Tag Archives: Diana Bitner

The power of community

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A social group can provide much-needed support and a sense of connectedness during menopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause can often cause feelings of loneliness.


Women don’t always want to talk about their difficult moments and, sometimes, they may even think they’re somehow to blame for how they feel.


As a result, too many women suffer in silence.


Midlife and menopause can be a confusing time as women deal with common experiences such as night sweats, anxiety, weight gain and low sex drive.


About 80% of women have symptoms that lower their quality of life and affect their work and relationships with family and friends. It can disrupt a woman’s sense of normalcy.


As Laura, a nurse practitioner I work with, says: “Menopause is normal, but suffering is not.”

Happy and connected

One of the highlights of summer in West Michigan is the Coast Guard Festival in Grand Haven, Michigan.


This big event reminds me of the power of community.


I grew up in Grand Haven and I’ve always loved how the week-long Coast Guard activities bring so many people home to experience the downtown streets, all bustling with families and friends out walking and enjoying the events.


It’s a time for reconnecting to people and place.


Being intentional about maintaining close ties with family and friends doesn’t just feel good—it’s a practice that helps us cope when times are hard.


Researchers have conducted studies to understand why some people cope with change and hardship better than others. One of the things they’ve found is that people who do three things in particular cope better than others:

  • They believe they deserve to be happy.
  • They keep a support network around them.
  • They ask for help when they need it.

Menopause is a time to reach out to others for help, just as you would with health issues like PMS or postpartum depression.


You must get the support you need.


Many women turn to the Midlife, Menopause & Sexual Health team to help them find solutions for the symptoms of menopause.


Our patients say they don’t feel embarrassed about their questions when they come to us. They know we will provide answers about why something is happening to them.


Most importantly, we give them options that will help them feel better.


We become a woman’s support network, which in itself starts a chain reaction in which we’re able to help others—one woman will come see us, then tell her friends and family about us. Soon, we’re seeing her whole group.


And that group becomes the support network for each other, too, as they discover they can understand and help each other.

A friend in need

One of our patients experiencing menopause—I’ll call her Janine—had felt like many women, in that she felt alone.


She felt embarrassed about her hot flashes and she did everything she could to keep people from noticing.


The anxiety about the possibility of having a hot flash, however, would only make a hot flash come on.


Night sweats kept her up at night. She grew more and more anxious and stressed. Out of the blue she experience some bleeding.


When her husband mentioned something about not having sex anymore, she felt really bad.


She’d been afraid that her pulling away would make her husband mad, or lead to something even worse.


But she just didn’t feel like herself. And she didn’t know what to do.


She felt alone, without answers.


Thankfully, Janine has a good friend—a friend who got frustrated at her for canceling dates to get together.


Her friend, Sue, showed up at her home one day and said, “I am not leaving without us talking.”


By the end of the conversation, Janine knew she was not alone in her symptoms of menopause.


There was hope.


As it turns out, Sue had been in to see us at the Midlife, Menopause & Sexual Health clinic. She chose to take hormones and she had been following our SEEDS program.


She was now drinking plenty of water, she’d given up sugar, she had quiet time each day and she walked every morning.


She had found a support group and got help when she needed it—and then she shared that info with her friend.


That connection could change Janine’s life.


Whether you’re in Grand Haven or in your own hometown this summer, take a minute to be grateful for beautiful communities. Be grateful for supportive family and friends.


When you have problems, reach out to them and ask for help.


Whatever group you turn to for help—a book club, a wine club, women at the hair salon, the church, the YMCA—recognize that it’s possible for other women to feel the same way you do. It’s OK to ask for help.


Reprinted with permission from Spectrum Health Beat.



Too young for a heart attack?

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Women too often ignore the signs of heart troubles and don’t take care with their cardiac health. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Heart disease can seem so distant, so unreal, and something you don’t have to worry about.


Unfortunately, it is very real, especially for women.


There’s no time like the present to start assessing your own goals on how you want to age and how you can enjoy better heart health. Where do you stand on meeting your goals? If having a heart attack is not something you want to experience, you need to act now.


Having a health goal is important and also the key to staying healthy as you age.


Making health changes such as exercising daily, changing eating habits, and practicing stress-reduction techniques can be challenging, especially if you don’t start with a clear goal.


When my patients say, “I can’t believe you are asking me if I want a heart attack; of course I don’t want a heart attack,” I show them how their actions speak louder than their words. By choosing not to exercise, eating high-sugar foods and allowing stress to rule their lives, they are actually choosing a heart attack.


The good news is that it’s never too late to get healthy, but the sooner the better.


A patient I’ll call Adrienne is living proof that heart disease can affect just about anyone.


At age 39, she suffered a heart attack—way too young—or so she thought. Adrienne was going through a very stressful time in her life and was having shortness of breath occasionally.


Adrienne thought being winded had to do with the stress she was experiencing or maybe because she was tired and had not been eating well. She would simply rest until she felt better and forget about the feeling until it would happen again. Adrienne never even considered she might be having a heart attack.


However, one day the feeling came back and persisted for a long time. When she received some especially bad news, her breathing became very labored, and she knew something wasn’t quite right. She mentioned her symptoms to her husband, and he insisted they go to the ER immediately. Just minutes after arriving at the ER, Adrienne had a full-blown heart attack.


Fortunately for Adrienne, the ER staff took her symptoms seriously. She is alive today thanks to the prompt and expert care she received that day.


Not everyone is as lucky as Adrienne.

More women die of first heart attacks

Many women don’t get help quickly enough or they are not taken seriously when they go for help. But the facts don’t lie: More women than men die from their first heart attack and more women than men have fatal heart attacks.


As Adrienne went through cardiac catheterization, open heart surgery and cardiac rehab, she learned she had risk factors for a very long time, but never realized it. As a result, she never received the preventive treatment needed to prevent a heart attack, and she wasn’t aware of the early symptoms.


Adrienne’s shortness of breath and fatigue had been going on for more than a month, but she never knew the severity of her condition.


Adrienne began to learn more about her health and important risk factors of heart attacks. These include family history, cholesterol levels, blood sugar levels, high blood pressure, obesity, smoking, diet, high stress, inactivity, inflammation (which can be caused by diet and the presence of heart disease), and age.


In addition, activity and increased stress level can affect your risk of having a heart attack. Adrienne had risk factors she never knew she had.


Unfortunately, Adrienne’s story isn’t unique.


Too many women either don’t know the warning signs of a heart attack or ignore them because they don’t want to bother anyone.

Know the symptoms

It’s important that we know the signs and symptoms of a heart attack, especially because they are different in women than men.


Men tend to experience a heaviness, like an elephant, on their chest. They also notice a true pain in their chest that radiates to the left arm and up the neck.


Women tend to have more subtle signs. The most common symptoms for women are progressive shortness of breath on exertion or with great stress, unexplained fatigue, nausea, subtle chest heaviness, neck pain, or arm pain.


I have had patients who dismissed some of their symptoms as jaw pain from TMJ or simply sleeping funny. I have even seen patients who presented with new onset hot flashes years after menopause. After sending them to a cardiologist, they find out they have angina and they ended up with heart surgery instead of hormones.


Risk scores also help physicians predict your chances of having a heart attack in the next year, and even in the next 10 years. My favorite scoring system is the Reynold’s Score, and it can be done at home by going online to reynoldsriskscore.org.


You will need to know your family history, total cholesterol level, HDL cholesterol level, systolic blood pressure (number on top), and C-Reacting Protein (CRP) level. You will also be asked if you smoke, which is a significant cause of heart attacks.


Other tests used to assess risk include an ultrasound of the artery in your neck to determine your risk of stroke, and a CT scan of the chest to look for calcium in the artery walls.


When you have symptoms, it is important to have two tests performed: an EKG to see if your heart is suffering low oxygen from blockages, and a stress test with an ultrasound of the heart (ECHO). If you are experiencing symptoms such as chest heaviness or shortness of breath, you will want to go to the ER or call 911.


In our clinic, we use risk scores, including the Reynolds Score, to score for Metabolic syndrome. This syndrome is a strong predictor of experiencing a heart attack or stroke.


If a woman comes to us for hormone therapy and also has Metabolic syndrome or is at high risk for a heart attack, we will not prescribe hormone replacement therapy as it would put her at greater risk for a heart attack. However, if she is at low risk and does not have Metabolic syndrome, hormone replacement therapy can actually lower her risk of having a heart attack or stroke.


In the not-so-distant past, it was common for women to go to the ER with chest pain and shortness of breath, only to be told it was heartburn or an anxiety attack. It was even thought that women couldn’t have heart disease.


Fortunately, health care experts now take this issue seriously, and we are very aware that heart disease affects both men and women.


We wish that every woman knew her risk factors and made healthy choices to avoid suffering a heart attack. Too many women (and their families) suffer an unnecessary loss. Take control before it happens to you.


Reprinted with permission from Spectrum Health Beat.


Cope with the ‘perfect storm’ of menopause

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A healthy diet is the best way to lose pounds during menopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause is often referred to as a “perfect storm” where all the odd changes and symptoms women experience collide.


This collision creates insulin resistance resulting in increased belly fat.


At the Spectrum Health Medical Group Midlife and Menopause Clinic, we have an entire team to help women with menopause symptoms, including weight gain.


One of our team members, Irene Franowicz, is a registered dietician who practices what she preaches. She encourages healthy eating and cooking and she teaches others how to prepare healthy foods in her weight management program, Eating the Mediterranean Way with Low Glycemic Carbohydrates.


Even better, Irene demonstrates techniques to counteract the effects of aging and menopause.


Right before and during menopause, one of the most common complaints women experience is weight gain. Many of my patients say, “I am doing the same things with my diet and activity level, but I keep gaining weight.”


One of my patients—we’ll call her Sarah—has experiencing this. At age 49, Sarah struggled to stop gaining weight. She knew she already had a bit of a weight problem, and at age 45 she noticed it was becoming more difficult to lose weight.


Busy juggling family and work, Sarah would often eat on the run as she and her family headed out the door to soccer games, school events and other functions. She exercised when she could, but it wasn’t enough. To make matters worse, when Sarah was 48 years old, she broke her foot and couldn’t move around for five weeks.


Unfortunately, she gained 15 pounds during that time.


Sarah knew her risk of gaining even more weight was high, because she had two strikes against her: she had diabetes when she was pregnant and diabetes ran in her family.


When her periods became very sporadic and she started having hot flashes, she came to see us in the Midlife and Menopause Clinic. From this visit, Sarah learned she was in perimenopause and smack dab in the middle of a perfect storm.

Modify meals

Sarah came to the right place for answers.


We helped her understand that her low estrogen was making her metabolism worse by making her more insulin-resistant. As a result, her body was storing every calorie it could.


No wonder she continued to gain weight. She was trying very hard to make some positive changes, including getting more sleep, drinking more water and exercising more regularly. Sarah still needed more help with her diet, so we sent her to Irene’s class at Spectrum Health.


Irene centers her teaching on the Mediterranean diet because it is low glycemic, meaning it’s low in simple sugar.


Irene’s real passion is working with women in perimenopause and menopause and teaching them how to eat in a way to overcome weight gain. Her low glycemic meal plans are carbohydrate-controlled and high in antioxidants. She created the Mediterranean diet program to help the thousands of women who come to her and say, “I can’t seem to lose weight any more, even though I am eating the same.”


In her classes, Irene offers ideas for meal plans, plus recipes for breakfast, lunch, dinner and snacks. Each week, the participants sample delicious recipes and leave with a list for grocery shopping.


Irene has seen great success in women who have adopted her Mediterranean diet program and she enjoys teaching how dietary modifications can reverse the metabolism. It’s simple—even with small weight loss, sugar levels drop.


After seeing me and then talking to Irene, Sarah was thrilled to learn we’re all teaching the same concepts.


She started preparing meals in advance and making healthy, tasty snacks for her entire family. Before too long, Sarah had lost 9 pounds and her sugar level dropped while her energy level went up—she was overjoyed.


Instead of feeling like her life was on the downslide, Sarah now envisioned a much brighter future for herself. She even considered joining Irene’s strength training and yoga classes, something she never thought she could do.


Using a team approach to health care, Irene and I often refer patients to each other. When Irene sees women struggling with hormone issues, she refers them to us in the Midlife and Menopause Clinic and we also send patients to Irene’s classes. We share our skills to provide a wide net of support to as many women as possible.


Reprinted with permission from Spectrum Health Beat.



The benefits of being physically fit

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A single goal can change an entire lifestyle. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


The doctors at Spectrum Health Medical Group and in our OB/Gyn practice are always encouraging our patients to be physically active.


The benefits of living an active lifestyle include keeping your cholesterol, blood sugar and weight under control; preventing cancer, type 2 diabetes and heart attacks; and improving your sleep.


Even better, regular physical activity also reduces falls, joint pain and depression. It helps you feel better about yourself.


Fitness is something that can be measured and improved, and it starts with having a goal.


When I talk to my patients about fitness and goals, I am always reminded of a patient I’ll call Cathy.

Cathy aims to get ‘hot’

While rushing from one room to another in my office one day, I came around a corner too quickly. I almost ran into a woman I didn’t know, so I excused myself.


She stopped me and said, “You don’t recognize me, do you?” I confessed that I wasn’t sure who she was, and she said, “Then you probably don’t remember what you said to me last year, either?” Again, I admitted that I did not. She continued, “You asked me how I wanted to be in the next year when I turned 50, and I had to really think about it. I decided I wanted to turn 50 and feel ‘hot’. So, I decided I would do what it would take, and I just ran my first half marathon. Now I feel ‘hot’!”


We stood there in the hallway for a few minutes and talked about her transformation, and hers was such a great story of how a single goal could change an entire lifestyle.


Cathy’s story began about a year before our chance encounter in the hallway of my office. She had come in for her annual exam, and she was discouraged about her weight and overall fitness level. She left my office that day approximately 25 pounds over a healthy weight, had belly fat she didn’t like, and wore clothes two sizes larger than she wanted.


