The Hot Years Magazine Issue 46

HotYearsMag.com

N 46 o

Hot Flashes and Cardiac Disease

Dr. Susanne Bennett

The Kimchi Diet

Omega-3s Lower Cardiac Risk Contraception During Perimenopause

How Menopause Changes Metabolism

+ Recipe Kimchi Hot Years Exercises Hormones in 2019

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The Hot Years

No 46

TM

My Menopause Magazine

In this Issue: Dr. Susanne Bennett The Kimchi Diet

Hot Flashes and Cardiac Disease

Contraception During Perimenopause

How Menopause Changes Metabolism

Recipe Kimchi

Omega-3s Lower Cardiac Risk

When To Stop Taking Hormone Replacement

Editorial

W

elcome to Issue 46!

You’re going to love this issue of The Hot Years.

Looking for a healthy food but not sure what to eat? Our feature article is on Kimchi. You’ve probably heard that this ancient Korean food is healthy, and now you can find out why, and how to incorporate it into your diet.

You’re also going to discover the latest information about the link between hot flashes and heart disease. If you’re having a lot of them, you’ll want to read this very important new research. Are you using contraception? Maybe you should be. Find out why and how long you need to be thinking about birth control. We’ll tell you how menopause changes your metabolism and some valuable tips to help you lose weight and prevent or control diabetes.

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The last section is News from NAMS (the North American Menopause Society). In these two videos, Dr. Mache interviews two of America’s top menopause researchers. The first is Harvard Faculty JoAnn Manson who will share her latest research on who should be taking Vitamin D and how much to take to get the best protection. Emeritus Executive Director of NAMS JoAnn Pinkerton answers a very common question that everyone is asking when should you stop estrogen.

It’s easy to understand news you need to know. Enjoy this issue! If you have topics you’d like to hear more about, or a story you’d like to share, drop us a line at info@mymenopausemagazine. com. We always love hearing from you!

Yours in good health,

If you want to try kimchi, your body needs to build up to the amount you eat. The kimchi recipe in this issue explains the 4 easy steps you’ll need to follow and will also help you with weight loss, even if you eat just one tablespoon daily.

Wish you could take a break at work and get a workout? You’re going to love getting two new exercises by Zumba Gold co-founder Josie Gardiner that take only a minute each to do and so easy, you can do them at work by your desk.

Dr. Mache Seibel

Dr. Sharon Seibel

Editor

Associate Editor

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Health Benefits of

Kimchi

Koreans eat over 250 different types of kimchi. Dr. Susanne Bennett shares findings from her new book, The Kimchi Diet, and why you should be incorporating this healthy food into your daily diet.

Dr. Susanne Bennett is a holistic chiropractic physician specializing in allergies, clinical nutrition, environmental and lifestyle medicine. She is also the #1 best selling author of Mighty Mito and The 7-Day Allergy Makeover. As a fifth generation Korean herbalist and one of the country’s leading natural allergy specialists, Dr. Susanne has been promoting natural health for over twenty eight years. She is the creator of PURIGENEX Skincare line and founder of the Wellness for Life Center in Santa Monica, California. Dr. Bennett is excited to share her knowledge about the benefits of kimchi.

Susanne Bennett: I’ve been eating kimchi my whole life.

In fact, my grandmother started feeding me kimchi at four months because I had a terrible digestive system early on. Maybe it was because I wasn’t fed natural breast milk.

Koreans eat kimchi with everything. They eat kimchi on tacos, pizza and burgers

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I left Korea when I was about 12 years old and never went back until I was 50 years old. My son was graduating from high school and wanted to go to my homeland. That’s when I got really interested in kimchi.

I couldn’t believe the city that I was born in was so different. There were pizza parlors and pastry shops and burger joints like the ones that we’ve got in the United States. I was expecting to see half of the people walking around obese like we have here. But over there, barely anyone was overweight.

per low, even though they have huge servings and are really into noodles and lots of white rice.

If kimchi was going to work, I was going to put it to the test with my patients, which I did. The things that I found out were incredible.

For instance, blood sugar levels and insulin levels went down when people ate kimchi, and their insulin levels didn’t spike when they ate carbs.

Triglyceride and bad cholesterol, or LDL, levels went down. Inflammatory markers like interleukin 6 and cytokines went down. The science shows that eating lots of kimchi daily helps to lower inflammatory markers, blood sugar markers, and fat markers.

Studies have also found that kimchi extracts help protect the brain

They were thin, flat bellied, with beautiful skin and lots of energy. I’m thinking, What is going on in Korea? They literally eat the same food as we do. But I realized there was one thing different: Koreans eat kimchi with everything. They eat kimchi on tacos, pizza and burgers.

By the end of my vacation, I realized kimchi was the secret. When I got back home, I dove into learning about kimchi, and became a kimchi-ologist.

I found out that in South Korea, their obesity rate is only at about 5.8%. Su-

Studies have also found that kimchi extracts help protect the brain. Eating kimchi reduces lipid peroxidation levels (the process in which free radicals “steal” electrons from the lipids in cell membranes, resulting in cell damage). Inflammation in your body causes plaque build up in the arteries, and kimchi decreases atherosclerosis and fatty streaks.

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Kimchi is an ancient fermented superfood that’s easy to make. You don’t need any form of heat. Only ginger, garlic, brine, and the fresh vegetables that you want to ferment. You do need solar sea salt or just sea salt. With just those ingredients, you can make kimchi.

