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The Fullness of Midlife

“Wow! So there’s hope!”

by Dr. Barb DePree MD

Dr. Pamela Peeke with Dr. Barb

Dr. Pamela PeekeDr. Pamela Peeke is a physician, scientist, and thought leader in integrative and preventive medicine. She is a Pew Foundation Scholar in Nutrition and Metabolism and Assistant Professor of Medicine at the University of Maryland, as well as a Fellow of both the American College of Physicians and the American College of Sports Medicine. She is a regular blogger for Huffington Post, US News and World Report, and Prevention, among others. Dr. Peeke is co-host of the popular HER radio show broadcast on iHeart, iTunes, and RadioMD, and which features news, guest experts, celebrities and lively commentary about women’s health and wellness. As a author, her work includes Fight Fat after Forty, Body for Life for Women, and The Hunger Fix: The 3 Stage Detox and Recovery Plan for Overeating and Food Addiction. She is the founder of the Peeke Performance Center for Healthy Living, and developed a holistic lifestyle coaching program that incorporates her trademark Mind, Mouth, and Muscle behavioral blueprint. Pamela is a Trustee of the National Senior Games Foundation and is a Senior Olympic triathlete. 

Dr. Barb: I’m joined today by Dr. Pam Peeke, a researcher and scientist as well as a physician. She’s also a vocal spokesperson on issues related to women’s physical wellbeing, including eating well and exercising effectively. She’s written a number of books including the Hunger FixBody for Life for Women, and Fight Fat after Forty. Welcome, Pam.

Pam: Hey, you! Good grief!

Dr. Barb: Hey, Good grief!

Pam: You know what we are? We’re a paradox [laughs]; we’re two docs. Come on, laugh. I mean, you know…

Dr. Barb: [laughs]

Pam: When do we ever get a chance to laugh at our crazy physician days? [laughs]

Dr. Barb: You know, and a smile goes a long way, doesn’t it?

Pam: Yeah, you got that one right. But we have to remember that we are physicians. And we need to walk the talk, and that’s one of the reasons why I love working with you, Barb, is because you have a deep sense of what that’s all about. And I think that women especially need to be able to see that they have models, role models, mentors; we’re all so smarty-pants about, you know, women’s health and all the rest of it in lifestyle, so that’s why I love to join you on this great podcast.

Dr. Barb: Yes. And thanks, because I think lifestyle matters a lot. And I think sometimes in our healthcare arenas as providers, practitioners, physicians, we maybe get too wrapped up in the clinical aspect of what we are trying to treat, and we maybe don’t emphasize lifestyle enough. So I’m so excited that this is one of your sweet spots along with many. Your accomplishments and your area of interests are broad, and any of us who have done women’s health for long certainly have come across you in our professional lives, because you have spoken into so many areas of women’s health. But, I’d like to hear a little more about some of your current work, which I think is focused on the connections between lifestyle, habits, and genes?

Pam: Yup, and I don’t mean Calvin Klein—although that could be helpful at times. You know what it is, is I think a lot of women feel kind of helpless, hopeless, and defeated. You know stuff happens in their life, or maybe they did a 23andMe, and found out they had some funky genes in there, and you know there’s some bad thinking: “I’ve just ruined my metabolism, I don’t get enough sleep, I’ve probably done all this permanent horrible damage to myself. Or, I don’t even know where to begin, and it doesn’t really matter anyway.”

Genes may load the gun, but lifestyle and environment pull the trigger.Well, my answer is look, there’s a brand new science, and this is what you are alluding to. It’s called epigenetics. And it’s simply a fancy word for saying that genes may load the gun, but lifestyle and environment pull the trigger. That means that we had a huge discovery—probably within the last ten/twelve years—I wrote about it in The Hunger Fix when I wrote about overeating and food addiction. And I was lucky enough to see that it had already—epigenetics had already arrived enough to start integrating it. 