Like many women, Cathy had a very busy work life, and she barely had time for anything besides work and family. It seemed that after a long work day, her evenings were filled with preparing dinner, packing lunches and helping her kids with homework.


Cathy would try to take a walk on the weekends, but she didn’t have time to exercise regularly, and she got winded just walking up a flight of stairs. She didn’t do any strength training, wasn’t flexible and often complained of leg cramps.


And the list of bad habits went on, including:

  • Drinking too much coffee and not drinking enough water
  • Eating on the run
  • Eating very few fruits and vegetables other than an occasional salad for lunch

Cathy knew that she wanted to look “hot,” but she also knew she had a lot of planning and work to do if she was going to become the person she envisioned in her mind.


During her annual visit, I mentioned the Presidential Fitness Test (adultfitnesstest.org) as a way to find a general measure of how she compared to other women her same age. She looked it up, saw what she was up against, and created a goal to help her on her journey to better health.

Achieving her goal

Cathy’s goal: She wanted to be fit. More specifically, she wanted to be able to run at least three miles, be physically stronger and more flexible. She knew she would not only feel better about her appearance but also be stronger as she faced her next 50 years of life. Her goal kept her motivated when it would have been much easier to give up.


Of course, there were barriers that Cathy knew she would need to overcome—time, motivation, energy and knowledge. During her visit, we talked about starting small so she wouldn’t get discouraged and give up.


She took my advice and started taking walks whenever she had even a little free time—at lunch, after work (before making dinner), and after dinner. Cathy began doing sit-ups and push-ups in the morning before her shower, and stretching every night before bed.


As the weeks and months went on and she had increased energy, Cathy added more to her routine. Her walks turned into a walk/run combination, eventually running more than walking. She started with just 15-20 minutes of exercise at one time but gradually increased the time as she became stronger.


One thing that really helped Cathy stay positive was to measure her exercise by time instead of distance or speed. This proved to be very beneficial to Cathy and helped her keep working toward her goal.


It also helped that Cathy’s husband and kids supported her efforts to become more physically fit. Her husband would take walks with her at night after dinner, and her son rode bikes with her on the weekends. She even found herself wanting to go for a walk instead of grabbing coffee with a girlfriend.


Cathy’s hard work and persistence began to pay off. At that point, she had dropped one pant size, her belly fat started to decrease, and she no longer had leg cramps. More importantly, Cathy’s blood pressure improved, her cholesterol decreased, and her blood sugar made it to the normal range.


As Cathy’s activity level increased, her numbers continued to go down. She was encouraged to keep on her journey, and by the time I saw her, she had run a half marathon, gone down three pant sizes, and lost 35 pounds.


She said she’d never felt better in her life. Although it took almost a year, Cathy met her goal and turned 50 feeling “hot.”


Reprinted with permission from Spectrum Health Beat.


Women: Don’t suffer in silence

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A new study of pre-menopausal and menopausal women has helped shed light on how every woman experiences menopause differently, and what treatments are most effective. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Every woman experiences menopause in her own unique way with a variety of symptoms.


She may suffer from hot flashes, night sweats, mood swings, weight gain, fatigue and a sense of not feeling right. Some of these symptoms may sound familiar to you—possibly all of them.


I’ve seen several patients recently who each complained of different issues related to menopause.


A woman I’ll call Peg had to stop wearing silk shirts to work because she sweat through each one. Another patient, Sue, became embarrassed in meetings because her face becomes very red when she makes presentations to her peers. Cindy felt depressed that even though everything in her life was great, she had a sadness she just couldn’t shake. And then there’s Gloria, who expressed frustration with weight gain she recently began experiencing.


The four women felt betrayed by their bodies.


Fortunately, I had some encouraging information to share with each of these patients, thanks to a comprehensive women’s health study called the SWAN study.


The Study of Women Across the Nation (SWAN) is an ongoing study that follows women between ages 42 and 52 in order to understand how they will experience the menopause transition. There are seven SWAN sites across the nation: Boston, Chicago, Detroit, Los Angeles, Newark, Pittsburgh and Oakland.


Each woman receives a physical exam that includes measuring her height, weight, waist circumference, blood pressure and lab work levels. The study also records whether or not she smokes, how much alcohol she consumes, her education status and family history. Race/ethnicity is categorized as African American, non-Hispanic Caucasian, Chinese, Japanese or Hispanic.


The results of the SWAN study are interesting and have helped doctors understand why each woman’s menopause experience is unique.


For example, the study showed that women who became at higher risk for heart disease—increased cholesterol, belly fat and blood sugar levels—tended to fall in the following categories: Hispanic or Japanese, less physically active, less likely to be highly educated, and most had higher BMI and cholesterol levels before the study began. Pre-diabetes was found to be a very high risk factor across all ethnic groups.


Another study done in Pittsburgh evaluated Caucasian and African-American participants at risk of depression. Twenty percent to 30 percent of participating women had new onset depression between the ages of 42 and 52.


The women in the study had an average age of 46, and 31 percent were African American. In addition, 34 percent had a family history of depression. The women who had a family history of depression proved to be more likely to be highly educated and have experienced at least one episode of depression.


The SWAN study has also taught doctors so many other important facts about women in menopause:

  • Hot flashes are different for each woman.
  • Women of color experience hot flashes for the longest period of time (average of 10 years).
  • Women of Asian descent have hot flashes for the shortest period of time, but they suffer more with depression and irritability.
  • Hispanic women suffer from hot flashes an average of 8.9 years.
  • Caucasian women experience hot flashes an average of 6.5 years.
  • The earlier women start having hot flashes, the longer they last.

There are so many other fascinating findings that have occurred as a result of this ongoing study, but the bottom line is that women do not have to suffer the symptoms of menopause.


There is help for you and plenty of research to back up the findings. Strong, scientific research is being done to help us know what works best and determine the safest method for treating menopause symptoms.


I recommend being active, drinking plenty of water, maintaining a healthy weight, staying off the sugar, and being grateful in your life daily. These are simple but very powerful tools used to combat the symptoms of menopause.


In addition, there are FDA-approved hormones that may help those who need them. They are a safe option for many women.


If you think you may benefit from this type of treatment, ask your doctor, or come see us at the Spectrum Health Menopause offices. If we discover that hormones are not safe for you, there are many other options to try.


Reprinted with permission from Spectrum Health Beat.



Get the dish on aging well

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Mediterranean food that’s full of vegetables, extra virgin olive oil, and fish tend to reduce insulin resistance. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


The best way to get through midlife and menopause is to know the tricks.


One of the tricks for healthy aging is to eat the Mediterranean way. This way of cooking and eating is healthy, tasty, satisfying and good for staying on a budget.


Mediterranean cooking includes whole grains, lean protein such as seafood and chicken, extra-virgin olive oil and lots of veggies.


For flavor and health benefits, the recipes use lemons, lots of garlic, and spices such as oregano, dill and parsley.


There are so many options to consider, and my favorite cookbook for Mediterranean cooking is Live to Eat by Michael Psilakis.


He organizes everything by key items to keep on hand: Greek yogurt for sauces and dips, garden-fresh veggies and fruits, peppers, onions, roasted cherry tomatoes, tomato sauce and garlic confit. From these items, healthy meals are a snap.


Mediterranean cooking has been proven to reduce risk of heart disease, stroke and type 2 diabetes.


Insulin resistance is the common denominator for all these issues, which combined are the cause of death for a third of women.


Insulin resistance is when the blood sugar stays higher longer after consuming food—and especially higher after consuming simple carbs such as white flour pasta, white bread, white rice, alcohol or treats.


When blood sugar stays high, it can damage tissue and cause higher levels of insulin, which increase cravings for sugar, as well as promote storage of sugar into belly fat.


One of the other things sugar does is make blood vessel linings sticky, which allows fat to adhere to them, increasing the risk of a blockage.


The bottom line, a diet high in foods made with simple carbs cause preventable disease.


Learning how to cook the Mediterranean way can save lives.


Reprinted with permission from Spectrum Health Beat.


Do you know the risk factors for breast cancer?

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By Diana Bitner, MD, Spectrum Health Beat


Many women come into the ER with chest pain, and they never thought they would be in that situation. But most heart attacks are preventable, and we need to be more active in telling women what they can do to avoid a heart attack.


The same is true with breast cancer—the more we know about preventing breast cancer, the more women we can help avoid being diagnosed with the disease.


Although breast cancer is far too common, breast cancer survival is improving due to more advanced treatments and early screening for women at high risk.


Do you know your risk, and do you have a plan for when you should be screened? If I asked you if you want to get breast cancer, of course you would answer with an emphatic, “No!” If you don’t want cancer, then you must know your risks, live a lifestyle that decreases your risk, and take your checkups seriously.


Several years ago, I read a story about a young woman who had metastatic breast cancer, and the article described her situation in detail.


There was a picture that showed her being comforted by her sister, who also had breast cancer five years earlier. Both women talked about their mother who had died of the same disease in her mid-40s.


As I read the story, I felt both sad and mad at the same time. Of course, I felt sad for them for all they had gone through, but I was also mad to think their cancer could have been prevented, or at least detected before it spread.


Here’s what I wish they would have known about the genetics of breast cancer:

  • Ten percent of breast cancer is associated with family history.
  • The risk of getting breast cancer increases two times if one first-degree relative has/had breast cancer.
  • The risk of getting breast cancer increases three times if two first-degree relatives have/had breast cancer.

In addition, 50 percent of breast cancer diagnoses are associated with known risk factors.


A patient I’ll call Kelly came to see me for a routine visit recently. In taking her history, several factors caught my attention: she was 48 years old and had never been pregnant; her mom had been diagnosed with breast cancer at 49; and she had regular mammograms that were always negative, but her breasts were very dense, decreasing the likelihood of diagnosis of a small cancer.


I recommended advanced screening with a special mammogram and ultrasound by a breast surgeon.


When she had the testing done, they detected several suspicious areas, and a biopsy showed pre-cancer. Kelly decided to have definitive surgery, and when she had a bilateral mastectomy, they detected early, almost-invasive cancer.


We were able to avoid invasive cancer by doing three things: 1) being proactive; 2) knowing her individual risk factors; and 3) acting early to save her from worrying about recurrence, and having to go through chemotherapy or radiation.


The lifetime risk of breast cancer for most women is 1 in 8. The risk at age 30 is 1 in 250 and increases as you get older. Other risk factors include being female, white and obese (having a BMI over 30). The risk is even greater if the weight is gained after the age of 40 and is in the form of belly fat (especially after menopause). In addition, your risk is greatest if you are diabetic and overweight.


So, what can you do to lower your risk of breast cancer? For starters, lifestyle matters:

  • Women who consume 10 or more alcoholic drinks per week have a higher risk for cancer of the colon and breast.
  • Women who started smoking early and have smoked for a long time are at higher risk.
  • Women who breastfed their children and are physically active have a lower risk.

Two other risk factors that may not be in your control include the following:

  • Women who work the night shift seem to experience more cancer, according to several large studies.
  • Women who received radiation for Hodgkins Lymphoma as a child have an increased risk of breast cancer.

If you have any of these high risk factors, get screening early and talk to your doctor about special screening with a Tomo mammogram or adding an ultrasound to your routine mammogram.


I had a patient who put off her mammogram because she had small breasts and thought she would easily be able to see any lumps, plus she had no family history of breast cancer. When her friend finally convinced her to get a mammogram, it showed she had breast cancer.


I’ve given you plenty of statistics and information about breast cancer in this blog, but there are a few takeaway points I want to make sure you remember:

  • Know your individual risk factors.
  • If you are at higher risk, talk to your doctor about special testing.
  • Be active! Exercise a minimum of 150 minutes per week.
  • Do not gain weight over 40—stay off the sugar.
  • Don’t drink more than ten drinks a week.
  • Don’t be afraid of mammograms—get tested!

Reprinted with permission from Spectrum Health Beat.



Prevent human papilloma virus—get vaccinated

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Children should get the HPV vaccine between the ages of 11 and 12, to ensure it is most effective. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


School is back in session, and if your child has had his or her annual checkup, their doctor might have talked to you about the importance of kids and adults obtaining the human papillomavirus (HPV) vaccine.


The HPV vaccine can prevent genital warts and penile cancer in men; cancer of the cervix, vagina and vulva in women; and anal and throat cancer in both men and women.


The HPV vaccine keeps the body from becoming a carrier even if a person is exposed to the virus through sexual contact.


A patient of mine I’ll call Deb recently went through some fairly intense testing to rule out cervical cancer, and it was very stressful for her.


She came to see me for her annual exam and Pap smear, and she had experienced abnormal Paps in the past. She even had to have a colposcopy to make sure she didn’t have cervical cancer. Fortunately, Deb did not have cancer, but she wanted to make sure her kids wouldn’t have to endure the same procedures and worries she endured.


I recommended the HPV vaccine to give her some reassurance for her children.


The HPV vaccine is available in three different brands, each covering two, four or nine different types of the virus. The vaccine is given in three doses within a 24-week period. It can be given to both boys and girls and it has been shown to be safe and effective for females and males between the ages of 11 and 29.


The vaccine can also be given even if the person already has the HPV virus, because it can protect against other types of viruses as well. The optimal range for girls and boys to receive the first shot is between the ages of 11 and 12, because the immune response is better the earlier it is given. In addition, whether or not we like to think about it, kids often have sex before we suspect they do.


In countries where vaccines are more mandated, the HPV vaccine rate is approximately 80 percent. In the U.S. the rate is 54 percent for the first shot and only 33 percent for all three shots. The higher the rate of vaccination, the fewer the women who will develop cervical cancer.


Bottom line: Get your kids vaccinated.


So, why is our vaccination rate so low compared to other countries? In a survey, parents gave the following reasons for choosing not to get their kids vaccinated against HPV:

  • They think the vaccine is unnecessary.
  • They think the vaccine is ineffective.
  • They think the vaccine is unsafe.
  • They don’t understand the details of the HPV vaccine.
  • They don’t think their children would have sex that young.

