplements contain full-spectrum hemp oil extract to rebalance the body’s endocannabinoid system. Formulated to nourish and strengthen strands with vitamins and minerals to support healthy hair growth. vegamour.com
Gillette SkinGuard (Razor + 1 cartridge, $12) One study found that the optimally designed lubricated blades on this sleek razor reduced the incidence of razor bumps by more than 60% after 12 weeks of daily shaving. gillette.com
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Viola Davis hopes that talking about her health scare will prompt folks to get their blood sugar levels checked.
ALARMING
STATISTICS WHEN ACTRESS VIOLA DAVIS LEARNED SHE HAD PREDIABETES, SHE HEEDED HER WAKE-UP CALL.
COURTESY OF WILLIAMS & HIRAKAWA/AUGUST
By Kate Ferguson
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test, which measures the amount of glucose, or blood sugar, attached to hemoglobin—a protein in red blood cells that contains iron and ferries oxygen from the lungs to the rest of the body. (A high A1C level may be a sign of diabetes.) The doctor confirmed that Davis’s A1C level was elevated. After that news, things got tough for her. Davis says she does everything she can to support her health, but difficulties persist. “I eat foods that don’t spike my glycemic index. I’m careful with the fruits, and I love fruits—they’re my answer to cookies,” she says. “Instead of having cookies, I can have fruit, and I don’t have to overdo it.” The glycemic index is a ranking of carbohydrates in foods based on how quickly they cause blood sugar to rise. (Too quick a rise can be dangerous.) But despite her efforts to eat healthy, Davis found it hard to lose weight. “I’m doing everything I can, but I’ve had a hard time with it, particularly because of being in menopause,” she says. “And I’m doing all I can to educate myself about this condition.”
VIOLA DAVIS LOOKS FIT AND HEALTHY.
Her arms display the chiseled definition that results from rigorous workouts at the gym. She eats nutritious foods and leads the kind of lifestyle doctors recommend for getting—and staying— in tip-top shape. “I do weight training three times a week, and then I work out another two or three days on my own,” says the actress, who has won an Oscar, Emmy and Tony and is the star of the hit TV show How to Get Away with Murder. “And the three days I do weight training, I work out with a trainer, and it’s pretty brutal. “I understand food beyond an inch of my life. I look at nutritional facts all the time. I know about carbs and glycemic index, and I drink complete almond milk. I feel that I’m a very fit and informed person,” Davis adds, sharing a list of her healthy habits. Then came the unexpected. “When I was diagnosed with prediabetes, it shocked me,” says Davis. According to the Centers for Disease
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Davis checks her blood glucose numbers
Top: Viola Davis is flanked by her sisters at her vow-renewal ceremony. Middle: Davis’s Aunt Bessie, who had type 2 diabetes and is mentioned in A Touch of Sugar, the documentary about diabetes the actress narrates. Bottom: Davis sits surrrounded by her family members.
more often than her A1C levels. But testing for both is important because the two measurements are key to determining whether an individual’s blood sugar levels are within the ideal range for health. Available over the counter, a blood glucose meter checks the amount of sugar in the blood at any given moment. According to the American Diabetes Association (ADA), normal is below 100 mg/dL before a meal and less than 140 mg/dL after eating. Diet, exercise and stress can affect this measurement. Knowing this level informs individuals whether there is too much or too little glucose in their blood. An A1C blood test provides information about an individual’s average blood glucose over the past three months and is used to make an initial diabetes diagnosis. Doctors usually perform this exam twice a year. (A normal A1C for someone who doesn’t have diabetes is less than 5.7%.) When levels don’t meet the desired target, health care providers advise
ALL IMAGES: COURTESY OF VIOLA DAVIS
