My Menopause Magazine
Tips for Breast Cancer Survivors
N 40 o
Molecular Breast Imaging
Preventing Falls Is Your Cell Phone
Zapping Your Hormones? Ann Louise Gittleman, PhD
Discover What You Need To Know Before The Change
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How to Prevent Bladder Splatter Ask Dr. Mache
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The Hot Years
No 40
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My Menopause Magazine
In this Issue: Ann Louise Gittleman
Discover what foods will help you maintain hormone balance in perimenopause to help control symptoms naturally Molecular Breast Imaging –a New Look at Dense Breasts
Please Help Me I’m Falling... 5 Essential Tips To Avoid Stumble and Tumble
Prevent Bladder Splatter with Pelvic Floor Exercises
Is Your Smartphone Zapping Your Hormones?
Breast Cancer Survivor Tips
This Proven Exercise Eases Back Pain Naturally!
Ask Dr. Mache
Recipe
Editorial
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The Importance of
Accurate Information
W
e’re excited to share this issue of The Hot Years magazine with you. It contains wisdom from some of the world’s top experts on things you can immediately put to use. The feature article is with Ann Louise Gittleman, PhD. She’s a multi-award winning New York Times bestselling author and she’s going to share with you how to use nutrition to improve the quality of your life and lessen your symptoms. It’s all part of the updated release of her best selling book, Before the Change. Next Dr. Deborah Rhodes from Mayo Clinic will discuss a new technology to diagnose breast cancer in women who have dense breasts. It’s called molecular breast imaging and it is new alternative to the mammogram. An interview with Dr. Neil Binkley follows and explains why falls are such a catastrophe for women as the age and how you can prevent them. It’s important information for you, and you need to know this for your mom. These tips could save a life. Want to improve or stop your stress incontinence without surgery... read
on! Discover how a painless non-invasive technique can keep you dry and in control. Got a smartphone? Of course you do. And did you know the electromagnetic waves from it may make you think you’re in menopause? Really important information for you to know. Dr. Mary Jane Minkin from Yale shares her expertise on how to treat the symptoms of menopause in women with breast cancer, and Suzanne Andrews, the host of Functional Fitness on PBS provides an easy to do exercise to help relieve your low back pain. Plus Q & A from Ask Dr. Mache on Facebook Live, and more. It’s a great issue of The Hot Years. We hope you enjoy it. Please share it with your friends by going to www.HotYearsMag.com. Yours in good health, Dr. Mache Dr. Sharon
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Associate Editor
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Discover What You Need To Know
Before The Change Want to know how to feel better just by changing what you eat? Read on!
A
nn Louise Gittleman, PhD, is a multi-award winning New York Times bestselling author of over 30 books on women’s health. She’s worked tirelessly on the forefront of health trends for decades and is widely recognized as the First Lady of Nutrition. She shares her thoughts about the updated edition of her bestselling book, Before the Change. Dr. Mache: I’ve been a fan of yours for a very long time. What led you to redo your book, Before The Change?
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Ann Louise: What really led me to redo the book was the concern that women are now, more than ever, confused about hormone replacement therapy, whether it’s synthetic or bioidentical, which may carry its own minefield of side effects.
In my book, I talk about the estrogen window, which is the name of one of your books and something you are so famous for. I truly believe that was the missing link in my first book, so you are featured in this new update.
Many of the chemicals out there actually function in our bodies as endocrine disruptors. They play tricks on our bodies and mess with our own hormones
They’re looking for natural alternatives, whether it’s herbal or a mineral like magnesium, to help smooth out mood swings, panic attacks, anxiety and sleeplessness. They want to empower themselves to navigate the change and regulate mood swings, lose weight and perhaps, sleep better and boost energy.
I was also concerned because as you well know, in 2002 that Women’s Health Initiative study (WHI) was abruptly halted with some confusing blowbacks. So, I think that women need to understand that there may in fact be a right timing for certain types of hormone replacement therapy, and I wanted to give them the opportunity to know exactly what to do and what I would do if I were going through the change again.
Dr. Mache: Thank you for that. The more we can get the message out to women that hormones have a window of opportunity, the better. If you start estrogen in that window, then your risks go down and your benefits go up. And if you start estrogen after your estrogen window closes, things can be different. That’s where so much of the confusion came in. What do you mean when you say that, “Menopause isn’t your mother’s change anymore?” Ann Louise: Well, we’re living in such a toxic environment, and many of the chemicals out there actually function in our bodies as endocrine disruptors. They play tricks on our bodies and mess with our own hormones. Xenoestrogens and parabens can be found in plastics and sprays.
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Obesogens, which are foreign chemical compounds that disrupt normal lipid metabolism, look like estrogen, and are notorious for causing weight gain. Dr. Mache: So xenoestrogens are in the soil and come from environmental toxins that our bodies interpret as estrogen. Ann Louise: Yes. They mimic what our bodies interpret as our natural hormones. Other chemicals can turn one hormone into another. I think that a lot of these endocrine-disrupting chemicals act like a wrecking ball for metabolism and lead to insulin resistance, obesity, diabetes and even fatty liver disease. So, I make a big deal in my book about cleaning up the environment. Choose household cleaning products and body care products that are as clean and natural as possible so your liver and detoxification systems don’t have to work so hard to metabolize them. There are also toxins in tap water, plastics, clothing, packaging and the BPA (Bisphenol A, an industrial chemical in plastics), which we know is so detrimental to our system. According to the CDC, BPA is in just about a hundred percent of us. So, in the book, I talk about swapping out these chemicals for natural alter-
natives. I talk about how important it is to support your liver, which is your detoxification method, and your bile, and what you do if your gallbladder has been removed. Dr. Mache: You’re saying that women are often unnecessarily fearful about taking hormone therapy, but most don’t realize they are getting exposed to environmental estrogens. You want women to make changes to lower their risk.
