HEALTHY RESILIENCY in CHILDHOOD Stepping Up to
USING NUTRITION AND LIFESTYLE TO ENHANCE
FERTILITY JUERGEN EISERMANN, MD MARTA MONTENEGRO, MS
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Aging and Low Testosterone
TIME TO INTERVENE!
Publisher Mauricio Portillo Editor in Chief Claudia Portillo Del Valle Marketing Director Arnaldo Del Valle Copy Editor Lora Incardona Website Director Healthy Media
Editor in Chief
Feeling Great!! This month’s publication is dedicated to the men in our lives, but, as always, we bring forth articles for the entire family. With this edition, we intend to craft a clear awareness of men’s health and provide powerful tools that will encourage men to achieve a desirable state of health and greater quality of life. Take heed of the guidance from the medical specialists you’ll encounter within these pages and encourage the men in your life to visit their physicians on a regular basis and have physical exams as recommended, even if they feel well. As customary, we continued working hard and it’s all worthwhile knowing that you, our readers, appreciate the results as much as we do. Meeting new people and experiencing what their lives are all about has been a wonderful gift. We are all united in a very unique way; we all want to be healthier and we are looking for the tools and techniques to make it happen. And now, let me present to you this month’s cover story. Pregnancy is an exciting time for expectant parents, especially for those with fertility issues. Dr. Juergen Eisermann of IVFMD South Florida Institute for Reproductive Medicine and wellness specialist Marta Montenegro take time to explain the important roles that preconception care and positive lifestyle choices play in a woman’s ability to become pregnant and have a healthy pregnancy. If you are or plan to be pregnant, you won’t want to skip over this month’s interview. Healthy Valley Magazine strives to bring you articles and organizations that aid and contribute to the enhancement of your health. Knowledge is the first measure of prevention and immediate action is the second so take the lead. Nothing is more important than providing a good example for your children, loved ones and community with your own words and deeds. Set high standards and teach by performance. Start by replacing your bad habits with those that will drive to you a healthier life. I want to thank Men’s Health Network for its support with this month’s issue as well as our doctors, without whom this magazine would not have the success that it has achieved. To the men in our lives, thank you—thank you for taking the responsibility to care and provide for, to lead and to teach your families through love and perseverance. To my husband, who is an extraordinary father and man who has set high standards not only for himself but for his children, thank you, thank you for being my kids’ dad.
Graphic Design Healthy Media Contributing Writers Roselind H Bardisa, DO Christina Peña, MD S Mur thy Badiga, MD, FACG Manuel Abella, MD, FACC, FCCP Rober t S. Tan, MD, MBA Ritu Goel, MD Chef Williams V. Charlotte Libov Lora Incardona, M.Ed. Maria Luisa Salcines Rubel Shelly
Social Media Director Faride Del Valle COVER Photography: Gala Ricote Hair Stylist: Orlando Lopez Bliss Intoxicating Beauty At South Miami Manicurist: Mairym Ramirez Bliss Intoxicating Beauty At South Miami Make up: Natasha Gross
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INSIDE HEALTHY KIDS 10. 12.
TEACHING HEALTHY RESILIENCY IN CHILDHOOD HARVEY MANGER-WEIL TEACHES STUDENTS TO ACE THE SAT
HEALTHY BODY, MIND & SOUL 14. 18. 20. 22. 24. 26. 28.
STEPPING UP TO FATHERHOOD USING NUTRITION AND LIFESTYLE TO ENHANCE FERTILITY HPV HUMAN PAPILLOMA VIRUS AGE PROACTIVELY LEG VEINS, SPIDERS AND OTHER UNCOMFORTABLE THINGS ENSURING GOOD HEALTH FOR LIFE LIVER CIRRHOSIS
FITNES & BEAUTY 32. 34.
AGING AND LOW TESTOSTERONE: TIME TO INTERVENE! SALMON WITH SAFFRON-VANILLA
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TEACHING HEALTHY RESILIENCY IN CHILDHOOD
HARVEY MANGER-WEIL TEACHES STUDENTS TO ACE THE SAT
By Megan Clunan, MA, LMHC, LPC
Almost every major life transition requires passing some sort of test before journeying on to the next phase. We cannot drive a car without passing a test; we cannot hold a job without first going through an interview; we cannot get into college without good SAT or ACT scores; we cannot get married without applying for a license and so forth. However, when it comes to having children, there is no test of parental capability and, needless to say, children are not born with a “how-to” handbook. Parenting would be easier if there were a formula, if we knew with certainty that every eight-year-old would act in a specific way. However, this is definitely not the case. Each child uniquely pushes the boundaries, experiences life and is impacted by outside influences. Parenting is not easy. From day one, we are supposed to know how to parent these little humans into wonderful big humans who have the resilient ability to contribute and thrive in society—a task that we, as parent, may feel we aren’t quite accomplishing. SO WHERE DO WE BEGIN? Children are said to be resilient. I disagree. Children are not resilient, rather they are absorbent. They absorb all that life throws at them—the good, the bad and the ugly. These little ones may seem flexible because they go with the flow or perhaps do not have much to say about a given experience when, in reality, what they are doing is attempting to work out in their own minds how to make sense of their worlds. As parents and caregivers, one of our key roles is to help children understand what is happening. Those who are able to make sense of what’s going on around them are better able to withstand life experiences.
Teaching resiliency is necessary and prepares children to healthily face all that life may bring. Children are said to be resilient. I disagree. Children are not resilient, rather they are absorbent. They absorb all that life throws at them—the good, the bad and the ugly. These little ones may seem flexible because they go with the flow or perhaps do not have much to say about a given experience, when in reality, what they are doing is attempting to work out in their own minds how to make sense of their worlds. As parents and caregivers, one of our key roles is to help children comprehend what’s happening. Those who are able to understand are better able to withstand life experiences. Teaching them how to bounce back is necessary and prepares them to healthily face all that life may bring. The following five (not-so-easy) steps can help ensure that you are leading your children towards healthy resiliency: 1. LISTEN AND TALK. When you take a moment to put down your computer and phone, turn off your television and radio, and stop worrying about tasks that need to be completed and actually communicatively engage with your children, you will find that they have quite a world to show you. Slowing down for just 20 minutes a day to interact face-to-face with your children tells them that you are there for just them and that you care about them. Remember, quality is more important than quantity. 2. PLAY. The language of children is play. They may not have the vocabulary to tell you what is going on so they will often act out their experiences via play. Playing with your children creates attachment bonds that last long into adolescence and adulthood.