Control and Prevention, of the 84 million American adults with prediabetes, 90% are unaware they’re living with this serious health condition. The condition occurs when cells in the body don’t respond normally to insulin, a hormone the pancreas produces to help blood sugar enter cells for use as energy. Individuals with prediabetes experience blood sugar levels that are higher than normal but not elevated enough to warrant a type 2 diabetes diagnosis. However, the condition increases the risk of developing diabetes as well as heart disease and stroke. Like many people with prediabetes, Davis showed no signs of a problem. “I didn’t have any symptoms,” she says. “I felt fine.” She received her diagnosis after undergoing a test to check her female hormones. “I felt like I was in menopause, but I wasn’t sure, so I went to get my estradiol—a type of estrogen—level checked, and the doctor just happened to do an A1C test,” the 54-year-old Davis says. This screening is the short name for the hemoglobin A1C (HbA1c)
folks to check their blood glucose more often to determine whether there’s a pattern that may help them customize a treatment plan for patients. “Right now, I’m on my way to a doctor’s appointment, where I’ll get a regular physical to check my glucose and my A1C again,” Davis says, adding that she doesn’t have her A1C checked often because doing so scares her. “But I check my glucose maybe two or three times a year.” In general, doctors suggest that those
with prediabetes get their blood sugar levels checked annually. According to the ADA, how often and when individuals should check their blood glucose depends on the advice they’re given by their doctor or diabetes care team. Additionally, the association advises folks to ask care providers what their target numbers should be. Higher-than-normal blood sugar levels don’t necessarily mean an individual will develop diabetes. Although a prediabetes diagnosis can be scary, and many people, like Davis, live for many years without any inkling there’s a problem, the condition can be managed. “My glucose levels are completely normal,” she says. Nevertheless, the condition can raise someone’s risk of developing type 2 diabetes and heart disease. Davis’s family has a history of type 2 diabetes. Davis’s Aunt Bessie died of complications from diabetes, and her two sisters, Dianne Davis Wright and Deloris Grant, have type 2 diabetes, as did their paternal grandmother. Davis shared her story and her family’s experiences with diabetes for the first time in A Touch of Sugar, a documentary she narrated. Produced in collaboration with the pharmaceutical company Merck as part of the company’s “America’s Diabetes Challenge: Get to Your Goals” initiative, the film debuted in April at the Tribeca Film Festival in New York. “My introduction to diabetes came through hearing people talk about ‘the sugar’ and through relatives who got the disease and succumbed to it,” she explains. “As a child, I never knew about diabetes; it was sort of like
talking about a phantom. “No one ever talked about what they ate and how you can turn the illness around,” Davis continues. “No one had any of those conversations. If you had diabetes, then that meant that you did something wrong in order to get the disease, and that was it. “But today the conversations about diabetes are more about education and awareness,” she adds. Davis hopes the film will achieve both objectives. “We’re in crisis mode!” she stresses. “Living with diabetes involves harnessing a complex system of support, management, constant information and a good health care provider— all of those are needed.” In addition to having prediabetes, being over 45, being Black, being physically active fewer than three times a week and having a family history are risk factors for type 2 diabetes. The combination of these should serve as a wake-up call not to be ignored. Luckily, Davis answered the call. She has invested in exploring all aspects of controlling this chronic condition. At the visit to her personal doctor, she plans to discuss adding another physician to her health care team. “I need to get an endocrinologist and more comprehensive care because the condition isn’t just associated with my diet,” she observes. “The bigger conversation is about the
complexity of the disease, managing it and advocating for yourself, which is why people need to know what kinds of questions to ask [their doctor] and have a support system that can help if you feel stigmatized,” Davis says. “It behooves us to know that we’re all in this thing together.” According to recent reports, Davis’s dramatic TV series was renewed for a sixth season. And JuVee Productions, which she launched with her husband, Julius Tennon, is developing a slew of other projects that will keep the actress busy. “These are the new sorts of things that people are focused on right now— that’s a part of our legacy,” Davis says. This awareness also extends to diabetes. Visit ATouchofSugarFilm.com to view the film and learn more. ■
HOW TO BEAT PREDIABETES Consider this diagnosis an opportunity to work on your health.