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Ann Louise: I do. I want them to support their livers so the liver can produce enough quality bile to transport excess xenoestrogens and even natural hormones out of the body. That will allow them to have good estrogen metabolism, so they are not constipated and not gaining weight.
Ann Louise: Yes, indeed. Bile is a primary detox method that the liver uses to get rid of daily toxins. Keeping bile free-flowing and your liver decongested is a very important and very helpful way to stall the weight gain so many women complain about.
Women are often unnecessarily fearful about taking hormone therapy, but most don’t realize they are getting exposed to environmental estrogens
In Before the Change I talk about the right foods, bile thinning supplements and the importance of beets and bitters in your system so that you can eat for health and eat to quell the uncomfortable symptoms that seem to arise 10 years before you actually go through the change itself. Dr. Mache: Bile comes from the liver. It’s like a detergent, used in our bodies to either digest fat and other substances like hormones and some drugs, or move them out of the body. So, bile is a pretty important fluid that we depend on in our natural digestion. And you’re talking about ways to keep bile fluid from getting viscous so your digestion and your body run more smoothly.
Dr. Mache: It’s all about understanding how your body works and what’s in the environment that can mess up your body works. What other things do today’s women need to know? Ann Louise: One of the important things we’re seeing in nutrition, which really applies to all women, is that we’re bringing good fats back to stabilize blood sugar levels. This helps control mood swings so that we don’t have to eat so frequently. I’m really in favor of 1) supporting your liver and getting free-flowing bile, 2) adding magnesium to the diet or as a supplement, and 3) getting some slimming, sexy fats back on your dinner plate to stabilize your blood sugar. That could be a little bit of coconut oil, olive oil, an EFA
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(essential fatty acid) rich fish oil or flaxseed oil. Oil is very important for a perimenopausal, menopausal, and postmenopausal woman, because it’s so helpful for the skin, hair, nails and blood sugar control. The key is moderation. Dr. Mache: What bad fats should people avoid or minimize? Ann Louise: I’d say trans fats, or anything hydrogenated (it’s bad for your heart, liver and your hormones) like margarine and anything hydrogenated or partially hydrogenated. I’d also avoid Genetically Modified Organisms (GMO) foods. So, a GMO-free diet. Dr. Mache: Many people don’t realize how harmful bad fats are. It’s like rust that happens slowly over time. You don’t see it. That’s why we are seeing more and more people with heart disease. It has killed more women than breast cancer or all the cancers combined. Ann Louise: That’s so true. And it contributes to all the problems that women have with their gallbladders, the taking out of the gallbladders and so forth. So, you really need to read labels and look for products with zero trans fats. Dr. Mache: You make a good point. We often shop with our wallets because food is expensive. And partial-
ly hydrogenated trans fats are often cheaper. But, they’re expensive for the long run because they affect your health. So get the healthiest food you can for the best price that you can. Ann Louise: You’ve led me to think of something else that I didn’t mention. Instead of using margarine on your healthy, whole grain toast, start switching to avocado. It’s a much healthier fat and is part of the Mediterranean diet. And for high heat cooking, avocado oil is one of the most stable. It can withstand temperatures up to 470° F. Dr. Mache: Before it turns rancid? Olive oil, which is in general good for you, turns rancid with high heat. Ann Louise: Right, which is why avocado oil is so important for roasting or coating your meat. Especially for high heat cooking. I also use ghee, a kind of butter with the solids processed out, or macadamia nut oil, which is also very good for high heat cooking. Dr Mache: What other foods are helpful for women in perimenopause? Ann Louise: I have a list of remedies I call peri-zappers. They’re the tried and true remedies I’ve used as powerful hormone balancers. I’ve found flaxseed oil to be helpful with depression and fatigue.
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About one to two tablespoons a day of these ground magical seeds help lower cholesterol and make insulin more effective. They’re high in lignans, which are antioxidants that help balance hormones. I use a little bit as a salad dressing, and they are good for your man’s prostate as well. I’m also a believer in magnesium. I think it’s a real hormone rescuer. I have been using it for people who have high blood pressure, and I recommend 400 to 800 milligrams a day for women who can’t sleep. I think it’s also a stress reliever. I believe most women are deficient in it.
Dr. Mache: Do you just squeeze a half a lemon into a glass of water?
I prefer taking the magnesium I created, called Mag-Key. It contains about a hundred milligrams per capsule and contains magnesium taurate, glycinate and malate so that it targets the brain, the muscles and the heart.
Last but not least, I think proper hormone replacement therapy is important, whether it’s traditional hormone replacement or the bioidenticals, which is what most of my people opt for, for some crazy reason, because it still has to be carefully monitored.