In my latest book, The Kimchi Diet, I talk about the different steps to eating the right type of kimchi because the kimchi that we’re all used to is the napa cabbage, which is a FODMAP food (Fermentable Oligosaccharides, Disaccharides, Mono-

saccharides, and Polyols). Those are short chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating. That means it has high levels of fermentable carbohydrates.

And people who’ve got hidden gut issues, SIBO (Small Intestine Bacterial Overgrowth), SIFO (Small Intestine Fungal Overgrowth) or colonic fungal infections, get a lot of gas and bloating if they start eating foods that are high in fermentable carbohydrates. It’s very uncomfortable. You can’t just go out and buy the commercial kimchi and start eating a ton of it a day or you will definitely get bloating, gas and maybe even diarrhea.

I figured out that there are four phases to begin eating kimchi. I explain them in more detail in The Kimchi Diet.

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• Phase 1: Days 1-14 Get cucumber kimchi into your diet for a couple of weeks. Start with only a tablespoon a day.

• Phase 2: Days 14-28 Begin eating one tablespoon daily of either baby bok choy, mustard greens, radish tops or beet tops. Work up to two tablespoons daily.

• Phase 3: Days 28-42 Start eating 1-2 tablespoons of either radish, daikon, turnip, or rutabaga.

• Phase 4: Days 42-56+ Eat 1-2 tablespoons of napa cabbage kimchi. Work up to eating 4 tablespoons of kimchi daily.

When you brine a vegetable, it kills all the bad bacteria, viruses, and yeast on the vegetable. And the salty medium helps lactic acid bacteria flourish. Eating just one gram of kimchi, the equivalent of a pretty large sized capsule, gives you a minimum of 1 billion CFUs (colony forming units) of good bacteria.

That’s a lot of healthy great probiotic.

Eating just one gram of kimchi gives you a minimum of 1 billion CFUs (colony forming units) of good bacteria

I was concerned about the amount of salt, so I did some research on kimchi and high blood pressure. The studies show that there’s high levels of potassium balancing out the salt. There was absolutely no blood pressure change in people when they ate kimchi, and it doesn’t cause fluid retention.

Korean stores are called H Mart everywhere and you can get the best kimchi there. But there is one Korean kimchi now available at Costco called Chongga. It is good tasting, but it does have seafood in it. There is no MSG in it,

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and no preservatives. If you go to a regular Korean store, you will see a lot with MSG. And they add sugar because sugar is food for the good bacteria. So having sugar in the kimchi is not a bad thing.

I treat a lot of gut disorders and SIBO. When I implement kimchi into their lives, they only eat one tablespoon a day. If they are very sensitive to spicy food, I tell them to keep the medium strength Korean red pepper out and only make the non-spicy version.

If you’re interested in kimchi and eating kimchi, I’d like to invite you to my kimchi diet Facebook group. When you go there you can get a free copy of my guidebook and learn about my kimchi detox program, which includes 40 videos that go with the book as a supplement to teach you exactly what to do. If you’re a woman going through menopause, the information will help you with constipation, sleep, anxiety, and osteoporosis.

Menopause Quiz:

Your personal menopause assessment

Find out how much your menopause symptoms impact your health, your happiness and your life.

Visit MenopauseQuiz.com to take the free Menopause Quiz.

It only takes a minute, then watch your email for your results and some suggestions on next steps to support you.

Your menopause mentor, Mache Seibel, MD

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Hot Flashes

My Menopause Magazine

May

Signal Heart Disease

Recent research has uncovered an association between the amount of hot flashes and heart disease

Dr. Rebecca Thurston, President of the North American Menopause Society and Professor of Psychiatry, Psychology, and Epidemiology at the University of Pittsburgh, discusses findings from an interdisciplinary research program she leads focusing on cardiovascular risk and midlife women’s health.

Dr. Mache Seibel: Your recent study has gotten a lot of interest lately because you have data that suggests hot flashes may be much more than a nuisance.

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Dr. Thurston: We’ve been doing research for a long time looking at the relationship between vasomotor symptoms (hot flashes) and women’s cardiovascular health. We wondered if hot flashes are just an incidental midlife symptom, or do they tell us about the health of our vasculature at midlife?

Most of the work that we’ve done has been looking at the relationship between vasomotor symptoms and car-

We want to empower women to understand that hot flashes are potentially an indicator of their cardiovascular disease health diovascular disease risk factors such as blood pressure, diabetes, hypertension, or what we call subclinical cardiovascular disease.

But in this study, we looked at the relationship between vasomotor symptoms over the course of the entire menopause transition. To do that, we followed women for 22 years from the time that they were between the ages of 42 to 52 well into their 60 plus

years. And we’ve been able to determine whether women who are reporting a lot of vasomotor symptoms when they enter the study, or persistently over the course of this study, were at increased risk for clinical cardiovascular disease.

Dr. Mache: So you’re asking if hot flashes can increase the risk of heart attack, stroke, heart failure, cardiovascular disease and mortality.

Dr. Thurston: Yes. What we call hard clinical endpoints. And what we really care about as clinicians are these heart attacks and strokes. In this large study of 3,300 women called the Study of Women’s Health Across the Nation or SWAN Study, women with more frequent hot flashes when they entered the study and very early in the menopause transition, or women who had vasomotor symptoms over the course of the study for long periods of time, were at increased risk for cardiovascular disease events down the road.