In a recent study, a number of health care experts declared that prediabetes is a worldwide epidemic. The condition is characterized by blood sugar levels that are higher than normal after fasting for at least eight hours. Typically, the number that folks want to see for a fasting blood glucose test is under 100 milligrams/deciliter. A result between 100 mg/dL and 125 mg/ dL qualifies as prediabetes; a reading of 126 mg/dL or higher indicates diabetes. Risk factors for prediabetes include being African American, overweight or obese; having a parent or sibling with diabetes, high blood pressure of 140/90 mm Hg (millimeters of mercury), a low level of HDL (“good” cholesterol)—40 mg/dL or less for men and 50 mg/dL or less for women— or a triglyceride level above 250 mg/dL; developing diabetes during pregnancy; giving birth to a baby weighing more than nine pounds; and having polycystic ovary syndrome. But even if you have some of these risk factors, you’re not at their mercy. Simple changes to your lifestyle can prevent or delay the onset of prediabetes, health experts say. Lose weight if you need to, exercise regularly at a moderate intensity for at least 30 minutes at least five times each week, opt for healthy whole foods and drink sufficient water. —KF
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PROTEIN SUBSTITUTIONS
PLANT-BASED BURGERS AND HOT DOGS THAT LOOK AND TASTE LIKE MEAT ARE BECOMING STAPLES OF THE AMERICAN DIET. By Gerrie E. Summers
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indings from a recent observational study published in The British Medical Journal suggested that individuals who ate the most red meat, especially processed meats, such as bacon and hot dogs, experienced a higher risk of premature death compared with those who cut back on these sources of animal protein. The study didn’t conclude how much meat folks can safely eat before their health takes a hit. But usually the response of consumers who are faced with such news is predictable: They embark on a quest for alternatives to meat, as evidenced by the growing popularity today of plant-based replacements
Today, revenue from textured vegetable protein, tofu, seitan and other plant-based sources of mock meat is projected to climb to $27.9 billion by 2025, according to a new market research report. A recent Nielsen Homescan Panel Protein survey shows that U.S. and Canadian consumers believe that plant-based proteins offer superior nutritional values and offer more health benefits compared with animal protein. Many think these meat substitutes improve overall health and help folks manage their weight. Millennials (those born between 1981 and 1996) show a particular affinity for vegan options, but they’re not alone. One third of consumers buy plant-based meat substitutes in addition to traditional meat products. Meatless alternatives have been advertised and promoted by manufactur-
percent of greenhouse gas emissions are from livestock.) Additionally, the water used for crops and animals and during the manufacturing process cannot be conserved. Animal waste pollutes waterways and causes disease, and workers exposed to toxic gases face health risks. Furthermore, the welfare of animals poses a concern for many. But these issues aside, the key reason for the surge in popularity of plantprotein-based diets is arguably their connection to health. In a recent study conducted by researchers from the Harvard T.H. Chan School of Public Health and Purdue University, which was published in the journal Circulation, people on diets that replaced red meat with healthy plant proteins experienced a decrease in risk factors for cardiovascular disease.
meant to mimic the taste, texture and appearance of meat. But this is hardly new. In the United States, John Harvey Kellogg, MD—of Kellogg’s Corn Flakes fame—created mock meats inspired by the vegetarian lifestyle embraced by the Seventh-day Adventist Church. Kellogg produced meat substitutes, aka meat analogues, named Nuttose and Protose, that were served at sanatariums—health resorts affiliated with the church where folks went to get rejuvenated—and were commercially available in the 1890s. These alternatives also met the demand for healthier, low-cost substitutes that could protect a growing population from health concerns such as foodborne illness and contamination caused by unhealthy meat production practices and conditions. 2 0 RE A L H EALT H FALL 2 0 19
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ers and some health professionals as being healthier than animal meat because they don’t contain growth hormones and antibiotics, which are fed to most cattle. Both humans and animals are susceptible to antibiotic resistance from the overuse of these drugs in meat production. In addition, not eating meat eliminates the chance of getting food poisoning from undercooked meat as well as the risk of food-borne illnesses from pathogens that cause diseases linked with animals, such as mad cow disease. By extension, getting protein from
plant sources is more ethical and better for the environment. Raising cattle for meat production requires a lot of energy, land and other resources. Cows contribute to climate change when they emit methane, a greenhouse gas. (Fifteen
Indeed, such findings have driven much of the hoopla over a slew of plant-based burgers currently dominating the “meatless meat” industry. And let’s not forget the yum factor. Beyond Meat’s Beyond Burger is said to taste better than traditional veggie burgers. Then there’s the Impossible Burger, a soy-based mock burger from California-based Impossible Foods that’s on the menu at Burger King. The company’s mock burger even sizzles and bleeds like hamburger meat— courtesy of soy leghemoglobin (short for legume hemoglobin). But a meat-free product labeled “vegan,” “vegetarian” or “plant-based” isn’t necessarily healthier. While meatless burgers are lower in cholesterol than beef burgers, these faux meats are heavily processed in order to look and taste more like the real
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MOST AMERICANS STILL LOVE TO EAT MEAT, BUT MANY ALSO DON’T MIND SCARFING DOWN PLANT-BASED BURGERS TOO.
