March 08, 2018

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diet ›   exercise ›   menopause ›   sleep ›   stress ›  


Sleep! We’re in Favor.

If you’re wearing a Fitbit to bed, like a patient I saw last week, you might be seeing pretty colored charts that confirm just exactly how poorly you slept last night. And if you’re like her, it may only be increasing your stress about what you already know: You’re tired! You’d like to sleep through the night!

Yes, as you’re likely tired of hearing, it’s hormones. Estrogen and progesterone are in decline, and the mix of hormones (add cortisol, the “stress hormone” to the cocktail, too) may be less friendly to sleep than it once was. Hot flashes, which can happen day or night, come with a surge of adrenaline, from which you need to recover before you can settle back to sleep.

What you're thinking of in the middle of the night is spam. Delete it!A few of the people I’ve talked to for The Fullness of Midlife, our podcast, have had some light to shed on our sleeplessness. Joan Vernikos, a retired NASA health science researcher, says sleep is “like a cleaning service in an office. ...The cleaning service starts out by emptying the garbage cans, by tidying up, picking up—and that’s what happens with the brain during sleep in the various cycles. If you wake up and you don’t sleep well, not only are you going to make mistakes the next day, but you’re not going to detox your brain.”

Menopause can sometimes bring its own befuddlement, right? Memory lapses. Foggy thinking. Well, add in some sleep deprivation and a brain in desperate need of a “detox,” and you can imagine a day that you’d rather forget.

Another podcast guest, Dr. Pamela Peeke, gave us a pep talk about making “sleep hygiene” a priority. She points out the relationship between sleep and diet: We’re much better able to be in control of our appetite—not because we lack self-discipline but because of busy hormones at work in our bodies—when we’re well-rested.

Make “sleep hygiene” a priority? Well, it sounds good. And there’s plenty of reason to do it, from easier healthy eating to clear-headed days. Here’s what it takes:

  • Make your bedroom comfortable for sleep. Is it dark enough? Cool enough? You might want to layer your bedding like you layer your outerwear for a hike on an early spring day—so both you and your partner can be comfortable throughout the night. Consider white noise if sounds are keeping you awake. If now is not the time to invest in your good sleep, when is?
  • Exercise. To patients in my office, I recommend 45 minutes five days a week of real exercise—walking, swimming, biking. Something that gets the heart-rate up. If some part of that can be outdoors, even better, because natural light helps us with our sleep-wake cycles. Get it in early, so you can avoid exercise in the three hours just before bedtime.
  • Stay awake during the day. I know it’s tempting to nap when you’re not sleeping well at night. But napping for more than 20 to 30 minutes can make it more difficult to sleep deeply overnight, which is when that brain detoxing Joan talked about happens.
  • Ease away from stimulants and heavy foods. The effect of caffeine can change as our bodies change. And the relaxing effect of alcohol wakes us up later when we’re metabolizing it. Digesting heavy foods can do the same.
  • De-stress generally, but especially as part of a pre-bed routine. Excess stress is a health challenge for us at any age. While it’s unlikely you can eliminate stress from your life, you can at least develop some routines for putting it in its place before you turn in for the night. Set a routine—yoga for relaxation, reading a novel, writing in a gratitude journal, taking a hot bath—that signals that it’s time to settle down. Avoid screens in the hour before bed, especially contentious text or Facebook exchanges or upsetting documentaries. And remember what Joan said when you’re churning at night: “What you’re thinking of in the middle of the night is spam. Delete it! You can’t do anything about it.”

A perhaps unexpected side effect? Since stress and fatigue are two of the three most common obstacles to sex (the third is lack of privacy), you just might find yourself with a little more romance in your life.

Makes “sleep hygiene” sound a little sexy.

Don’t Be Like an Astronaut

Recently I had the privilege of interviewing Dr. Joan Vernikos for my podcast series “Fullness of Midlife,” which are conversations with interesting people about health, love, life, and meaning. Dr. Joan was director of Life Sciences at NASA until 2000 when she “retired” to write and speak (some retirement!) about some of the groundbreaking research she had conducted from her special perch at NASA.

You can listen to the entire interview here, but I wanted to also distill the pertinent bits for MiddlesexMD readers.

As you might imagine, the effect of gravity, or lack thereof, is a fundamental concern for scientists at NASA. Astronauts are exposed to low-gravity environments, sometimes for months at a time, which has wide-ranging and deleterious effects on bones and organs, blood and cardiovascular systems. During her time at NASA, Dr. Joan specialized in the effects of gravity on the human system.

