Aging: Conquering the Middle Aged You (cont.)

So if you truly want to slow your clock you have to minimally do 30 minutes of aerobic exercise (and it can just be walking most every day), plus 15 minutes of weight resistance exercises, two or, ideally, three times a week. And to make it easy, I give examples of exercises. In order to get the woman psyched up to do it, I give the horror stories of what will happen if she doesn't!

Subsequent to that chapter, I also have a chapter on how to take a bite out of time, subtitled, "What Should I Eat?" And here I talk about our bigger is better mindset, and our American "right" to get more for our money, and some of the issues it's caused, including our American obesity epidemic. I tell the reader how to evaluate a diet, how to figure out how many calories she needs to lose a certain amount of weight (I try to keep her expectations realistic), and how 10% loss of body weight can have major positive health effects. And I explain that keeping that off is more important than losing 50 pounds for a reunion, followed by a rebound months later.

I give what is now considered a healthy eating pyramid, and I give an actual diet that I suggest, which is called the LA-meets-Mediterranean Diet, to slow your clock down. Then I give guidelines on what to each in restaurants, what to eat while traveling, and what to do when invited out to dinner. Because I commute to New York every other week from Los Angeles, I feel like I can be expert in telling women what to do about airborne eating (by the way, I've not gained weight as a result of my travels).

I then go on to one of my favorite chapters called "Herbs, Schmerbs, and Verve." This is where I address the $18 billion-a-year supplement industry. I talk about what vitamins do, how much we need, what we should take, and what will make a difference in our health. Then I go on to talk about other supplements, so called "antiage" supplements, amino acids, human growth hormone, and DHEA, as well as all the herbs that are out there, and what they can and can't do based on valid studies rather than the non-FDA-approved promises on the bottles.

MODERATOR:
In that story of the woman who put off having children you raise an interesting point, that it seems some women need to both be reminded they will not be young forever, and at the same time told they don't have to give up on living a full life just because they are over 40. That's a lot to process and accept!

REICHMAN:
Well, life is a lot to process. Our bodies may continue to look and feel great, but the unfortunate fact is that our ovaries have their own clock. Because we're born with a certain number of follicles, the cells that produce the egg, we have no way of slowing. In our late 30s the follicles that are left are what I call rejects. Although they can work, they work at a slower speed; fewer of them will "take" when it comes to fertilization, and when an embryo is formed there is a greater chance for chromosomal abnormalities and miscarriage as we enter our 40s. If we don't realize that, we may miss out on an opportunity to spontaneously conceive with our own eggs.

What we're now doing in our 40s is pushing those eggs to come forth and ovulate at greater numbers with fertility drugs, and we're not allowing nature to take its course. We're actually harvesting eggs, inserting sperm, through the process of in vitro fertilization, to improve the odds, but those odds remain lower the older we are, and after age 42 the odds are so low that many fertility clinics will advise a woman to use younger donor eggs for fertilization. The resulting embryo is then implanted in her uterus, so she's the biologic or birth mother, but not the genetic mother.

MEMBER QUESTION:
What are the main health issues that women over 40 need to begin educating themselves about?

REICHMAN:
Quickly going ahead with what's in the book, (and I wrote this so a woman can look at the chapter that interests her, or use it for a source of information on a particular subject), there is a chapter called "Disease Prevention and Detection for a Longer and Better Life." What I start with is what kills us, and go from there. If we can detect those diseases, or prevent them, then clearly we'll lengthen the span of our lives. Heart disease is the major cause of death in women. So, I talk about how we can prevent broken hearts, and what tests women should have to ensure their heart is whole and doing well.

I talk about our cancers; the one that worries us the most is breast cancer, but the one most likely to kill us is lung cancer (we've come a long way, baby!.) And I spend a lot of time helping women figure out how to stop smoking. Anyone who has finished this book and thinks she can still light up safely has not really read the book.

I do give at the end of the chapter a checklist of the routine tests you should have. I call it the health span list. When we buy a new car we get a list of when to bring the car in for checkups. With that in mind, although I don't want to give expiration dates, I've given a "slow the clock" list of what to do monthly, annually, three years, five years, and at least once in your life. It's a list you can tack up to your refrigerator to remind you of what you need to have done. The disease you detect may be your own.

And I tell stories of patients who, because they did their tests, are alive and well:

  • The woman who said she'd never have a colonoscopy and then had one. We caught colon cancer early.

  • The woman who came in with hot flashes. I insisted on checking the cholesterol levels. One thing led to another, and she had emergency angioplasty. She was a heart attack waiting to happen.
  • A woman who had a lump and it's probably nothing, and the mammogram was normal. Not only was the lump not normal, she had positive lymph nodes.

Just so everyone will really want to read the book, I wrote a chapter called "Looking Young From the Outside In." This is where I talk about what ages our skin, what we can do about it, aggressive "wrinkle be gone" medical therapies, and all the creams over the counter. Basically, it's what women can do to keep their skin looking young, and what the dermatologists and plastic surgeons are offering. And since I'm not selling anything I can tell them what works, what doesn't, and how much it costs.

I did write and epilogue called "My 120," and this is something I do in all my books, because when all is said and done my patients usually turn to me and say, "What do you do?" because she's not going to do something I don't. I use the 120 because there's a wonderful biblical expression that when translated from Hebrew is, "May you live to 120." So I figured that was a pretty good goal. I'll die trying to get there.