deal. Some of these burgers post calorie counts and saturated fat content similar to those of red meat, and most are also very high in sodium. Additionally, the juicy burgers may also contain questionable ingredients. Many commercial organic pea proteins have tested positive for high levels of glyphosate, an herbicide linked to cancer. Soy also receives scrutiny because of the plant’s estrogen-like isoflavone compounds—genistein and daidzein—which were once believed to interfere with hormones, increase the risk of breast cancer and contribute to thyroid problems. Ingredients in plant-based textured vegetable proteins labeled “soy protein isolates” or “isoflavone supplements” are processed and could also contain questionable additives. In 2014, MorningStar Farms products, as well as some Boca Burgers, were tested and found to contain GMOs, or genetically modified organisms. The soy leghemoglobin in the Impossible Burger is derived from yeast genetically engineered to mimic the heme molecule found in natural meat. The new and improved Impossible
Burger that launched this year shone a brighter spotlight on meatless alternatives, fueling the growing market. Consumers who shun carbs in favor of protein for health reasons but want to avoid loading up on red meat are driving the demand for plant-based proteins. And mainstream meat companies are responding by investing in a variety of meat-free foods. Tyson Foods, America’s top manufacturer of meat products, launched Tyson Ventures, which, until recently, owned Beyond Meat. The start-up is investing in plant-based meat products via its Raised & Rooted brand. In addition, Perdue now offers vegan and plant-based proteins. Hormel Food’s Applegate Farms, producers of natural and organic meats, is said to be eyeing investments in the plant-based industry, and Nestle will have a pea protein–based burger (to be sold as part of its Sweet Earth brand) this fall. Previously, meat alternatives were created more as options for vegans and
vegetarians and those who wanted to eliminate meat from their diets or those who already had. While some were delicious, most didn’t truly taste like beef or chicken. But the next generation of meat substitutes are being designed to attract meat eaters by actually tasting exactly like meat. In the future, faux meats will be
produced from animal cells. Cargill, a multinational agricultural foods corporation, is investing in companies— such as Memphis Meats—that produce meat from cell cultures. These manufacturers are using techniques to engineer meat from pieces of lab-grown animal cells to make chicken strips, meatballs and other foods that don’t require breeding, raising and slaughtering living creatures. But the current cost is prohibitive—one meatball costs $1,000 to produce. One major problem with introducing new meat alternatives into the market is how difficult it will be for consumers to decipher ingredient lists. The challenge will involve making sense of new, unfamiliar substances—some of which might not even be disclosed for proprietary reasons—as well as packaging and nutrition claims. Currently, certain meat alternatives can be just as pricey as meat, and, considering their contents, some people may deem it better simply to buy free-range chicken, grass-fed beef or wild-caught seafood that is antibioticand hormone-free. (It should be noted that prices might decrease if the big companies manufacture their own plant-based meats.) The Department of Agriculture predicted that in 2018 meat consumption would hit an all-time high—222.2 pounds of red meat and poultry per person—and this trend continues. As the world’s population grows, so will meat consumption. But the good news is that renewed interest in reducing how much animal flesh we eat means alternatives to meat will continue to evolve. That very well could mean better flavor, texture and way less processing to make plant-based proteins a truly healthier option. ■
More Mock Meat History Grinding out replacements for animal protein is a uniquely American industry. After John Harvey Kellogg, MD, used nuts and cereals to make vegetarian substitutes for meat in the 1890s, other entrepreneurs quickly followed suit. By 1900, Madison Foods near Nashville was developing soy-based meat alternatives. Another business, The Sanitarium Food Company in Loma Linda, California, sold some of the first commercially available mock meats made from soy and wheat. In 1937, Madison Foods launched Soy Burger, the earliest known meatless burger. Sales of meat substitutes soared during World War II when the government rationed red meat. Later, a line of meatless breakfast fare made of textured soy protein was sold under the MorningStar Farms label. Then Gardenburger launched its veggie burger in 1981 and Tofurky its turkey meat replacement in 1995. After the Food and Drug Administration initially issued an authorized health claim in 1999 that soy protein as part of a healthy diet might lower cholesterol and the risk of heart disease, the demand for analogue meats grew even more. The agency later proposed a rule to revoke this claim because of inconsistent findings to support it. At press time, a decision by the FDA to retract or retain the claim was expected. In 2000, Kraft acquired Boca Burger. Two years later, Burger King became the first major fast food chain to make veggie burgers available nationally. Most recently, Impossible Foods and Beyond Meat launched their own branded patties, which are sold in many restaurants across the country. —GES
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WHEN HEALING GOES HAYWIRE THE LONGER THAT INITIALLY BENEFICIAL INFLAMMATION PERSISTS IN OUR BODIES, THE GREATER OUR RISK FOR HEALTH ISSUES. By Jeanette L. Pinnace
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THE TYPE OF INFLAMMATION MOST