What does it mean? It means that yeah, maybe you do have the FTO gene; it’s the most common obesity gene found globally and so if you look at it, and you get 23andMe back or Genetic Direction or or one of those guys, and you go, “Oh my God!” Does this mean that you’re going to become obese? No. It means that you have a tendency toward it, if you don’t stay vigilant. So this is where lifestyle comes in.

So what you stay to yourself is, “Wow, so there’s hope!” Heck yeah, there’s hope! What it really means is that you put on red alert. It means that you do have a vulnerability here. It means that your wiggle room for getting away with days with no physical activity—notice I didn’t say the “e” word: exercise; I said physical activity—your wiggle room is less than someone who doesn’t have this gene. So you can’t get away with as much. That’s ok. So just remember to be more physically active. Remember that eating whole foods and keeping, you know, portions and quality as high as possible, and then also at the same time doing other things. Getting the sleep that you need because when you don’t, you’ll eat everything that’s not tacked down, because you’ll make all those appetite and hunger genes go crazy and back and forth. And at the same time, how about that mind of yours? You know you’re a woman, which means we were born with a mental Cuisinart. If we can beat any thought to death, chop it up in a cazillion pieces, and let it swirl around in some obsessive, compulsive way, trust me, we will. If you’ve ever owned a pair of ovaries, honey, this is what we do. 

It’s all about calming it down. You, Barbara, with all of your work with spirituality, and really going deep into how a women thinks about how herself in life—well you of all people know and have role modeled for women—what this is really all about. Calm down your little anxiety and the rest of it. So I like to put it all together in sort of a mind-mouth-muscle, right? Allegory. And the mind part also includes the sleep thing too because you know that mental Cuisinart keeps going even when we hit the sack. And we can’t stop it. And then we just keep running into all kinds of problems.

So what I’m saying, every single thought you have, every single mouthful, every single step you take, every single Z you get from sleep, all of those things are altering how your own genes will express themselves to the rest of the body. So if you can imagine these genes like that, these obesity genes, having a dimmer switch on it, so when you do take that walk with your dog or your friend, or you hit the gym or you take the stairs instead of the escalator, whenever you do any of that then what you are actually doing is down-regulating, bringing down, turning off that obesity gene as much as you possible can. That is absolutely paramount to being successful with all of this.

Every action, every thought—literally, literally—has a profound effect upon how your genes are expressing themselves.

Dr. Barb: So for those of us who haven’t done any genetic testing, don’t know our genes, we could maybe look about at our families and understand what some of the gene prevalences might be towards obesity, or anxiety, etc. But, is it important for individuals to have any actual genetic information to apply the things you’ve talked about, or are the things you’ve mentioned critical no matter what our genetic composition might be?

Pam: You know honestly, you don’t need to go spend $150 on some gene test. It’s kind of interesting. It’s sort of a psychological play, you know. Some people may see that they have the FTO gene, for instance, and it puts them on more red alert. And then what they do is they say, “That is the hand I was dealt in life.” There’s no if, and, or but; you either have the gene or you don’t. It sort of reminds you, it becomes more front and center in your brain to be able to say, “I really need to pay more attention because I do have this strong predilection toward obesity or heart disease or cancer or diabetes.” I could go on, but you get the point.

So many of these genes are malleable; they have these little dimmer switches. On the other hand, hell, just look in the mirror, look at your family, figure out how you want to be able to get back on track, if you’re off track. Because, between you and me, you’re going to have to do the same thing anyway, whether the genes are known or not. It’s just that sometimes knowing the genes just gives you that extra little fire under your belt.

Now it goes the other way too. One of my patients got the 23andMe thing—you know I have nothing to do with the company; this was just one of those things; it’s the most popular one out there—she got a packet from her husband for Christmas, and so she did the little swab and sent it off and she literally just forgot about it. And then all of a sudden, boom, it popped up in her email, and she said, “Oh look. There are the results.”  And she’s buzzing through, and true to form, she did have the obesity gene.