Health care providers know the vaccine is safe, effective and necessary—and they know that parents need to learn more about the vaccine and appreciate the reality that some children will have sex at a young age. There is excellent information available to support the decision to vaccinate kids early.


I am happy that Deb trusted me and was willing to consider the vaccine to reduce her daughter’s chance of having abnormal Pap smears in the future.


Even if the shot has been given, it is still important to screen for HPV and abnormal cells on the cervix. Pap smears should be started at age 21 and performed every three years after that.


I follow the recommended guidelines to start co-testing of the Pap and HPV at age 30; if the results are negative, repeat the test every three years. If there are abnormal cells present, the next step is to do a colposcopy, where we look at the cervix with a telescope and take a biopsy of the cervix.


Of course, there are several other ways to prevent the HPV virus, and I told Deb to give the following advice to her children:

  • Do not smoke.
  • Use a condom every time.
  • Delay sex until after age 15.

Deb appreciated the information I shared with her and scheduled appointments for her kids to get their vaccines during their checkups.


As a gynecologist who has had to perform hysterectomies on many women because of cervical cancer, I’m very happy that Deb made the choice to have her kids vaccinated.


Reprinted with permission from Spectrum Health Beat.



An ounce of prevention goes a long way

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Courtesy Spectrum Health Beat

By Diana Bitner, MD, Spectrum Health Beat


Many of my patients come to see me about symptoms and health issues they are experiencing, but I make it a point to help them recognize when they are at risk for something they don’t yet have.


This is especially true if they have increased risk factors for specific diseases or various health problems. There are changes they can make to help prevent these issues.


One of my patients, who I’ll call Judy, was faced with some life-changing decisions she needed to make, so we sat down and talked about what was happening in her life.


Judy’s mom had recently been diagnosed with end-stage endometrial cancer, and Judy wanted to know how she could shape her own future to be different from her mom’s. We first looked at Judy’s current health and how she was handling perimenopause.


For the most part, she was taking her perimenopausal symptoms in stride, but she struggled with weight gain (especially around her middle) and she was a smoker. She was afraid to quit smoking, fearing that she would gain even more weight.


As with all of my menopause patients, we discussed what she wanted her Picture of Self to look like at a specific point in her future and what she had planned to help her achieve her goals.


Before we discussed the changes Judy could make, we talked about some of the well-defined risk factors of endometrial cancer that she can control.


Excess estrogen increases the risk of endometrial cancer because it induces the lining of the uterus (endometrium) to grow. When this growth occurs unchecked, there is a risk of abnormal or cancerous development. Progesterone acts as a natural balance by stabilizing the endometrium and keeping it from growing out of control.


Excess estrogen can occur for two reasons: the levels can increase naturally during perimenopause, or there may be too much “unopposed” estrogen if you take estrogen-containing medications without balancing them with progesterone.


Low-dose combination oral contraceptives and appropriate doses of hormone therapy can help prevent endometrial cancer by controlling the level of circulating hormones and thus the growth of the lining of the uterus. Progesterone-releasing IUDs also help control the growth of the endometrium and decrease the likelihood of abnormal growth.


Finally, Judy and I discussed some lifestyle habits that can make a significant impact on her risk of developing endometrial cancer.


Smoking increases the risk of developing many cancers—another great reason to quit! Weight loss can help to decrease the risk, because estrogen, like many hormones, is stored long-term in body fat. Therefore, decreasing the body fat reduces the excess estrogen in your body. Other healthy changes you can make include increasing your physical activity, and eating a diet low in saturated fats and high in ruits and vegetables.


After talking with Judy, she was much more optimistic about her future. She has a clear understanding of her specific risk factors, specifically her smoking and central obesity. She has also regained a sense of control, and by making healthy choices, she is continuing to work toward her goals.


Reprinted with permission from Spectrum Health Beat.



Five questions to ask your health care provider

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Courtesy Spectrum Health Beat

By Diana Bitner, MD, Spectrum Health Beat


Even if your yearly physical isn’t scheduled for several months, there are questions you should ask your doctor, physician assistant, or nurse practitioner during your appointment.

Here are five questions you should ask at your checkup:

1. What is my risk for a heart attack?


It’s important to know what factors are in your control and which ones are out of your control when it comes to your risk for a heart attack. I recently saw a patient for her annual exam and she told me she had experienced a scare with chest pain since her last yearly physical.


A visit to the ER revealed a problem with her gallbladder instead of a heart issue. She knew she had high cholesterol and her weight put her at risk for heart disease, but she wasn’t too concerned about her numbers. After her recent scare with chest pain, she began to care a great deal more. So, she asked me what she needed to do to keep her risk as low as possible.


First we looked at her family history. Her father had experienced a heart attack but not until age 72, and her mom was healthy, with no heart disease. She didn’t have pre-eclampsia during pregnancy and had not experienced gestational diabetes. All of this showed that the things she could not change were in her favor—good news!


Next, we looked at things she could change: cholesterol (overall 240—high), triglycerides (180—high), HgA1C level used to test for diabetes (5.7 percent—borderline high), CRP level (2.5—indicates an average risk for heart disease), waist circumference (39—very high), and blood pressure (142/89—high).


The reality was that the factors she could control were increasing her risk of heart disease. In addition, her health habits could be improved. She walked three days a week but didn’t do any strength training, and her diet was mostly meat and potatoes with a salad thrown in once in a while.


So, together, we mapped out a plan to include some dietary changes and add at least two Zumba classes each week, plus water aerobics on the weekend. She also promised to buy the book Sugar Busters to help her learn about healthy versus unhealthy sugars.


2. What is my risk for breast cancer?


We use a scale called the Gail Model to measure breast cancer risk. It includes your family history, your age when you started your period, whether or not you have been pregnant, whether you ever had breast biopsies, and how old you were with your first pregnancy.


Other risk factors we study include your alcohol intake, Body Mass Index (BMI), and current activity level. I recently had a patient who had a significant risk of developing breast cancer based on the following factors: her sister had breast cancer, she had early onset of periods, and she had chosen to not have children. She made an appointment at the high-risk breast clinic and made the personal choice to have a mastectomy. The results revealed extensive DCIS (Ductal Carcinoma In Situ), which indicates pre-cancer in many women.


For this patient, understanding her risk saved her life and early treatment allowed her to continue taking hormones. Even if your risk of developing breast cancer is low, it’s important to talk to your physician about the risks and follow the guidelines suggested for mammograms. If it’s time, get it done.


3. What is my risk for osteoporosis?


Bone health starts early—in the womb, to be exact.


Our bones begin to be formed based on the amount of Vitamin D and Calcium our mothers take when they are pregnant. After we are born, our bone health depends on our diet and activity level. By age 32 our bone mass reaches its peak, and we experience overall loss the rest of our lives.


Our bones are constantly being remodeled. Over time, breakdown occurs more rapidly than buildup. During menopause, if there is no estrogen replacement, the bone loss accelerates to a rate that increases the risk of fracture.


Several factors can make us lose bone even faster than normal aging: smoking, inactivity, consuming large amounts of soda water or pop, drinking more than two alcoholic beverages per day, hyperthyroidism, and conditions such as rheumatoid arthritis.


Long-term use of birth control hormones such as Depo, as well as taking drugs used to fight breast cancer, can also increase bone fragility. Of course, there are medications to improve bone strength, but the most important way to prevent fracture is to live a healthy lifestyle and eat a balanced diet.


4. What is my risk for colon cancer?


Colon cancer is very common, and the strongest risk factor is aging. Everyone needs a screening colonoscopy at age 50, but some of us need it sooner. If you have a family member who has had large colon polyps or colon cancer before 50, you are at high risk of having the same. Ask your doctor about early screening if you fit into this category.


Also, if you are experiencing persistent, unexplained symptoms such as lower pelvic or abdominal pain, a persistent change in bowel habits (lasting more than two weeks) or blood in your stool, you might need a colonoscopy to see what is causing these issues.


You can reduce your risk by living a healthy lifestyle: consuming less than two alcoholic drinks a day; eating a maximum of two servings of red meat per week; eating a high fiber diet; and exercising at least five days per week. Remember—a colonoscopy is much less stressful than colon cancer. If it’s time, get it done.


5. What immunizations do I need?


There are several immunizations that are recommended, and I encourage you to discuss these with your healthcare provider:

  • A flu shot before winter arrives.
  • The Hepatitis A and Meningococcus vaccines if you are heading off to college soon.
  • The Gardasil vaccine if you are under 29 and have not had this series yet.
  • The Gardasil vaccine if you are newly single, over 29, and HPV negative.
  • The Tdap (including Pertussis) once in your lifetime.
  • A Td (tetanus) vaccine every 10 years.
  • The Shingles vaccine at age 60.
  • The Pneumococcal vaccine at age 65.

Be sure to ask your doctor to look at your immunizations record and confirm that you are up to date on all of these.


The bottom line is that it is your responsibility to maintain your health and keep a journal or record of your health history. As you send your kids off to school each year, use that time as a reminder to pull out your book and make sure you are on track.


Reprinted with permission from Spectrum Health Beat.


Start your day the green way

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The best part of waking up? A fresh smoothie packed full of nutritious goodness. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Good medicine is about getting back to the basics and leading a healthy lifestyle. And there’s no better way to do this than to start your day with a healthy meal.


I know this can be difficult some days, especially if you are in a hurry. If you are like me, you are lucky to get out the door on time to get to work, school, exercise class, or an early-morning meeting.


I want to help you be prepared for whatever may come your way throughout the day.


Even if you make an unhealthy choice (or two) later in the day by eating or drinking something high in sugar and low in nutrition, at least you know you started your day the healthy way. Adding veggies, protein, hydration and nutrition to your breakfast can help you lean more toward a healthy lifestyle.


Smoothies are a good choice for breakfast because you can add so many different (and healthy) ingredients to help you stay full all morning.


It’s important to remember that not all smoothies are the same. Some are full of sugar and lacking in nutrition. My favorite green smoothie is full of nutrients because, remember, our bodies need vitamins (vitamin D, calcium, B vitamins), minerals (iron), protein, fat and carbohydrates every day.


The ingredients in my green smoothie help in several areas of wellness, including heart health, protection from cancer and maintaining strong bones. I have listed the ingredients separately, including an explanation of what each ingredient brings to the smoothie.


I make this smoothie for breakfast most days, not only because it tastes great but also because it can prevent colon cancer.


Colorectal cancer is the third most common cause of cancer death in the United States, and the second most common cancer in women.


This is just one more excellent reason to give this smoothie a try for breakfast tomorrow and every day thereafter.


Colorectal cancer is preventable in most cases by early detection, though you can also improve colorectal health by maintaining a healthy weight and eating a proper diet—rich in fiber and antioxidants (like the ingredients in my green smoothie), low in saturated fats and red meat, and high in vitamins.


Reprinted with permission from Spectrum Health Beat.

Pay attention to your colon

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Stop colon cancer in its tracks, early, with lifestyle changes and preventive screening. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Did you know your lifestyle choices could tip the scale for whether or not you experience cancer in your lifetime?


It’s true.


No one purposefully acts to increase their cancer risk, however, not everyone knows which lifestyle choices will make a negative—or positive—difference.


Take colon cancer, for instance. Colon cancer risk is affected by lifestyle habits and can be detected early if people are aware of their risk, get timely screenings and watch for early symptoms.


Studies show there are ways we can proactively reduce our chances of developing colorectal cancer.


People who exercise daily, eat a diet high in fiber, fruits and vegetables, take adequate vitamins B6 and D, and eat fish regularly (not deep fried) have a lower relative risk of getting colorectal cancer.


People who smoke, drink more than two alcohol drinks per day and are obese have a higher risk. Hormone replacement therapy, statins and daily aspirin are also shown to be associated with a lower risk of colorectal cancer.


Many women I have cared for never thought they would get colorectal cancer. Some women think it is an older person’s disease or that only men are at risk.

Risk factors for colorectal cancer

• 50 years or older

• HPV infection

• Family history of colorectal cancer

• History of Crohn’s or ulcerative colitis

• Diet high in saturated fats and low in fiber

• Diet low in vitamins D and B complex

• More than one alcoholic drink per day

• Lack of exercise

• Obesity

How cancer develops

Cancer happens when cells start to grow out of control either from exposure to a cancer-causing agent like cigarette smoke, or damage in the process of growth control like with BRCA gene mutations.


If there is both exposure and a gene mutation, the risk is even higher. When cells grow out of control, they group together in a lump or mass and then can break free of the organ boundaries, and spread.


The earlier a cancer is caught, the easier it is to treat. Once cancer spreads, it is much harder to cure.

A cautionary tale

A patient I’ll call Susan never thought colon cancer would affect her. In her case, there was no family history, no inflammatory bowel disease, and she lived a healthy lifestyle. She is active, rarely drinks alcohol, eats low fat and takes her vitamins.

But Susan had symptoms. She ignored those symptoms, thinking it must be a yeast infection, constipation, or simply not important. Like many of us, she was so busy caring for her family she didn’t make the time to get checked out.


Her pain worsened, the discharge worsened and her bowel habits started to change more dramatically. She finally had no choice but to pursue testing. Susan learned she had Stage 4, metastatic colorectal cancer.


Susan underwent aggressive surgery and chemotherapy with a good result. Her story is one that should make us all pause and remember to seek care when something does not seem right. Another takeaway: Get your colonoscopy.

Be proactive

Donald Kim, MD, is a Spectrum Health Medical Group colorectal surgeon and cares for patients with colorectal cancer.


“Colorectal cancer is not only treatable but preventable with proper colon cancer screening,” Dr. Kim said. “Unfortunately, most patients present without symptoms, so it’s essential that you have your recommended screening colonoscopy.”


If you have risk factors for colorectal cancer, it is important you not only get an early screening, but also follow a healthy lifestyle to reduce your chances of getting cancer.


Risk factors include being 50 or over (45 and over if African American), have a first-degree relative with colorectal cancer, have a family history of colorectal cancer or genetic syndromes such as familial polyposis syndrome or Lynch syndrome. It also matters if you have a personal history of colon polyps or inflammatory bowel disease such as Crohn’s colitis or ulcerative colitis, or if you have had abdominal radiation.