folks are familiar with occurs during the acute stage of this healing and recovery process, causing pain, swelling, redness and heat in response to a cut, sprain, fracture or infection. Usually, this type of inflammation subsides after the problem resolves. Inflammation begins when sentinel immune cells that are embedded in tissues such as skin sound the alarm that invaders are attacking the body. This, in turn, causes the release of chemicals called cytokines that direct the capillaries to leak fluid, which causes the familiar swelling. Next, macrophages, another group of sentinel cells, swallow invading organisms and secrete specific chemicals to defend against the onslaught. This alerts B and T cells to help destroy attackers and heal damaged tissues. Chronic inflammation, however, isn’t short-lived. This type of inflamma-
tory response continues for an extended period of time and can linger for months or years. In addition, sometimes, low levels of inflammation can occur in the absence of an injury or infection. This can prompt the immune system to release white blood cells that target healthy tissues and organs near the site of inflammation, which contributes to the development of many health problems. One of the most important advances in health research in recent years is the discovery that inflammation plays a role in more than a few disorders. The condition causes many diseases, observes George M. Slavich, PhD, an associate professor in the department of psychiatry and biobehavioral sciences at the University of California at Los Angeles. “Inflammation is involved in eight of the 10 leading causes of death in the United States today,” he explains.
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This is why researchers are trying to paint a more complete picture of inflammation and how it affects the body—and how to control it. The missing piece of the puzzle is why the immune system does not shut itself off after the inflammatory process finishes its therapeutic work. Right now, this function is poorly understood. But scientists do know that chronic inflammation plays a role in triggering certain autoimmune diseases, such as rheumatoid arthritis and lupus. In addition, researchers are now finding low-level inflammation in people who are obese and those who lead a sedentary lifestyle. Research shows that these factors place individuals at a higher risk for heart disease, cancer and type 2 diabetes. “Chronic inflammation is also insidious, meaning it develops quietly with few noticeable symptoms—and often those symptoms could be related to many things—and it continues, often slowly increasing in intensity,” says Carolyn Williams, RD, PhD, a nutritionist who authored the informative cookbook Meals That Heal: 100+ Everyday Anti-Inflammatory Recipes in 30 Minutes or Less. As a result, aging occurs at a faster rate, pushing the body more quickly toward diabetes, cancer, heart disease, autoimmune issues, dementia, Alzheimer’s and other inflammation-related conditions, Williams adds. CRUCIAL FINDINGS SHOW THAT EVEN
in the absence of harmful pathogens, fat cells can trigger a steady release of cytokines that damage perfectly
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Inflammation is a biological function by which the body attempts to heal itself in response to cellular injury. But this same process can also cause a great deal of harm if it continues unabated. Under normal circumstances, this key function of the immune system protects the body by releasing white blood cells and chemicals to destroy invading germs that can cause infections. But once viruses or bacteria have been eliminated from the body or an injury that has triggered the reaction has healed, a prolonged immune response can create unhealthy outcomes.
healthy tissue, nerves and organs. When someone is overweight, more cytokines are released, which affects the body’s ability to use insulin. Inflammatory cells can also cause issues in other areas of the body. For instance, inflammation of the gums may be linked to an increased risk for heart attack and stroke. Additionally, chronic inflammation contributes to the development of congestive heart failure, hypertension and Alzheimer’s disease. In cancer research, scientists know that inflammation triggers the production of free radicals. These unstable, toxic molecules, which form when the body breaks down oxygen, can damage genetic material and cause cells to grow out of control, resulting in cancerous tumors. An increase in inflammation that triggers chronic heartburn can boost the risk of cancer of the esophagus. In addition, colon cancer may develop when mucus-covered cells that line the walls of the colon are ruptured by bacteria and become inflamed. Inflammation that damages the lining of the intestines allows bacteria to leak, setting off a vicious cycle that leads to more bacteria and more inflammation. The good news is that investigators are searching for solutions to stop, or at least interrupt, this sequence of events. Additionally, scientists are working to create drugs that interfere—in a positive way—with the immune cycle and support this bodily system that fights disease. Because aging initiates an increase in inflammation, such a medication could possibly benefit everyone’s health. But until researchers learn how to more effectively control inflammation, they suggest people do everything they can to at least tame the effects of the body’s efforts to heal. One thing you can do is to lose weight and reduce the fat cells that generate inflammation. In addition, you could eat more fruits and vegetables, lower your intake of fats and sugar and consume fewer processed foods. Also, exercise and physical activity in general offer significant and proven anti-inflammatory benefits.