Ann Louise: Yes, half a lemon into a glass of hot water, first thing in the morning. It cleanses the palate and it helps to thin bile. And it’s very good for individuals who have constipation, indigestion or a little bit of weight gain. The lemon and water is my go-to, instead of coffee. I also like to see menopausal women drinking roasted dandelion root tea because it’s a liver tamer as well. Drinking a lot of coffee is a hard on the system because it’s a potent diuretic.
Keeping bile freeflowing and your liver decongested is a very important and very helpful way to stall the weight gain so many women complain about
It’s also helpful to take something daily for your liver. Something as simple as lemon juice and water, first thing in the morning, will thin your bile and tone up the kidneys and the liver.
But I think there’s a role for it under the guidance of a practitioner that really has experience in helping to navigate you through the change of life.
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I was a guinea pig at one point for the hormone pellets, and they did not work well for me. Instead, I chose to use a very mild patch that worked wonders, and I always matched it with my natural progesterone. Dr. Mache: I’m not a fan of the pellets because they’re not FDA approved and they can crumble after they’re inserted. Also, hormone levels are often much higher than expected. And, levels can stay up for months. Ann Louise: Oh, it was the most horrendous experience I’ve ever had. So, you’ve got to know what you’re doing. I’m a believer in the right kind of hormone replacement that can be monitored properly. Dr. Mache: You mentioned progesterone, which is very important if you have a uterus, because the progesterone prevents the estrogen from causing the lining of the uterus to get too thick. Why do you focus on progesterone so much in your book? Ann Louise: Well, I’ll tell you the real reason. I was motivated by Dr. John Lee, the promoter of natural progesterone way back in the day. He was a guide for me, a real assistant in the writing of three or four books. Through him, I became very imbued with the progesterone message. I started using
it myself and found out that my sleep problems, which I had developed before the change, went away with natural progesterone. I then developed a product that I have used for myself and my clients, called ProgestaKey. I still use it because I think it’s very helpful as a natural antidepressant and for water retention. I also think progesterone impacts the brain and nervous system. I’m a lot calmer with progesterone. Over the years, it’s worked near miracles for me. Dr. Mache: Interestingly, in perimenopause estrogen is typically higher, and progesterone levels are actually a little lower because ovulations aren’t as good. There is a relative imbalance, which causes the PMS-type symptoms. Dr. Lee did a lot of good things before his death in 2004. And his books have continued to be popular. Unfortunately, they do have a lot of misinformation about hormone therapy and estrogens because so much has changed in a decade and a half since he died. That is why one has to be careful about the source of their information. Hormone therapy is very confusing for women and their doctors. A recent article in the New England Journal pointing out that because of the fear of hor-
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mone therapy, 80 percent fewer women use hormones today than in 2002 when the first WHI paper came out. As a result, according to the New England Journal, many of today’s doctors are less trained in menopause and hormone therapy, which makes it challenging due to misinformation and myths. Ann Louise: I agree, and I think that estrogen has been, unfortunately, maligned and unduly demonized. That’s why I’m so grateful for your work and, that’s why it was so important for me to update Before The Change and give real homage to the importance of estrogen. I also learned the lower your zinc, the lower your progesterone. The higher your copper, the higher your estrogen. By balancing those two minerals, you can achieve a wonderful, hormonal homeostasis between the two. Dr. Mache: When I see patients or when I do one-on-one coaching via Skype, I make a point of looking at the whole person. Ann Louise: That’s what it’s all about. That is why diet, exercise, stress control and all of that are so important and a reason why I talk about all of it in the book. One of my peri-zappers is taking the distress out of stress. Do whatever it takes for you to calm yourself down, whether that’s yoga, meditation or an aromatherapy bath.
Dr. Mache: Since food is so important, what would you suggest a typical women in this window of life eat in a typical day? Ann Louise: I think starting the day with lemon and water is terrific in terms of the liver and the gallbladder toning up. For breakfast, a little smoothie made with whey protein from A2 milk (a healthy milk derivative), maybe a little bit of fruit, a little bit of oil like a tablespoon of flaxseeds Dr Mache: What’s A2 milk? Ann Louise: The A2 milk is the healthiest milk, which has non-mutative casein. I find a lot of women, as they get older, become much more lactose and casein intolerant. This is the healthier type of casein because there’s no real allergic responses to it. A2 casein hasn’t been connected to an outbreak of diabetes or cardiovascular events. And for lunch, four ounces of baked salmon, wild-caught salmon if possible, on a bed of lettuce, with some kind of delicious pesto dressing. For dinner, lots of vegetables and a nice salad, maybe two cups of spaghetti squash with ground beef and maybe a little bit of tomato sauce with a lot of garlic. Also, some added milled, healthy kind of allergy-free grain.
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Try to intake half of your body weight (ie 128 pounds = 64 ounces) in ounces of water daily For in-between meals, maybe a Granny Smith apple or something with a little bit of almond butter. That’s just so you’re eating moderate fat, moderate protein, lower to moderate carbohydrate, and drinking lots of water in between. Dr Mache: What’s the right amount of water for a person in a day? Ann Louise: About eight to ten cups or 64 ounces; maybe a little bit more. Theoretically, you’re supposed to intake half of your body weight in ounces of water. For a lot of people, that may not be possible. Instead, maybe two cups of water between meals, a cup in the morning and maybe four ounces before you go to bed so that you’re not up at night. But drinking a lot of water is important, maybe that’s where your two cups of the dandelion root tea can come in handy. I think it’s a pretty simple program. For more information about Dr. Ann Louise Gittleman visit www.AnnLouise.com.