Dr. Mache: How many hot flashes is a lot?

Dr. Thurston: Well, we asked relatively crude questions about hot flashes. We just asked women how many days in the past two weeks have you had hot flashes? And we categorized it as no days, one to five

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days in the past two weeks, and six or more days in the prior two weeks.

So this is really every other day. It’s really not all that frequent if you think about it. So those women having hot flashes six or more days in the prior two weeks were at increased risk for cardiovascular disease events down the road. And this was not explained by blood pressure, diabetes, hypertension, lipids, smoking, et cetera.

risk because women don’t have those until they’re well into their sixties and seventies. Another study presented at the conference found a link between a childhood history of sexual, physical or emotional abuse and hot flash frequency in mid-life. More work has to be done in this area.

Dr. Mache: So at present, it’s really not how many you get an hour, but how many days a week?

Dr. Thurston: I will say this one thing upfront. We do not know whether treating the hot flashes will improve women’s cardiovascular health. It may be true, but we don’t know that it is. That is research we have yet to do. It needs to be done.

Dr. Thurston: We don’t know that level of granularity. Is it how many you get a day? Is it globally? What we think from these data is that women with more frequent hot flashes are at increased risk for heart disease. Our next follow-up studies really need to measure these hot flashes in more fine grained ways. In my laboratory, I hook women up to monitors and we measure their hot flashes during the day and night.

And our studies show that those women’s cardiovascular health looks worse. But we need to do these kinds of large longitudinal studies over the course of 22 years. That is the kind of data we need to really get this relationship between the hot flashes and the actual heart attacks and strokes

Dr. Mache: If you’re a woman with hot flashes, what’s the take away?

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Women with more frequent hot flashes when they entered the study and very early in the menopause transition, or women who had vasomotor symptoms over the course of the study for long periods of time, were at increased risk for cardiovascular disease events down the road So what I tell women at this point, the last thing we want to do is frighten you.

This is not what we’re trying to do here.

weight or obese, which is many of us at midlife, this is the time to start losing some weight.

Dr. Mache: You’ve got me scared.

Get serious about your health. If you have high blood pressure, take your medications. A lot of people don’t. If you have diabetes, make sure you get that treated. This is really just a wake up call to take care of your mental health as well as physical health. This is the time to do it.

Dr. Thurston: Right. This is really not what we want to do with this information. We want to empower women to understand that hot flashes are potentially an indicator of their cardiovascular disease health. So if you’re a smoker, stop smoking. If you’re over-

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Contraception & Perimenopause

Women in perimenopause can still become pregnant. Here are some of the options to help you avoid a surprise pregnancy as you approach menopause.

Amanda Black, MD, FRCSC is a Professor of Obstetrics and Gynecology at the University of Ottawa in Canada. Dr. Black has been involved in a number of educational initiatives in the area of contraception.

Dr. Mache Seibel: Menopause is the time you think you’re through with preg-

nancy, but leading up to it, what should women be thinking about contraception?

Dr. Black: Leading up to the actual time of menopause, women have to remember that they’re still at risk of an unintended pregnancy if they’re sexually active. But there’s often a lower self-perceived risk of pregnancy, and certainly fertility declines with increasing age, but pregnancy can still happen. So you want to protect yourself against that if you don’t want to become pregnant. It’s important that women have that

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conversation with their healthcare proSo, we need to ensure that women are viders to determine what sort of opstill using condoms if they’re at risk of tions are suitable for them, and look a sexually transmitted infection. at what options they Dr. Mache: My unwant to use in the derstanding is in that context of their own there’s an increased group of women, needs. risk of chlamydia, those diseases are gonorrhea, herpes, actually on the rise.

Dr. Mache: What’s the value of condoms HIV, and genital warts for women even if in women in the older Dr. Black: That’s correct. There are they’re on a contrareproductive ages. ceptive, like an oral increased rates of So, we need to ensure those sexually transcontraceptive? that women are still mitted infections Dr. Black: One among women in using condoms if mistake we somethe older reproducthey’re at risk times make as tive age groups. healthcare providers Dr. Mache: You commented that is to forget to talk to women about some women in perimenopause the whole issue of condom use and would rather be on hormone replaceprotection against sexually transmitment therapy (HRT) than a contracepted infections (STIs). In the older retive pill of some sort or contraception, productive age group, women may per se. Because of the risk of pregbe entering into new relationships, nancy, you commented that one was and they are at risk of STIs. And we better than the other. know from studies that condom use tends to decrease in the older reproDr. Black: It’s not so much that one is ductive age women. better than the other. You need to use We think maybe it’s not really relevant contraception until menopause is dianymore once contraception is no lonagnosed because menopause is often ger needed. But, in fact, studies have a retrospective diagnosis. You look shown that in many countries there’s back and you say, okay, you haven’t an increased risk of chlamydia, gonorhad a menses for a year, so you meet rhea, herpes, HIV, and genital warts in the criteria for menopause. But up until women in the older reproductive ages. the time you’ve made that diagnosis,

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you still need to be using an effective method of contraception.

Some types of contraceptives can be used not just for contraception, but also as an adjunct to post-menopause HRT. For example, a levo-

I think it’s important that women realize that they are at risk of an unintended pregnancy even in the later reproductive years norgestrel intrauterine system can be used - that’s an IUD with a type of progesterone attached.