But here’s the thing: Dr. Joan came to understand that gravity operates on earthbound humans in similar ways! When we are upright and moving around, we are subject to the full effects of gravity pulling us to the center of the earth vertically. But when we are horizontal, lying in bed, for example, gravity’s pull is spread evenly throughout our bodies and is much less intense—similar to the experience of astronauts. “…The changes that accompanied lying in bed… 24 hours a day… are very similar to those we see in astronauts. Granted, maybe a little less intense,” said Dr. Joan.

Interestingly, these metabolic changes don’t happen when we sleep at night. Normal sleep appears to have a restorative, “detoxing” effect on the body and the brain, which is also important to good health.

The body is designed to move all day long...Since the few astronauts who actually spent time living in micro-gravity were harder to find than subjects willing to lie in bed, Dr. Joan began studying the effects of long stretches of time spent horizontally. She found, for example, that after about four days “very significant changes” began to happen in the way her subjects metabolized fluids, in the cardiovascular system, and in stress responses. Of course, as with astronauts, these changes mostly were reversed when the test subjects got up and walked around or the astronauts came back to earth, and gravity took over.

Then, Dr. Joan visited a friend’s elderly mother who was bedridden, and she realized the low-gravity changes she’d been studying looked a lot like aging. Was there a link between our increasingly sedentary culture and the symptoms of early aging? Dr. Joan feels that the chronic diseases of the elderly—diabetes, cardiovascular problems, obesity, bone loss and muscle wasting—are happening at younger ages, even in childhood, because we no longer allow gravity to do its work. We sit too much and move too little.

Dr. Joan hypothesized that the body is meant to move all day long, and in the not-so-distant past, that happened pretty naturally. Our grandparents “…bent over and reached up and made beds and cleaned and washed and gardened. And went and bought groceries and walked home or rode a bicycle, or whatever.”

Following several studies, Dr. Joan feels that simply standing up is “fundamental” to countering the effects of inactivity. Simply standing up and then moving around reverses the micro-gravity effects of lying in bed—or of aging. Trouble is, we don’t live like our grandparents. More likely, we sit for hours in front of one screen or another in the office and at home. Then, if we’re disciplined, we might exercise a few times a week.

Exercising, while good in itself, isn’t enough to counteract the effect of sitting around for hours every day. Our bodies are designed to move, to work against gravity. That, not sitting, is our normal state, the result of eons of evolution.

After her 2011 book, “Sitting Kills, Moving Heals,” was published, a slew of new research supported the hypothesis she’d developed from her work at NASA: Long periods of inactivity have deleterious health effects. “…sitting makes worse absolutely everything. Whether you’re talking about cancer—prostate, breast cancer, cardiovascular conditions, stroke, metabolic conditions, diabetes, obesity—you name it, it makes it worse,” said Dr. Joan. (Here, for example, is NPR’s report on recent studies of aging subjects. The conclusion? If you don’t walk now, you might not be able to later.)

So, what should we do, especially if we’re still working and chained to a desk all day—but even if we’re retired and reading or knitting? Fortunately, the solution is simple. “Stand up!” says Dr. Joan. Go to the watercooler, the bathroom, just take a break every 30 minutes or so. You don’t need to hop on a treadmill or take a 30-minute walk, just stand up and move for a few minutes. You won’t lose weight or tone your muscles with this regimen; it isn’t meant to take the place of exercise and a healthy diet, but it’s a good habit to develop if you regularly sit for hours every day.

Gravity is your friend, says Dr. Joan. Embrace it!

 

 

Menopausal Weight Gain: Fighting Back with Exercise

In previous posts, we discussed why menopausal weight gain is such a game-changer, and we explored how to limit the damage through dietary changes. Now, we’ll talk about the second critical key for maintaining—or regaining—a healthy weight after menopause.

You know what I’m gonna say.

Exercise. Not only does a regular exercise regimen help you burn more calories, which is what weight loss is all about, but it can also give you a higher quality of life and actually stave off illness.

Longitudinal studies have found that people who are more fit at midlife have lower levels of chronic illnesses, such as heart failure, diabetes, Alzheimer’s disease, colon and lung cancers, as they age. Although other factors, such as heredity, play a role, in general, higher fitness levels were strongly linked with lower rates of major chronic illnesses. “Compression of morbidity” is when debilitating illness doesn’t happen until close to the end of life—and people with healthy, active lifestyles tend to have compression of morbidity.  

How’s that for paybacks?

I can tell you from personal experience that a regular, moderately challenging exercise regimen relieves stress, helps you sleep better, reduces the “aches and pains” associated with aging, and helps you to keep up with normal activities of daily life. It regulates your bowels and your moods. And simply feeling stronger and more capable physically helps you to feel more capable and in control of your life generally.

