Here we go again.  I know you have the best intentions.    This year is going to be different.  It’s  barely one week into the new year so  how you doing with that diet so far? 

About 65% of us are at least overweight and over 30% of us are obese, that is having a body mass index  (BMI) of 30 or more.  (Go  to   http://www.nhlbisupport.com/bmi/  to calculate your BMI)  Fifty million people go on diets every year, spending  millions of dollars on programs, pills and other diet aides.   Only 5% will be successful.   Why, why, why do we do it?  Because losing weight is good for you?  Or because you really, really want to get into those smaller size jeans you wore 5 years ago?  Probably a little of both.  Most of us know that losing weight is beneficial to our health.  We know that being obese puts us at high risk for high blood pressure, heart attack, diabetes, breast cancer and other cancers, gall bladder problems and a host of other ailments.  But still diets don’t seem to work.  Why not?  Obesity at its core is very simple but fixing the problem is very complicated.  We are obese because we are taking in more calories than we are using.   The surplus is stored as fat.  Researchers are finding that the reason we are staying fat is complex.  It seems that lousy food actually changes our physiology.  Over consumption of nutrients changes  chemicals and hormones in our body reducing our ability to recognize when we are full.  It causes something called leptin resistance.  Leptin resistance also causes cravings, and interfers with our body metabolism.  The fatter you are the harder it is to lose weight but the more important it is to lose weight.  In other words, getting fat changes our chemistry and then our chemistry keeps us fat.  But don”t despair.  There is good news.  Science has identified some things that will  increase your chances of success with weight loss.  Here they are:

1.  Doesn’t matter what kind of eating program you use.  Atkins, Weight Watchers, South Beach, low carb, high carb, high protein- all will cause weight loss.   As long as the calorie intake is controlled.  The key is sticking with it.  Find something you can do and live with long term-like the rest of your life!  Very strict fad diets that you can’t stick with don’t work.  You go off the diet and gain back the weight.

2.  Get regular moderate activity like vigourous walking for at least 150-175 minutes per week.  That is about 25 min per day or 30 minutes 5 days a week. Got to, got to, got to keep moving.

3.  Use portion control for meals.  Learn what a normal portion is.  Meal replacements such as Lean Cuisine  or Weight Watcher- type meals have been found to be effective for this.  It teaches you what 300 calories looks like and  it is all portioned out for you, reducing the temptation to eat more.  To learn more about normal food portions  go to  http://hp2010.nhlbihin.net/portion/

4.  Start with a modest and realistic goal.  Studies have found that even  small amounts of weight loss can have dramatic effects on reducing your risk  for disease.  As little as a 6-7% weight loss makes a differnce. That means if you weigh 200 lbs even a 12 lb loss is important.  Fitting into those jeans may be nice but don’t be discouraged if you don’t get there.  As far as I’m concerned this is not about fashion, this is all about your health.

5.  Monitor your intake of food.  Writing down what you eat has been proven to be effective.  Everything that goes in your mouth.  It truly raises your awareness.

6.   Include behavior modification as part of your plan.    You must change your habits if you are to be successful.  That includes how you think about food, manage your stress  and  how you shop for food.   Also includes getting social support  through a program, friends or family and getting educated about nutrition.  Go on line, talk to your health care clinician, find out about community resources and programs.

There are numerous other tips and tricks that can help with weight management.  I am sure that many of the readers can share some that have worked for them.    Also keep in mind that some medications contribute to weight gain and hinder weight loss.  Be sure to talk to your health care provider about your weight loss goals and what options you may have for  changes in current medications.   If you have been attempting weight loss for at least 6 months without success, this may be a good time to talk about whether you are a candidate for weight loss medication or surgery.  And if you live in the Detroit metro area, be sure to check out our Menopause Support group meetings this month  for more support in reaching your health goals.  Finally, have a happy healthy 2010.

written by Deborah McBain, CNM MSN

Seems I’m hearing a lot more about the importance of Vitamin D in the last few years.  And this time of year as the days shorten and sunshine becomes a rare treat, it is timely vitamin to address.  We have long understood the link between Vitamin D and bone health.  Those of you who remember the practice of giving cod liver oil to children  to prevent rickets are witness to this old-time knowledge.  Cod liver oil is an excellent source of nutritional vitamin D.  Since vitamin D is known to help absorption of calcium, menopausal women often are advised to take it with calcium  to help prevent osteoporosis.  Studies now suggest that Vitamin D does a whole lot more than effect the bones.  Low vitamin D levels during pregnancy are being linked to more preeclampsia, low birth weight and premature labor.  Low vitamin D levels in childhood are now being linked to development of  asthma, diabetes and high blood pressure in later years.     A recent study published in the Journal of Nutrition suggests that women with vitamin D deficiencies may have more bacterial vaginosis, a common vaginal infection.  Other research links low vitamin D  levels to higher rates of colon and breast cancer, depression, diabetes, heart disease,  weight gain and chronic pain. Wow!

Chances are that if you live in Michigan you are vitamin D deficientor at least insufficient.  Your risk is even greater if you are older, dark skinned or cover your skin while outside.  Experts in the medical community generally agree that vitamin D deficiency among women is widespread.  Some predict that as many as  70% of white people and 97% of black people are deficient.   Vitamin D is either synthesized in the skin through exposure to ultraviolet B rays in sunlight or ingested as dietary vitamin D.  However it is difficult for humans to get adequate vitamin D from diet alone.  And our Michigan climate and latitude make it difficult to get enough sun exposure.  Then there is the dilemma of increasing the risk of  skin cancer with sun exposure.  Sun screen blocks the skins ability to synthesize Vitamin D.  What is a person to do?