A hormonal IUD is a very effective method of contraception. But for five years, it can also be used as the progestin part of your HRT. Dr. Mache: So to be clear, HRT may not keep you from getting pregnant so you should use a contraceptive and not HRT in perimenopause to play it safe. And the second part was if you want to avoid using an oral progesterone or progestin when you reach menopause, you could use

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an IUD with progesterone or progestin in it as your progestin and add estrogen to it as your hormone therapy.

Dr. Black: Exactly. I think it’s important that women realize that they are at risk of an unintended pregnancy even in the later reproductive years. But as we get older, sometimes there’s some health risks that develop or some other conditions that may develop. So we need to look at our contraceptive needs across our lifespan, and what might be good for us when we’re 20 may not be good for us when we’re 35 or may not be good for us when we’re 48. So it’s important that we regularly reassess our contraceptive needs throughout the reproductive ages so that we can ensure we get the best fit for us and also to make sure that we’re safe in what we’re using.

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How Menopause

Changes Metabolism

Menopause is a time of changing metabolism, and that has an effect on a woman’s body and her ability to control her weight.

R

asa Kazlauskai, MD, MSc, FACE is an endocrinologist, Associate Professor of Internal Medicine and Director of Diabetes Technology at Rush University Medical Center. She is a co-investigator on the Study of Women’s Health Across the Nation, a multisite longitudinal cohort study of the menopausal transition.

Dr. Mache: First of all, what do you mean by metabolic when you’re talking about women’s health and menopause?

Dr. Rasa Kazlauskai: Metabolism is commonly used to refer specifically to the breakdown of food and its transformation into energy. And how we produce building blocks for the cells to function and survive.

From the perspective of medicine and clinical medicine, when we talk about metabolic health, we typically have in mind metabolic syndrome, which is defined by three out of five of the following standard criteria: • Abdominal obesity • High blood pressure • Low good cholesterol • High triglycerides, and • Fasting glucose over 100 Dr. Mache: And if you have three out of five of those it defines metabolic syndrome. But you pointed out that what we eat has so much to do with our long term health, and I wonder if you could talk about which kinds of foods to get more of and which kinds to get less of.

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By age 65, nearly 40% of US men and women will have diabetes that we change our lifestyle, not just go on a diet.

Dr. Kazlauskai: Absolutely. When people approach me about improving their metabolic health and preventing chronic disease, they typically look at their weight and they mention that they want to lose a couple of pounds. And when I ask them how they’re going to do that, most of them say, “I’m going to do more exercise.” But the reality is that 80% of the benefit comes from nutrition, from what kinds of foods we eat and how much of those foods we eat.

What we eat and how we eat depends both on our brain, and on our digestive system. And there is a very tight and close connection between the brain and digestive system. When we’re trying to prevent chronic disease or control chronic disease, it’s very important

The issue is that when we are on diets, we depend on willpower. But eventually we get willpower fatigue, and then we fall off the bandwagon and stop. My most successful patients actually look into how the foods they choose affect their health and then modify their patterns of eating, dependent on what they need for their health.

I deal a lot with diabetes, and an interesting factoid is that by age 65, nearly 40% of US men and women will have diabetes. That means that we work so that 40% of us could afford all the money to control diabetes after age 65 when we retire.

Dr. Mache: Could you share some of the impacts of diabetes that some people may not be aware of?

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Dr. Kazlauskai: I talked about diabetes and metabolic syndrome.

Diabetes in general affects the metabolism of all organs and systems. It’s not just about glucose levels. It’s also about our brain function, our cognitive function, and by that I mean how fast we catch cues in conversations, not only how it affects the memory.

Diabetes also affects heart health, not only causing bad plumbing in the heart, meaning the clogged blood vessels, but it’s also heart muscle strength and how the heart fills up with blood, which is what the cardiologists often refer to as diastolic function and diastolic dysfunction.

Dr. Mache: So diabetes affects how good a pump your heart is.

Dr. Kazlauskai: Yes. But diabetes also affects how thick the heart muscle is. The thickness of the heart muscle

can be an impediment because that might actually decrease the chamber size and the blood might not be pumped as effectively because it doesn’t fill up with the blood effectively enough.

Diabetes and metabolic syndrome is also associated with fatty liver.

The liver is our detoxification factory. When the liver becomes fatty that means the factory is not working at full strength.

Diabetes affects the kidneys, affects all the blood vessels, including the blood vessels in the eyes and the blood vessels in the legs.

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Diabetes also affects our mood in terms of depression and anxiety, and it affects our social life tremendously.

A lot of my patients who have diabetes, if the diabetes is not controlled, feel fatigued. But they don’t realize it’s because of diabetes. And when we get the diabetes under control, one of the things that they get surprised by is realizing how tired they were until their diabetes got under control.

Dr. Mache: How does diabetes affect menopause or how does menopause affect diabetes?

Dr. Kazlauskai: There is no straightforward relationship between diabetes and menopause, but there is actually quite impressive evidence about how metabolic syndrome progresses through late premenopause and perimenopause. Most of the harm of diabetes is done before the final menstrual period, so that means in the late premenopause, before

Most of the harm of diabetes is done before the final menstrual period, so that means in the late premenopause, before women go into menopausal transition

women go into menopausal transition. And that’s why it’s important to get our health together earlier.

In the United States, the preventive health examination is encouraged at age 65 by the time we enter the Medicare age. In Europe, for example, Sweden and Denmark, people are supposed to undergo their first mandatory preventative visit at age 40. That’s when we enter midlife, and that’s what I wish would happen in the United States. That would help us prevent metabolic health consequences that are related to metabolic syndrome and eventually diabetes.