However, I will also say that maintaining a serious (and by serious, I mean regular and moderately challenging) exercise regimen is not easy. It takes time and self-discipline. It makes you sweat. It makes you breathless and it might make you sore.

Not only that, you have to approach exercise differently in your golden years than you did before. You won’t be able to just take off running without a serious warm up; you’ll have to watch your form more carefully; you’ll want to opt for low-impact exercise. Your postmenopausal exercise regimen should contain four elements:

  • Cardio. This is the aerobic stuff that gets your heart rate up, like walking fast enough that you can talk, but not sing (about 3.5 mph, which I find I can do with practice and conditioning), biking, swimming, dancing. Unless you know your joints can take it, stick with low-impact aerobics. The Centers for Disease Control and Prevention (CDC) recommends two-and-a-half hours of moderately strenuous aerobic exercise per week.

Lately, high intensity interval training (HIIT) is recommended to increase the effectiveness of an aerobic workout. In this regimen you alternate bursts of higher activity, such as jogging, with a less active period, such as walking. This gives you an “afterburner” effect in which your muscles continue to burn oxygen after the period of high activity. This AARP article has a good explanation of the benefits of HIIT.

  • Strength (resistance) training. This helps you maintain muscle strength. (Remember that you lose at least 20 percent of muscle mass as you age.) You can use weights or resistance bands, body weight or exercise machines. The CDC recommends weight training 2 days per week.
  • Flexibility. Stretching and toning exercises maintain your range-of-motion and keep your tendons healthy and your joints juicy. Don’t bounce or jerk while stretching. Hold positions for at least 30 seconds and don’t stretch to the point of pain. It’s a good practice to stretch after your regular workout. Here’s a simple stretching routine from the Mayo Clinic. Yoga is fabulous for maintaining flexibility and relieving stress. (Listen to our podcast on this topic here.) It also counts as strength training, so consider joining a class once or twice a week.
  • Balance. Balance is another capacity that diminishes with age, but it’s important to maintain because injury from falls is common and serious. Tai chi is a great discipline to improve balance, but so are simple exercises, such as standing on one foot, unassisted, for 10 seconds or standing first on tiptoe and then heels—simple exercises you can do every day.

Arguably, the hardest part about exercise is getting started. If you have any health conditions that might limit your activity, such as high blood pressure or arthritis, you need to talk with your doctor about what exercises you should and shouldn’t do.

Ideally, you should find a gym with classes or a trainer to get you started—to make sure you’re using correct form, and to show you how to use the machines. Yoga or Tai chi classes with experienced teachers are fantastic and motivational for establishing an exercise regimen.

Get on your mat every day.If this isn’t practical or possible for you, you might turn to the internet for videos and programs. You want substance, knowledgeable leaders, and safety, not razzle-dazzle. Try Fitness Blender (free workout videos and programs for all levels of fitness), Daily Burn, ($15/month; variety of workouts, including yoga, tailored to age and fitness level) or Yoga Today ($15/month with a discount for yearly membership; many workouts tailored to fitness level).

The next hardest part of an exercise regimen is continuing. You will miss days; you will have days in which you don’t work as hard as you should. After a few missed sessions, starting again is hard. That’s just how it goes. You start over; you don’t quit.

Part of the battle is finding a program that works for you—one that is varied, challenging (you are progressively lifting heavier, going longer and faster), but that isn’t killing you. Soreness is good; pain is bad. Move carefully without overextending or snapping joints. Always warm up and cool down.

This is your new normal: a clean diet, a daily exercise regimen that alternates weight training and aerobic exercise and incorporates stretching and balance segments.

I promise you that every ounce of effort invested in a healthy diet and regular exercise will return to you many-fold in a much higher quality of life now and in lower risk of chronic illness down the road. Let me know how it goes and send me any questions you may have. This stuff is too important to overlook.  

Lifestyle Choices to Beat Breast Cancer

In the last post, we talked about the major risk factors for breast cancer. Unfortunately, a whole lot of them, such as a family history of cancer, you can’t do anything about. But there are some really important things you can do to affect your chances of getting breast cancer—and other cancers as well.

Every five years, the American Cancer Society (ACS) brings together a panel of experts who review hundreds of the latest scientific studies and create detailed guidelines for healthy, cancer-resistant living that are based on sound science.

According to the latest guidelines from the ACS: “For the great majority of Americans who do not use tobacco, the most important modifiable determinants of cancer risk are weight control, dietary choices, and levels of physical activity.” Then the guidelines offer up the latest findings on what lifestyle habits, specifically, make a difference—and what don’t. (Tip: No evidence that garlic reduces cancer.)