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Breast Imaging
a New Look at Dense Breasts
If dense breasts are making your annual mammogram less than optimum, this new technology may help you find a breast cancer years sooner
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t’s a big challenge for women with dense breasts to be screened for breast cancer. It’s so hard to see the cancer cells hiding in the dense tissue. Molecular Breast Imaging is a new technology resulting from years of research by a team at the Mayo Clinic looking to solve this problem. At the North American Menopause Society’s Annual Meeting in Philadelphia, Dr. Deborah
Rhodes, a Professor of Medicine at the Mayo Clinic, shared her insights with Drs. Mache and Sharon Seibel about this exciting new screening tool she and her team developed to overcome the limitations of routine mammography in dense breasts.
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Dr. Mache: How did you get involved in developing a new screening tool?
guish it from the background dense white tissue.
Dr. Rhodes: I practice in a breast clinic at Mayo Clinic. I’m an internist by training, and we have a multi-specialty breast clinic where we see women with all kinds of breast issues, ranging from breast pain to screening abnormalities, to benign breast disease all the way to breast cancer.
Dr. Mache: So cancer just blends in and you can’t see it.
I was seeing women who had very dense breast tissue, and they were often traveling long distances to come to our institution for their screening. They would have a screening mammogram and I would say to them, “Good news, your mammogram looks normal.” But in my heart, I knew that we were very unlikely to see a tumor if one was present. Dr. Mache: What makes dense breasts so problematic for the radiologist?
Dr. Rhodes: It blends in. And so, I felt that I was really giving false reassurance that yes, the mammogram didn’t look abnormal, but I didn’t have a high degree of confidence that it would, if a tumor were present. Through a series of some chance meetings with some scientists at Mayo, we began work on developing a completely different way of looking at the breast tissue. Mammography relies on X-Rays, and X-Rays cannot distinguish between tumors and dense tissue, but other forms of radiation can.
With Molecular Breast Imaging, a tumor is very apparent, even in a dense breast
Dr. Rhodes: Breast density is like the wolf in sheep’s clothing. A dense breast appears white on a mammogram, but so does a tumor. So a tumor that’s in an area of dense tissue will be obscured because you cannot distin-
We began developing an imaging modality that relies on Gamma Rays, not X-Rays. Gamma Rays are not impacted by the density of the surrounding tissue, so a tumor is very apparent, even in a dense breast, using a Gamma detector. Our team has been working on this now for over 15 years. We’ve done a number of large studies, all funded
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can tell you very honestly that I would rather have a very brief injection than a mammogram with 40 pounds per square inch of force applied to my breast. Dr. Mache: They don’t have to squish your breast so much?
by the Komen Foundation, all funded by women who are passionate about breast cancer survival. And we have found that Molecular Breast Imaging, the name of our technology that is now licensed to several imaging companies, detects three to four times more cancers in the dense breast than mammography does. Dr. Mache: Tell us about the patient experience. Dr. Rhodes: Well, probably the biggest downside is that it does require an injection, and of course many of us are a little squeamish about that, but having just had my annual mammogram, I
Dr. Rhodes: They don’t really squish at all. Very gentle compression is applied, just to keep the breast still, but it’s certainly not a painful test. It does take longer to complete than a mammogram, so I think that there are advantages and disadvantages for both of these tests, but to me the most compelling aspect is the fact that it’s detecting three to four times more tumors. And of course that’s the reason why you’re screening for breast cancer anyway. So in my opinion we ought to be using the test that’s most likely to detect the cancers. Dr. Mache: Is this available everywhere? Dr. Rhodes: No, it’s not, and it’s been slow to gain adoption. Mainly because mammography has been the gold standard, the one size fits all approach
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for breast cancer screening since breast cancer screening began. And although mammography has evolved, we’ve gone to digital mammography and now there’s 3-D tomosynthesis mammography. At the end of the day it remains an X-Ray of the breast, which is always going to be problematic if you have dense breasts. Dr. Mache: And if you have this procedure done, it takes a little longer. How much radiation do you get with this versus a regular mammogram?
Dr. Rhodes: That’s an interesting questions, and I’ve acquired a sort of baptism by fire education in radiation risk through my research in Molecular Breast Imaging. Interestingly, in medical school and residency, I never received any training whatsoever on radiation risk. And so, I really had a lot of misconceptions about it, and frankly I think most doctors do, and certainly most patients, as well. Namely, because we have been indoctrinated with this idea that any amount of radiation exposure is risky and we should do whatever it takes to avoid it. But it turns out that’s simply not true, because the body is beautifully designed to encounter low doses of radiation, and in fact we do every day.