3. TEACH EMOTION WORDS. All emotions are okay to feel but children may not have the words for every emotion, therefore may act out in response to feeling something they do not understand. Teach children words by wondering aloud about feelings, for example, “I wonder if you’re feeling frustrated because it is time for bed but you want to watch T.V.,” drawing pictures of faces together or making the faces of different emotions, and helping your children notice body messages, e.g., “When someone stands with clenched fists, what do you think that means?” Teaching emotions encourages self- and other-awareness. 4. ENCOURAGE SELF-REGULATION. Children need to be taught how to self-regulate. In other words, they need to be taught how to calm themselves down. The best way to encourage self-regulation is to provide a safe predictable environment with consistent reassuring interactions. Modeling is elemental as well so be sure you are showing parental strength by calming yourself down even when it may be easier to lose it. Remember, these little ones are watching and absorbing everything! 5. PRAISE. Recognizing what children do wrong is easy. Catching them doing something right and verbally acknowledging their actions isn’t as easy but is essential in encouraging healthy growth. Praise conveys that you see them and that you know they are contributing something of value. Children thrive on hearing that you are proud of them and that they have done something to please you. The more a behavior is praised, the more likely you will see that behavior repeated.
INTERVIEW HEALTHY kids
Harvey Manger-Weil Teaches Students to Ace the SAT By Charlotte Libov
Harvey Manger-Weil has launched several successful careers but his most enduring legacy will likely be his role as “The College Wizard” because he’s spent three decades training students to excel at the SAT and get into the colleges of their choice.
Manger-Weil, a successful entrepreneur, has tutored students to conquer this ‘make or break’ exam ever since he was a college student. Now, thanks to technology, his business is nationwide as he uses SKYPE to tutor students face-to-face.
A high SAT score isn’t about how smart you are; it’s about how motivated and persistent you are, and whether you have the ability to delay gratification.
was quickly embraced as a college admittance test and is now taken by some three million students. Originally, the College Board, which administered it, claimed the exam was an aptitude test, thus tutoring was useless. They had to drop that claim after they were proven wrong, and the description of the test was changed from “aptitude” to a tool that evaluates reasoning.
“I started out tutoring as a way of Harvey Manger-Weil making some extra money while at Dartmouth. I had scored nearly perfectly on my own SAT and I had already begun decoding the Manger-Weil credits his success SAT system,” said Manger-Weil. Now 55, he spent the to years spent reverse engineering the SAT in order to next three decades launching one extremely successful unlock its intrinsic nature as well as perfect methods of business after another, but his SAT tutoring business quickly communicating strategies of beating the SAT to remains a constant. his students. “A high SAT score isn’t about how smart you are, it’s about how motivated and persistent you are, He believes his skill at beating the SAT springs from his and whether you have the ability to delay gratification,” ability to think “outside the box,” which is also how he he said. succeeds as an entrepreneur. Even though both his parents were teachers, Manger-Weil had no interest in He is also a keen motivator, showing students that the following the family profession. “I credit my success in difference between doing well on the test and excelling teaching the SAT to the fact that I’m a non-educator,” he at it is within their grasp. “A full 20 percent of my students says. break 2300 (out of a total 2400). The reason that’s so important is that if you do that, you can get into pretty Indeed, linear thinking was never part of his toolbox. much any school that you want,” he said. But, he warns, “I was always very good at puzzles and figuring things “If you only break 2100, that puts you in a much larger out but I had no encouragement that my skill set would group of 25,000-30,000 students, so your choices will be be good for becoming an entrepreneur. All I ever heard far fewer,” he noted. “The difference between scoring from my parents was ‘Make sure you have a job to 2100 and 2300 is only 11 questions, so your whole future is support yourself,’ but it was just my bent to look at things determined by only 11 questions,” he added. differently.” Although there are other online SAT services, MangerIn fact, Manger-Weil said he “struggled with rules Weil takes the preparation concept a giant step further because I saw them as obstacles preventing me from by offering a far more comprehensive program that succeeding as high and fast as I could.” The result? He involves not only SAT tutoring but advising students completed high school in three years instead of four and on the entire college admissions process. This includes was named valedictorian for the class ahead of his. inventing one-of-a-kind extracurricular projects for students to complete as well as selecting unique college Since then, he’s excelled at many different careers but his essay topics to make the entire application stand out. “I true satisfaction comes from his nationwide SAT tutoring don’t just help kids with SATs, I give them a roadmap for business. According to him, he can enable students to marketing themselves over every other student so they achieve remarkable 500-, 600 and even 700-point gains in can get into places like Stanford, Yale and Harvard. It’s a a record amount of time, although he notes that students free service I offer to anyone who signs up to work with have to be committed to practice the skills they learn. me,” he said. The SAT exam dates back to 1926, when a Princeton professor adapted a U.S. Army intelligence test to gain information about college students who had already been admitted there to better guide them. But the test
Manger-Weil also works with parents to create an atmosphere that motivates students to achieve success. As he puts it, “My goal is to help my students in any way I can to be happy and successful in their lives.”