Healthy diet and regular exercise are your best bets for reducing risk.The drumbeat from the ACS and most other sources is very consistent and very clear: diet and exercise are your best bets for reducing cancer risk. Even better, a healthy diet, regular exercise, and maintaining a good weight critically impacts your overall quality of life. You will be more flexible, have more energy, and a better sex life. You will preserve your joints; you are less likely to have heart problems, diabetes, and dementia. And…you’ll just feel better.

Such a deal!

So, let’s drill down into some of the details. Breast tissue is particularly susceptible to environmental insult because breast cells take longer to mature than those in other organs and because immature cells react more to environmental hormones. “The breast is a sponge for everything in the environment,” says Dr. Jose Russo, breast pathologist at Fox Chase Cancer Center. In fact, breast cells don’t completely mature until a woman has a full-term pregnancy. Then, breastfeeding completes that maturation cycle.

Additionally, the way we live and the environmental stresses that surround us are different from even a generation ago. We are more sedentary at our jobs and at home; more of us are carrying a lot more weight than is good for us; we are exposed to thousands of new and often untested chemicals in water, air, earth, and food; animals grown for food are routinely given antibiotics and hormones that we then ingest.

This could seem like a depressing list of uncontrollables, but we can do a lot to limit our exposure to carcinogens and to create a healthy, cancer-resistant life for ourselves.

The main focus of the ACS (and other) guidelines is to encourage us to maintain a healthy weight (“Be as lean as possible without being underweight”). According to the ACS, being overweight or obese accounts for 14 to 20 percent of all cancer deaths, and specifically breast cancer because fat cells release an estrogen-like hormone in postmenopausal women. The guidelines state: “Overweight and obesity are clearly associated with an increased risk of developing many cancers, including cancers of the breast in postmenopausal women.”

Determining your body mass index (BMI) is the most accurate way to determine where you fall on the skinny-to-fat continuum. Here’s an informative calculator that gives you a “smart” BMI range based on gender, age, height, and weight.

In order to lose weight, you have to both reduce the calories you take in as food and to burn more calories than you ingest—i.e. by being physically active. In fact, evidence suggests that physical activity all by itself is a protective factor against breast cancer. The ACS recommends 150 minutes (2.5 hours) of moderate activity per week, such as walking or yoga, or 75 minutes of vigorous activity per week, such as jogging, swimming, or cross-country skiing. “This level of physical activity has been shown to have clear health benefits, including reduced rates of premature death and reduced incidence of or mortality from various cancers,” according to the ACS guidelines.

Now, I completely understand how difficult changing lifelong habits can be. I also understand that exercise can be hard and even unpleasant. If you sit in front of the computer at work and flop in front of the TV at home because you’re mentally exhausted, it’s going to be very hard to begin a half-hour daily workout regimen.

Here’s the deal: a little is better than none, especially at first. So if you can only do fifteen minutes, or ten, or five, just start there. If you miss a day or two (or three), don’t make that an excuse for giving up. The trick is to persist. Yes, it’s hard to get started again, but the point is to just do it, not to do it perfectly.

Psychologically, you’ll tend to stick with a change if you make a commitment to a specific regimen (say, walking for a half-hour five days a week) and then tell someone about it. Choose an activity you like and do it with others. Join Curves or the local gym or just walk for a certain distance or period of time. Honestly, it’s a better way to chill after a stressful day at work than sitting in front of a screen.

I will tell you from personal experience that when regular physical activity becomes a habit, however haltingly, you will notice the change—in your mood, in your flexibility, in your strength, and, often, in how those nagging little aches and pains begin to fade. I’m a true believer because I’ve experienced the benefit. (And I will confess that it’s still hard to make myself get off the couch—but I always feel great after.)

Physical activity is one critical part of a healthy, cancer-resistant lifestyle. Diet is another, and both work together to keep weight at an appropriate level. There is no magic bullet for absolute protection from diseases like breast cancer, but the ACS guidelines offer “…a decreased likelihood that the disease will occur…” Plus, an increased likelihood of a higher quality of life.

Which is about the best promise anyone can get in life, don’t you think?

 

 

Raging Hormones? Ways to Deal

In the last couple of posts we talked about the significant subset of women who suffer from debilitating emotional swings during the menopausal transition—and also about their loved ones who suffer right along with them.

It’s a Catch-22. You truly can’t control the hormonal storm that lashes you with sudden waves of uncontrollable rage, sadness, irritation, anxiety, and depression. Yet, you really can’t unleash these emotions on the people closest to you. People whom you love and have no wish to harm.

If you are caught in that cycle, there is work to be done, stat, to stabilize your emotions and allow you to get through this transition without further disruption to your life or hurt to your closest relationships.