She’s really been working hard to take good care of herself, and she’s in really great shape, and so it didn’t matter that she had the obesity gene, she was already there. Something else happened that was really kind of fun. It said that she has the muscles of an elite athlete, you know, the genes of those. All of a sudden she was getting a little bit sloppy with some of the gym stuff. We’re showing up in the gym a lot, because she walks in just strutting it and saying, “I am elite.” So it goes both ways, and it is so cute because now she’s saying, “Well, if I have genes like that, I’m going to turn the dimmer switch the other way. I wanna really take advantage of some very cool genes.” So it goes both ways. But honestly between you and me, it’s not necessary. It’s just playing around with this stuff.

Dr. Barb: Talk to me a little bit more about sleep. I see so many women in my practice who are searching for that elusiveness of a good night of sleep. And I understand there is some mind connection, and you alluded to that. But outside of sleep hygiene, which I think we try to make our patients aware of, and most people have some knowledge of that, can you speak into sleep? Besides our busy minds and maybe some habits, are there some genetics that go into sleep or are there some insights we could implement to improve our sleep patterns?

Pam: You know something, that is such a great point. You and I are both seeing so many women in our practices, and sleep is just as you said, an elusive goal out there. How can we possibly, right? As we’re well aware, we already know that sleep is grossly impacted by age and hormonal status. And so when you meet with someone like you or I, we’re very open about the fact that estrogen, progesterone, testosterone—as they’re going through all those waxing and waning, starting in the 40s and well into the 50s as you’re entering menopause—it is going to play around with your sleep because of its close association with the stress hormone, cortisol.

You have these bottles and lotions and potions for your skin. What are you doing for sleep?That being said, there’s something called sleep hygiene. Now look girlfriends. You have all these bottles and lotions and oceans and potions for all of your skin hygiene, and you spend a boatload of time and frustration and money on taking care of your gorgeous skin and all the rest of it. What are you doing for sleep? It’s like a blow-off, you know. It’s like well, you know…. Your mind is still spinning like this. We don’t put in the time to be able to make sleep even happen most optimally. Before you go to sleep at nighttime, it’s not the time to be having three screens open in front of you. But you know, “Busted!” I’ve done it. Come on, we’re all human beings here. But if you are more mindful, and you pay attention, then you’ll know to get those screens out of your face, and do something else… anything. Oh, I don’t know, meditation anyone? Read a real book? Oh, okay, fine. Kindles are fine. But, oh maybe not because there’s that screen again… just kidding with you.

So, have a nice talk with someone you love. Do something. But whatever you do, you’ve got to calm it down. Here’s what happens if you don’t do that. If you don’t do that, there are two very important hormones; one is called ghrelin, and it’s in charge of hunger and is secreted in your stomach—your stomach has kind of a lima bean part of it here—and so right in the middle of the lima bean part of it, and it’s in charge of hunger. When you get super hungry, ghrelin is what is being secreted right and left. It works in concert, like a beautiful dance, a beautiful ballet, with leptin. It is found in the area around each of the fat cells. Leptin’s main job in life is to handle appetite and also to look at the fuel sources in your body. So, like a dashboard, you are looking at the gas fuel and everything. So they talk to one another and they communicate through the brain. When you get a good night’s sleep, do you ever notice how you get up in the morning and you just feel like you are in so much better control of your eating? Okay, bring on that yogurt and blueberries and the walnuts. Yeah, we can do this!

When you don’t get enough sleep do you ever notice that you will eat everything that’s not packed down? And it could be anything. You go into your barista, and every pastry... and it’s like an out-of-body experience—you know you shouldn’t be doing this.

Well, there’s a reason why. When you are sleep deprived, both of those extremely important hormones [leptin and ghrelin] are completely discombobulated. They are dysregulated. They can’t function normally. You just shot yourself in the foot. So that’s why it’s extremely important to stay on top of that, let alone getting up and having the energy to be able to do a little physical activity? Just sayin’. And to be able to take that nice walk with your dogs or whatever else.