Dr. Rhodes: It’s about twice the amount of radiation, but it’s still within the category of very low dose imaging tests. Radiation safety organizations in this country and Living on planet around the world Earth exposes have said that It’s about twice the us to radiation tests associated amount of radiation (as a from our environwith these low mammogram), but it’s still ment. Taking a levels of radiation have no known within the category of very flight exposes us to radiation, and biologic risk assolow dose imaging tests yet, for some ciated with them. reason, people It’s really only feel like imaging when you get up tests are this special dangerous kind of to very high doses of radiation which radiation. They’re not, as long as they can accrue if you do a series of differremain in this low dose range. So I’ve ent imaging tests at the same time, really come to understand that choosthat you begin to see any biologic risk. ing the best test should not be about whether there’s a little bit more radiaDr. Mache: Are Gamma Rays safer tion. It should be about whether that than X-Rays?
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test succeeds in the purpose of doing the test in the first place. Dr. Mache: Final question. Since it’s more sensitive in that you can see better, can you do them less often? Dr. Rhodes: That’s a great question and I wish that we had been able to study that question. We are going to address this in a study that just began in July and will take three years to complete. It’s the first time that we’ve ever examined serial Molecular Breast Imaging to look at whether it would be possible to alternate mammography with Molecular Breast Imaging every other year instead of doubling up on them, which of course doesn’t make sense from the standpoint of time and cost.
Choosing the best test should not be about whether there’s a little bit more radiation. It should be about whether it succeeds in the purpose of doing the test And my personal view, although we haven’t proven this, is that it probably would be perfectly adequate to alternate these every other year because Molecular Breast Imaging is eliminating that reservoir of cancers obscured by mammography in the dense breast. Click to watch Dr. Mache’s interview with Dr. Rhodes
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Please Help Me I’m Falling...
Essential Tips To Avoid
Stumble Tumble
S
ometimes the things that are right in front of our noses are the things we don’t see. Like the dog’s toy that got left on the stairs, or the end of the carpet that got turned up. Maybe the night light was not on or the path to the bathroom was not clear. Then it’s stumble and tumble time. According to Dr. Neil Binkley, a geriatrician at the University of Wisconsin-Madison, a third of adults over age 65 fall every year and after age 75 that’s almost 50%. Adding insult to
and
Even antihistamines like Benadryl can affect thinking and balance and increase the risk of falls injury, falls often lead to an injury that results in loss of independence. Think you’re too young to be thinking about this? Think again. According to Dr. Binkley, one of the biggest risk factors for falls is muscle weakness with advancing age. The $95 word for that is sarcopenia. We all know older adults who have difficulty climbing steps,
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getting out of a chair, getting off of the toilet, etc. Those individuals in essence have sarcopenia. So we need to keep our muscles strong, and it’s not too soon to begin. Exercise is the cornerstone and that doesn’t have to mean going to the gym and putting 50 pounds on your back. Just walking and climbing steps are helpful, as are strength and balance exercises. Adequate protein intake is another key ingredient for muscle strength. Women in perimenopause/menopause need to get a gram of protein per kilogram of weight per day, broken up in divided doses. So if you weigh 132 pounds, that’s 60 kilograms (132 pounds/2.2 pounds/kilogram), and you need 60
grams per day of protein. It probably doesn’t matter whether the protein comes from animals or vegetables; they’re all broken down to amino acids and those are the building blocks of our muscles. In addition, make sure to get adequate daily vitamin D. And remember calcium for your bones. Another tip in reducing falls risk is reviewing all of your medications. As we age we tend to see multiple healthcare providers and we get prescribed drug X, Y and Z, and pretty soon we’re on 10 medications that are interacting. Even over the counter antihistamines like Benadryl have anticholinergic effects that can affect thinking and balance that increase the chances of falling.
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Dr. Binkley highly recommends practicing getting up. So rather than waiting until you fall and then saying, “How do I get up?,” start thinking about how to get up off the floor. He recommends checking out the website from the Ministry of Health in New Zealand called, “Love your Independence”. It’s very commonsensical and there’s nice pictures that describe what to do. In one example, it illustrates how to scoot over to a solid chair, grab onto the chair to pull yourself up, sit down on the chair and get up from there.
Women in perimenopause/ menopause need to get a gram of protein per kilogram of weight per day, broken up in divided doses Don’t let falls get you down!
So keeping pathways and stairs clear, using night lights, minimizing medications, diet and exercise are really straightforward, common sense things that we can do.
Click below to watch Dr. Mache’s live interview of Dr. Binkley
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Prevent Bladder Splatter with Pelvic Floor Exercises
Want to improve or stop your stress incontinence without surgery...read on!
D
o you always need an aisle seat at the movie theatre? Do you know the location of every bath-
room at the mall? If so, you are not alone. Up to half of midlife women have a sensitive bladder and struggle with urinary incontinence - it’s a best-kept secret. Music Video by Dr. Mache called: Incontinence Leave a Box
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There is a common misconception that urinary problems are a normal part of aging, but it is not normal
Why? Studies show that women are embarrassed to talk about it and often wait up to 5 or more years before discussing urinary incontinence with their healthcare provider. Yes, it’s a challenging problem but there’s good news! There are a number of effective treatments. And in many cases, the treatment of choice is physical therapy. According to Denise Hartzell-Leggin, a physical therapist at Penn Medicine
near Philadelphia, it’s important to keep the pelvic floor muscles strong and toned just like any other muscle in your body. When you go to the gym and work out using your biceps, triceps and hamstrings, you see results; you’re getting firmer, stronger and more toned. But what about your pelvic floor muscles? Do you have a work out routine for them?