I’m going to lay out your options, but you also need to have a conversation with your doctor, who will assess your risk factors and monitor your response to treatment.

Before you consider medications, you must lay a foundation of good health habits, if you haven’t already. I’ve mentioned this, oh, maybe a thousand times before, but that’s because it’s so important. Good health hygiene is even more critical now because some of those bad habits could be messing with your mood.

Exercise regularly. Just 30 minutes of moderate daily exercise improves circulation, relieves stress, improves sleep, makes your heart stronger, and more to the point, improves mood by releasing endorphins, which gives you a little euphoric lift.

Bad habits could be messing with your mood.You also have to eat moderately and healthfully. That means cutting down on sugar and caffeine, which causes mood and energy to peak and crash. In Great Britain, fish and veggie-eating folks had fewer depressive episodes than their junk-food-eating colleagues. In Spain, those who filled up on nasty trans-fats from pastries and fast food were 48 percent more likely to be depressed than those who ate good fat, such as olive oil. (And these folks weren’t even menopausal!) Magnesium is also linked to mood and sleep, so a magnesium supplement might be in order.

At the risk of being an absolute killjoy, you also have to stop smoking and cut back on alcohol, both of which affect mood. Alcohol, of course, is a depressant. I’m not talking about a glass of wine with dinner, but about regular and/or heavy drinking.

A further brick in that health foundation is to develop a strategy for relieving stress—meditation, yoga, mindfulness practice, or another religious practice that is meaningful to you. These are known to relieve stress, stabilize mood, relieve pain, including psychic pain, and generally make life more hopeful.

I am not for a minute saying that an honest self-improvement plan will be easy or immediate—in fact, it’s a lifelong endeavor. I’m also not saying that good health alone will adequately address your menopausal mood swings. But I can assure you that getting in shape, eating well, and implementing a spiritual practice will absolutely help, both now and later.  


Now let’s address the medical options. Your healthcare provider will need to work with you to find the best treatment. So it’s time for a heart-to-heart with your doctor. Ask her about:

  • This is a journey, with turbulence and change.Hormone Therapy (HT). We've learned a lot about HT over the last decade. For many women, it's hormone fluctuations that lead to disruptive symptoms. Using hormones systemically to counter that can be a good choice for some women. Reviewing your health status and risks can help determine whether you're a good candidate for HT. It’s even possible that going on a birth control pill for the hormonal effect might bring relief.
  • Mood medications. This approach, using anti-anxiety, sleep aid, or antidepressant medications, works on your brain rather than your hormones, and many women find them effective during this menopausal transition. Antidepressants work because the brain has many estrogen receptors, and when you lack estrogen, the feel-good neurochemical, serotonin, tends to break down. So, the class of antidepressant that may give you relief is called a selective serotonin reuptake inhibitor (SSRI), such as Prozac, Zoloft, or Celexa. Antidepressants can dampen libido, which is the last thing you need right now, so work closely with your healthcare provider to find the right medication and the right dosage. And addressing lack of sleep or an excess of anxiety can break the cycle just enough for some breathing room for taking control in other ways.

Medication isn’t a substitute for those common-sense efforts to improve your overall quality of life, but they can help you get through this bad patch.

This is a long journey, ladies, accompanied by a lot of turbulence and change. Life will be different—and very likely better—on the other side.

Traveling mercies.

 

 

A Little Olive Oil with Your Workout?

So my medical journals are telling me, AGAIN, that I need I need to eat better and keep moving. Gee, folks, thanks for the news!

But I rarely receive such specific advice as I have these past few weeks. They have handed me very, very clear directions: 

  • Eat a Mediterranean Diet including extra-virgin olive oil.
  • Exercise 300 minutes a week.

Wait… Really?

Specifically….  for menopausal women… my medical journals are suggesting we do this to avoid breast cancer.

Well! That’s pretty specific! And pretty awesome when scientists are paying special attention to my favorite people!

So let’s look at these studies suggesting ways we just might, through diet and exercise, provide our bodies an optimal environment for fighting off breast cancer. 

The PREDIMED study, published in JAMA, September, 2015, was conducted in Spain from 2003 to 2009, wherein more than 4,000 women at high cardiovascular risk, aged 60 to 80, were randomly placed on three diets: the Mediterranean diet, supplemented with extra-virgin olive oil (first cold-pressed), The Mediterranean Diet supplemented with mixed nuts, or a Low-Fat diet.

The results of this study have been coming out for some time, and have been fascinating. This latest release shows that those on the olive-oil-supplemented diet had a 68-percent lower risk of developing breast cancer than the other participants in the study. It’s one study, of course, and needs to be repeated, but it’s rather fascinating. Earlier outcomes of the PREDIMED study suggested the same diet resulted in a delay in cognitive decline for the same population. There will be more news from this cohort. We will stay tuned. 