Dr. Mache: One of the really interesting things you discussed was the impact of drinking alcohol. Could you comment about alcohol’s effect on fat, etc.

Dr. Kazlauskai: You will see a lot written in the media that moderate alcohol drinking is associated with overall better longevity and better health. From the weight perspective, alcohol is a weight loss kryptonite. When we get a drink of straight alcohol, our fat burning is reduced by 87% for the next four hours. If we have a margarita, which is sugar with alcohol, fat burning is reduced to zero for the first 90 minutes.

So if we are trying to lose weight, alcohol prevents us from using our fat for fuel, and sabotages our fat loss.

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Dr. Mache: When you think about it, when you go to the gas station, they often have a type of sugar put into the alcohol which the car uses for fuel.

And what you are saying is that if we drink alcohol, we’re going to be burning the alcohol instead of our food.

Dr. Kazlauskai: Precisely. Alcohol both adds calories, and also prevents us from mobilizing our own fat to be eliminated. And to your readers, where do you think fat goes when we lose weight? How do we get those triglycerides out of our body into the environment?

Some people would say that it gets eliminated with urine, sweat, and stools. But that’s not really true. When we mobilize the fat out of our fat stores, out of our insulation, the fat actually has to go inside the cell and

Alcohol is a weight loss kryptonite. When we get a drink of straight alcohol, our fat burning is reduced by 87% for the next four hours we use oxygen to burn the fat into carbon dioxide and a little bit of water.

So for each 10 pounds of fat we lose, we are supposed to eliminate about eight pounds of carbon dioxide. And how do we eliminate that? We have to exhale it. So when people wonder why the fat loss and weight loss is so tedious, it’s because we have to exhale all that fat.

Dr. Mache: Maybe that’s where the exercise comes in. We may be actually exhaling the byproducts of our labors as carbon dioxide.

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Dr. Kazlauskai: Certainly the exercise helps as long as we don’t eat after exercise, because when we’re exercising, we primarily use glucose as a fuel for energy. And when we exercise long enough, we start using the fat. So after exercise, if we just drink water and then go to sleep, that is a perfect recipe for optimizing your fat loss, because in the first half of the sleep, we predominantly use fatty acids; during the wee hours around wake-up, we switch back to glucose. So that’s why eating late is not really a good thing from a metabolic perspective and for long term health.

Dr. Mache: Other than alcohol, are there other foods that people should avoid?

Dr. Kazlauskai: People should avoid very highly processed and concentrated foods. Chugging in sugar through juices and sodas would be the total no-no from the metabolic and from the chronic disease prevention perspective.

Dr. Kazlauskai: A lot of times my patients are surprised when I tell them from a diabetes perspective and from a metabolic perspective, Cheerios is not such a great thing. If you look at the Cheerios ingredients, one of the principle ingredients is corn starch or any starch which makes the Cheerios crispy, and that is actually equivalent to sugar even though it doesn’t

We get fermentable fiber from vegetables like beans and legumes, and from the husk of unrefined grains like whole rice, whole rye or whole wheat taste like sugar. But it’s actually multiple glucose molecules in the refined product added to Cheerios, and that raise blood glucose quite fast in people with a propensity to developing impaired glucose and diabetes.

Dr. Mache: Are there foods that people should really try to be eating if they’re trying to control their weight and metabolism and their diabetes for that matter?

Dr. Kazlauskai: Absolutely. Soluble and insoluble fiber, which may help to keep us regular. Soluble fiber, like fiber in oatmeal, might help very much with heart health. However, there is also another type of fiber which is called fermentable fiber and that fiber actually helps to keep our gut bacteria happy. The average person has approximately three kilograms of bacteria, and interestingly enough, 95% of the cells in human body aren’t of human origin. It’s just that they’re 100 times smaller than human cells and

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that’s why we have a larger human body mass than microbial mass.

Fermentable fiber helps to keep the good bacteria happy, so it’s called a prebiotic. We get fermentable fiber from vegetables like beans and legumes, and from the husk of unrefined grains like whole rice, whole rye or whole wheat.

Dr. Mache: So not the minute rice.

Dr. Kazlauskai: Right. Not refined products. In general, if someone is trying to lose weight, when they’re thinking about what they’re going to eat, they have to think, “What am I going to eat for vegetables? What I’m going to eat for protein?” Because the vegetables and protein provide the weight and volume of the food and that can help to maximize satiety from smaller portions. We use healthy fats and a little bit of carbohydrates to make that food tastier.

Dr. Mache: And you said that when people reach menopause that they gain fat and lose protein in the form of muscle.

As women increase their body fat, they also lose lean muscle mass, and bone mass

Dr. Kazlauskai: We all knew that women tend to lose bone mass as they go through the menopause transition.

However, recent data from the SWAN (Study of Women’s health Across the Nation) study that I’m an investigator on, has shown that as women increase their body fat, they also lose lean muscle mass, and bone mass.

And what’s even more important is that women gain fat at an accelerated rate on the way to the menopause, to their final menstrual period. We would be more effective at weight control if our brain would allow us to restrict food. But our brain actually tells us that we’re supposed to eat and we’re supposed to eat highly palatable foods to soothe ourselves and to make ourselves happy. So we tend to gain fat mass at the expense of lean mass of muscle and bone.