Get your vitamin D level checked.  Ask your health care provider about getting this simple blood test the next time you go for an exam.

Consider taking a supplement.  There is no general agreement about the optimal intake of vitamin D. Some researchers say the current recommended intake of 400 international units (IU) to 600 IU daily is inadequate and suggest a much higher daily intake, from 1,000 IU to 5000 IU.  Cholecalciferol is the preferred form.   It is easily available in any drug store and not terribly expensive. If your blood levels are low your health care provider may give you with a high dose prescription form of vitamin D.  Experts reassure that it is rare and dificult to get too much Vitamin D but check with your care provider.

Include nutritional sources of Vitamin D in your diet.  Look for vitamin D fortified foods such as milk,cereals, orange juice and yogurt.  Other foods with vitamin D include tuna, salmon, beef liver, egg yolks, cheese. ( and of course cod liver oil if you can stomach it)

Continue limited sun  exposure.  (if you can find it!)  Most experts say that 15-30 minutes of sun exposure without sunscreen is reasonably safe.  Getting this amount most days of the week can help boost most peoples vitamin D levels safely.

written by Deborah McBain, CNM MSN

A new year naturally becomes a time for many of us to reflect on our goals for the coming months.  The post holiday barrage of ads for weight loss  and exercise equipment products attest to the popularity of  new year dieting and fitness intentions

If you are like the majority of us, you have found it increasingly difficult to maintain or lose weight as time goes on.  Weight gain  is  related more to aging than menopause. Men have a tendency to gain weight as they age as well.   Aging is related to decreased activity muscle mass and metabolism. The good news is that you can do something about it. No one said it will be easy. But nothing worthwhile is.  Increase your chances of success by implementing some simple strategies that are scientifically proven. Below are tactics that research has shown to be effective.

1. Use a food diary. Doing this can double the amount of weight loss.  It helps you become aware of the mindless eating that adds on calories.  It takes less than 200 extra calories a day to gain 20 pounds a year.
2. Start your meal with soup. That would be a brothy vegetable rather than a cream filled clam chowder!  A nice satisfying bowl of veggie soup has been shown to reduce calorie intake at a meal by 20%.
3. Eat slowly. It is not true that food eaten standing over the kitchen sink has no calories (See number 1). A study at University of Rhode Island reported that women who ate slowly compared to those who gulped down their meals ate 70 fewer calories and felt more satisfied.
4. Drink more water. Two cups of cool water before a meal can cut calories by 13%.  Another study shows that this also revs-up your metabolism by 24%.
5. Increase fiber. North Americans are notoriously bad about getting enough dietary fiber. Whole grains, fruits and vegetables not only are full of necessary nutrients but keep you feeling full longer and therefore less likely to nibble ( see number 1).
6. Don’t skip breakfast. Several studies have shown that eating a good breakfast, particularly concentrating on protein, supports weight management.   In fact, studies support the fact that eating 2 eggs a day can actually help you burn more fat than equal calories in bagels.
7. Exercise. I know, I know.  You don’t have time, you don’t have the energy, you just had knee or back surgery.  There is some kind of exercise that nearly everyone can do, even the wheelchair bound.  Resistance or strength training with hand weights or resistance bands will help build muscle mass which increases metabolism.  This assists with weight loss but does even more.  It reduces insulin resistance, builds bones, reduces arthritis pain and improves energy.  If you do have a medical condition by all means discuss appropriate exercise strategy with your health care provider. A good resource book on strength training is Strong Women Stay Young by Miriam E. Nelson, Ph.D.

Do you have any other strategies that have been successful?  Please share them.

written by Deborah McBain, CNM MSN

What symptoms are normal and what is not normal during menopause?
During the perimenopause, irregular menstrual periods which may be longer or shorter, heavier or lighter, skipped periods or periods starting every three weeks are all within the norm. Periods coming less than every 21 days or lasting over 7 days should be reported to a health care practitioner.   Spotting between periods or after intercourse should also be evaluated.  Once menopause is reached, any vaginal bleeding should be investigated by a health care practitioner.  Often these irregularities are a result of  hormonal changes but occasionally they can herald more serious problems which should be ruled out.

Some women sail through perimenopause and menopause with nary a problem. Some have all the symptoms in the book.  Hot flashes, mood swings, trouble sleeping, skin changes, dizziness, heart palpitations have all been attributed to the hormonal changes of perimenopause and menopause.  Many women find these things manageable and do not need treatment.  It is best to discuss symptoms with a health care provider.  He or she can determine if any symptoms are suspicious for diseases like thyroid disease which may minic menopausal symptoms.

Symptoms of depression, weight gain, decreased sex drive, sleep disorders and memory loss are commonly atributed to menopause.  Studies do not show a strong relationship between these symptoms and hormonal levels.  These symptoms are often more related to stress or aging.  Unplanned weight gain or loss for which there is no explanation should be looked into.  Any symptom effecting one’s ability to function at home or at work should be investigated.

Coming- Part 3- ”Ok so now what do I do?”- Remedies and Solutions.

written by Deborah McBain, CNM MSN