The symptoms of colorectal cancer depend on the location of the tumor. They include a change in bowel habits such as new constipation or diarrhea, consistent new bloating and gas, rectal bleeding or dark tarry stools, a feeling of incomplete emptying, or persistent cramps and pain. Another sign of cancer is iron-deficiency anemia.


Reprinted with permission from Spectrum Health Beat.


Perimenopause have you down?

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Be free of the symptoms of perimenopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Any of this sound familiar?


Your periods are so heavy and irregular, you are left exhausted and weak. You never know when your period is going to appear, and during it, you can barely stay ahead of the mess. The cramps are not too bad, but once the bleeding starts, you know you are in for several bad days followed by a week of spotting. When the bleeding stops, the aftermath means being tired with less motivation to run or lift weights, let alone go for a brisk walk.


What is your diagnosis? Probably perimenopause.


Probably is an important word as just because someone might fit the story for perimenopause, it is necessary to make sure the irregular periods are not caused by anything else.


Perimenopause is the normal life phase when periods start to change as your ovaries run out of follicles, or immature eggs. Hormone levels change and fluctuate.


The result? Irregular periods, often close together or spaced out and sometimes heavy and sometimes light. These changes can also be caused by an over- or under-active thyroid, changes in weight such as rapid loss or gain, high prolactin levels, polycystic ovary, and conditions which affect the uterus such as polyps or fibroids.


Especially in women who are overweight, with diabetes or high blood pressure, it is crucial to make sure the uterine lining is not too thick, which could be caused by pre-cancer or uterine cancer.


A patient I’ll call Molly came to see me to figure out why she felt so tired all the time.


At 48, she could hardly keep up with life, including her high school kids’ schedules, spending time with her husband beyond comparing schedules, and her full-time job.

Her work was hosting a biggest loser contest, and she felt too tired and lacked motivation to start an exercise plan or make any real attempt at eating healthy in order to lose 15 pounds. Her periods interfered with work in that she had to leave a planning meeting because she felt her period start and feared she would make a mess.


What made matters worse, she was planning for a dream trip with several families and worried about bleeding while on the trip.


Her recent blood work revealed that her hemoglobin blood count was 10 and her iron (ferritin) was 15, which prompted her primary care doctor to find her a gynecologist. She had lost enough blood on a regular basis and couldn’t take enough iron to make up what her body needed.


Her doctor ruled out thyroid or prolactin problems. She had an ultrasound and came to see me, hoping for some options to get her irregular and heavy periods to stop.


She appeared otherwise healthy except for being slightly overweight. Her cholesterol and blood sugar levels were borderline high and thyroid and prolactin normal. Her ultrasound—done after a period—showed a normal lining thickness and no fibroids or any other abnormality.


We talked about the phase of life she’s in and her options.


Because her periods were so heavy, it would be a good idea to first sample her uterine lining with an endometrial biopsy. Because she did not smoke and had no family or personal history of blood clots, she was still a candidate for the low-dose birth control pills, which could be used to help her not have her period while on a trip.


Another option: bioidentical FDA-approved progesterone to take from day 10 of her cycle for 15 days, which could make the periods more regular and light, but would not provide birth control. An IUD with progesterone could also work for her as it would give her birth control as well as control heavy bleeding.


After a good discussion about the pros and cons of each option, she chose an IUD as she also needed birth control, and we placed the IUD in time to ensure her periods would at least be better, if not gone.


In terms of the other symptoms of perimenopause, she chose to focus on a healthy lifestyle now that the periods would no longer be the issue.


She chose a schedule of short daily workouts to fit in between other obligations, having been reminded she needed to care for herself in order to care for others.


This included all of the SEEDS and supporting her system with consistent sleep, water, multivitamin, Vitamin D, iron-rich foods, calcium in her diet, exercise—a bit every day—and a short time of quiet and gratitude every day.


Reprinted with permission from Spectrum Health Beat.


The not-so-sunny side of bone health

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What you don’t know about bone health may hurt you. Get in the know with a doctor’s expert information about osteoporosis. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


The sunny days of summer are long gone, which means it’s time for all of us to start taking our vitamin D supplements.


Vitamin D is a necessary and crucial component of bone health. Unfortunately, we often don’t think about bone health until it is too late and the damage is done.


Osteoporosis, a condition in which the bones become brittle and fragile from loss of tissue, is often a silent disease. By the time a fracture occurs, there are usually several other bones already affected.


The good news is that osteoporosis can be prevented. And, if your bones are already weak, there are ways to keep more loss from happening and strategies to keep fractures to a minimum.

Bone mass reaches a peak

Our bones are constantly turning over and renewing. In fact, there are cells that build new bone and others that break it down to make way for new bone.


Our bone mass level and fracture risk depend on the rate of new bone growth compared to the rate of breakdown.


Most women reach a peak bone mass at age 32 and lose a small amount of bone mass every year. In the first five years of menopause, if a woman does not take estrogen, her bone loss will accelerate, increasing her risk for issues such as osteoporosis.


If we aren’t active enough, our builder cells don’t think they are needed and won’t make new bone. Osteoporosis can result, making our bones weak enough to increase the risk for a fracture from minimal trauma—like stepping off a curb awkwardly or a minor fall.


We also need to be aware of a similar but less severe disease than osteoporosis: Osteopenia can occur when the bones are thinner than they should be at a given age.


Osteoporosis has a staggering effect on women’s health.


The most common fractures occur in the hip, but can also occur in the wrist and upper leg bone, with a possibility of micro fractures in the spinal bones.


You may be surprised to learn that another, less well-known complication of osteoporosis is the loss or cracking of teeth and poor healing after dental procedures.


Unfortunately, the effects of osteoporosis impacts our lives in many different ways. There may be surgeries to repair fractures, time off work and physical therapy. Complications from surgery may also occur, including weight gain, muscle weakening, infection, pneumonia and even stroke. Chronic pain can become an issue as well, especially for spinal bone fractures.


The risk factors of osteoporosis are numerous, but the most common are aging, vitamin D deficiency, inactivity, oral steroid intake, cigarette smoking and poor calcium intake.


For women who are underweight, they are at risk of rapid bone loss due to not having enough stress on their bones. There are many other, less common risk factors, including the following: medical issues such as eating disorders and poor nutrition, excessive consumption of carbonated sodas, and poor absorption of nutrients due to colon problems (prior gastric bypass or Celiac disease).


A family history of osteoporosis, rheumatoid arthritis, early menopause due to surgery or chemotherapy, or lupus can also increase a woman’s risk of developing osteoporosis.

Options and opportunities

I had a patient I’ll call Sue several years ago who was diagnosed with osteoporosis. I saw Sue in my office just after she started menopause.


As I always do with my menopause patients, I asked about her risk factors for accelerated bone loss. Sue was at a healthy weight but only exercised occasionally. She didn’t have any medical risk factors and had never had a fracture before, but she had also never taken a vitamin D supplement. Because Sue was in menopause and had never taken vitamin D, I ordered a DEXA scan—an enhanced form of X-ray technology that is used to measure bone loss.


When I called Sue with the results of her DEXA scan, she was not pleased. Her results showed that she had osteoporosis, and she had a greater than 20 percent risk for an osteoporotic fracture in the next 10 years. She also had a greater than 35 percent risk of a hip fracture during the same time period.


Sue’s reaction was very typical of many others when they are told they have osteoporosis. She was angry at herself, but she was also angry at the medical community because, at that time, we were not yet routinely recommending vitamin D supplementation.


She had always been told to wear sunscreen, which she did, whenever she went outside. And now she was being told a lack of vitamin D possibly contributed to her osteoporosis diagnosis? It just didn’t seem fair.


Once Sue’s anger subsided, we discussed what she should do next. I tested her for thyroid disease, vitamin D deficiency and parathyroid disease. Since Sue was in menopause, we discussed estrogen patches and pills that are FDA-approved for the prevention of osteoporosis. Sue chose not to take estrogen, but she was open to other options.


Although the tests showed Sue’s vitamin D level was very low, her other tests were normal—good news! So, we came up with a plan to keep Sue’s bones as healthy as possible.


I explained that the most important factors for keeping bones strong and preventing fractures is to eat a healthy diet and exercise regularly. I recommended Sue start on a prescription vitamin D tablet of 50,000 IU per week for two months and then 2,000 IU per day after that. I also suggested calcium-rich foods such as dairy products, almond or soy milk, and dark, leafy greens.


For exercise, we created a routine that included walking, jogging, Zumba classes and weight lifting. On days when Sue simply couldn’t fit in a workout, I advised her to jump up and down 50 times as a way to remind her bones to stay healthy.


In addition to diet and exercise, we discussed a few different prescription drugs, such as Raloxifene or Bisphoshonates, that help treat and prevent osteoporosis.


In the end, Sue chose to look at the situation as a gift. She strove to maintain the bones she already had and make them as strong as possible.


Reprinted with permission from Spectrum Health Beat.


When life hits you like a hurricane

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Find your way through the menopause storm with an overall health and wellness approach. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


So many women come into the office and share now familiar symptoms.


“Why am I gaining weight?”


“I do not feel like myself!”


“How do I avoid a heart attack so I do not suffer like my mom?!”


“I am afraid to go out in the winter because I do not want to break a hip.”


“How do I deal with all of my stress?!”


Women’s health is different than men’s health and the topic deserves research and attention to better recognize and offer the best prevention and treatment options to women.


Menopause symptoms are important to understand and treat as these symptoms can be a sign more is going on under the surface.


Low estrogen causes hot flashes, night sweats and vaginal dryness. It also accelerates development of heart disease, bone loss, diabetes and obesity.


Emotional changes can be a sign of the existence of a high level of stress from handling kids and aging parents. Or this can be a red flag symptom of changing levels of brain chemicals, less sleep and a need for improved coping tools.


Women who cope well with life and body changes have three things in common:


1. They believe they deserve to be happy.


2. They keep a support network around them.


3. They ask for help when they need it.


A patient I’ll call Katie came to us because she was facing the perfect storm of menopause and felt like it was a hurricane.


She had all the symptoms—hot flashes, night sweats, irritability, insomnia, bladder urgency and low sex drive.


She no longer felt motivated to get up early to exercise and ate cookies at 3 p.m. to stay awake.


She and her husband argued about minor things, especially about how to deal with their son who was failing his class. Her mom, who’d suffered a stroke, fell and broke her hip in the assisted living center.


Work seemed crazy as her boss had left and she had to do both their jobs until a replacement could be found.


She came to us at Midlife, Menopause & Sexual Health and said, “I do not even know where to start! My life is a mess.”


Katie came to us because she heard we could help with hot flashes. We certainly could offer meds and call it a day, but we see such a situation as an opportunity to become her partner in her health and consider all options.


This included a practical plan for a healthy lifestyle using the SEEDS, tracking and treating her symptoms, and assessing her health risks for bone loss, stroke and heart attack.


We also know emotional health is a big part of healthy aging. We support this facet of wellness by listening, discussing how the SEEDS can support the body and mind, and also having a team that includes a psychotherapist who can help our patients cope with strong emotions.


Three months later, Katie had improved sleep, better moods, only a rare hot flash, and she and her husband had a plan worked out with their son. Her mom had started to heal and feel better, and she was excelling in her new role at work.


Further, she ate better, took her vitamin D and calcium, and made time for small bursts of exercise. She no longer needing cookies to stay awake.


Best of all, she had a plan to reduce her risk of stroke, heart attack and bone loss.


Her hurricane of menopause had passed and life returned to smooth sailing.


Reprinted with permission from Spectrum Health Beat.


Own your future

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Picture yourself at some point in the future — on a cruise, at an event, or reaching a milestone. How do you want to look and feel? Make a plan to achieve your picture of self. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Several years ago (well, a few more than several), when I was 39 years old and not happy with the size of scrubs I fit into at the hospital, I really began to think about how I wanted to be in the future.


I realized that if I couldn’t run a 5K or fit into yellow tie scrubs (the smaller scrubs) at 39, how would I be able to run a 5K or fit into anything I wanted to wear at age 60? So, I started to think about my future.


I am a very visual person, so I picked a specific age —53— and pictured myself at that age. When I am 53, my youngest child will graduate from high school, and I pictured myself at his graduation party. How did I want to look and feel at that age? At that party? To reach my goal, I knew my plan had to be very clear, so I sat down and started to develop my plan.


The following week, during a busy day in my office, I almost bumped into a patient as I rushed through the hallway.


I apologized and started to continue on my way when she stopped me and said, “You don’t remember me, do you?” I told her I did not recognize her, and she said, “During my appointment last year, you asked me how I wanted to be when I turned 50. I left your office and really thought about that question. I decided I wanted to be ‘hot’ — and now I am! I ran a 10K, and developed a new food plan that I love and can follow. I have so much more energy now, and I feel great!”


She looked amazing.


This patient really listened to what I had to say at her yearly physical, and she came up with a plan to reach a goal she set for herself.


The truth is that many women don’t have a plan for the future. It’s easy to think, “I will exercise and eat better tomorrow,” but tomorrow comes and nothing changes.


In addition, many women don’t have any plan, and they foolishly think that being healthy will just magically happen. Unfortunately, good health doesn’t just happen. It requires commitment and a detailed strategy.


This is true for all women, including those who are successful at work, successful at home and successful at being a good parent. But, all this success doesn’t mean they are also happy with their health, weight, or energy level. In other words, they don’t plan for themselves.


So, where should you begin? Every strong plan starts with a goal, and I recommend you call your goal your picture of self.


Picture of self is simply how you see yourself at a specific point in the future. It can be short term or long term—a college graduation, before you get pregnant, one year after the birth of your child, your daughter’s wedding, retirement, or an upcoming trip. It just needs to be a specific event or time where you can picture the event well and put yourself there figuratively.


You begin with visualizing the overall picture and then breaking it down into the fine details — the style of your hair, how it feels to walk into the event, how you interact with others in the room.