Stepping Up to
by Rubel Shelly
Yesterday was Father’s Day. And I suspect that several of you either heard or read some meaningful things about the importance of being a father. If you are a father, I hope that you got some affirmation and affection from children in whom you have invested much love and nurturing. I hope you felt it appropriate to affirm your father—and found a way to do so. To be a father is a high spiritual calling. One day doesn’t do justice to good fathers. One day certainly isn’t enough for making the effort to be one. And that brings me to my point. There is a wondrous transparency in our nation’s president about fatherhood. Barack Obama had precious little time, presence or influence from his father. “I don’t want to be the kind of father I had,” he is quoted as having said to a friend. The president’s father left a family in Kenya to come to the United States for his education. Once here, he started a second family—only to leave his wife and two-year-old Barack Jr. to return to Africa with another woman. While the boy left behind with his mother was bright, received an excellent education and was driven to achieve, the man at the end of the process goes to great lengths to affirm the importance of men who are sperm donors becoming real fathers to their children. On Father’s Day 2008, the man who was running for President of the United States said this about
fatherhood: “Any fool can have a child. That doesn’t make you a father. It’s the courage to raise a child that makes you a father.” For this year, the now-president added this: “We need to step out of our own heads and tune in. We need to turn off the television and start talking with our kids, and listening to them and understanding what’s going on in their lives.” I will leave the psychologists to speculate about the connection between one man’s lack of connection to his own father and his present emphasis on the importance of being one. And this essay certainly isn’t a Democratic or Republican take on his statements for the sake of partisan posturing. It is nothing more nor less than delight in hearing one prominent male leader of our world say something bold and positive about the role too many men appear to disdain. Hard work is a good thing. Earning a living is honorable. Achieving success and recognition in a field cannot be wrong. But none of these things on which so many men have expended their energies are nearly as valuable or satisfying as the nurturing of a child to be a confident and functional man or woman—and to reap the dividend of love that comes back from that well-formed adult soul. “Father’s, don’t exasperate your children by coming down hard on them. Take them by the hand and lead them in the way of the Master” (Ephesians 6:4 MSG).
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Body Mind & Soul
STEPPING UP TO FATHERHOOD
USING NUTRITION AND LIFESTYLE TO ENHANCE FERTILITY
HPV HUMAN PAPILLOMA VIRUS
LEG VEINS, SPIDERS AND OTHER UNCOMFORTABLE THINGS
ENSURING GOOD HEALTH FOR LIFE
USING NUTRITION AND LIFESTYLE TO ENHANCE By Charlotte Libov
JUERGEN EISERMANN, MD
MARTA MONTENEGRO, MS
It’s vitally important for women to be at the peak of their health when they are planning to become pregnant. This is also true for those who use fertility treatments to help them conceive. This is why Dr. Juergen Eisermann, founder and medical director of IVFMD South Florida Institute for Reproductive Medicine, has joined with Marta Montenegro, MS, an internationally known nutrition, fitness and wellness specialist, to create a new service that enhances his already successful fertility practice of over 20 years. “I am very honored to be working with Dr. Eisermann and his team of seven physicians on his new program, which is a culmination of the years I’ve spent working on how to use nutrition health, fitness and lifestyle to enhance fertility treatments,” said Montenegro. “We’ve learned over time that fertility treatments that lead to normal pregnancies depend on a number of factors. These include good nutrition and healthy body composition, and that is where Montenegro’s expertise comes in,” said Dr. Eisermann, whose center is among the largest reproductive medicine practices in South Florida. As the Institute’s lifestyle consultant, nutritional specialist and exercise physiologist, Montenegro works one-onone, on-site, with prospective parents to optimize their health, thus enhancing their probabilities of becoming pregnant and having healthy babies. This is especially important considering the busy lives that women tend to lead, Montenegro noted. “In society today, we are delaying more and more pregnancies because of our professional goals. But after the age of 35, a woman may feel young and look young but her fertility has decreased. Fertility options are far better now than years ago but it’s still a challenge for a physician to bring a couple’s dream to life. So, I do all I can in terms of nutrition, supplementation, exercise and overall lifestyle to increase the success possibilities of those treatments,” added Montenegro. Dr. Eisermann firmly believes that preconception counseling is not only
important for couples that are planning to conceive naturally but that it is equally important for all of his patients as well, which is why he started the pilot project with Montenegro. He is so pleased with its success that he is expanding the program to his other locations.
“We are one of the few reproductive medicine practices that has incorporated the field of preconception medicine into a practice for women who are not able to get pregnant on their own,” said Dr. Eisermann. “Just like it’s important for women to undergo testing to make sure they don’t transmit genetic problems, it’s also important to optimize their metabolic and lifestyle practices,” he added. “Montenegro is well experienced and highly motivational with an amazing track record in helping people perform at their best, whether they are athletes or regular people trying to optimize their lifestyles or to simply live healthy. So, we knew that she would be an excellent enhancement to our program,” Dr. Eisermann added. Helping women conceive is not only Montenegro’s passion but also a challenge for which she is well suited. Montenegro graduated from Florida International University magna cum laude with a master’s degree in exercise physiology and is now an adjunct professor there. In addition, she is a cardiac rehabilitation specialist and holds several certifications from the world’s top nutrition, health and fitness organizations, testifying to her expertise in nutrition, strength and conditioning, and lifestyle consulting. Montenegro is a popular speaker known for her skill in motivating people to become healthy and release their “inner athlete.” In addition, she is a journalist and has been featured as a guest expert on CNN, CNN en Español, Fox News Latino, as well as NBC, ABC, CBS and Univision. Montenegro writes an award-winning blog at MartaMontenegro.com, where she conveys the latest news and research that demonstrate the best ways to adopt and maintain a healthy and balanced lifestyle. She is also a regular columnist for many
national news programs and is regularly quoted in many top nutrition and fitness publications, and websites. Montenegro’s interest in helping women who wish to conceive goes back to her life in her native Venezuela, where she owned and operated a successful wellness center. “When I started my practice in Venezuela, I worked with doctors focusing on how exercise and nutrition could impact various health conditions. During those years, I found that being overweight, sedentary and eating particular foods in excess while not including others can hinder fertility,” she said. “Having the right diet and supplements are not necessarily a magic bullet that can resolve fertility issues but those elements make an impact on so many health conditions, helping to turn the odds in favor of becoming pregnant,” she said. For instance, Montenegro noted that as a woman ages, her estrogen decreases, her metabolism slows down and she adds more fat to the abdomen, all which set the stage for other medical ailments in addition impacting fertility. “We know that by changing our diets we can delay a lot of diseases, such as heart disease and diabetes, so we want to use this tool to hopefully enhance fertility as well,” Montenegro said. Exercise is also very important, she said, noting that women who are hoping to become pregnant need to strike a balance between too little activity and too much. “I have patients who are super active and they are addicted to their spinning classes. I counsel them to decrease the duration and intensity. When you work at that intensity, your body focuses on replenishing all of the energy that was lost during the workout. So your body protects you from becoming pregnant,” she said. But the responsibility does not only fall to the women. Montenegro also helps the men involved. “Men, who for many years live sedentary lives and excessively drink alcohol and/or eat junk food, often suddenly realize they may face fertility issues too. Men always think it is the woman’s problem, but there are things they need to do to preserve their fertility as well,” she added.