By the way, when shopping for olive oil, it is best to stick with first-cold-pressed, extra-virgin olive oil for your good health. It costs a little more, but that’s the healthy choice that this study is based upon. Cheaper oils have been heat-treated or chemically treated, and are no longer a healthy choice for your body. 

The exercise link is a the Breast Cancer and Exercise Trial in Alberta, Canada, published in JAMA Oncology in 2015. The study followed 400 women. Half of them worked out for a half an hour a day, 5 days a week. The other half worked out for an hour a day, 5 days a week. They worked out at 65 to 75 percent heart rate for at least half of their workouts. All without changing their usual diets. The women were overweight, disease-free non-smokers, and they were followed for three years. Subcutaneous and abdominal fat and waist-to-hip ratio decreased significantly more in the high-exercise-volume group.

Since body fat increases postmenopausal breast cancer risk, this suggests this higher dose is a better dose of exercise for us to keep the weight off, the body fat down. Lower body fat is a better environment for lower breast cancer risk. 

So I’m going to take a brisk walk to the grocery store, buy two big bottles of my favorite extra-virgin oil, and do biceps curls with them on the way home. Or maybe I'll just stay a little longer on my treadmill and have a nice salad with dinner. 

Lifestyle Choices for Breast Health

You know that silly song about the thigh bone being connected to the hip bone—and so on?

Well, the kernel of truth in the ditty is that, when it comes to health and our bodies, things are indeed beautifully and intricately connected.

You can’t do healthy things for your thigh bone—or your heart or your sex life—and not have it affect other corporal systems as well. So, while we might focus on breast health in honor of Breast Cancer Awareness Month, rest assured that healthy, cancer-free breasts involve habits and choices that are good for the rest of your body as well.

There’s a lot to celebrate when it comes to breast cancer, like steadily decreasing rates since the year 2000. But we still have a long way to go. About 12 percent—1 in 8 women in the US—will develop invasive breast cancer sometime in her life. Our most significant risk factors are 1. being a woman and 2. being older.

Women over 55 account for two-thirds of invasive breast cancers diagnosed each year. This is because, over time, we tend to accrue genetic mutations, and with age we’re less adept at repairing them.

Those are the facts. But we don’t have to helplessly wait for the shoe to drop. We can make lifestyle adjustments that will lower our risk of getting this cancer and improve our overall quality of life, including our sex life. (And don’t forget that a healthy sex life is also good for our health.)

Because it’s all connected, right?

So here are lifestyle changes that you can make specifically targeted toward breast health:

Maintain a healthy weight. Being overweight or obese—those with a body mass index (BMI) over 25—increases one’s risk of developing breast cancer, especially in postmenopausal women. This could be because estrogen is stored in fatty tissue, and women who have more fat are also exposed to higher levels of estrogen, which has been undeniably linked to breast cancer. But other issues related to obesity may also be involved, such as insulin and glucose levels. Some estimates suggest that 17 percent of breast cancers in North America could be avoided simply by maintaining a healthy body weight. Check out this page for a solid, common-sense approach to weight loss.

Eat healthy food. Not only will a healthy diet help maintain a healthy weight, but it’s a critical component to avoiding cancer. Some foods contain properties that help repair the wear and tear to our bodies in the normal course of life. These “super foods” contain antioxidants that help protect our bodies from cancers.

The link between food and cancer isn’t always straightforward or well-understood, and dietary fads change with the season. Basically, though, the approach to healthy eating remains the same: eat a variety of foods with an emphasis on fruits, vegetables, and whole grains. Avoid processed foods. Avoid fats and sugars. Above all, avoid super-sugary beverages, which are directly linked not only with obesity but also with some forms of cancer.

Finally, eat fresh and eat at home. (You can’t control what goes into your food at a restaurant.) Eat organic foods to avoid exposure to synthetic chemicals.

While the voices touting various diets and food fads are myriad, confusing and contradictory, here are some basic food facts from breastcancer.org. The USDA also has a website with tons of food and diet information here.

Exercise. Weight, diet, and exercise. This is the trifecta of good health. Some well-regarded sources say that 30-40 percent of cancers could be avoided simply with these healthy lifestyle choices. That’s staggering. And when you add in quality of life factors that come with the trifecta, well, it’s overwhelmingly worth the difficulty of losing weight, eating well, and exercising regularly, wouldn’t you say?