Creating your picture can help you start thinking about your own health both now and in the future. Then, make a plan for how to become that picture of self. Start today.


Reprinted with permission from Spectrum Health Beat.



Escape the summer hot flash

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One of the first steps to combat hot flashes is proper hydration—about 80 ounces of water per day. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Summer is the worst season to deal with hot flashes.


In the winter, you can get at least some relief by cracking open a window to let in the arctic air.


In the summer, not even air conditioning is enough. The days and nights are hot enough already—you shouldn’t have to face hot flashes, too.


If this has become your reality, it’s time to learn what to do to make these hot flashes go away.

Too hot, too cold

First, it’s important to understand why a hot flash happens.


A hot flash or night sweat is the body’s way of cooling off. The blood vessels in the skin are commanded to open, or dilate, and blood rushes to the surface, allowing heat to escape.


Sweating goes along with this, of course, further allowing the body to cool.


Women will say they glow or radiate heat during a hot flash. That’s exactly what’s happening.


Hot flashes often happen in the years before menopause, in the days before a period, and then more frequently in early menopause because estrogen levels are low.


Estrogen is a powerful regulator of temperature regulation. When estrogen levels drop, the thermostat gets very sensitive.


The comfort zone changes from a comfortable 4 degrees to a narrow range of 0.4 degrees. This is why many women in perimenopause or menopause say, “I’m always too hot or too cold—never just right.”


The body’s air conditioning—hot flashes—can also be triggered by sudden stress. The adrenaline rush can flip the switch.


High blood sugar, even after eating something as simple as a little cookie, can also trigger it. It can also happen 30 minutes after that cookie, when the blood sugar crashes.


Alcohol can trigger a hot flash, too. Many women will agree that drinking wine at dinner can cause night sweats.


Failing to drink enough water can cause hot flashes to increase in frequency and intensity. Weight gain can also make the body warmer and harder to cool.


Sleep-deprived women may experience hot flashes more frequently. Fluctuations in brain chemicals—brought about by situations involving chronic stress, for example—can also increase the frequency of hot flashes.

Finding hope

By understanding why hot flashes occur, women can avoid the suffering and begin to find solutions.


The most effective treatment for hot flashes and night sweats is estrogen medication.

The estrogen we prescribe at Spectrum Health Midlife, Menopause & Sexual Health is FDA-approved bioidentical, covered by most insurances.


It’s not compounded, but available by mail-order or from your local pharmacy.


Estrogen medication is safer than most people think.


We have many good studies to back that up.


Even a low dose of estrogen—much lower than normal ovary function back in the day—can reduce hot flashes within seven to 10 days.


If a woman has a uterus, she needs to take a progesterone with the estrogen. This can often help with sleep, too.


Safety comes first—and for some women, estrogen is not safe. We go through a checklist before prescribing it.


If estrogen is not the treatment of choice, the next best medication is the same class of drugs used for depression and anxiety.


This is used not because the woman has depression or anxiety, but because the medications can increase serotonin.


Serotonin makes the thermostat less sensitive and reduces the frequency of hot flashes, almost as effectively as estrogen.


Ultimately, you have to build the right foundation for treating hot flashes. This entails a healthy lifestyle and maintaining a healthy weight.


About 80% of women have symptoms that interfere with their quality of life.


But there is hope.


SEEDS (Seven Essential Elements of Daily Success) is the best place to start.


It begins with water—80 ounces per day—and 50 hours of sleep each week.


It also involves daily activity and exercise, a multivitamin and vitamin D and a healthy diet rich with complex carbs, smart protein and healthy fat. Limit yourself to just one treat per day and make sure you get all the fiber you need.


Practice metered breathing and gratitude.


As you do more SEEDS each day, you’ll experience fewer hot flashes.


The SEEDS approach can help in everyday life, too.


Reprinted with permission from Spectrum Health Beat.



Run your way to your best self

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Want to run a 5K, 10K or 25K? Set a goal and make a plan for how to achieve it. (Chris Clark | Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Why do you run? Why should anyone run?


I once had a patient I’ll call Laura who taught me the power of goal-setting and running.


I always knew goal-setting could be an effective motivator and used this in my personal life to get through school, medical training, fitness goals, to help my kids, and so forth, but had not explored how to utilize the power of a goal for healthy aging for others.


I remember seeing Laura for her annual physical, and she told me she had been through a rough time in her marriage, did not like her job, had stopped working out, gained weight, ate without planning or thinking, and did not feel attractive or energetic.


When asked what goal she had for herself at a date in the future, she said she wanted to be hot. She defined ‘hot’ as fit, back in her old clothes, and able to run and exercise like when she was 40.


My next question was, “How badly do you want this?” She told me she knew she wanted this.


In the past she had been a runner, and knew the River Bank Run was coming up. She told me to expect great things and left with her shoulders back and a smile.


More than a year later, while rushing through a busy day, I went around the corner fast in the hallway. I almost ran into a woman I did not recognize, and excused myself. It was Laura, and she laughed when she realized I did not recognize her. I looked closer and my chin dropped.


Laura had achieved her goal. She looked fit, had lost a significant amount of weight, and had a big smile on her face. She said, “I did it, I am hot!”


In the intervening year, she had gone online to the River Bank Run website, and used its planning tool to train for the race.


She had not run in years, and took the first several months slow, working on her endurance, and being careful to not get too impatient. She took note of warming up, stretching and improving her core strength to avoid injury, and even visited a local trainer to make sure she was being smart.


Once she built her base, she started working harder, and at the same time did research on a healthy diet for her workouts and made sure she had plenty of complex carbs like brown rice, Ezekiel bread, sweet potatoes and oatmeal.


Running most days helped her sleep improve, and on busy days she would even run indoors at 8 or 9 at night. Her mood improved, she made better choices in her personal and professional life, and began to fit into her old clothes again. The image of being hot at 50 kept her going, even on days she did not feel like running. She always felt better after a run.


Race day came and she finished in a respectable time. She lost 55 pounds, regained her self-respect and liked herself again. She was ready to enjoy her 50th.


I loved her story as it shows what a goal can do to motivate someone. Not only did she achieve her goal, but felt better and better each day. And not only did she change her outside, but her inside as well.


With exercise and weight loss come a healthier blood vessel system with smooth walls and a lower chance of building up plaque. This lowers the chance of dementia, stroke and heart attack.


Her bones increased in density, lowering the risk of osteoporosis and fracture. The weight loss also lowered her risk of many cancers, namely breast and uterine cancer.


Most of all, Laura took care of herself.


Even if running is not your thing, we encourage all people to set a life goal. Think of a key event in your life — a birthday, a child’s wedding (or your own), retirement, or a dream vacation. Write it down, talk about it, make a plan on how to achieve that goal, and get busy.


Reprinted with permission from Spectrum Health Beat.


Hormones? Let’s clear the confusion

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Hormone replacement therapy can be the right choice for the right person. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Hormone replacement therapy can be a good option for many women as they struggle through menopause.


It’s used not only as an aid to reduce hot flashes, but also as a medicine to replace hormones and help women improve their overall health.


Hormones are safe for many women, but not all, so it’s important to separate the facts from the myths to make sure you’re well informed.


You probably already know that menopause is a time when most women experience a variety of body changes and symptoms. In fact, 80 percent of women will experience at least one symptom and 45 percent will have significant distress from symptoms.


These are pretty significant numbers.


It’s also important to know that, during menopause, body changes in women can cause more than just sleep issues and mood swings.


The risk of heart disease in women surpasses the risk in men within five years of menopause, and the risk of diabetes and obesity in women climbs rapidly. In addition, many women gain 10 pounds or more of belly fat during this transition.


The facts are scary, but the more you know about the changes happening to your body, the more you can do to stay healthy during menopause.

Risks and rewards

Menopause symptoms and body changes are a result of estrogen loss.


Estrogen affects many cells in the body, including your brain, bones, liver, skin, vagina and uterus. Research over the years has given health care professionals valuable insight into who should and should not take estrogen.


A large study performed by the Women’s Health Initiative included 110,000 women who were randomly selected to take estrogen or to not take estrogen. The results taught doctors about the safety and effects of estrogen in women, and it also showed us that not all women have the same risks.


The timing of estrogen treatment is a key factor in a woman’s risks.


If a woman starts taking estrogen early in menopause, her risk of heart disease, stroke, diabetes and obesity decreases.


However, if a woman is already at high risk for heart disease, stroke, diabetes or obesity, and she then begins taking estrogen later in menopause, her risk for all of these issues becomes higher.


You can see why it’s important to talk to your physician about taking hormones before you make any decisions.


Estrogen in the system—versus estrogen in the vagina—is very different is terms of effects and risks.


Vaginal estrogen barely, if at all, goes into the blood. It stays in the vagina and greatly improves the vaginal and bladder symptoms of menopause. These symptoms include dryness, difficulty in achieving orgasm, pain with sex, bladder urgency and some forms of incontinence.


So, who cannot take systemic estrogen? A woman who:

  • Is more than 10 years from her last menstrual period.
  • Already has heart disease.
  • Has previously had a stroke.
  • Has migraines with significant visual issues.
  • Had a prior blood clot in the deep veins of her legs or lungs.
  • Had breast cancer.

Most of the estrogen I prescribe is bio-identical, which means it is identical to the estrogen made by the ovary.


The estrogen I prescribe is FDA-approved, which means there are safety checks and consistencies not found in compounded hormones. When I prescribe hormone medication, I do not receive any financial gain from any of the manufacturers.


Estrogen prescription medicine can be given in the form of a patch, spray, or pill. (More good news: Many estrogen medicines are covered by insurance.)


My goal in prescribing estrogen medicine is my patient’s safety first, and then reducing her symptoms and improving her quality of life.


Another important hormone study, the Kronos Early Estrogen Prevention Study trial, found that women who took patch estrogen had a lower risk of gaining belly fat and sugar cravings, and they saw significant improvement in symptoms and quality of life.

Cindy’s story

One of my patients, who I’ll call Cindy, is a good example of someone who experienced menopause symptoms but didn’t know what to do about them.


In the beginning, Cindy felt she’d been on auto pilot for years.


She felt blessed to have the life she had always wanted—she graduated college, landed a good job at a bank, fell in love, got married, had two children. She loved her busy life and felt lucky to rarely get sick or need a doctor’s visit.


At her yearly exams, she was always told to watch her weight and her cholesterol. She would think, “Watch them do what?” and then she’d rush out of the office to pick up the kids and start dinner.


It was all very uneventful, and Cindy liked it that way.


Life continued in this same pattern for many years—until Cindy’s periods started becoming very irregular.


She also noticed she was more tired than normal, and she began to experience night sweats. She was having crazy mood changes. Even worse, she noticed her spring clothes didn’t fit when she went to put them on after a long winter. She craved sweets (not normal for her) and she couldn’t remember things.


She began to wonder what was happening. She didn’t think these changes were normal.


Cindy and her family had enough, so she called her doctor.


Her symptoms prompted a referral to Spectrum Health Medical Group’s Menopause Clinic, where we talked about why these things were happening and what could be done to make her feel better.


Cindy’s history was good overall: no smoking, no migraines, no diabetes, and no blood clots in her legs or lungs. Her cholesterol was slightly high, but she didn’t have any signs of heart disease and she always had regular mammograms.


The first step to relieve her symptoms: Add some healthy habits back into her life. She needed regular sleep, adequate water intake, vitamins, less sugar, more exercise, meditation and gratitude.


She was also a perfect candidate for estrogen prescription therapy, so we talked about her options. She chose estrogen in the form of a patch prescription bio-identical estrogen, which she would need to change twice a week.


Cindy had never had a hysterectomy and still had her uterus; therefore, to be safe, she had to take progesterone along with the estrogen.


I prescribed Prometrium, which is bio-identical progesterone dissolved in peanut oil in a capsule that she would take every night.


Within two weeks, Cindy was experiencing fewer night sweats and hot flashes. After one month with hormone replacement therapy, she was sleeping better, she felt like exercising, she was motivated to make better food choices and she had lost weight.


Most importantly, she felt like herself again—and her family noticed.


Reprinted with permission from Spectrum Health Beat.

The key to avoiding diabetes

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Those approaching menopause should be extra careful about diabetes. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Diabetes is a far too common disease, and unfortunately, it is on the rise.


The statistics are sobering: Diabetes is the seventh leading cause of death among Americans. Sadly, 1 in 11 (29 million) Americans suffer from diabetes, and 1 in 3 (86 million) have pre-diabetes.


The good news is that some forms of diabetes can be prevented, and the best way to prevent this disease is to become educated about what it is and how you can avoid it.


First, let’s be clear about the definitions.


Type 1 diabetes is typically diagnosed in kids or young adults. In Type 1 diabetes, the body (specifically the pancreas) does not make insulin and, therefore, cannot process sugar. The sugar then stays in the blood and can’t get in the cells to be used as energy. Symptoms of this type of disease include weight loss, fatigue, thirst, frequent urination and extreme hunger, even after eating. Type 1 diabetes does not tend to run in families, and diagnosis is done with a simple blood sugar test.


Type 2 diabetes does tend to be hereditary, by both genetic risk factor for insulin resistance and health habits (physical activity and diet). Type 2 diabetes is preventable and is caused by high blood sugar from insulin resistance. Symptoms of this disease include those listed for Type 1 diabetes, plus blurred vision and headaches.


What exactly does insulin resistance mean? Here’s how it works: Insulin is the key to getting blood sugar into the cells—brain cells, liver cells and muscle cells. If someone has insulin resistance, it takes more insulin to get the door of the cell to open. Therefore, while waiting for the pancreas to make more insulin, the blood sugar rises and not only gets pushed into fat, but also causes the many complications of diabetes. As the belly fat increases, it leads to more insulin resistance.


Here’s a simpler way to think about it: When someone with pre-diabetes says they are “craving carbs,” or they are a “carbaholic,” I like to say that they aren’t actually craving carbs; instead, their fat is craving sugar. Unfortunately, when they eat the sugar, it goes straight to their fat, instead of going to their muscles, brain or liver. When people with pre-diabetes eat sugar, they are starving themselves and feeding their fat. To stop the craving, they must stop the sugar for 10 days and tell the fat to “shut up.”