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In a span of 6 to 8 visits a person can go from having bladder splatter to having more control and confidence Most people have a hard time even recognizing where their pelvic floor muscles are because we can’t see them. Normally the pelvic floor muscles are a series of thick, strong muscles beneath the bladder, the uterus, and the pelvic bowl, which is the name given to the “floor” of the abdomen. Imagine them as a trampoline that connects the bones you sit on: the ischial tuberosity, the pubic bone in front, and your coccyx or tailbone. The pelvic floor muscles form passageways for the urinary system, the vaginal reproductive system, and the GI system. So it’s not surprising that the condition of these muscles impacts bladder control among other things. There is a common misconception that urinary problems are a normal part of aging, but according to Ms. Hartzell-Leggin, any leakage problems, whether from the urinary system or from the bowels, is not normal. And it can happen at a very early age, like in adolescence, or more commonly as we age.
Physical therapy teaches people where the pelvic muscles are located and how to voluntary direct these muscles to do their job so they can work more efficiently; both how to contract and get tightened, or how to relax. For a simple voiding problem, in a span of 6 to 8 visits a person can go from having bladder splatter to having more control and confidence. Often there is resolution of the problem
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during this time period. But sometimes that’s not the case and it takes continued pelvic floor exercising to see the long-term benefits. 5 Must Know Facts about Physical Therapy for Bladder Control • Treatment is typically 12 to 16 weeks, with weekly or biweekly sessions • The treatment does not hurt • Therapy is individualized for each person taking into account symptoms, anatomy and medical history • The goal is to look at mechanics and how to improve coordination of the muscles during the specific task
• It teaches how to integrate use of the muscles from a functional perspective. For instance, how to pre-contract the muscles prior to coughing, sneezing or standing So if you’re having difficulty with sensitive bladder, don’t suffer in silence. Talk with your health care provider and see if physical therapy is the right treatment for you. Click below to watch Dr. Mache’s interview with Denise HartzellLeggin
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Smartphone Zapping Your
Hormones?
New data is showing how the electromagnetic fields from your smartphone could be making you sick and your hormones out of balance
W
ith new apps each promising to help you manage menopause better, it’s tempting to think that a smartphone might be every menopausal woman’s best friend. But did you know that the electromagnetic fields (EMFs) emitted by your phone could actually be silently zapping your hormones? Recent recommendations by the California Department of Public Health (CDPH) have stirred the debate on cell phone safety once again – a good reminder that wireless technologies might not be completely harmless after all. As Investigative health journalist and author of “The Non-Tinfoil Guide to
Hot Years Technology EMFs” Nicolas Pineault discovered through his research, cellphone radiation has been shown to disrupt many aspects of your health and wellbeing, including:
1
Your Sleep Did you know that sleeping with your cell phone under the pillow or on your nightstand has been proven to reduce the body’s production of the melatonin hormone, making it more difficult for you to fall and stay asleep? The same goes for tablets, computers and other wireless devices that each contribute to your exposure to “electrosmog” – a new kind of pollution inside your bedroom that is invisible, odorless, but which comes with its lot of health consequences. Action Step: Ensure that your smartphone, tablets and any other wireless device in your bedroom is either set to “Airplane Mode” or powered off completely. Reducing your EMF exposure at night will help you sleep more soundly, and has even reversed insomnia in some women.
2
Your Stress Levels Not only is your smartphone a source of stress in your life because of the constant pinging, buzzing and endless flow of social media notifications it sends your way – the EMFs
Sleeping with your cell phone under the pillow or on your nightstand reduces the body’s production of the melatonin hormone it emits towards your head have been shown to make your adrenaline and cortisol stress hormones surge. Many researchers have also found that cell phone use near the head might increase symptoms of depression and anxiety in some users, mimicking what some women might think are symptoms of hormonal imbalance. Action Step: Minimize your cell phone use as much possible, and opt for
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speakerphone or the use of wired earbuds when you need to take a call. Also, avoid the use of Bluetooth headsets, which could expose your brain to a similar amount of EMF radiation as your phone – making it a very poor alternative. Finally, if your work requires you to spend time on the phone each day, have your cell phone number redirected to a landline. Your brain will thank you for it!
Action Step: On top of using “Airplane Mode” more often and creating distance between you and your phone at all times, Nicolas recommends following these easy recommendations emitted by the California Department of Public Health:
• Carry your cell phone in a backpack, briefcase, or purse; not in a pocket, bra or belt holster (or make sure to hit “Airplane Mode”) using 1 out of 3 people exposed • Avoid your cell phone to “electrosmog” will Your Age in a fast-moving suffer from something Dr. Magda vehicle, or when Havas from you only see researchers have the Trent Univerone or two bars coined the Rapid Aging sity in Toronto displayed (your Syndrome (RAS) has demonstratphone emits ed that 1 out of 3 more EMFs when people exposed the signal is low) to this “electrosmog” will suffer from • Children and teenagers might be at something researchers have coined the an even bigger risk from cell phone Rapid Aging Syndrome (RAS). radiation. It’s recommended that The symptoms of RAS include “poor they use speakerphone and hit “Airsleep, chronic fatigue, confusion, plane Mode” as often as possible, chronic pain, anxiety, depression, and and to only talk on the phone in a host of other symptoms that doctors case of emergency mistakenly treat with pharmaceuticals.” For more easy tips on how you can This begs the question: Are you “getenjoy the countless benefits of a lowting old”, or are you simply responding EMF lifestyle, check out Nicolas’ latest very poorly to these stressful electrobook, “The Non-Tinfoil Guide to EMFs” magnetic signals? which you can find at EMFBook.com.