Papilloma Virus By Christina Peña, MD
HPV stands for Human Papilloma Virus. It is a virus that is transmitted by direct contact and over 75% of the population has it. As a gynecologist, I will focus here on the sexually transmitted types. It may surprise you to know that this virus can be transmitted orally, digitally and even if a condom is used. It may also surprise you to know that while an HPV vaccine exists, and I highly recommend it for both young men and women as it covers the four most common strains, there are over 100 strains of the virus. Some of the strains are regarded as ‘high risk’ because they can act aggressively and cause a cancer. Other strains are considered ‘low risk’ because they can’t kill you, but I can guarantee you that not one of my patients would want any form of that strain either as they can cause genital warts. This is why the screening well-woman exam is so important. When transmitted sexually, HPV prefers to invade the cervix, which is deep in the vagina. There are no symptoms. There is no pain, abnormal discharge or odor until a tumor exists. And this never has to happen. Cancer of the genitals is completely preventable with proper screening. SO WHAT IS THE TEST? We have traditionally recommended the Pap smear. To perform the Pap smear, the gynecologist passes a brush along the cervix to essentially exfoliate the cells that are on the surface so they can be looked at under a microscope. We want to see that the cells are not disfigured. The good news is that so much is known about how HPV transforms cells toward a cancer that the Pap smear can detect the stages that the cell goes through. Based on the stage of transformation, there are treatments that can get rid of those transformed cells and never allow a cancer to develop. The bad news is that the Pap smear reading can be wrong up to half of the time. This means that up to 50% of the results that come back as “normal” may have missed an underlying abnormality. This is where HPV testing can help. We have the capacity to test for the virus itself from the same Pap smear sample. This result guides us as to whether we should believe what the Pap is saying or investigate further. It is not mandatory for a gynecologist to test for HPV at the time of a Pap. There are guidelines that are followed based on the patient’s age and history for testing it. In my office, I do offer the testing to all my patients. I test not only for the presence of the virus but which strain may be present. I also test for something called HPV E6/E7.
“It is very important that you develop a close, trusting relationship with your gynecologist and, on the same token, that your gynecologist takes the time to listen and explain all these complicated issues to you during your office visits.” Christina Peña, M.D. 20
HAVE YOU HEARD OF E6/E7? E6/E7 is a specific gene within the virus itself, though not all of the HPV strains have it. The evidence suggests that if you have been exposed to one of the strains that does have this gene, your cells would be more likely to progress to cancer than if you have been exposed to an HPV that does not have that gene. This is a brand new test that is cutting edge. In fact, it is so new that the medical community has not yet decided how it will be incorporated into routine screening. Based on alarming results of an ongoing observational study that I am conducting in my practice, I have no doubt that this will change how we screen in the near future. So get your screening exam and ask your doctor which testing is best for you. Cervical cancer is a completely preventable disease. While there is not yet a cure for the virus, there is a cure for what the virus can do.
By Roselind H. Bardisa, DO
Age PROACTIVELY When we think of aging, we think of all the physical things that get worse over time. Common aging occurrences include wrinkles setting in, bones becoming achy, loss of muscle, fatigue and chronic diseases. But what if there were no need to fear these things? While there are proven methods that exist to slow down and, in some cases, completely eradicate pathological aging processes, Americans continue to suffer and die prematurely. The majority of are victims of an epidemic of medical ignorance that results in higher incidences of cancer, vascular occlusion, arthritis, dementia and, eventually, every other age-related disorder. By following a science-based youth restoration program, aggressive and successful action can be taken to delay degenerative changes. The choices we make every day regarding our nutrition, how well we oxygenate and detoxify our bodies through exercise and even the way we think and choose to feel all affect the aging process. Each of us can age to our own genetic perfection. It is, however, necessary for each of us to set up and follow our own unique and specific game plan to remain youthful and vital. By addressing the five most controllable causes of age-related diseases, we can put ourselves in position to take advantage of future medical breakthroughs that can result in dramatic extensions of the human lifespan while looking and feeling better in the process.
01 CHRONIC INFLAMMATION Inflammation that persists over time is one of the primary reasons that the body deteriorates as time passes. Because it is triggered by both internal and external causes, inflammation may be difficult to prevent. Americans put themselves at risk of chronic inflammation through poor diet and lifestyle choices. For example, excess belly fat releases inflammation-causing molecules called cytokines, which could inflict damage on anything from brain cells to arterial walls to regulatory genes. The most commonly used blood test for inflammation is known as high sensitivity C-reactive protein (CRP) test. Any doctor should be able to provide this test for you. Ideally, the CRP level in men should be below 0.55 mg/L and in women, below 1.50 mg/L. High LDL (bad cholesterol) can also cause chronic inflammation. Ideal LDL levels are below 120 mg/dL; however, in some patients with additional risk factors, they should be below 100 mg/dL. There is an array of clinically proven nutrients and hormones that have been shown to effectively lower the mechanisms behind inflammation: NUTRIENT TYPICAL DAILY DOSE Fish Oil EPA 1,400 mg Fish Oil DHA 1,000 mg Curcumin 400-800 mg Bromelain 500-1,000 mg DHEA 15-50 mg
GLYCATION AND METHYLATION
It is a well known fact that those with diabetes age prematurely and live about 10 years less than non-diabetics. One reason is due to the acceleration of a process called glycation, in which glucose binds to proteins and/or fats in the body to form nonfunctioning structures. This is most evident in damage to the kidneys, eyes, nerves and blood vessels. Methylation is the enzymatic reactions within the DNA of cells for maintenance and repair. Aging deteriorates the methylation metabolism. The resultant DNA damage can manifest as brain cell deterioration, liver damage and even cancer.
The cells in our bodies are programmed to function via communicating signals called hormones. Aging creates severe hormonal imbalances in testosterone, estrogen, progesterone (in women) and thyroid hormones that inevitably reduce energy levels, muscle mass, metabolism, memory, mental agility, mood and libido. In addition, there are more severe consequences such as coronary artery blockage, osteoporosis, depression and cancer.