Not all carbs are bad

Now let’s focus on carbs.


Carbohydrates are necessary fuel for our bodies—especially our muscles and our brain. Our liver needs to store a little bit of carbs as glycogen for when we need a boost, like after walking at a good pace for 40 minutes. However, there is a difference between healthy and unhealthy carbs.


Complex (healthy) carbs raise the blood sugar slowly and allow the pancreas to make insulin slowly and push the sugar into the right cells—not into the fat on your body. We need complex carbs at breakfast, morning snack, lunch and afternoon snack, and then not so much for the rest of the day. Healthy carbs include whole grain whole wheat bread, brown rice, sweet potatoes, quinoa, oatmeal (cooked—not the sugary packets), beans, peas and green vegetables.


Simple (unhealthy) carbs raise your blood sugar quickly, overwhelm the insulin in your body and get pushed into your fat. Think of simple carbs as a treat—white rice, white tortillas, baked goods, candy, many cereals, and anything made with mostly white flour.


Unfortunately, too many people think they are doing the right thing by staying away from all carbs. That is the wrong tactic.


When my patients (all women, of course) tell me they don’t eat any carbs, I let them know that’s the wrong approach to good health. The goal is to achieve an even blood sugar with minimal insulin spikes. High insulin can make us hungry for sugar and then pushes the sugar into fat. A healthy diet only contains one small treat per day—a piece of chocolate, a serving of alcohol, or a white flour tortilla.


Think of these types of carbs like a budget—you can have some carbs, but you can’t have them all at once.


Blood sugars and Type 2 diabetes can cause many complications—kidney disease, hypertension, stroke, skin problems, neuropathy, foot problems, infections resulting in loss of toes, eye issues (glaucoma and blindness), and impotence in women and men.


High blood sugars damage and clog small blood vessels, and if organs, including the eye, heart, kidney and sex organs, do not get blood, the various organs can’t work properly and problems occur.

Risk factors to know

It’s important to know the risk factors associated with this disease. Family history of diabetes, being overweight (especially with belly fat), and inactivity are all serious risk factors. In addition, women have two other factors that can work against them: having diabetes during pregnancy and menopause.


Menopause increases the risk by causing insulin resistance, and menopause can also make things worse by causing poor sleep from night sweats. The cycle continues because poor sleep makes it more difficult to have the energy to exercise and make good food choices. Menopause can definitely wreak havoc for women and diabetes.


I see many menopausal women in my office each year, and so many of them tell me about their struggle with weight. I remember one patient in particular I’ll call Sue.


Sue came to see me for heavy bleeding around the time her menopause had started. We did an ultrasound, which showed a thick uterine lining, so I scheduled a dilation and curettage.


During her exam, I also asked her what was the No. 1 struggle in her life. She started crying and told me her weight was her biggest struggle. Over the years, she had managed to keep her weight at a “tolerable” level, but in the past six months (around the time she started menopause), her weight continued to climb and she was giving up.


I couldn’t let Sue leave my office without trying to see what she could change to help with her weight struggle. We went through her diet, and she mentioned that she was avoiding carbs most of the day. She would eat some protein throughout the day and try to starve herself by eating little else.


By the time she began preparing dinner, she was extremely hungry and tired. As a result, she would eat the same meal she had just made for her family—some type of meat and a potato or pasta.


Even though Sue limited her portions throughout most of the day, she was actually causing herself to put on more weight. Her body was so hungry that whatever food was being consumed was being pushed into belly fat. Sue was surprised to learn she was making it worse, but I helped her develop a simple and easy plan to incorporate complex carbs into her diet.


By the time I saw her for her dilation and curettage several weeks later, she was feeling better, had more energy, and had lost six pounds for the first time in years.


It’s important for all of us to know as much as we can about diabetes in order to avoid falling victim to this disease.


Knowing the risk factors plus ways to avoid diabetes (exercise and diet) are imperative.


Reprinted with permission from Spectrum Health Beat.

Having trouble sleeping?

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A restless night may be the result of poor habits before bedtime. A helpful hint: Leave the cell phone out of the bedroom. (Courtesy Spectrum Health Beat)

By Diana Bitner, Spectrum Health Beat


Sleep is everything. It needs to be a high priority for all of us to be happy and healthy.


It is truly the basis of good health, because it gives our brains a chance to rest and process the events of the day and then make brain chemicals for the next day.


Do you have trouble sleeping? If so, you’re probably dealing with a host of negative side effects.


Without sleep, we may experience bad moods and perform poorly at work, at school or at home with our families. A lack of sleep also puts us at risk for heart disease, diabetes and depression.


Researchers have spent years analyzing sleep patterns to learn why sleep is so important to our overall health and wellness. Their observational studies of people with and without good sleep patterns show a strong effect on chronic disease.


People who get less sleep have a higher risk of being overweight, developing diabetes, experiencing high blood pressure and having a heart attack. Overall, these people have a lower life expectancy than those who get a consistent eight hours of sleep each night.


Typically, those who consistently sleep less than six hours a night are plagued with the highest weight, while those who sleep eight hours or more have the lowest weight.


Is it really that simple? For the most part, yes.


Less sleep leads to a rise in cortisol—our stress hormone—and also causes a rise in insulin, which promotes belly fat storage. Decreased amounts of sleep also cause an increase in ghrelin—a brain hormone that stimulates appetite—and a decrease in leptin, which signals when we feel full.


Of course, it goes without saying that when we don’t have enough sleep, we don’t feel like exercising and we often gain weight due to inactivity.


Unfortunately, sleep (or a lack of it) can have a strong effect on our moods and coping skills. Lack of sleep puts people at a greater risk for depression, anxiety and mental stress. All of this makes it difficult for these people to remain optimistic and thrive in social situations.


The bottom line? To be happy, sleep is a prerequisite.


We know we should be getting our sleep, but what really happens when we are having trouble sleeping?


There are several different types of sleep problems that can cause us to sleep less than we should at night.

Sleep disorders

Chronic insomnia, narcolepsy, sleep apnea and parasomnias are some of the more common sleep issues my patients experience.


Insomnia can be a result of too much overstimulation from watching TV or working on a computer late at night. Consumption of alcohol, sugary foods or caffeine before bed can also interfere with the ability to fall asleep easily.


Insomnia can be caused by taking certain medications such as antidepressants, oral steroids or allergy pills. Medical conditions that cause pain—arthritis, for example, or breathing problems such as asthma—can also be underlying causes of insomnia.


The good news is that insomnia can be improved.


The best treatment starts with awareness, which begins with a close examination of our habits and rituals around bedtime. Turning off the computer or TV several hours before going to bed can help you fall asleep more quickly. Sometimes, prescription medications or over-the-counter remedies can also be helpful.


Narcolepsy, associated with excessive daytime sleepiness, can be genetically linked. A diagnosis of narcolepsy can be determined with a sleep study.


Medications aimed at improving sleep quality and stimulating daytime wakefulness are typically prescribed to help with this condition.


Sleep apnea, typically linked to obesity and heart disease, is also diagnosed by completing a sleep study.


Treatments for sleep apnea range from changing sleep positions to using a Continuous Positive Airway Pressure machine to keep airways open.


Weight loss is also an effective treatment for sleep apnea.


Parasomnias occur when people are fearful of going to sleep because they are afraid of what might happen to them during sleep. Night terrors, sleepwalking or sleep eating without memory are common things they may fear.

Sleepless nights

Many women come to see me because they are having trouble falling asleep or staying asleep during the night.


A woman I’ll call Jane is one of those patients.


At age 49, she began experiencing irregular periods, night sweats and disturbed sleep around the time of her period. She led a very busy life with teenagers, a husband who traveled for work and parents who required more care.


Her sleep issue was causing problems in her life.


Jane would have difficulty falling asleep and, if she woke up during the night, she had trouble getting back to sleep because her mind would start racing and she couldn’t turn it off.


As a result, she was chronically tired and unmotivated to exercise. She began to gain weight. She felt irritable and crabby most days and she just didn’t know how to get off the roller coaster.


Jane had tried to fix her sleep problems by herself, but it wasn’t working.


She tried every tea and over-the-counter medicine she could find, including melatonin. She had recently resorted to drinking a glass of wine in the evening, but that just made her feel even less rested.


It was time for a new plan for Jane.

Simple changes

We started by discussing what she probably already knew: Lack of good sleep made her very unhealthy and caused her bad moods.


I then explained the correlation between hormones and brain chemicals.


We worked on deconstructing her nighttime routine. I asked her how she could structure her day so she wouldn’t have so many chores to complete at night, leaving her more time to prepare for the next day.


As Jane talked out loud to me, she realized she could make some simple changes—packing lunches and doing a load of laundry at night—that could help her be more efficient in the morning.


I then pressed Jane about making time for herself before bed.


I also made some suggestions.


I recommended that she write down her worries or duties on paper and then make a list for the next day (or several days), detailing how she would conquer these obligations.


Other suggestions I made: Avoid screen time 30 minutes before bed, refrain from alcohol in the evening, write in a gratitude journal before going to sleep.


And, finally, I suggested that Jane practice metered breathing every night before going to bed.


Metered breathing is a technique I discuss with many of my patients to help them fall asleep at night or get back to sleep if they wake in the middle of the night.


Here’s how it works:

  • Find a quiet place in your home and sit in a comfortable chair.
  • Begin staring at a spot somewhere in the room and focus on the sound of your breathing.
  • Continue breathing like this for five minutes, uninterrupted.

I felt confident Jane’s plan would be effective if she followed it. After tracking her progress, we would consider menopause hormone therapy to treat her night sweats if they continued to be an issue.


Jane took my recommendations seriously and changed her routine. She began to sleep again and she started exercising, lost some weight and improved her overall mood.


More than anything, she felt like herself again.


Reprinted with permission from Spectrum Health Beat.

Have the dry eyes of menopause?

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A common complaint among middle-aged women, there is help for dry eyes. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Menopause can be tough enough to handle, but when hot flashes and weight gain are accompanied by dry, scratchy, irritated and red eyes, it’s time to take action.


This condition actually has a name associated with it—dry eye of menopause—and it is a common complaint of women over 50.


Many women talk about it, ask their physician about it, and don’t like it, but there are no clear answers as to why women suffer from this condition. And, unfortunately, we don’t really know what to do about it. Is dry eye really associated with menopause, or is it a product of aging? We aren’t completely sure.


A patient I’ll call Rhonda suffered from several symptoms during menopause, including dry and irritated eyes. The 54-year-old finally decided to call our office for help.


She had been period-free for about 15 months, and her menopause symptoms were not going away. She started with night sweats and irritability roughly six months before her last period, but soon after her final period (not knowing it was her last one), the hot flashes started with a vengeance.


And the symptoms just kept coming. Rhonda didn’t sleep well, her moods became erratic, and she gained weight without changing her diet or exercise plan. For many months, Rhonda thought she could just handle everything, but after blowing up at a lady who left her cart in the middle of the aisle in the grocery store one day, she knew something had to change.


Rhonda took her first step by seeing her family practice physician. Although helpful, Rhonda wasn’t sure about her doctor’s recommendation to start taking hormone supplements.


So, instead, her doctor started her on the medicine Lexapro for the hormone-related mood changes. Lexapro increases the brain chemicals lost with poor sleep and lower estrogen levels. The medicine quickly helped with her mood swings and also cut her hot flashes in half.


Unfortunately, the weight gain continued, and she started having really scratchy eyes. She went back to her doctor thinking she had something stuck in them. After a thorough examination of her eyes with a special lamp, the doctor concluded they were clearly red and irritated despite having no foreign particles in them. She told Rhonda she had seen many women with dry eyes when they started menopause and perhaps it was time to consider hormone medication.


Rhonda left the office determined to take the next step in getting relief for this annoying symptom. She made an appointment at the Spectrum Health Medical Group Midlife and Menopause Offices with Natasha Peoples, a nurse practitioner and certified menopause practitioner. Peoples walked her through our menopause symptom and lifestyle assessments, also known as SEEDS (Seven Essential Elements of Daily Success).


The assessment confirmed that Rhonda had many of the symptoms, even though some of them were better with the Lexapro. Rhonda’s No. 1 goal was to get help for her dry eye issue, and she hoped Natasha could give her some advice. Her job required her to sit at a computer screen for several hours each day, and her eye symptoms made it difficult to concentrate.


After listening to Rhonda’s concerns, Natasha explained how the body changes with menopause, focusing specifically on the dry eye problem. We know that dry eye of menopause in women is common, no matter what age they experience menopause—at 30, 45 or 55. And, for many women, the symptoms of dry, scratchy eyes get better with estrogen. Testosterone is thought to possibly play a role in tear formation as well, and, without good studies to help us, testosterone in low doses added to estrogen could also help.


There are also some other options that may help dry eyes if a woman either can’t (because of medical reasons) or simply won’t add hormones to her daily routine. Dry eye of menopause is thought to be from quicker evaporation of tears and lower-quality tears (tears that are watery and don’t have much oil to coat the eye surface). Conversations with patients tell us that over-the-counter medications such as artificial tears and lubrication ointment can be effective for some, as well as adding fish oil or flax seed supplements to their diet. Even the basic habit of drinking water and staying hydrated can also play a positive role in eliminating this symptom.


Peoples thought Rhonda would benefit from taking hormones, but she first needed to make sure Rhonda was a good candidate. Natasha asked many questions about Rhonda’s medical history and lifestyle habits, and determined she was very healthy, except for being overweight. They talked about getting back to the basics and incorporating the SEEDS into her daily routine. And, they also worked out a plan to start menopause hormone therapy, deciding on the patch and FDA-approved progesterone capsules called Prometrium-bioidentical.


Three months later, Rhonda returned to see Peoples for her checkup and happily reported she felt better. She added one more walk to her week, started doing a DVD with weights, added yoga once a week, and began a routine of daily stretching. In addition, she drank more water, got better sleep and took a multivitamin, Vitamin D and fish oil.