Additional ways to stem chronic inflammation include improving sleep habits, decreasing stress levels, getting gum disease treated and visiting your doctor for regular checkups. What’s more, don’t smoke, quit if you do and avoid inhaling secondhand smoke, as tobacco smoke can induce an inflammatory response. One symptom of inflammatory disease that’s not often discussed is depression. However, inflammation can contribute to this mental health condition as well as mood swings in some people. According to findings from a study conducted by the Emory School of Medicine in Atlanta, even a small increase in inflammation may trigger episodes of depression and mood swings. OMEGA-3 FATTY ACIDS AND VITAMIN
D are popular supplements that some credit with reducing inflammation. But researchers don’t recommend taking dietary supplements advertised as having anti-inflammatory properties. Some of these products can be dangerous, they warn. For instance, recent findings published in the international medical journal Case Reports in Hepatology found that consuming turmeric in large amounts may be toxic to the liver and other organs. The authors of this study suggest that folks tell their doctors about all the supplements they take and be careful of the dosage amounts. Most experts agree that this advice is sound and recommend getting nutrition from a healthy, balanced diet, rather than from supplements. If all this talk concerns you, various screenings can help determine what’s happening inside your body. A blood test that identifies a marker of inflammation in the blood, called C-reactive protein is available. Additionally, doctors can check for elevated levels of homocysteine—an amino acid—in the blood, which may be a risk factor for heart disease. In the meantime, watch your weight, eat properly, get enough sleep, control your blood sugar, exercise regularly and reduce stress. These lifestyle tips can help keep inflammation at bay so that good health is yours to enjoy for years to come. ■
TAMING THE TIGER Tried-and-true ways to fight chronic inflammation Too much of a good thing can be pretty bad. Case in point: When the body’s healing inflammatory response becomes chronic, it must be stopped in order to avoid potentially deadly health consequences. The easiest fixes for decreasing your level of inflammation are simple lifestyle changes, such as watching your weight and eating properly. An anti-inflammatory diet should include fresh vegetables and fruits and no processed foods. In addition, since obesity can drive inflammation, losing weight may help alleviate chronic inflammation. Furthermore, regular exercise can also help to slow a healing engine on overdrive. Experts recommend that individuals perform 30 to 45 minutes of aerobic exercise and 10 to 25 minutes of resistance training with weights four to five times each week. Also, be sure to get enough sleep and try to decrease the amount of stress in your life. But the best bet, researchers say, is to stick with habits already known to support good health. Embracing these proven practices can improve your chances of keeping inflammatory responses in check. —JLP
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AFFORDABLE OPTIONS MANY CANCER SURVIVORS WHO UNDERGO MASTECTOMY CAN’T AFFORD RECONSTRUCTION SURGERY. BUT HELP IS AVAILABLE. By Kate Ferguson
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“I WASN’T EVEN THINKING ABOUT the fact that implants were going to make me look like I have breasts,” she says. “It was just that I knew that I wouldn’t have breasts; therefore, I wasn’t even going to look like a woman.” Next, Allen had to negotiate the insurance process. “I’d heard that if you were going to get the surgery done, you needed to find someone who specialized in breast reconstruction because there’s a total difference between
someone just getting a breast job done and a person who got a double mastectomy and needs to have their breasts reconstructed,” she says. At one point, Allen became so fed up with the search that she almost gave up. The plastic surgeons on her state health insurance plan didn’t include breast reconstruction specialists. But her aunt convinced her to keep looking, and she began reaching out to different organizations she found online. After spending almost 24 hours on her computer, Allen found the Alliance in Reconstructive Surgery (AiRS) Foundation. “After all of the searching, they were the only place that I came across that actually talked about breast reconstruction,” she says. “It was about one o’clock in the morning, so I waited until the next day to call.” THE A IRS FOUNDATION IS A NONprofit organization founded by businesswomen and friends Janet Denlinger and Morgan Hare along with Rod Rohrich, MD, the founding chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center. Rohrich suggested ways in which the two could make a difference in the lives of women who needed breast reconstruction surgery after mastectomy. By the time Allen connected with Tamara Sieger, the director of advocacy at AiRS, she’d found a plastic surgeon recommended by her doctor. “He told me the surgery would cost me about $10,000,” she says. “I told him there was no way I could pay him that fee out of my pocket for the surgery. At this point, my husband wasn’t even working because he was at home help-