Numerous studies have shown that the following nutrients suppress glycation reactions and restore methylation. NUTRIENT TYPICAL DAILY DOSE Carnosine 1,000 mg Vitamin B1 150 mg Vitamin B6 100 mg Vitamin B12 1,000 mg Folic Acid 1,000 mcg Chromium 500 mcg TMG (trimethylglycine) 500-1,000 mg S-adenosyl-methionine(SAMe) 200-400 mg
The most effective way to achieve hormonal balance is by restoring them to youthful levels through bioidentical hormone replacement. Levels for each individual are based on the unique needs of the patient. Together, the doctor and patient set the dosage based on the symptoms being experienced and the results of the careful monitoring of blood levels. Depending on a patient’s specific requirements, there also may be benefit from other nutrients found in cruciferous vegetables that help the body regulate estrogen metabolites and neutralize dangerous ones. Some of these include indole-3-carbinol (I3C) at 80-160mg daily and vitamin D at 5,000 IU per day.
LOSS OF INSULIN SENSITIVITY In youth, when carbohydrates are ingested, they are efficiently utilized to produce cellular energy with a minimal amount converted to fat storage. As we age, our bodies have less sensitivity to insulin and, consequently, higher blood sugar levels and its sequelae. Even in patients who are spared and do not eventually become part of this diabetes epidemic, the constant exposure to excess glucose causes the circulation of destructive free-radicals. These molecules have been linked to everything from blood vessel damage to stroke to cancer. This is why some experts call glucose the “silent killer.” Longevity researchers and geneticists have discovered that the ideal diet is one that is low in calories and sugar while meeting all nutritional needs. The compound found in red grapes and other plants, called resveratrol, in doses of 250mg, has been shown to activate some of the same genes as caloric restriction. Luckily, there is also a number of natural substances that can safely keep our after-meal blood sugar levels in check to minimize the production of these free-radicals:
Left in the open, a freshly cut apple quickly turns brown. This happens through a process called oxidation. In our bodies, oxidation creates the unstable by-products discussed above called free radicals. Oxidative stress happens when too many free radicals exist in the body and the regenerative and repair parts of the cell are too old to neutralize the damage. They inflict enormous damage on our cells and have been associated with most diseases related to aging. Anti-oxidant supplements have become popular as a means to protect against free-radical induced cell damage; however, few people actually take the proper combination to compensate for the age-induced loss of endogenous anti-oxidants such as SOD, glutathione and catalase.
Superoxide dismutase (SOD) 500 mg Green tea extract 725 mg Grape seed extract 150 mg S-adenosyl-methionine (SAMe) 200-400 mg Pomegranate extract 500 mg R-Lipoic Acid 300-600mg
NUTRIENT TYPICAL DAILY DOSE Green tea phytosome 300 mg Green coffee bean extract 350-1,050 mg Chromium 500 mcg Cinnamon 175-350 mg Irvingia gabonensis extract 300 mg R-lipoic acid 150-300mg
So, what is YOUR game plan for aging? It is never too soon to start. It’s your life and how you manage your health is in your hands. I challenge you today to age PROACTIVELY, not REACTIVELY.
If you suffer from varicose veins, you’re a member of a very large club. Some 25 million Americans face a daily struggle with the swollen, ropey veins that can cause throbbing pain, severe swelling and heavy, tired legs. The symptoms are sometimes so insidious that patients are unaware of how advanced their disease really is.
Leg Veins, S and other uncomfortable things
By Manuel Abella, MD, FACC, FCCP
Half of all Americans over 50, and two-thirds of women over 60, have the condition. Surprisingly, many have dealt with it for decades because varicose veins can appear even in teenagers too young to vote. Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as swelling, skin changes and venous ulcers. It is estimated that in America, 72% of women and 42% of men will experience varicose veins by the time they are in their 60s. Also known as venous insufficiency, venous reflux disease is a medical condition that affects the circulation of blood in the lower extremities. The tiny valves that normally force blood back up towards the heart no longer function, causing blood to pool in the legs, and the veins of the legs become distended. Ten times more patients suffer from venous insufficiency than peripheral arterial disease in the United States and, although often mistaken as a cosmetic problem, the condition can produce a number of clinical problems for the patient. Heredity is a factor in venous reflux disease—if your parents or siblings have had varicose veins, you’re more likely to develop them—and people who are obese or have had multiple pregnancies are particularly susceptible because the extra weight adds strain to the veins. Women are more
vulnerable to the problem than men partly because the hormonal changes brought on by menstruation, menopause and hormonebased drug therapy can relax vein walls and cause venous reflux. Lifestyle, particularly physical activity, can affect the odds of developing varicose veins as well. Standing for long hours, as is common with nurses, teachers, waitresses, flight attendants and other service personnel, or regularly lifting heavy objects also increase the risk of venous disease. Venous insufficiency can significantly impact a person’s lifestyle, especially when the person’s job requires extended standing or heavy lifting. Market research indicates that over 2 million workdays are lost annually in the US and $1.4 billion is spent each year on this common medical condition. Venous reflux disease commonly produces varicose veins, the abnormally swollen and discolored superficial leg veins that affect more than 25 million Americans. Varicose veins can range from small, thin purple lines just under the skin (known as “spider veins”) to thick, bulging veins that can protrude well beyond the skin surface. In any form, varicose veins serve as indicators of venous reflux, a progressive disease that can cause significant circulatory problems as it worsens.