So sleep is extraordinarily important. Now here’s the more real quickstep. When you are sleeping, your brain is doing housekeeping—and your whole body, quite frankly—there’s a whole regenerative process. Because cells need to be able to take a little super vacuum Dyson—whatever it is these days—to each one of the cells and clean up the dead and dying cells because they are kind of used up. Right? And You want to get rid of the debris. It’s like putting the garbage out for the morning. So that’s extremely important. Very, very important.

In the brain there’s another system going on as well in parallel. And what it’s actually doing is it is clearing out a tremendous amount of drainage—lymph drainage up there—at the same time it is also clearing out and regenerating cells. That’s neurogenesis going on (neuro means the brain; genesis means creating more). So you have this fabulous housekeeping going on. Sleep deprivation—no housekeeping. It’s grossly impaired.

Dr. Barb: And there just isn’t a substitute for that.

Pam: Nope! And you know something? For all of you little wonderful people people out there listening who think they can sort of catch up on the weekends? Uh uh. All the sleep experts say don’t even try it. It doesn’t work. You have to do it every flipping day. When we were younger, fine, whatever. But we had very different sleep rhythms at that time. And there’s another thing too, if you know how to take a strategic nap during the day, if you’re able to steal away and get about 15 to 20 minutes in, that also helps to refresh and keep you going. And that classically takes place in the time of the day that’s called the trough. Which is, for the classic person who gets up in the morning, does their thing, that’s the peak of their performance. The trough happens kind of in the mid-afternoon, and then there’s a rebound period later in the day when we kind of pick up more of our work. But we do it differently. It’s a different kind of work; more creative work. In the morning it’s more task-oriented.

So, during that trough, it’s a great time to re-energize. Now you can re-energize with a walk. You can re-energize with meditation, right?. But you don’t energize or re-energize by hitting the vending machine. Wrong! Wrong answer. Okay, busted again. We’ve all been there. We keep thinking, well if I had some more sugar, or if I had some whatever, or sucked down one of those monster venti $23.95 coffees, that maybe you could sort of stay up. No, it’s just going to screw up your sleep. And, more importantly, you’ll just be irritable, impatient, and a rotten person to be around. So no, that’s not a great idea. A little bit of coffee is fine. A little bit of tea is perfectly fine. It’s not a problem whatsoever during the day. But please, enough of these things. Doesn’t work.

Dr. Barb: So what would you tell me about expectations around memory and focus and concentration, and maybe understanding genetics and what I might do lifestyle-wise, and how can I be optimized around that part of my health and wellness? A lot of women express frustration about memory and focus and concentration. And I hear a lot of women questioning whether they are ADD in this 40-to-60 age range. I think they are probably not ADD, but certainly we have some knowledge about, back again to, menopause transition and the impact it might have. But what’s our understanding around genetics or expectations for natural aging in this?

Pam: Okay. Such a great question! And I hear it all the time too. A lot of women think, “I’m losing my mind!” So here’s the deal. First thing you ought to realize is that no, I would honestly put money on the grand majority of women have nothing to do with ADD. What they have is a disorganized mind, a mind that is absolutely hammered with stress, and it’s like you just get used to that high crazy level of stress without realizing what it’s doing and its impact on a certain part of the brain—the prefrontal cortex, right behind your forehead here—which, as you know Barb, is known as the CEO of the brain. It’s sort of like the chief operating officer, an executive officer here.

The prefrontal cortex is in charge of organizing, focus—hello focus—focus, strategizing, love making, strategizing, planning, reigning in impulsivity, reigning in impatience and irritability. So, it’s really important that whatever you do, you try to optimize this function. You cannot do that if you are sleep deprived. You cannot do that if you are gripped with anxiety from the moment you wake up in the morning. And did you know anxiety is inherent to the genetics of the majority of women.