I tell the reader what I do, based on all my reading and so called secret knowledge: What I eat, the exercise, what I've done in the past, like everyone else, the good, the bad, and the lazy, and how I'm trying to fix it now. Although I do not give the answer to mortality, I'm trying to give a road map for women to mature with the health and sense of well-being they want.

MEMBER QUESTION:
How do you feel about natural progesterone cream as part of HRT?

REICHMAN:
The cream often doesn't really have progesterone. It's made from wild yams, and the skin cannot convert it to true progesterone. When used in conjunction with estrogen, it may not protect the lining of the uterus to precancerous changes. However, there are modes of natural FDA-approved progesterone that will protect the uterine lining. These include prometrium, and there are two other forms of progesterone that haven't been FDA approved, but are used in Europe and often used with appropriate follow-up by doctors in the U.S. That includes a vaginal gel, Prochieve, and a special progesterone-releasing uterine system called Mirena.

"There is a greater chance for chromosomal abnormalities and miscarriage as we enter our 40s. If we don't realize that, we may miss out on an opportunity to spontaneously conceive with our own eggs."

MEMBER QUESTION:
I'm 40 years young but it seems that gravity has taken control. I also have hepatitis C and I'm extremely tired all the time. Should I attempt to exercise, because the rear end isn't looking too good!

REICHMAN:
First, talk to the specialist who is treating the hepatitis C. If you are in hepatic failure or severe liver compromise, you may need therapy before attempting to do the other things in your life.

In general, we tend to gain fat in our middles as we get older, and less in the tush and thighs. It's been found the best way to combat that newly developing apple shape, which is a risk for heart disease, is to do aerobic exercise. But clearly, any exercise program has to be cleared with your doctor, if you have an underlying medical condition.

MEMBER QUESTION:
Does your book touch on perimenopause symptoms and solutions?

REICHMAN:
Oh, yes. Before menopause, there's peri, which can last anywhere from three to 10 years. It's a time of life when our hormones can be fluctuating from highs, similar to when we were pregnant, to lows that mimic menopause. I explain why we get the symptoms, what's happening, and ways to deal with them. One of my favorites is simply to do a "corporate takeover" of the misbehaving ovaries by using low-dose birth control pills. This can be safely done until menopause as long as the woman doesn't smoke (I think the pill should be over the counter; smoking should be by prescription), doesn't have uncontrolled high blood pressure, or has a history of family history of abnormal clotting.

If a woman does stay on the pill, she may not know when she goes through menopause because she'll get regular cycles and feel fine. So at 50 or 52 I suggest she goes off for two weeks, then have a blood test to check hormone levels. If she's entered that stage, she can stay off the pill to see how she feels, then make a decision about HRT.

MEMBER QUESTION:
How can I get rid of dark circles under my eyes?

REICHMAN:
Sometimes the circles are due to change in pigmentation, which can be treated with Retin-A, or Tazaroc; sometimes it has to do with fluid or fat accumulation, or changes in the accumulation, so that pouches are formed, and that can be dealt with through some new surgical techniques. On occasion, it's a genetic phenomenon that is hard to treat. But in order to differentiate, you need to see a dermatologist or a plastic surgeon.

Remember that dark circles often occur as a result of simple lack of sleep. Sleep is one of the best things we can do for our skin. Be sure you are sleeping seven to eight hours a night, nutrition is good, and make sure you're not abusing alcohol or cigarettes.

MEMBER QUESTION:
I am a 52-year-old woman in good health and normal weight with no bad habits! Ha. I am still cycling (menstruating). What is the average age for a woman to stop menstruation? I am still fairly regular but I am getting more and more tired as the years go by and wonder if it is related to the fact that I am still fertile.

REICHMAN:
The average age of menopause if 51.7. But it's a Gaussian curve, which means that is an average age, and there are women who will go through it at 47 and others at 55. You can sometimes get an idea as to whether you'll be early (in your case, you're not early), or late, by looking at your mother. If she had a late menopause there's a good chance that you will too. It's dependant on the number of follicles that have been in your ovaries from puberty on.

Now, the fact that that you are menstruating does not mean you're fertile. The reproductive pause generally occurs 10 years before menopause. Having said that, however, I have to, as a doctor who goes according to guidelines, suggest that every woman who still gets her period naturally use some form of contraception, because surprises can occur.

As far as fatigue, I'm not sure that's a part of the perimenopausal symptoms. The issue is are you exercising, taking care of yourself, getting enough sleep, is nutrition good, are you under stress, and if, like all of us, the answer is yes and no, I'd start there rather than saying that it's your hormones.

MEMBER QUESTION:
I exercise regularly but find myself growing out of my clothes at age 46. What should I do?

REICHMAN:
Unfortunately, every decade our basal body metabolism diminishes by 5% to 10%. So if we eat the same and exercise the same, we'll gain weight. And the secret is to decrease what you eat so that you have less to burn. That means portion size, and if that doesn't help, make sure your doctor checks your thyroid function. Then be honest with yourself. Is the type of exercise you're doing really burning those calories?

MODERATOR:
We are almost out of time, Dr. Reichman. Do you have any final words on aging gracefully for us?

REICHMAN:
At this point, I'll simply say that we are extraordinarily lucky to be in a time and place where we can acquire the knowledge and access the health care and make the behavioral changes that will slow our clocks down.

MODERATOR:
Thanks to Judith Reichman, MD, for sharing her expertise with us. For more information please read her book, Slow Your Clock Down: The Complete Guide to a Healthy, Younger You . And also be sure to visit our message boards, including Women's Health: Friends Talking, to share your concerns with others and ask questions of our in-house experts. You'll be welcomed warmly!

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