Venous reflux disease never goes away by itself—it’s a progressive condition that can only worsen unless treated. Fortunately, the minimally-invasive, device-based advances in medical technology, which have so profoundly impacted heart, lung and brain surgeries in recent years, are now having a similarly revolutionary impact on the treatment of varicose veins. In the absence of other symptoms, patients with cosmetic concerns due to the presence of varicose veins may be evaluated with only a physical examination. However, patients presenting with other symptoms of venous insufficiency, such as those listed below, should also undergo an in-depth evaluation, including a duplex ultrasound study:
• Leg pain, aching, tired or weak legs, • • • • •
especially after long periods of standing or sitting Varicose veins Burning or itching of the skin Swollen legs and/or swollen ankles (edema) Color and texture changes of the skin Open wounds (skin ulcers)
Varicose veins are typically found in the superficial venous system and often involve the main trunk veins—the great and small saphenous veins—as well as tributaries. They
Spiders are superficial veins that have expanded in response to increased pressure caused by incompetent or absent valves. Progressive vein dilation eventually prevents the valve cusps from closing properly, resulting in reflux. Alternatively, a lack of competent valves can also cause dilation of the vein. As one valve fails, increasing pressure is exerted on each more distal valve until it, too, becomes incompetent.
superficial vein systems. Extreme reflux and venous hypertension result in changes in the microcirculation of the skin, eventually leading to severe ulceration. Anatomic involvement at these stages generally involves the saphenous system, the perforators and the deep venous system. A smaller subset of the population has deep system-only involvement (<5%) and an even smaller portion perforator-only incompetence.
WHAT IS RADIOFREQUENCY ABLATION? Radiofrequency (RF) endovenous ablation is a minimally invasive treatment procedure for venous reflux disease, using radiofrequency to heat and seal diseased great saphenous and perforator veins and address the underlying cause of severe varicose veins. The catheter for the treatment of venous reflux delivers radiofrequency energy to a heating element to heat and contract the collagen within the vein walls and cause the shrinkage and collapse of the vessel. Although the word â€œcatheterâ€? can be intimidating, this is done in the office as a simple, fast, outpatient procedure.
Swelling of the ankles is the next progressive state of venous insufficiency and occurs as the result of increased pressure in the veins, forcing fluid into the lymphatics and tissues. This can also cause changes in skin pigmentation. Severe pain and discomfort are typical of these conditions, particularly in the lower leg (calf and ankle) where proximity of nerves exacerbates the situation. In addition to superficial involvement, these stages often include some portion of the perforating, or deep vein, systems. Venous ulcers indicate the most severe forms of venous insufficiency and typically involve both the deep (including perforators) and
The procedure involves inserting the catheter into the diseased vein through a very small incision and threading the device through the vessel up to the groin area. Radiofrequency waves are applied to the heating element in 20-second intervals to sequentially heat and ablate the vein in seven centimeter increments. After each segment is treated, the catheter is manually withdrawn down the vein and the process is repeated until the entire length of the vein has been ablated. The body automatically re-routes blood flow through healthier veins and the restoration of normal circulation relieves the distention of the surface veins. The ablated vein becomes scar tissue and is eventually absorbed by the body.
GOOD HEALTH FOR LIFE
IN THEIR 20S • A complete physical every three years • Check blood pressure every year • Screening for cancers of the thyroid, testicles, lymph nodes, mouth and skin every three years • Cholesterol test for total, LDL and HDL (the good kind) every three years • Testicular self-exam every month IN THEIR 30S, ALL OF THE ABOVE, PLUS • A complete physical every two years
Besides encouraging the men in your life to exercise, eat a high-fiber/ low-fat diet, quit smoking and do monthly self-exams, the most important step you can take is to get them into the habit of getting regular medical check-ups. Here are several health maintenance milestones recommended by leading health organizations:
IN THEIR 40S, ALL OF THE ABOVE, PLUS • A complete physical every two years • A baseline prostate-specific antigen (PSA) test and digital rectal exam (DRE) at age 40 for all men • A prostate-specific antigen (PSA) test and digital rectal exam (DRE) every year if in a high-risk group. Other men should consult with their health care provider about an annual exam. • Cancer tests every year • A stool test (for colon and rectal cancers) every year STARTING AT AGE 50, ALL OF THE ABOVE, PLUS • A sigmoidoscopy or colonoscopy (for colon cancers) every three to four years or as recommended by your health care provider • A prostate-specific antigen (PSA) and digital rectal exam (DRE) test every year Encourage the men in your life to get regular checkups and age-appropriate screenings. Regular checkups improve health and extend life! Many of the issues covered here can be difficult to talk about but it’s essential that you talk about them with the men in your life. Take seriously even the smallest symptom of any of the conditions outlined above because they could indicate a more serious—even life threatening—condition. If you don’t have a family physician or can’t afford one, look for health fairs and free screening events in your area. Ask your employer, fraternal organization or place of worship to establish a yearly health fair or screening event. Men’s Health Network can provide advice and guidance for these and other events.
Liver By S Murthy Badiga, MD, FACG
Cirrhosis is scarring of the liver caused by long-term inflammation or disease of the liver. Scar tissue replaces the normal healthy liver tissue, causing impairment of liver function and blockage of blood flow through the liver. As a result, the liver becomes leathery and nodular. A healthy liver makes proteins, helps fight infections, cleans the blood, helps digest food and stores a form of sugar that is used by the body for energy. A severely scarred, or cirrhotic, liver cannot function properly and can cause various symptoms and ill effects. One cannot live without a working liver but early treatment can control the symptoms and keep cirrhosis from getting worse.
WHAT CAUSES CIRRHOSIS? • Heavy alcohol use • Chronic hepatitis C (and less commonly B and D) • Nonalcoholic fatty liver disease, which is often caused by obesity • Auto-immune hepatitis, wherein the body’s immune system destroys the liver cells • Some drugs, medicines and harmful chemicals • Infections • Diseases that damage or destroy bile ducts (tubes that carry bile from the liver) • Some inherited diseases • Hemochromatosis: a disease that leads to iron deposition in the liver • Wilson’s disease: a condition that results in accumulation of copper in the liver WHAT ARE THE SYMPTOMS OF CIRRHOSIS?