Two weeks after starting the hormones, her hot flashes disappeared, and although her dry eyes weren’t completely back to normal, they were only a minor nuisance and no longer bothered her at work. Even her friends and family members noticed she was acting and feeling better.


Women, including Rhonda, do not have to suffer during menopause. Sometimes even the most basic habits can make all the difference in helping us feel better. And, even though Rhonda’s health care providers aren’t completely sure which change helped her eyes improve the most, Rhonda enjoyed feeling better than she had in a long time.


Reprinted with permission from Spectrum Health Beat.

‘SEEDS’ require water

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Courtesy Spectrum Health Beat

By Diana Bitner, MD, Spectrum Health Beat


Water is a critical component of our body’s structure and all its functions.


It makes up approximately 55 percent of the female body.


Key organs—muscles, heart, brain and lungs—are made up of more than 75 percent water.


So what happens when we get busy and don’t take the time to hydrate?


If we leave water out of our daily habits, the results can be subtle but significant. Hypo-hydration can take its toll in ways that affect our normal daily function.


A patient I’ll call Sally is a prime example of what can happen when we don’t hydrate enough.


When she came to see me in the Spectrum Health Midlife and Menopause Health Clinic, she wondered if she was going into menopause because she felt so terrible. She had attended one of my talks and remembered me mentioning the symptoms of menopause—fatigue, hot flashes and irritability.


She had been experiencing all these symptoms, as well as suffering headaches and feeling short-tempered with her husband and kids. Her periods were also irregular, but not entirely indicative of menopause.


After gathering Sally’s information, I had a very good idea what was going on with her.

Dried out

As Sally talked, I noticed her skin and hair were dry. She looked tired and quite thin.


To confirm my suspicions, I started by asking Sally if she practiced her SEEDS (Seven Essential Elements of Daily Success) every day, especially the first one—drinking plenty of water.


Sally said she drank only about one or two 8-ounce bottles of water most days, but she hoped her five cups of coffee and nightly glass of wine would make up the difference. Wrong!


Unfortunately, Sally wasn’t doing very well on the rest of her SEEDS either. She only slept about five hours a night. She didn’t eat balanced meals. She rarely exercised because she was too tired. She barely practiced any meditation or gratitude.


Instead, she found herself rushing to the next event or handling another emergency at work or at home.


When we finished discussing the SEEDS, I told Sally her symptoms were not the result of menopause or her hormones.


She asked why I focused on water and diet. I explained how body function depends on water, especially for cooling and energy. When the body is dehydrated, the muscles can get hotter more quickly, causing them to get tight like beef jerky.


Without adequate water, women can experience hot flashes, muscle spasms and fatigue.


Dehydration can also cause constipation, because the colon removes all the water from the bowel movement to keep enough for survival, causing the bowel movement to be dry and slow-moving.


Why was Sally’s skin so dry? Without adequate water, skin dries up like a sad houseplant. It can look old and tired before its time.


I asked her to think about the water-coffee balance. Her body requires about 80 ounces of water per day. Because coffee and alcohol are dehydrating, she needed to drink an additional glass of water for each cup of coffee or glass of alcohol she consumed, just to stay in balance.


Sally began to realize that her inadequate water intake, combined with her diet poor in complex carbs and protein, had been contributing to her poor energy, bad mood and lack of motivation to exercise or play with her kids.

Lots of libation

Sally’s story is similar to those of many women who come to see me.


She got out of the habit of self-care and thought she did a better job by focusing first on work and others. Wrong again!


Unfortunately, the result is just the opposite of what she strove for. Everyone, including herself, ended up worse off because she neglected herself.


All women, including Sally, must include themselves on their list of people to take care of.


We used the list of SEEDS to make a plan to get Sally back on the road to feeling healthy again.


She agreed to drink two glasses of water before she left the house in the morning (and before her first coffee), another one in the car, one in her office with her second cup of coffee and one more before lunch.


She also committed to drinking another glass of water at lunch, one in the afternoon, one in the car on the way home and a glass at dinner. She even agreed to sacrifice her nightly glass of wine and only drink one or two glasses on the weekend—at least until she felt better.


In addition, she said she would start eating at least two small meals of things like Ezekiel Bread with peanut butter, bananas (for potassium) and a salad with a protein for dinner.


These were all small changes, but at least it would be a start.


I suggested waiting until she felt a little better before beginning a strenuous exercise program. Instead, we talked about incorporating yoga and stretches into her daily routine and focusing on getting more sleep and taking walks with her family.


Sally was surprised when I told her it would take her body at least three days to really catch up on hydration, noting that her muscles, skin and hair would take some time to soak it all up.


She was relieved to hear she would not have to urinate so much after three or four days.

Back to basics

When Sally came in for her recheck four weeks later, I almost didn’t recognize her!


She actually laughed at herself for thinking she was in menopause and not realizing how she had let her health go. She came in hoping for a hormone patch or magic pill to make her feel better, but she was pleasantly surprised to discover she simply had to get back to the basics and recognize the power of hydration.


In the past four weeks, Sally drank plenty of water and felt so much better that:

  • She was no longer depending on coffee to give her energy. She still drank coffee but did so just because she enjoyed the taste, instead of using it as a vice.
  • Her muscle cramps were gone.
  • Her mood improved and everyone noticed. She didn’t even miss her nightly wine.
  • Her night sweats had improved to the point she only experienced them the night before her period started.
  • Her hairdresser commented how much better Sally’s hair felt and looked.
  • She began to think about how she could put daily exercise back in her schedule.
  • She began to have more fun with her kids than she had in a long time.

Things are definitely headed in the right direction for Sally and her family—and it all started with going back to the basics!


Reprinted with permission from Spectrum Health Beat.



Maintain your bone health

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Don’t forget to give your skeleton what it needs to carry you safely through life. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


One in 3 women and 1 in 5 men older than 50 will experience an osteoporosis-related fracture.


Hip fractures often require surgery and may lead to loss of independence, and vertebral fractures lead to loss of height, pain, nerve compression, and sometimes deformity.

A bit about bones

Our bones are constantly remodeling, with steady building and breakdown, and we reach a peak bone mass in our late 20s.


After our peak, we lose a bit more each year than we build, and when the bones get to be too porous and weak, we are at risk for a fragility fracture, or a break that occurs with minimal trauma such as stepping wrong off a curb or a low-impact fall.


Osteoporosis is the condition when the bones are thin enough to increase risk of fracture to the point that treatment might be indicated, and our goal is to keep osteoporosis from happening.


Osteoporosis is a silent disease, and has no symptoms. The good news is osteoporosis can be prevented, and also predicted if you know the risks.


The basic concept is we want to support our bone-building cells by supplying adequate calcium in our diet. This includes four servings of dairy or leafy greens, adequate vitamin D to allow for calcium absorption (about 2000 IU per day for most adults), and enough weight-bearing activity to let the bones know they are needed. Research shows we need approximately 20 minutes of weight-bearing activity per day.

Midlife wellness

As a busy obstetrician and gynecologist, I should have been thinking about my patient’s bone health way more than I did, but it was not on my radar for those years of delivering babies.


As I started to care more for women approaching midlife and thinking about how I could support wellness, I started asking my patients about risk factors.


I soon met with an internal medicine physician who is passionate about bone health and supports our patients on how to avoid fracture and disability. He taught me about prevention, diagnosis and treatment options.


Also at that time, I had a patient who underwent a bone scan and, when I called her with the bad news that she had osteoporosis, she felt absolutely floored. How could she, a healthy 52-year-old, have osteoporosis?


We went through the risk factors, and she probably never took enough D like the rest of us, avoided dairy due to lactose intolerance, was active but perhaps not enough, and occasionally took oral steroids for asthma.


She decided to start hormone replacement therapy for her menopause symptoms, which is also indicated for prevention of osteoporosis as it supports the good bone she still had. She also became serious about vitamin D and calcium supplements, and exercised every day or at least did her 50 jumps.


A followup scan three years later showed stable bones. Further, her fitness regimen had improved her balance so she was less likely to fall. Thank goodness we found her osteoporosis before she had a fracture.

Supporting your skeleton

We support bone health by knowing what risk factors to avoid. If we have other health conditions that put our bones at risk, we should be aware of the issues and do what we can to make up for the risk.


Lifestyle risk factors for osteoporosis include more than two alcohol drinks per day, cigarette smoking, inactivity, low body weight, and inadequate calcium and vitamin D.


Genetic factors for osteoporosis include family history and conditions such as cystic fibrosis and other metabolic conditions. Hormone conditions— such as menopause, especially if premature, diabetes, Cushing disease and parathyroid dysfunction—are also factors.


Medical conditions such as anorexia and bulimia also put people at risk, as well as celiac disease, epilepsy, rheumatoid arthritis, gastric bypass surgery and lupus. Many cancers also put people at risk for accelerated bone loss such as multiple myeloma, treatments for breast cancer, and medication use to include oral steroids, antacids and anti-seizure medication.


The good news is, if we look, we can get information in time to act and help slow or prevent bone loss. The results from a scan, together with risk factors, help us make recommendations for potential treatment.


Reprinted with permission from Spectrum Health Beat.

Enjoy sugar, but in moderation

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By Diana Bitner, MD, Spectrum Health Beat


Too much sugar is never good for you. Combine it with extra stress, and you have a recipe for disaster.


There are certain times of the year we know we will indulge in extra sweets: holidays, birthdays, graduations and work outings. These are also times when we might feel more stressed.


But is it possible to enjoy sugar in moderation and be healthy at the same time? Absolutely.


If you can master the basics of healthy eating, despite the extra stress you may be feeling, you can keep your eating in check during any occasion.

Belly up and listen

What I’m really talking about is belly fat. I take this topic very seriously because belly fat can kill you. It can happen to any of us, and it’s something I discuss with nearly all of my patients at one time or another.


Shelly is one of those patients. She came to see me for her physical, and she was upset because her favorite jeans did not fit.


She was just 50 years old and still having periods, and she began to notice her metabolism changing. She had gained her usual 5 pounds over the summer because of numerous summer parties, backyard barbecues, fruity cocktails and beer.


She typically didn’t drink during the week, but it was just too easy to crack open a cold beer when she was doing yard work under the summer sun. When friends would stop over, she’d mix up some drinks. I’m sure we can all relate to these same situations.


In the past, Shelly would go back to her normal routine when fall arrived. The 5 pounds would come right off. She would only drink on the weekends and she’d begin a better routine of regular exercise and sleep.


This year, however, something was different: She didn’t lose the 5 pounds and she actually started gaining weight.


Knowing that the holidays weren’t far off, she was worried her weight would get out of control and she would have even bigger issues.


Shelly was smart to be worried.


Once belly fat starts, it gets a mind of its own and can get out of control quickly. That’s exactly what was happening to Shelly—she was gaining all of her weight in her belly. I knew she was concerned and disappointed.


She said she always had a flat belly, but now that was changing.

Icky, sticky

A recent study in the Annals of Internal Medicine proves what we already know: Belly fat leads to early death in men and women by increasing our risk of heart attack and stroke—up to 10 years earlier than it might have happened if we didn’t have any belly fat.


The reality is most of us will die of heart attack or stroke at some point. But belly fat makes it happen sooner.


How? Belly fat is deep on the inside, wrapped around your bowels and liver, and craving sugar. As belly fat grows, your liver uses it to make bad cholesterol, and then the belly fat produces inflammatory chemicals to make your blood vessel linings sticky.


At the same time, the fat makes your body insulin-resistant, raising insulin levels and keeping blood sugar high by making you crave sugar.


This combination—sticky blood vessels, high blood sugar, and high cholesterol—causes plaque to build up in the blood vessels, blocking blood flow to your brain and heart muscle. All of this can lead to heart attack and stroke, and once the belly fat gets going, it doesn’t give up easily.


Bottom line: We can’t let the belly fat start.

Back to basics

Another factor that makes belly fat grow is stress—both good stress and bad stress.


Added stress can raise insulin levels and use up stress hormones such as cortisol and DHEA. It can cause our sleep to be interrupted, leaving us sleepy and fatigued. We know that sleep deprivation leads to insulin resistance, causing us to crave and store more sugar. It’s a vicious cycle.


During Shelly’s physical, I asked if I could measure her waist circumference. Measuring waist circumference is easy, but it can feel more personal than a pelvic exam.


Here’s how it’s done: Take a tape measure and wrap it around the small of your back, over your hip bones and around your belly.


We measured Shelly’s belly and it was 39 inches. Healthy is 35 inches.


After seeing that number on the measuring tape, Shelly made it a goal to lose 4 inches of belly fat.


After hearing what I had to say about belly fat, Shelly knew she needed to get off the sugar, reduce stress in her life, and change her sleep habits.


In other words, she needed to get back to the basics.

Grow with SEEDS

By having a plan, you can succeed even during the toughest of times.


When you adopt these habits and work hard to follow them every day, it is easier to get back on track if you have a stressful day or have a sleepless night.


When I talk about the basics, I am referring to the SEEDS—Seven Essential Elements of Daily Success—concept as a way of life.


Here are the seven basic things I discussed with Shelly:

  • Drink plenty of water (eight glasses a day). Add one more for each cup of coffee or for each serving of alcohol.
  • Get plenty of sleep (seven hours a night). Take power naps if necessary to be sure you are getting enough sleep.
  • Take your vitamins daily, including Vitamin D and a multivitamin.
  • Eat a balanced diet, including plenty of healthy carbs and protein, with only one sugar treat (including alcohol).
  • Eat plenty of fiber (think vegetables) and take a fiber pill if needed.
  • Exercise regularly (30 minutes a day, with a mix of walking, aerobic activity, strength training and stretching).
  • Start a gratitude journal and do metered breathing each night before going to bed.

You may have noticed that alcohol is mentioned more than once in the list of SEEDS.


Beer, wine and liquor are all forms of alcohol, and they all contain sugar. Since alcohol is often a part of a celebration or party, it’s important to limit your other forms of sugar (pasta, white bread, cookies, etc.) if you will be consuming a drink (or two or three) that same day.