3
Hot Years Sexuality
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Breast Cancer Survivor Tips
For breast cancer survivors, menopausal symptoms can sometimes be a challenge. Here are one expert’s opinions on how to make those symptoms better.
T
he most wonderful news for any cancer patient is being told she is disease free. And fortunately, with medical advances, more and more breast cancer survivors are getting this great news. But what’s next? How do you get back in balance after treatment that may have left you with severe hot flashes,
vaginal dryness, and more? And how do you manage symptoms if you’re in the throes of therapy? Many treatments for breast cancer include some kind of hormonal medication like tamoxifen or aromatase inhibitors, which basically block the action of estrogen, leading to hot flashes, night sweats and vaginal dryness.
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And some patients start experiencing the symptoms of menopause again because they had to stop hormone replacement therapy when they developed breast cancer. Because menopause symptoms are a common side effect of chemotherapy, Dr. Mache spoke with Dr. Mary Jane Minkin, a member of the Yale faculty, about her approach to helping women with breast cancer tackle these problems. Dr. Mache: How do you deal with the menopausal symptoms in women who have breast cancer and who are coping with these symptoms? Dr. Minkin: Well, there are certain ones that are easier to take care of and certain ones that are trickier, but we can help with everything, and that’s the bottom line. If you’re having problems, don’t hesitate to talk to your gynecologist, your oncologist. There is always help available. Dr. Mache: Let’s talk about hot flashes and intimacy issues, two of the most common concerns. Dr. Minkin: Those are the primary issues. And certainly for things like hot flashes, most oncologists do not want their patients taking what we call systemic estrogen therapy, things like
estrogen pills or patches. However, there are certain things that women can do. For example, lifestyle changes like wearing layered clothing if they’re getting hot flashes. They can take off an outer sweater and leave a shell on underneath. We also encourage women to stay in rooms that are cooler and to keep their bedrooms cooler at night to help deal with hot flashes and night sweats. But there are also certain things that can be done as far as interventions. For example, I’m a big fan of an over the counter remedy called Remifemin, which is a German brand of black cohosh, used widely in German breast cancer centers for women dealing with hot flashes. There’s very good data on it in the German literature showing effectiveness for hot flashes. There are also medications for women for whom over the counter remedies aren’t effective, and some of those medications include things like SSRI antidepressants and SNRI antidepressants can be helpful with hot flashes. Also a medication called Gabapentin (an anti-seizure medication) is one we use regularly for hot flashes and night sweats. Dr. Mache: And now there is a form of SSRI that’s specifically for hot flashes.
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Dr. Minkin: Yes, Brisdelle. It’s the only non-estrogen prescription remedy approved by the FDA for the treatment of hot flashes and it’s quite effective. It’s basically paroxetine, 7.5 mg. It’s also good for sleep, and the other nice thing about it is that because it is such a low dose of paroxetine, it does not lead to an increase in weight or an increase in problems with sexuality and libido. It seems to be pretty good for not having side effects other than making you sleepy, which can be good if it’s taken at night. Dr. Mache: And for vaginal problems, do you have two or three suggestions? Dr. Minkin: Absolutely. As far as for vaginal symptoms, there are many good over the counter helpers. There are, of course, lubricants that can be used at the time of sex, which can be
If over the counter treatments like Replens and lubricants aren’t working, talk to your gynecologist or oncologist about using other therapies in the vagina very helpful. Those are all non-hormonal. And there’s a product that many of us like called Replens, which is a long-acting moisturizer. It’s available over the counter at pharmacies and it’s something that you insert into the vagina every three days or so in a pre-filled applicator. It’s a very good vaginal moisturizer. And if those don’t work, again there are other remedies that can be used. The American College of OB/GYN issued a position statement on this topic
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a little over a year ago. It said that for women having problems with sexuality and intimacy, and vaginal dryness, that if over the counter remedies don’t work, it is quite reasonable for almost all women to use vaginal estrogens. Furthermore, because so little is absorbed into the bloodstream, it’s quite reasonable for women who are breast cancer survivors to use. So, again, if over the counter treatments like Replens and lubricants aren’t working, don’t hesitate to talk to your gynecologist or oncologist about the possibility of using other therapies in the vagina. Dr. Mache: Can you comment on the new medicine that recently came out as a vaginal treatment.
Dr. Minkin: Yes, there’s a new medication which is really quite interesting. It’s a vaginal form of DHEA, which is a precursor to many different hormones. It seems to be metabolized solely in the walls of the vagina where it gets broken down. It’s trade name is Intrarosa. It’s a little vaginal suppository, and it’s quite effective. And again, no warnings on it about hormonal issues or things like that because it is not an estrogen product. It is vaginal DHEA. Dr. Mache: There are many treatment options available. So if you are having difficulty with symptoms, speak with your gynecologist or oncologist to get help. Click below to watch Dr. Mache interview Dr. Minkin at NAMS
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Hot Years Fitness
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This
Proven Exercise
Back Pain Eases
Naturally!