There usually are no symptoms in early stages of cirrhosis. As cirrhosis gets worse one may develop: • Weakness and tiredness • Loss of appetite • Abdominal discomfort • Weight loss • Spider shaped blood vessels under the skin
Cirrhosis may lead to more serious problems such as: • Easy bruising because of impaired production of clotting proteins by the cirrhotic liver and • • •
• • •
decreased platelets as a result of an enlarged spleen, which is often associated with liver cirrhosis Bloating or swelling may occur due to fluid buildup in the abdomen (ascites) and legs (edema) Waste materials may build up in the blood and brain as a result of loss of “refinery function” of the liver, resulting in confusion and sleepiness (hepatic encephalopathy) Increased pressure in the veins entering the liver because the leathery cirrhotic liver does not allow normal free flow of blood through it (portal hypertension). This in turn leads to engorgement of collateral veins causing varices in the esophagus and stomach that can rupture and cause serious and life threatening bleeding resulting in vomiting of blood or blood in the bowel movement. Yellow discoloration of the skin and eyes, called jaundice, due to increased deposition of bilirubin pigment Serious itching when bile ducts are blocked A small number of patients do develop liver cancer as a complication of liver cirrhosis.
HOW IS CIRRHOSIS DIAGNOSED?
By physical examination the doctor can identify the signs of cirrhosis, which include spider veins, jaundice, protuberant abdomen, leg swelling, a certain smell on the breath called fetor hepaticus (a musty sweet odor), flapping tremor of the extremities, bulging veins that snake out from the belly button (caput medusae), enlarged liver (in later stages the liver actually shrinks in size) and enlarged spleen. Blood tests help doctors further evaluate for liver disease and determine the liver function. These may include CBC (complete blood count), blood chemistry tests, liver function tests (LFTs), test of clotting proteins such as prothrombin time (PT) and a whole host of specialized tests to zero in on various types of hepatitis and other chronic liver disorders. An elevated plasma ammonia level is associated with liver related confusion or stupor (hepatic encephalopathy) and often is measured as well. Blood tests in conjunction with examination findings allow the doctors to grade the severity of cirrhosis. Imaging tests, such as an abdominal sonogram, a CT and an MRI, are performed to evaluate the size, shape and texture of the liver, size of the spleen and to exclude tumors. Occasionally, a liver biopsy is done but, in most cases, the physical examination, blood tests and imaging studies are enough to make the diagnosis of cirrhosis.
HOW IS CIRRHOSIS TREATED?
There is no treatment that can make the scar tissue of cirrhosis go away. But, luckily, the liver does regenerate, or produce new cells, and by removing the cause or treating it, cirrhosis can be kept from getting worse, e.g., complete cessation of drinking alcohol in alcoholic liver cirrhosis, treatment of hepatitis C or auto-immune hepatitis with medicine. Treatment generally is based on the cause of the cirrhosis and symptoms the patient has. Patients with cirrhosis need to exercise caution in taking medications, including over the counter vitamins and herbal supplements, because of their ill effects on the liver as well as altered metabolism of the drugs by the cirrhotic liver. Patients with cirrhosis need to be vaccinated against hepatitis A and hepatitis B. Even though hepatitis A does not cause cirrhosis, it can damage the liver further in a cirrhosis patient. A flu shot and vaccination against pneumonia are also recommended. Avoidance of eating raw oysters and other raw shellfish is important as these can harbor bacteria that can cause serious infections in people with cirrhosis.
Imaging tests, such as an abdominal sonogram, a CT and an MRI, are performed to evaluate the size and texture of the liver, size of the spleen and to exclude tumors. TREATMENT OF COMPLICATIONS EDEMA AND ASCITES
These conditions are treated by a lowsalt diet and water pills (diuretics) like spironolactone and furosemide. If the ascites persists, one might need removal of the fluid via insertion of a small needle into the abdominal cavity in a procedure called paracentesis. Occasionally, the fluid may become infected with bacteria, a condition called spontaneous bacterial peritonitis (SBP), which can be serious, and requires antibiotic therapy.
BLEEDING FROM VARICES
Because of portal hypertension, there is engorgement of veins in the esophagus and upper stomach, resulting in varicose veins called varices, which can rupture and bleed. The bleeding is usually severe and can be fatal without prompt treatment. The variceal bleeding usually causes the patient to vomit blood or coffee ground-looking material and/or have dark stools (called melena: blood made dark by exposure to stomach acid). These patients need urgent hospitalization and require blood transfusions and medications to lower the pressure of abdominal veins. The bleeding varices are typically treated with endoscopy and the bleeding veins are tied off using rubber bands or are injected with sclerosing agents to stop the blood
flow and to obliterate the varices. If these measures fail, a shunt can be deployed in the liver connecting the portal vein and hepatic vein, thus decompressing the high pressure system. This is called TIPS, or transjugular intrahepatic portosystemic shunt, and is placed via the neck veins by specially trained radiologists. While TIPS is very effective in controlling the bleeding, it can result in elevated ammonia levels and encephalopathy because the blood flow through the shunt actually bypasses whatever little functional liver tissue that remains in the cirrhotic liver.
This condition results from the declined refining capacity of the liver or decreased ability to remove the toxins from the food before it enters general circulation. These toxins essentially short circuit the brain and cause mental confusion, increased or altered sleep pattern and sometimes frank coma. The treatment involves restricting the patient to a 70g-protein diet and giving medications like lactulose and/or Rifaximin.
If the treatment measures outlined above do not work and the cirrhosis patient develops relentless worsening of the liver function resulting in liver failure, liver transplant can be a life saving option.
AGING AND LOW TESTOSTERONE: TIME TO INTERVENE!
SALMON WITH SAFFRON-VANILLA
Aging and Low TESTOSTERONE: Time to Intervene! By Robert S. Tan, MD, MBA
Andropause affects approximately 10 million men in the United States!
ANDROPAUSE AND THE AGING PROCESS: The aging process leads to low testosterone in men. This process occurs gradually over many years resulting in hypogonadism (low testosterone). Hypogonadism in aging men is called andropause, popularly known as male menopause. Male menopause may be a misnomer as men continue with fertility beyond andropause and not all men become symptomatic with this transition, which typically appears in the fifties. TRANSITORY SYMPTOMS AND LONG-TERM EFFECTS: The transitory symptoms could include fatigue, loss of libido, memory problems and depression. The long-term effects of andropause affect all men eventually, as progression of andropause can contribute to osteoporosis (bone loss), dementia, frailty, falls, and heart and circulatory problems. Circulatory problems can contribute to erectile dysfunction. If we think about what happens to women as they age without estrogens, we will understand that andropause is truly not a figment!