When we enter the menopausal transition, we are really just a spring chicken. Our bodies are programmed to live to about 120 years. So if we think that our reproductive years are approximately 20 to 30 years, women could have another 50 to 60 years to live without estrogen. So it’s very important to plan how healthy we are going to be during those years and what we’re going to do to prevent debilitating illnesses, and to maintain our physical and mental health.

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Cucumber (Oi) Kimchi Ingredients

8 to 10 seedless, waxless Kirby (pickling), Persian or Lebanese cucumbers or 6 long Korean or English (hot house) cucumbers 2 tablespoons coarse solar sea salt

Kimchi Paste Ingredients 1 medium carrot, thinly sliced into matchsticks 1-1 ½ inches in length or shred with a grater if short on time 1 cup daikon, thinly sliced into matchsticks 1–1 ½ inches in length 1 cup garlic (Buchu) or common chives, chopped into ½ – ¾ inch pieces 2 teaspoons minced garlic 1 teaspoon grated ginger ½ cup grated Asian pear, Fuji apple or ½ cup rice porridge 2 teaspoons anchovy fish sauce (optional) ½ cup Korean red pepper powder* (reduce the amount for a less spicy kimchi) 1 tablespoon purified water

*If you’re sensitive to spicy foods, then red pepper powder can be omitted in all kimchi recipes, but you’ll have to adjust the initial time of fermentation at room temperature by shortening a couple of hours and eat it before it over-ripens. Red pepper powder slows down the fermentation and ripening process, so you’ll need to adjust accordingly. If you don’t want to add red pepper or any seafood, then you’ll need to make the brined vegetable a bit saltier before adding the sub-ingredient kimchi paste.

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Instructions Brining time: 1 hour 1. Wash the cucumbers and drain.

2. Cut off the ends of each cucumber and chop them into 2–3 inch pieces.

If you use Kirby’s, cut them in half, or if you have longer cucumbers, cut them into 3 pieces, around 3 inches in length each.

3. Place a cucumber piece on the end on the cutting board and cut them

down through the diameter of the cucumber vertically (lengthwise), leaving ½ inch on the bottom of each cucumber piece uncut. Then turn 90 degree angle and perpendicularly cut through the diameter, again without cutting through completely, making an “X”. This will make each 3-inch cucumber piece into a 4-petal floret, leaving room to add the kimchi paste after the brining.

4. Add the cucumber florets into a large glass or ceramic bowl and sprinkle the coarse sea salt on the inside

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and outside of each floret evenly. Cover the bowl and let it brine for an hour away from sunlight. After 30 minutes, you’ll notice some “sweat” water in the bottom of the bowl. Toss the cucumber florets a couple of times, then let them brine for the final 30 minutes.

Prepare the kimchi paste ingredients by chopping, mincing and grating the sub-ingredients.

5. After brining, the cucumber should be flexible and you’ll be able to bend them easily without snapping them in half. Add the brined cucumber florets to a strainer (discard the brined salty

liquid) and quickly dip into a large bowl of fresh water once, to take the excess salt and any debris off. Drain in a colander for 10 minutes while you make the kimchi paste.

Kimchi Tip: If you plan on adding anchovy fish sauce to your kimchi paste, quickly dip the cucumber twice in the bowl of water. Try not to submerge the brined cucumber too long. Otherwise too much of the salt will be drawn out of the brined vegetables and optimal fermentation process may be affected. This “double dip” rinse applies only when you add fish sauce or shrimp paste to your recipe.

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Kimchi Paste 1. In a large glass or ceramic bowl, add the garlic, ginger, grated pear, and red pepper flakes. Wear disposable food preparation gloves to prevent the red pepper from irritating your skin and mix the ingredients into a paste. Add the carrots, chives and daikon to the paste and mix well.

2. Stuff each cucumber floret with the chive/carrot kimchi paste. Set each stuffed floret aside in the bowl as you stuff the next floret. Don’t worry if the florets break apart, it will still taste great!

3. Rub extra kimchi paste on the outside of the cucumber florets.

Kimchi Tip: It’s better to have extra paste rather than not enough, make more if you have to!

Storage and Temperature Regulation 1. I like to bottle a few jars per recipe, so that while you’re eating out of one jar, the others can continue their fermentation process without being disturbed. The other bottles will be untouched, bubbling with carbonation until you are ready to eat them. Fill the jar with the florets and when you’ve filled the jar half full, push the florets down with a wooden spoon to bring up the oxygen bubbles to surface. This will help prevent yeast growth. Contin-

ue to fill to the top and push as many oxygen bubbles out as possible.

Pushing down on the cucumber florets also excretes more water. This extra juice submerges the cucumber florets, which keeps the oxygen away from the vegetables and helps prevent yeast growth. Don’t worry if you still see bubbles. As it ferments, more water will be released and the bubbles will come up to the surface.

Finally, add one tablespoon of purified water to any leftover kimchi paste in the bowl, and distribute it evenly in each bottle before covering with a lid.

You can add parchment paper to the top of the jar and close the lid over it.

If by any chance there’s an overflow, the kimchi will not touch the plastic or metal lid. Parchment paper also helps keep the lid on tight.

2. Don’t fill the jar completely. Leave some room at the top—about 1 inch from the top of the rim. As fermentation occurs, carbon dioxide gases will build up produced by the LAB, and more water will sweat out from the cucumbers, so the level of liquid and kimchi will rise up to the top. If you fill the jar up all the way, there’s a chance the kimchi will overflow.