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LIKE MANY WOMEN UNDERGOING treatment for breast cancer, Heather Allen just wanted to feel well enough to get through each day. From the start, her doctor had told the 38-year-old married mother of six, who lives in Joliet, Illinois, that she would need breast reconstruction surgery. Allen was adamant that she wasn’t going to undergo any more operations. “I’d already lost my hair, gone through chemo and figured they’re just going to take the lump and let it shrink, and then I’d go with that,” she says. “The doctors kept telling me that I was triple negative and positive for the BRCA gene, so if I didn’t remove both breasts I’d probably end up with breast cancer again. I didn’t want to hear it, and I didn’t want to believe it. I’d heard about a lot of people not doing reconstruction, so I wasn’t going to be that person who did it.” Allen had become acquainted with cancer three years earlier, at age 35,
when she learned during a visit to relatives that cancer was ravaging her family. Her mother had ovarian cancer, and her grandmother on her mom’s side of the family had breast cancer. As the oldest daughter, Allen was chosen to make all decisions about her mother’s care. “It was a terrible time because a week later I was burying my mom; she did not survive,” she says. Her mother’s doctors were the ones who convinced Allen to get a mammogram and take the BRCA gene test. Eventually, she spoke with her doctor at great length about her reservations and fears. Allen says her doctor stressed that the removal of her breasts would greatly reduce any chance that her cancer would return. In the end, Allen’s desire to stay cancer-free won. “In my mind, if I wanted to be alive and not go through diagnosis and treatment again, I had to go ahead and say this is what I had to do.” Allen also wondered how her husband and children would react to her not having breasts. As she neared the end of her therapy, she thought harder about getting the breast reconstruction surgery.
ing to take care of me.” Eventually, the surgeon brought his fee down to $8,000 and asked Allen for $4,000 up front. But the cost was still too high. That’s when Sieger stepped in to help and got the funds needed for the surgery to happen. “I don’t know how this woman got it done and how she pulled it off, but within a two-week span, she got my surgery approved,” Allen says. Sieger managed to facilitate Allen’s reconstruction surgery thanks to a grant the foundation offers. Grants awarded may range from co-pays to the full cost of surgery. “Whether you fit within the program’s guidelines is all based on income,” Allen says. “You have to send in your tax return to show how much money your family makes and the bills from the surgeon to confirm the costs of surgery. “You’re also asked to write a short piece explaining why you feel you want the surgery and the benefits of you having the operation,” continues Allen. “I was excited about the prospect of getting the chance to actually get the procedure done. I felt like, hey, I’m in control of this, unlike not being in control of anything else having to do with my cancer.” Allen’s emotions simmered close to the surface when Sieger spoke to her. “I cried on the phone as I was telling her ‘thank you,’” she says. “I couldn’t believe this. Everything had worked out, and I was able to have my surgery. I thought about being able to feel as much of a woman as I could feel.” The preparation for surgery involved doctors inserting tissue expanders in Allen’s chest. Once these temporary implants have sufficiently stretched the skin and muscle, they’re removed during another operation and replaced with permanent breast implants. “They feel like bricks on your chest because at that moment they are sitting under your muscle,” she says. “They filled them up weekly with a saltwater solution to stretch my muscle; it was very tight and painful.” When it came time for the surgery, Allen was very nervous, fighting against a barrage of negative thoughts. “It was that old voice in your head that says,
BREAST RECONSTRUCTION
A quick Q&A on managing expectations Alexes Hazen, MD, a member of the board of the AiRS Foundation and an associate professor of plastic surgery at NYU Langone Health in New York City, answers key questions about breast reconstruction surgery. What factors determine whether someone is a good candidate for breast reconstruction surgery? The healthiest patients are the best candidates. Sometimes breast cancer treatment can affect the timing of reconstruction. So, for example, if it’s recommended that someone undergo chemotherapy, you wouldn’t want to operate on that person while she was undergoing chemo or radiation, but you can do so before or after treatment. Also, I think somebody who has a sense of what they want in terms of the reconstruction and who’s informed makes for a really good candidate. What can folks realistically expect from breast reconstruction surgery? Some people think that because they are getting “plastic surgery” that their result is going to be better than how they looked before. They sort of fail to think about the fact that they’re losing a breast that has to be reconstructed. In many cases, people are extremely happy with their results, and they feel really good about the way they look. But we are still having to replace something that is not there. Purely cosmetic surgery is a very different starting point than breast reconstruction, so I think individuals have to expect that breast reconstruction surgery is not going to make them perfect; their breast is not going to be how it was before. People must come to terms with that aspect of the procedure. —KF