To ease your back pain, these exercises work on other muscles to support and strengthen your back
D
oes your back ache? Numerous studies suggest that physical therapy is very effective at treating many types of back pain with far less risk than surgery.
When you go to the physical therapist, you may be surprised that they don’t just focus on your back muscles when treating you for back pain. Your back pain treatment will include working your glutes and your abdominals utilizing therapeutic techniques because these muscles support your back and your pelvis. When you have stronger supporting muscles, you will notice a decrease in back pain.
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Important Tip 1: Raise slowly: 4 counts while raising your leg up and 2 counts while lowering your leg down. Here’s an exercise you can do that targets both your glutes and your abdominal muscles. Make sure to perform at the correct pace and form for best results. ABDOMINAL AND GLUTE ACTIVATOR MOVE
1
Lie on your back and prop yourself on your elbows making sure to keep your shoulders down. (Don’t allow your shoulders to raise up towards your ears).
2
Bend one knee as shown. Raise and lower the opposite leg while tightening your glutes (buttocks).
Important Tip 2: Make sure you don’t hold your breath. Relax for 5 seconds and continue for a set of 15. Repeat other side. Do one set in the morning and in the evening. Suzanne Andrews, Occupational Therapy Practitioner/L and President of Healthwise Exercise, is the original founder of Functional Fitness on PBS TV! She shows you how to correctly perform the best healing exercises for arthritis, osteoporosis, bladder control and more. See the DVD selection at healthwiseexercise.com. See what’s streaming at vimeopro.com/suzanneandrews/fitnessonline.
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Got Questions? Join us every Thursday at 9pm EST on Facebook LIVE (@MyMenopauseMagazine) when Dr. Mache answers your most pressing questions about perimenopause and menopause. Ask your questions live or submit in advance at AskDrMache.com. Dr. Mache, I am 61 years old and have been taking bioidentical EPT since I was 50 after having hot flashes, moodiness and sleepless nights. Is it safe to continue taking a lesser dose of this indefinitely or should I stop after this 11 year window? I have always been confused regarding this matter so I continue to take it. Martha Hi Martha. You’ve asked a very good and common question. Of course it depends on your general health and your exam, but according to recent guidelines by the North American Menopause Society (NAMS), it is reasonable in many women to continue for another 3 to 5 years with a lower dosage of EPT. Talk with your healthcare provider to assess your overall health and risk factors and if those are all good, see if he or she will continue treatment a bit further.
I got my period again after not having it for 11 months and this has happened to me twice now. Is this normal or should I be concerned? JoAnn L Hi JoAnn. Menopause is defined after you go one year without having a period. If you are going 11 months twice you’re probably close. But not knowing more details it’s not possible to say. I suggest you talk with your healthcare provider and get a blood test run for FSH. Depending on your physical exam, he or she may want to do other testing as well.
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Join the weekly Facebook LIVE HouseCall® Every Thursday 9pm Eastern Ask Questions • Get Answers • Bring Friends Go to AskDrMache.com to submit questions in advance and join me at www.facebook.com/MyMenopauseMagazine
Hot Years Recipe
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Reena’s One Pot Vegan Heal Meal
My Menopause Magazine
By Reena Jadhav
T
he new year always makes me want to start off clean! So, if you’re feeling like a little cleanse is required after your holiday indulgences, this meal is quick, healing and still yummilcious! In fact, its one of my 2 secrets on how I pulled off an entire year eating only home-cooked meals made of local farmer market produce. My formula for a healing 1 Pot meal is: 2 to 4 cups of Greens (chard or kale or spinach) 1/2 cup Orange veges (carrot/yam/sweet potato)
1/2 cup zucchini/summer squash/opo squash 1/2 cup cabbage/broccoli/cauliflower/Brussel sprouts 1/4 cup or less of quinoa/rice/lentils/mung bean mint/cilantro/basil to taste (I actually would toss all three in!) You can also turn this meal into a coconut curry with a Thai twist by replacing the vegetable broth below with coconut milk and tossing in some lemongrass. For the 15 months I spent eating home cooked meals, this formula helped me shop and cook without losing my mind! I had a unique meal each day, with no brain contortions on “what am I going to eat”. I would prep and purchase everything on Saturday from Farmer’s market. The other secret? Pressure cooker or InstaPot! Your meal is ready in under 15 minutes.
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Obstacles do not block the path; they are the path. Zen Proverb
CLICK HERE to hear the Song of The Month. March is colorectal cancer awareness. To celebrate, listen to this original song by Dr. Mache called “Light at the end of your tunnel.� You can find this song and other similar health songs at healthrock.com/music/amp-up-your-health-3-cd-set Every effort has been made to ensure that the information contained in this magazine is complete and accurate. However, neither the publisher nor the author(s) is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this magazine are educational and not intended as a substitute for consulting with your physician. All matters regarding health require medical supervision. Neither the authors nor the publisher shall be liable or responsible for any loss, injury, or damage allegedly arising from any information or suggestion in this magazine. The opinions expressed in this magazine represent personal views of the author(s) and are not a substitute for medical care. All content in this magazine is Copyright Š HealthRock, LLC
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