Now obviously, there’s a huge wide spectrum, but the mass majority of women can go from zero to anxious just that fast. So when that happens, if you can imagine, it puts this part of the brain, called hidden purposes, into a vise. And you cannot… you don’t allow it to be able to function well. So if you want to ruin focus—let’s just say you are writing really beautifully and you’re doing a project, and you are so focussed. And then I walk up and I say, “Hi, your best friend just got run over by a mack truck.” Now you tell me where your focus just went. Oh, goodbye, see ya. You know? But women live like this without even realizing it. In the back of their mind, there’s like a little mental crockpot that’s constantly churning away. And what’s inside of it? “Oh my God, my kid is never going to get a job.” “My partner in life is a pain in the ass and they just screwed up the checkbook.” You know it just goes on and on and on. So what happens is, “Oh no. Is it a mental Cuisinart again?”

What I ask women to do then is bag this whole ADD thing. That’s not what’s happening. What’s happening, girlfriends, is stress. And you don’t know how to handle it. You’re not managing it. You are doing the two A’s that I love to say: adapt and adjust; go with the flow and learn how facile you can be in handling all of these crazy ass things that keep hitting you. Right?

So this is why I’m a nutcase when it comes to meditation. Now, here’s what I say about meditation. I don’t care how you do it. You can join a TM group—you know, transcendental meditation—you can do mindfulness, you can do Thich Nhat Hanh and the whole Buddhist thing. God bless! Take a little piece of each; I’m a cherry picker. Prayer works. I have one woman who is like super Christian and I’m telling you, she’s just letting it rip, and it’s worked beautifully for her. You can integrate and weave all of this into something. Create something.

Do you have to do this for three hours? What are you crazy or something? So start with three minutes, four minutes, five minutes. Now, why am I saying this? Because Barb, you asked me about genetics. We now have eloquent work that shows that when you do this, there are genes in the body that express for inflammation. As you know, inflammation is the core of most disease in the body. You do not want to have an over-expression of inflammation.

Women get an F-minus-minus in saying no.So these genes, called the loci, this group of genes is almost always looked at in terms of what kind of effect can we have on this group of genes by doing whatever? Guess what meditation does? Down-regulates. There goes that dimmer switch on all of that inflammation. When it does that, that’s an indirect—or even direct—way of saying that what you are doing is decreasing the level of stress in your body and, by doing so, opening up the opportunity to be able to focus. To be able to stay centered. To be present. To pay attention. And then there’s one cute little thing about women. And that is, women get an F-minus-minus-minus in saying “no.”

We have something I like to call helium hand. “Oh, please help me with this…” “Sure.” Like a balloon. “Yeah, I’ll do that.” Raise your hand. “Yeah, I’ll be more than…”

What are you doing? Stop! You have to learn to be able to say this. Practice in front a mirror, because I know this is going to kill you.

“Hey, thank you so much. I’m so honored that you asked me to do X-Y-Z, but you know, I can’t do that, it just doesn’t work for me right now. But thanks for checking in.”

And if someone comes back and, “Oh please…” Just keep doing it. Like a barking dog until they stop barking. And you have to stay firm. Why? Because no one is going to protect you. You have to protect you. You are your best advocate. It’s something you say, Barbara, all the time. You and I are like crazy people about this.

Start developing a way of living that has limits and boundaries to protect yourself.You stand up for yourself. You protect yourself. You have to start developing a way of living that has limits and boundaries to protect yourself. Because there’s only so much of you, and nobody’s going to come and save you. It’s not happening. So that’s one of the reasons why it’s so terribly important to take time out of your day and to be able to, what I love to say, “Check in with yourself.” That’s a very PC way of saying, meditation. Check in. Just ask yourself, “How you doing?” You don’t even have to close your eyes. Take a walking meditation. Get the hell out of your work building right now. Lie. “I have to go see Susan in the next building.” There is no Susan. It’s irrelevant. Just go frickin’ take a walk, you know? I have people doing this all the time. It’s absolutely hysterical. Because you are going to do one thing at the end of the day:  save yourself, open up, optimize your focus and attention on what you have to do, and at the same time save yourself.