‘You’re not going to wake up,’” she says. Allen also considered that she hadn’t been declared cancer-free at that point. In addition, she told herself that her body was still weak and rebuilding after cancer treatment, her hair hadn’t grown back yet and her red blood cell count was still very low. “I WAS VERY NERVOUS THAT DAY, so while I was walking in, I was praying and saying in my head, ‘It’s going to be OK. Everything is going to work out. The surgery is going to go as it should because the doctors know what to do.’” Besides her doctors and other medical professionals there to conduct the surgery, Allen’s team of supporters included her husband and an
aunt. In deference to her strong faith in God, the group formed a prayer circle before the procedure began. “We were all sitting holding hands, and my husband was leading us in prayer,” Allen says. She says she remembers only that as they prayed, everyone held one another, and she hugged each person in the prayer circle individually. “And then I woke up,” Allen says. “I never remembered going back into the operating room or anything.” Still, Allen doesn’t mind not remembering any details about the surgery or what happened while she was under anesthesia. After all, her prayers were answered. She found a way to get her breast reconstruction surgery done right on time. ■ realhealthmag.com
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THOUGHTS
Superpowers Thoughts about using drugs to boost performance
Can genius be packaged?
FILMS SUCH AS LIMITLESS AND LUCY EXPLORE THE ABILITY OF CERTAIN drugs to enhance people’s cognition. In real life, however, these so-called smart pills are supported with only limited evidence that they sharpen an individual’s memory, decision-making skills and capacity for creativity. Sold over the counter as supplements, these substances are classified as nootropics. Many of them are marketed as a blend of vitamins, minerals and ancient herbs that contain phytochemicals and antioxidants purported to improve brain function. Some prescription stimulants are also used by perfectly healthy people who want to boost their energy and concentration. These include Vigil or Provigil (modafinil), which are used to treat sleep disorders such as narcolepsy, and Ritalin (methylphenidate) and Adderall (a combo of several amphetamine salts), which are prescribed for attention-deficit hyperactivity disorder. But researchers are still studying whether these medications might allow people to enjoy the super-duper results some characters in the world of science fiction films have experienced. —Kate Ferguson
The Expert Says Barbara Sahakian, PhD, a professor of clinical neuropsychology at the University of Cambridge, discusses ethical and practical issues raised by the use of smart drugs on her school blog. 3 0 RE A L H EALT H FALL 2 0 19
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Who could benefit? More effective cognitive enhancers with fewer detrimental side effects can help people in certain professions, such as doctors and military personnel, focus and avoid serious adverse events at work.
realhealthmag.com
Are there additional issues to consider? “As a society, we certainly need to be concerned about the use of these drugs by healthy children and adolescents whose brains are still in development,” Sahakian says.
What guidelines should govern smart-drug usage? The long-term safety and effectiveness of these medications in healthy people must be proved, and individuals should be dissuaded from purchasing them online because doing so can be dangerous.
ISTOCK
Science Smarts
I’ve always been fascinated by comic-book heroes—men and women endowed with superpowers who save the world from destruction and from bad guys who hurt good people. Years ago, I watched the British TV series The Champions. The program followed the adventures of a team of United Nations law enforcement agents—two men and one woman—who were almost killed when their plane crashed in the Himalayas. The three were rescued by members of an advanced civilization who restored them to health with medicine that transformed them into superhumans. They were smarter and stronger than other people and used their newly acquired gifts for good. One episode that stood out in particular concerned a group of rival agents who were injected with drugs that gave them the same abilities as these heroes. But unknown to this trio was the tragic downside of the drug: Once its effects wore off, they would become permanently comatose. When I hear about smart drugs, I can’t help but remember this show. —As told to Kate Ferguson
how well do you know these
girls?
Learn more about your breast health at
KnowYourGirls.org
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