Regular, moderate exercise can lower your risk of breast cancer. Not to mention all the other good things you get with exercise, such as better mood, cardiovascular and joint health, greater stamina and flexibility, better sleep, better bones, and more regular bowel movements. What are we waiting for?

Even women who have already been diagnosed with breast cancer may improve survival rates or prevent recurrence with moderate exercise, like walking only 4-5 hours per week, according to the American Cancer Institute.

Don’t have time? As the trainers in my exercise video say, “Make time.” It doesn’t matter what your physical ability is right now—just start slow and keep on going.

Don’t drink. Sorry to be a killjoy, but the more you drink, the greater your risk. A woman who has three alcoholic drinks per week is 15 percent more likely to get breast cancer than a woman who doesn’t drink at all. If you’re on hormone replacement therapy or if you’ve already been diagnosed with breast cancer, you should be one of those non-drinking women.

What about that healthy glass of red wine? Sorry, it all counts. The benefit of red wine doesn’t outweigh the risk. If you’ve never had breast cancer, just don’t drink every day, but if you have risk factors, switch to non-alcoholic options.

Don’t smoke. This almost goes without saying. Yes, the major risk is lung cancer, but actively smoking as well as exposure to second-hand smoke increases the risk of breast cancer in premenopausal smokers. Plus, women who smoke have greater difficulty recovering from breast cancer treatment.

Avoid chemical exposure. This is like trying to dodge raindrops, given the chemical soup we live in every day. And most of the chemicals in our environment and in the things we use have never been tested for toxicity or carcinogenic properties. Some types of chemicals are known to be hormone-disrupting, which alter the way our natural hormones function. Research is ongoing about the way these substances work and their link to possible cancers, but the connection isn’t well understood.

In the meantime, how do we negotiate the reality of the world we inhabit without neurotic overreaction but also without putting our heads in the sand? Of greatest concern with regard to breast cancer are those chemical with hormone-disrupting properties, including those in pesticides, growth hormone residues in meat and dairy products, and certain plastics.

In general, some precautionary practices would be to

  • Buy organic food. Here’s a list of the “dirty dozen”—the foods that have the highest levels of pesticide residue.
  • Plant a garden. Put up your own food.
  • Use fewer and simpler cleaning and personal care products. Look for certified “green” cleaning products (with GREENGUARD or EcoLogo insignias, for example) or make your own.
  • Don’t use pesticides on your lawn or garden.
  • Use BPA-free plastics or glass or stainless steel jars and bottles. Avoid #3 (PVC), #6 (polystyrene) and #7 (polycarbonate) plastics, which are linked to breast cancer.
You may not be able to tackle everything on this admittedly intimidating list, but it’s better to make a few changes than not to do anything at all. And the foundation you lay now will become even more important in maintaining health and functionality as you age.

Q: What's with weight gain and menopause?

This is a common question; unfortunately, it’s complicated to answer. First let me say that while I know weight gain affects many women’s sense of being desirable, what I read and my own informal research suggests it’s rarely an issue for their partners (some of whom are, in fact, oblivious—in a good way—and just as attracted as ever).

There does seem to be a physiologic drive to deposit fat during the menopause transition. The theory is that fat produces estrogen (estrone—a relatively weak estrogen), so in the presence of impending organ failure (menopause) and loss of estrogen from the ovaries (estradiol-the major, more important estrogen) that will occur, the body does its defensive thing: It deposits fat, really efficiently and effectively.

Unfortunately, estrone doesn’t provide many favorable effects. The major location for depositing fat is the midsection. Women who have yo-yoed in weight over the years seem to struggle more; those fat cells seem to remember readily how to deposit fat. Even women who have no weight gain during this transition will have a waist circumference increase of up to two inches.

Minimizing the weight gain starts with maintaining a healthy weight over time; those who are most successful in this transition benefit from years of stability at a healthy body weight leading into those years.

Those menopause transition years will be an added challenge, so start to make small healthy changes early on. Women lose muscle mass quite readily at this time of life, so work to maintain or gain muscle with strength training activities.

It’s a fact of life that at this point, it takes more effort to get the same results, requires more dietary caution and exercise, and leaves little room for not paying attention. My motto: You’re now high maintenance; behave like it!

Priming the Pump for Better Orgasms

I never knew what it meant to prime a pump until I watched a plumber work on one at my cottage. To prime a pump means to pour a little water into its fill cap to create suction and, with luck, to pressurize the thing so it draws water rather than spurting air.

The hydraulics metaphor may be more appropriate for men, but I’m betting that some of your orgasmic pressure has leaked out over the years, too. Or, maybe it wasn’t very dependable to begin with. According to some studies, from 25 to 50 percent of women have trouble achieving orgasm.