Finally, put a dish or bowl under the container to catch any excess juice

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that may leach out during the first couple of days of fermentation. Leave the container out at room temperature (68–72 degrees Fahrenheit) away from the sun for one or two days. There is a very small possibility of cracking in your glass container. To prevent any problems, after a couple of days of fermentation, “burp” the kimchi bottle by turning the lid slowly and letting the gas out, just as you would with a bottle of carbonated water. Do this over the sink. You may be surprised by the carbon dioxide action!

3. Refrigerate between 3–5 °C (37–41 °F) and slip a dish under to catch any possible overflow.

4. Consume as directed in Phase 1 of The Kimchi Diet™.

Note: I like to taste the fermented kimchi just before I transfer it to the refrigerator.

First, I want to see how good the kimchi tastes. I’m looking for a slightly salty, sweet, tangy and savory taste.

Second, the flavor also tells me the speed of fermentation, which will govern how quickly I need to eat it before it over ripens. If I feel it needs to ferment a bit longer, I’ll keep it out at room temperature for another 6–8 hours. The speed of fermentation all

depends on the amount of salt used during the brining process, as well as the temperature of the ambient environment where the jars will be stored during the initial fermentation process.

In the winter, kimchi will ferment slower.

In the summer months, it will ferment faster. The saltier the kimchi, the slower it ferments. And finally, if you use red pepper powder, then the kimchi will ferment slower as well. These are all nuances you’ll learn as you make your kimchi from season to season.

What I love about cucumber kimchi is that it can be eaten fresh as soon as it’s been prepared. This also allows anyone who’s had a lot of digestive issues to introduce kimchi slowly into their diet without any strong reactions, and to gradually build up a healthier microbiome. With each day of fermentation, the LAB grows exponentially in the kimchi, and as you eat small amounts daily, you’ll reap the benefits of it—and in no time you’ll be transforming your inflamed, weak dysbiotic gut into one with a robust, diverse and balanced microbiome!

Cucumber kimchi is to be eaten within two weeks, but save the juice! It’s still loaded with probiotics and postbiotics (LAB metabolites). You can have a couple of teaspoons a day to continue your journey towards vibrant health.

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Hot Years Exercises My Menopause Magazine

Z

umba Gold co-creator Josie Gardiner shares two easy-to-do exercises for the workplace. They take only a minute each and can be done throughout the day at your desk or elsewhere to keep your body fit and fabulous. Share these videos with your co-workers and turn work into a workplace!

Click Here to find out more about Josie’s books and videos.

EXERCISE VIDEO 1: Simple stretches to relieve your posture after sitting at the computer

EXERCISE VIDEO 2: Desk Exercises to Work Your Upper Body

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Omega-3s Lower Cardiac Risk My Menopause Magazine

A new study reveals that omega-3s lower the risk of heart attack.

Read on to discover who benefits the most.

I

n a large, randomized trial of over 25,000 US men 50 years of age, and women age 55 or older, investigators looked at the effects of taking one gram (1,000mg) a day of omega-3 fish oils. There are three types of omega-3 fatty acids: ALA, EPA and DHA. The study capsules contained both EPA/DHA with a ratio of about 1.3 to 1, which is very similar to preparations you can get in overthe-counter supplements.

According to Dr. JoAnn Manson, Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital and Harvard Medical School and the study’s lead investigator, the omega 3s used were a prescription product known as Omacor in Europe, and Lovaza in the United States. The trial lasted 5.3 years on average.

“We looked at the effects of this omega-3 fish oil supplement on the risk of

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developing cardiovascular disease and cancer in a generally healthy population without a history of these conditions,” Dr. Manson explained. “Overall, we saw no statistically significant reduction with taking the omega-3s in total cardiovascular events or cancer.

However, we did find that some subgroups really benefited.”

The risk of heart attack was reduced by 28%, which was statistically significant. “We also saw a reduction in death from heart attack and from certain types of procedures such as angioplasty, stent kinds of procedures, and total coronary events, but we saw no reduction in stroke and no significant reduction in the primary endpoint of combined heart disease and stroke,” Dr. Manson explained.

There appears to be heart health benefits of taking omega 3s among people who eat less than one and a half servings of fish per week But, what was most interesting was that there appears to be heart health benefits of taking omega 3s among people who eat less than one and a half servings of fish per week. Those people had significant, clear benefits from the omega-3 supplements - a 19% reduction in the primary endpoint of combined cardiovascular events and a 40% reduction in heart attack.

Dr. Manson also said that, “African Americans had particularly large reductions in heart attack by taking omega-3s regardless of whether they had high or low intake of fish. The study, reported in the New England Journal of Medicine, found no reduction in cancer from taking omega-3s.

“There were definitely promising findings for a reduction in heart disease in those with low fish consumption and among African Americans. So, we’re recommending that people who don’t eat fish increase fish consumption to at least two serv-

There appears to be heart health benefits of taking omega 3s among people who eat less than one and a half servings of fish per week ings per week because if you increase fish, you not only get the omega-3s but you’re less likely to be eating red meat, refined foods and processed foods. But many people don’t eat fish. Under those circumstances, a fish oil supplement can be helpful. If they’re vegetarian, there are algae based omega-3 supplements that will give you the EPA/DHA.”