Dr. Barb: Well, I appreciate your passion in your message because I’m on the same page with you. But the ability for women to translate that into their own lives, there’s just something that gets in the way for most women. But I think you’re great in saying it doesn’t have to be big. It doesn’t have to be major. It can be minutes. It can be small snippets of time, but just understanding that reflection, introspection, even for the briefest amount of time has some payback.

Pam: Yes, anything! What I’m saying is the smaller the better, the smaller the better. Become superb at small steps and then as each step is practice, practice, practice—like how you learn to play a piano, practice practice practice—and then it becomes a habit, and then it becomes a new foundation for you. And then from that one step, move to the next one. And then go back to anything you’ve ever learned in life. You’ve got to be patient. Really, just use anything from technology, apps, whatever, headspace—all the rest of that for meditation—to just little reminders, to have yourself check in with yourself. I love to use loving humor one way or the other.

I have this one woman who has this screensaver that says, “Hey, how you doing today?” And it has a big meme of her kind of going like this [waves hands]. It’s absolutely a scream. And it’s just a sweet little way of saying, um, you know I got my best friend. It’s me. Because I take care of myself, and I'm checking in. Sweet little things because honestly Barb, you and I and all of our beautiful patients just forget we even exist. We fall off our own radar. And next thing you know, it’s like 10:00 at night and you don’t even know what happened to that day. It’s gone.

Dr. Barb: Yeah. Well, thank you for your insights. And I would like to mention your podcast. You have a podcast HER mind, HER body and HER life. can you tell our listeners more about what you have to offer and where they they can seek more information and messages that you have?

Pam: Absolutely. It’s the HER show, and you’ve been on it, Barb, enough times. If you go to  iTunes and you simply do HER Dr. Pam Peek, you’ll be able to find our shows. We’re up to, good Lord, almost 200 shows now with some of the coolest guests, including Barbara in a big way—the tops in their field, but fun, wonderful, engaging, and entertaining—what I love to call “edutainment.” Really kind of delving into things in a wild and crazy way. Go over to my website as well, and that is, and on Facebook it’s PamPeekeMD again.

When I say Facebook, I educate. So I tie in the podcast into professional Facebook which is a lot of fun, getting to part of the community. And the website also has the postings of each of the shows that we do for HER right on the front page. So you can constantly stay on top of that as well as all the social media around it, including Twitter.

It’s really important to know there’s so many different ways to reach out, and we’d love to be able to have you head on over to the HER podcast. Between Barb’s podcasts and my podcasts, good Lord, you don’t need to hear anything else! That’s it, we’re done!

Dr. Barb: Exactly! You are such a great combination of educator and entertainer that I think it’s just such a sweet spot for so many people to get information. So I appreciate the work that you do.

In closing, I would like to hear where you find richness at this stage of your life.

Pam: You know, as I’m entering another chapter in my life, I’m finding richness in experiences. Experiential is so big. Now, it has always is played a monster role in my life. But, I’m now like you, at a high level of wisdom and experience and stature within our specific specialities in the work that we do. Now I want to take that to even higher and higher levels through multimedia, through teaching.

And then there’s that beautiful experience of nature. I’ve hiked the Grand Canyon twice, rim to rim. I constantly find any opportunity I can to be able to be outdoors and that. Now what’s coming up is I’m on the board of the Senior Olympics. I’m a senior triathlete, and so we are qualifying this year. I’m going to try some new add-ons in addition to the triathlons—swimming, biking, running, and doing some more fun stuff. They even added the power walk in addition to the race walk. So isn’t that going to be fun, turning people on to that experience! You’re outdoors and you’re having a blast. It’s just a celebration of the fact that when you wake up in the morning, quite frankly, everything is still here. It may creak, but it’s still working. You know? [laughs]

Dr. Barb: [laughs] Well, thanks for sharing and thank you for being an inspiration! Wow, that’s pretty amazing. We’ll look forward to hearing more about what your future adventures bring. Thanks so much Pam!

Pam: Awesome! And listen. Keep up the incredibly important work that you do. I mean you’ve touched so many lives with your work as a physician and a mentor. So, rock on!

Dr. Barb: Thank you.


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