There are, however, ways to repressurize your orgasmic system—techniques that may help get the sexual juices flowing again. It’s not magic—there is still no pink Viagra that guarantees an orgasm, given that the female sexual response cycle is a lot more complicated than a water pump.

If your orgasmic mechanism needs a little priming, here some holistic ways to repressurize.

  1. Exercise. (I heard that groan.) Good orgasms require good circulation to keep all that oxygenated blood flowing to your genitals. Aging does a number on the blood flow and nerve endings in the genital area, making them sluggish and less responsive.  Exercise helps maintain good circulation. It also keeps blood circulating nicely to the brain, which, as we’ve said, is really your biggest sex organ.
  2. Kegels. C’mon. These are easy and painless (there are tools available), and they do you a lot of good. Kegels tone and strengthen your pelvic floor muscles; those muscles keep you from leaking urine when you sneeze as well as holding your internal organs in place. Strong pelvic floor muscles also create a firm “vaginal embrace,” which is nice for your man, but also gives you a more powerful orgasm.
  3. Check your medications. Several categories of drugs are libido killers, including some antidepressants, but also some drugs that reduce cholesterol and high blood pressure. If you suspect that your meds may be messing with your sex drive, talk to your doctor.
  4. Masturbate. You need good circulation down there, right? Self-pleasuring helps. It also helps you identify what you like and how to “do it” the way you like it—so you can tell your partner.
  5. Get a vibrator and other sex toys. There are all sorts of physical reasons to use a vibrator. (See #4 above.) Toys may help you release some inhibitions and learn to play.
  6. Drink a little (not a lot.) Sharing a little pre-sex cocktail can create a cozy sense of intimacy and also help lower your inhibitions. Drinking too much is a libido-killer. Share a glass of wine in front of the fireplace and move the action to the bedroom—or keep it by the fireplace.
  7. Fantasize. Think of it as your personal romance novel. You can sleep with anyone you want and do anything you want. You’re only limited by your imagination. Fantasy helps some women “get into their heads.” Try it.
  8. Positions. If you’ve been using your vibrator, you know where your sweet spots are, and the missionary position often misses them. Try the back entry “doggie-style” position which is good for hitting the G-spot, although not so good for the clitoris, or try sitting on his lap, which is good for all kinds of things.
  9. Foreplay. If you take seriously Esther Perel’s statement that, for erotic couples, “foreplay pretty much starts at the end of the previous orgasm,” you may extrapolate that good sex arises from consciously introducing sensuality into your relationship in a sustained way. Touch. Snuggle. Sextext. Write love notes. Introduce beauty and sensuality into your life that might leach into lovemaking as well.
  10. Have sex. This cannot be repeated too often. The more you have it, the more you want it, and the better at it you become. As one happily married husband said: “Practice, practice, practice.”

Riding a Bike? Take Some Care

You know that we always encourage you to exercise. Keeping fit is excellent for your overall health, and it keeps you sexually tuned up as well. You have more energy; you have a better self-image; you probably have less pain in your joints and elsewhere; and you probably have better range of motion.

So, far be it from us to discourage any form of exercise. But, we have a teensy qualification for those of you who like to ride bicycles.

Take care of your bottom.

Turns out that the numbness and tingling you feel after a nice, long ride is an indication that the nerves and tissue on the pelvic floor may be affected, which means less sensation in the genital area. And lord knows we don’t want to compromise anything down there.

A few years ago, researchers found that policemen who rode bikes on the job had less sensation and some erectile dysfunction. Following the study, women cyclists began to suggest that this wasn’t just a guy thing.

Sure enough. A new study of female bike riders by researchers at Yale University confirms that women who ride at least 10 miles a week also lose sensation on their pelvic floor. This effect was particularly striking for women whose handlebars were lower than their seats and was even greater when riders lean forward onto the dropbars for a more aerodynamic effect. These positions put the most pressure on the perineum. “That part of the body was never meant to bear pressure,” Dr. Steven Schrader, lead researcher for the study on male riders. “Within a few minutes the blood oxygen levels go down by 80 percent.”

Granted, these gals were competitive bikers, so a maximal aerodynamic position isn’t likely to be your overriding concern, but if you tend to lean forward as you ride, or if you feel numbness, pain, or tingling in your pelvic floor, you should raise your handlebars to a more upright, granny-style position. This helps to distribute pressure to the anatomical part that’s meant to take it—your sit-bones.

And if you really, really like to ride, you could consider a no-nose bike saddle. A list of manufacturers and a cyclist’s discussion of the pros and cons are here.

The take-away? By all means continue with your regimen, and more power to you. With a few minor adjustments, you should be on the road and more comfortable than ever.