INTERNATIONAL RECOGNITION IN THE MEDICAL COMMUNITY: We have not paid enough attention to this aspect of aging menâ€™s health in the United States. There is no national body to study andropause, which is a very important physiological phenomenon in aging men. Andropause is also about preventive medicine during the aging process. If andropause were
not a significant epidemiological societal issue, many countries would have left it alone. The European Menopause Society changed its name to The European Menopause & Andropause Society a few years ago. Our neighbor to the north has an active Canadian Andropause Society. There is a similar organization in the United Kingdom and Australia. Ashamedly, we do not have an American equivalent and yet andropause affects approximately 10 million men in the United States! This figure is projected based on epidemiological studies of hypogonadism in aging men. The estimates could even be higher if we include men who go under diagnosed because of lack of knowledge by doctors and patients. PUBLIC HEALTH AND COST CONSIDERATIONS: If we pay attention to the preventive health aspects of andropause, we would definitely be able to demonstrate not only improvements in quality of life but also perhaps cost savings in the long term. As it is, the Medicare budget is strained with excess utilization. Addressing andropause issues can mean decreasing osteoporosis, erectile dysfunction, circulatory, heart and memory problems in men. Preventive aspects of andropause management would include exercise, nutrition, weight management and in some cases hormonal replacement for men. Testosterone is not only about sexuality for men as hormones regulate many functions including bone, brain, heart and circulation.
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Fitness &&beauty FITNESS BEAUTY recipe
SALMON with Saffron-Vanilla INGREDIENTS • • •
4 slices of salmon, about 3 oz each Salt Pepper
SAFFRON-VANILLA SAUCE ½ Vanilla Bean 1 cup Fish Stock ¼ tsp Saffron Threads 1½ tsp Heavy Cream 5 oz Unsalted Butter
By Chef Williams V.
COOKING INSTRUCTIONS Place the slices of salmon side by side in a casserole dish and coat with a little butter. Cover the dish tightly and cook the fish for 6 to 8 minutes, depending on the thickness of the slices, on the lowest rack of an oven preheated to 300° F. Remove from the oven and let the salmon cool for a minute. Scrape the seeds from the vanilla bean into a saucepan and add the next two ingredients. Bring the stock to a simmer, then simmer until reduced to a glaze (1½ tablespoons). Add the cream and simmer for a few more seconds. Over medium heat, whisk in the butter bit by bit until you get a smooth creamy sauce. WHITE ASPARAGUS • 1 lb white asparagus • Salt to taste Gently peel the asparagus and cut off the tough ends. Cook for 6 to 8 minutes in salted boiling water. SPINACH • 1 lb large bunches of spinach • Olive oil, extra virgin • 3 cloves garlic, minced • Salt to taste Heat 2 Tbsp olive oil in a large skillet on medium high heat. Add the garlic and sauté for about 1 minute until the garlic is just beginning to brown. Add the spinach to the pan. Use a couple of spatulas to lift the spinach and turn it over in the pan so that more of it is coated with the olive oil and garlic. Do this a couple of times. After 5 minutes of cooking, the spinach should be completely wilted. Remove from heat. Drain any excess moisture from the pan. Add a little more olive oil, sprinkle with salt to taste. Serve immediately.
June 30 2014
The Stars For Life Benefit 2014 On May 7th ASAS South Florida hosted the 6th Annual STARS for LIFE BENEFIT at LMNT Gallery. ASAS South Florida celebrates and recognizes outstanding supporters of high-quality afterschool programming at the chapter’s annual STARS for LIFE BENEFIT. Special honorees included the Miami Heat’s Official DJ and Irie Foundation President DJ Irie; Agency 21 President, Allen Furst; Pediatric Neurologist Dr. Elza Vasconcellos; Fox Sports Florida’s Eric Esteban; and life-long supporters of The Marian Center School, Maria and Tom Fogarty.
JUNE 16 La Leche League of Miami Dade First of four in a series of meetings through Aug. 18 based on book “The Womanly Art of Breastfeeding.” Coral Gables Congregational Church 3010 De Soto Blvd., Coral Gables For more information, call 305-448-7421.
JUNE 27 Heart Health Screenings 9:00 am Screenings offered include blood pressure checks, glucose tests, cholesterol levels. North Shore Medical Center 1100 NW 95th St., Miami For more information, call 800-984-3434.
JUNE 17 Remember Love Share Support Group Nondenominational group for widows and widowers 40-65 who are grieving. Office of Dr. Maxine Weinstein 7241 SW 63rd Ave., South Miami For more information, call 305-666-4445.
JUNE 26 “The Tools for Brain Health Are in Your Kitchen” A research professor of neurology at the University of Arizona College of Medicine, Dr. Sabbagh teamed up with chef Beau MacMillan to write “The Alzheimer’s Prevention Cookbook: Recipes to Boost Brain Health.” Covenant Village of Florida 9201 W. Broward Blvd., Fort Lauderdale For more information, call 954-472-2860.
JUNE 21 Fight for Air Climb Miami 7:30am To support American Lung Association’s local programs Wells Fargo Center 333 SE Second St., 39th floor, Miami For more information, call 954-524-4658. Celebrate Your Soul Spa treatments, sunrise yoga, fashion and style workshops, journal writing, nutrition and fitness, self-image and self-awareness. The Betsy Hotel 1440 Ocean Dr., Miami Beach For more information, call 305-531-3934. JUNE 25 Emergency Preparedness Lecture Discussion on importance of being prepared when an emergency happens and what items and routines should be planned. North Shore Medical Center 1100 NW 95th St., Miami For more information, call 800-984-3434.
EVERY TUESDAY Team Trinity-A Running Club for All 6:15pm 5K run/1.5-mile walk on the Venetian Causeway Trinity Cathedral 464 NE 16th St., Miami For more information, call 305- 374-3372. Every 4th WEDNESDAY Parkinson’s Disease Caregiver Support Group 11:30am to 12:30pm St. Matthews Episcopal Church 7410 Sunset Dr., Miami For more information, call 305-243-2609. Every 2nd/4th Friday Dance Therapy for People with Parkinson’s Disease 1:00pm to 2:00pm Dance and have fun with the ParkOptimists Support Group. St. Matthews Episcopal Church 7410 Sunset Dr., South Miami For more information, call 305-243-2609.