So, if you’re not going to be eating fish, or if you’re African American whether or not you eat fish and you have other risk factors for cardiovascular disease, talk with your healthcare provider about whether you would be an appropriate candidate for taking a fish oil supplement.

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Stop Taking Hormone Replacement

My Menopause Magazine

When To

If you’re taking hormones and aren’t sure how long to take them, or when to stop them, the answers are just below.

D

r. JoAnn Pinkerton, Professor of Obstetrics and Gynecology at the University of Virginia and the Emeritus Director of the North American Menopause Society spoke with Dr. Seibel about a dilemma facing many women in menopause.

Dr. Mache: Women face two difficult decisions: the first is whether or not to take estrogen and when to start it, and the other that doesn’t get talked about as much is when to stop it. I wonder if you could speak to the second one?

JoAnn Pinkerton, MD: In 2002 when the Women’s Health Initiative (WHI) study came out, the FDA suggested that women take the lowest dose

for the shortest period of time, and that turned into a recommendation of three to five years.

Well, in reality, hot flashes often go much longer than that. And so many women don’t want to stop, or if they do stop, they immediately want to go back on because they have persistent hot flashes.

So the next mantra was, well, you need to stop by 60. The truth is, there’s actually no data that says at 60 you have to stop your hormones, or even at 65.

Dr. Mache: I know 8% of women are going to have hot flashes well beyond age 60 or 65.

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8% of women are going to have hot flashes well beyond age 60 or 65

Dr. Pinkerton: In 2012 the American Geriatric Society made a recommendation that women over 65 should not take hormone therapy because of safety issues. And therefore we have to fight with the insurance company every time we want to extend it. However, as you said, 8% of women still have hot flashes. They may be taking them to prevent bone loss. They don’t want to take some of the other bone specific medications, or for quality of life, or women who work feel like they

can concentrate better or sleep better if they’re on hormone therapy.

So for women who want to think about staying on longer, we consider their health risks, because they go up as women age - there’s more risk of heart disease, blood clots, dementia, and strokes. So with aging, the questions we have to ask are what are your risks, and how do we minimize them. That’s how we determine if you’re a good candidate for hor-

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mone therapy. So for women who want to continue, we recommend lower doses, transdermal (through the skin) and really the very lowest dose that allows you to function, but keep your hormone therapy going. And then we reevaluate every year to see if you have new health risks, if we have new information, or if there are better types of medications to take.

necessary, and it’s possible to continue taking hormones for a percentage of women on an individualized basis.

Dr. Pinkerton: We call it extended duration. If your doctor says at 60 you have to stop hormone therapy and you stop it and you are miserable, find a menopause specialist. Go to www.menopause.org. Look us up by zip code. Find one of us, and we’ll try to individually help determine what’s safe or best for you.

If your doctor says at 60 you have to stop hormone therapy and you stop it and you are miserable, find a menopause specialist

Dr. Mache: So stay in touch with your doctor every year. Make adjustments if

The Hot Years Musing

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Blossom Where

You’re Planted

My Menopause Magazine

Mache Seibel, MD

Click Here to hear this Musing

I

recently spoke with a colleague of mine I hadn’t seen in a while. She seemed to be in particularly good spirits and so I asked her what she did to maintain her mood.

I always follow my mother’s advice.

She taught me these 5 things:

forever. But to tell the truth, she is very unpleasant to be around. After a few hours of listening to her I feel miserable. So, now I spend very little time with her and not very often. My other friends and I have a lot of fun together and I’m a lot happier.

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4

2

5

“Life is for living.” My glass is always half full. When I work, I work hard. But I also make sure I take time to relax and have fun. For instance, I came to this meeting to learn some new things. But I always make time to see some of the city and enjoy some of what’s here. I always try to live my life.

“I don’t hold any grudges.” Along the way, there have been times people have done things to me that really got me upset. At first, I was angry with them. But after a while, I realized that my anger wasn’t helping me and it wasn’t hurting them. So, I let go of the anger. It takes a lot less energy, so I have more energy to enjoy my life.

3

“You become who your friends are.” I hang out with people I enjoy. I have a friend I’ve known

“Laugh till you pee.” My mother told me that children laugh over 300 times a day and adults laugh about 17 times a day. So I try to increase my laugh quota. I watch more comedy, hang out with people who are funny, and look for the humor in everything I do. I think the kids got it right.

“Blossom where you are planted.” In my life I’ve done a lot of different things and lived in a lot of different places. But I learned that if I do my best, work hard, make friends wherever I am, good things happen.

Just like those trees that grow along the highway out of the rocks, I blossom wherever I’m planted.

Sounds like your head is in a good place, I told her.

It is, she said. I learned a lot from my mama.

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When I asked for a smoking hot body, menopause was not what I had in mind!

Anonymous CLICK HERE to hear Are You My Brother, from From my Gospel Roots CD, written by Dr. Mache and piano performed by Ben Schwendener. You can find this song and other health songs at www.HealthRock.Bandcamp.com.

Every effort has been made to ensure that the information contained in this magazine is complete and accurate. However, neither the publisher nor the author(s) is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this magazine are educational and not intended as a substitute for consulting with your physician. All matters regarding health require medical supervision. Neither the authors nor the publisher shall be liable or responsible for any loss, injury, or damage allegedly arising from any information or suggestion in this magazine. The opinions expressed in this magazine represent personal views of the author(s) and are not a substitute for medical care.

All content in this magazine is Copyright Š HealthRock, LLC

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