And remember to add an extra glass of water for each drink consumed.


Shelly may not have been excited to see that her waist circumference was 39 inches, but she was happy with our discussion.


Reprinted with permission from Spectrum Health Beat.

Ladies, cherish your heart

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Work with a care team to reduce your cardiovascular disease risks. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


For many women, cardiovascular disease is personal because they have lost their mom or sister to a heart attack or stroke.


They get how heart disease is the No. 1 killer of women, and that too many women are robbed of happy years with family and friends. They have experienced firsthand a loss that could have been prevented.


Women’s heart disease is more common than thought, and especially increases after menopause if women do not take estrogen medication.


There are other risk factors, which include belly fat, pre-diabetes or diabetes, lack of exercise, sleep deprivation, and a diet high in processed foods, unhealthy carbohydrates and saturated fats.


Prevention of heart attacks and strokes is possible, but has to start with a goal and a plan.


Once a woman decides to not have heart disease, or if she survives a heart attack and wants to prevent another, she needs a team. On that team, at minimum, should be a preventive cardiologist and a certified menopause specialist. This team will put the patient in the middle, and partner with her to help her achieve her wellness goals.


An example of how such a team collaborates might be best told by a patient I’ll call Laura.


Laura came to see our menopause specialists because her hot flashes would not go away and interfered with her life.


She had been told hormones might not be safe because she was overweight, had high cholesterol and took blood pressure medication. Her family had a history of cardiovascular disease and her loved ones had suffered heart attacks.


Her biggest concern? To not have a heart attack herself. She was also desperate to get the hot flashes to stop.


As menopause specialists, the first thing we do after understanding a woman’s story and risk factors is to consider treatment options.


We always start with the SEEDS and Laura definitely had room for improvement in this area. She realized she needed to drink more water, cut the sugar, and get more restful hours of sleep each night.


These lifestyle habits alone could significantly ease her symptoms, but since she was only two years out from her last period, we also had the option of considering hormones. We know that FDA-approved hormone medications used the correct way can actually help reduce risk factors for heart disease and could definitely help her feel better.


In reviewing her history, I saw she had enough risk factors that I wanted the opinion of preventive cardiologist Thomas Boyden, MD. After an evaluation, testing and suggestions for how to prevent heart disease, Laura was cleared to proceed with our treatment plan.


The end result? Laura felt more informed, had the tools to be successful from her care team, and she could start taking hormones because they would be a safe option for her.


Laura now had hope for how she could age differently than her relatives.



Reprinted by permission from Spectrum Health Beat.

Get your workout mojo back

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Strength training is a great way to build muscle and avoid weight gain. (Courtesy Spectrum Health Beat)


By Diana Bitner, MD, Spectrum Health Beat


If you’re like most women, you have a tough time getting back into a workout routine once you get out of the habit of exercise.


We think we are active enough with weekend activities, yard work and the occasional jog or bike ride. But as we get older, we realize this type of exercise routine isn’t quite enough, and we start to gain a few pounds each year.


Worse still, if we become more relaxed about our diet, the weight gain is even greater.


We might not notice until our clothes are suddenly a little too tight.


This may be the wake-up call we need to get our exercise mojo back.


So where do we begin? Let’s start with the basics of exercise.

Aerobic, strength, stretching

I like to focus on three types of activity: (1) aerobic exercise, where we get our heart rate up and keep it sustained for a given time; (2) strength training, to maintain and build muscle; and (3) stretching, to prevent injury and fatigue.


All three aspects are important to help maintain a healthy and strong body.


All three also play a vital role in helping you fit into the clothes you love.


Strength training is especially important for women as we age, because if we allow muscle mass to be lost, fat moves in between the muscle fibers, leaving muscles weak and flabby. When muscle mass drops, weight gain starts.


Men don’t often have the same issues as women when it comes to weight gain. They tend to keep weight off more easily for many years because they start with more muscle mass and naturally express more testosterone.


Women who keep their muscles toned by doing interval training, weight lifting, resistance training and incline training can keep the weight off more easily as well.


You may be shaking your head and thinking all this exercise sounds way too difficult, but it’s much easier than it sounds.

Choose it

First, make sure whatever type of workout you pick is something you like to do. For example, I like to swim—I participated on the swim team in high school. I also like to lift weights, and I learned the proper way to lift from my roommate in college.


One of my other favorite forms of exercise is yoga. I do it twice a week at home. As you can see, if you find something you enjoy doing, you can make it work. If I’m pressed for time, I lift weights and do yoga without ever leaving my home.


Fortunately, there are many different forms of exercise—you just need to find the right one for you and your lifestyle.


If you don’t like yoga, try a Zumba, body pump, or kickboxing class. Pilates, Tai Chi, or aquafit classes are also good options. Even better, mix it up and try several types of workouts each week.


To help build muscle, add in some weight-lifting exercises either at a gym or in the privacy of your own home if you have some weights.


If you need a little help getting started, check out one of my favorite health books, Body for Life for Women by Pamela Peeke, MD.


You’ll find some simple strength-training workouts for the upper and lower body in the back of the book. Even if you do the book’s lower-body workout two or three times per week, you can maintain—and possibly even increase—muscle mass. I think you’ll find the exercises and the entire book helpful.

Schedule it

In addition to the type of exercise you choose, you also need to determine a time when you’ll actually do the exercises each day, or at least several times per week.


I prefer to do my workout at night, when I’m too drained to do other work such as paying bills or writing.


When I have finished helping my kids with their homework and my kitchen is cleaned up after dinner, I head to the exercise bike or yoga mat—usually around 9pm. This allows me to get in a good workout, clean up and head to bed before it gets too late.


This routine works well for me and allows me to de-stress from the day. I know I don’t have time to exercise in the morning, so I don’t plan on it. Many women, however, see morning as the best time to do their workout—they’re then done for the day, and they know there’s no way they would do it at night.


After you’ve chosen an exercise and a time frame, you need to put it on your calendar. You may think you don’t need to schedule your workouts, but it really does help you stick to your plan.


Here’s what I recommend: On Sunday night, plan out your week. Start by listing your priorities: work, kids’ events, appointments, exercise. The rest of your day should be planned around these scheduled priorities.


As I look at each day, I plan a longer workout, such as swimming, when I have more time. On days when I’m pressed for time, I schedule a shorter workout, such as the legs and core session from Dr. Peeke’s book.


There is usually one day each week when I simply have no time to fit in a workout, and that becomes my day off. So when the day comes, I have already planned to take it off—no guilt.

Do it

So what are you waiting for? Create your exercise plan today!


Usually by day five of my routine, I’m feeling so good that I’m choosing to exercise instead of making myself do it.


If you can get into a regular routine, add some strength training, and cut down on your carbohydrates intake—especially after 3 p.m.


The results will soon follow.


Reprinted with permission from Spectrum Health Beat.

Break the cycle

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Learn from your parents and teach your children how to live a healthy lifestyle and age well. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


It’s possible that a simple conversation between parents and their children is all it would take to stop the cycle of some diseases.


If parents would discuss their own health problems with their kids, things like heart disease and diabetes might occur much less often.


Diabetes, heart disease and even breast cancer are preventable by following a healthy lifestyle. A well-timed conversation—before another generation suffers—could make all the difference.


When people say, “Everyone in my family has diabetes” or “Everyone has heart disease,” the underlying reason is usually a sensitivity to sugar.


What does this mean? Some families have a predisposition to belly fat weight gain and get diabetes earlier in life. Anyone can get diabetes if they eat enough sugar and gain enough weight, but some people get diabetes at lower weights.


Examples of this include the Freshman 15, gaining 30 pounds after having a baby, or the 15 pounds many women gain at menopause. More belly fat means more sugar cravings for foods like white bread, white potatoes, white rice and sweets.


Once ingested, the sugar then goes straight from the stomach to the belly fat. It’s a vicious and very unhealthy cycle.


Unfortunately, high blood sugars typically mean high cholesterol as well, especially if your diet is also high in fats like butter, lard, bacon and red meat. Sugar and fat together are a bad combination because high blood sugars make blood vessel walls sticky, the fat sticks to the walls, and plaque or blockages are formed. When enough blockages form in blood vessels, enough blood cannot get through to your vital organs (heart and brain), which would lead to a heart attack or stroke.

Tackle your risk factors

I have discussed the topic of risk factors in previous blogs, and I believe the topic is important enough to mention again here. We all have risk factors we can’t change—family history, age and timing of menopause. But there are risk factors we can change (exercise, sleep habits, and food choices), and it’s not as difficult as you may think.


The first step is to make a goal toward better health.


To create your goal, look at how well your mom, dad, or grandparents aged.


Hopefully, they were able to be a good example of how to lead a healthy life. Sadly, many women have not grown up in households with parents who were positive examples of how to eat right and exercise.


Many parents never talked to their kids about eating a healthy diet or maintaining an active lifestyle in order to avoid diabetes or heart disease. If you were lucky enough to have a mom or dad who talked with you about the importance of being healthy, use that positive example to create your own goals.


If not, create a clear picture of yourself and how you want your own life to be, and use that picture to set some goals for your future. How do you want to look and feel in three months, one year, or when you are 50 years old?


A patient I’ll call Leonica is an example of someone who grew up with several family members who suffered from a variety of health problems.


They had heart disease, diabetes, obesity and cancer, but they never talked about their health issues. The memories continued to haunt her, and she decided she did not want to suffer in the same way. Leonica respected that her family was strong and independent, however, she wished her family could have talked about their health problems to help her and others from her generation lead better lives.


For example, Leonica had no idea about the connection between craving sugar and eating simple carbs. She didn’t realize that eating things like white bread, white rice and potatoes would make her feel tired.

Things to know (and remember)

By educating herself, Leonica learned how eating more complex carbs like sweet potatoes and brown rice, and having a protein and vegetable for dinner would help her lose weight—without giving up her favorite foods. She continued making diet changes to reverse early diabetes and became more active in her everyday life.


As a result of her changes, Leonica became an example for her children, nieces and nephews. She also became the voice to get others talking about how to change their lives for the better. By passing on this knowledge to her extended family, Leonica hopes to stop the cycle of the diseases that have plagued her family for years.


Here are a few key points to remember:

  • See your doctor—If your family members have heart disease, diabetes or obesity, it doesn’t mean you will have the same fate. However, you are more likely to suffer from these issues, so see your doctor, get tested early for diabetes, and learn how you can avoid the same health problems.
  • Talk with your family about their health—Ask your parents, aunts, uncles, grandparents and siblings about their health. Learn from them what you should and shouldn’t do to be healthy. Women who cope best ask for help and get educated so they can develop a goal and a plan. It’s OK to talk about bad moods, depression and anxiety; sharing can help others and take away the fear associated with these issues.
  • Know your numbers—Find out your waist size, blood sugar (A1C) level, cholesterol levels and blood pressure. It can be scary to know you have pre-diabetes, but knowing gives you power and can be motivating to get a plan in place—before it’s too late.
  • Know how close you are to menopause—Being healthy gets harder after menopause, so you want to know how close you are to being there. As estrogen hormone levels fall, the body craves sugar and stores it in belly fat. And belly fat raises insulin and insulin factors, which increase the risk of breast cancer. Everything is tied together.
  • Cut back on the simple carbs—These are the same as sugar, and, if you want to avoid diabetes and heart disease, you need to have only one simple carb serving per day. Examples of simple carb foods include white bread, white potatoes, white rice, white flour tortillas, sweet treats and alcohol. Remember—only one per day.
  • Eat a good breakfast—Include a complex carbohydrate (whole wheat bread, cooked oatmeal, whole wheat bagel), a protein (eggs, low-fat cheese, turkey bacon), and a healthy fat (olive oil, avocado, nuts). Eating a healthy breakfast will keep your blood sugars stable and curb your cravings all day long.

Reprinted with permission from Spectrum Health Beat.

Power of the sweet potato

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Sweet potatoes are an excellent source of potassium, calcium, and vitamins A, B and C. Sweet potatoes are also a source of antioxidants, which are important to reduce cancer and heart disease risk. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Midlife and menopause are stages of life when weight gain happens fast and weight loss can be very slow.


Let me share a secret that can help: sweet potatoes.


Many people are surprised to learn the sweet potato is a healthy food that can to be added to any meal and help us all keep a healthy weight and get daily vitamins and fiber at the same time.


The sweet potato qualifies as a superfood—a weapon against weight gain, belly fat and diabetes. It can be enjoyed for breakfast, lunch, dinner and even as a snack.


The sweet potato has so many health benefits. For weight control, it is a low glycemic index food, meaning that while it contains carbohydrates, the carbs are slowly broken down in the blood and can be used by the brain, muscles and liver and not sent straight to the belly to become fat.


Low estrogen levels, which define the life stage of menopause, cause cravings for sugar or any simple carbohydrate, such as what is found in white potatoes, white rice or white bread. Our body’s response to stress or sleep deprivation can include a rise in insulin surges and insulin response, which can result in an increased waistline.


Including foods such as sweet potatoes in your diet can help slow weight gain and add many good vitamins and fiber.


Sweet potatoes are an excellent source of potassium, calcium, and vitamins A, B and C. Sweet potatoes are also a source of antioxidants, which are important to reduce cancer and heart disease risk. Manganese is also in sweet potatoes and can help with your metabolism.


Being healthy is about using small tips and tricks in daily life. The sweet potato can be used in fast and easy ways. They can be roasted, boiled, steamed, or even eaten raw.


The vitamins are best preserved when steamed, but I tend to roast my potatoes because it is easier. I wash the sweet potatoes, poke holes in the skin to avoid explosions in the oven, and put them on a cookie sheet for an hour at 350 degrees. Once they are cooled, I use the cooked sweet potatoes in a variety of ways to make satisfying and tasty recipes.


For breakfast, especially on the weekend when I have more time, I love to make one of my favorites—sweet potato hash.


Sweet potato hash: 1/2 cup chopped onion, 3 cloves chopped garlic, 1 tablespoon extra virgin olive oil, 1 cup of greens such as spinach or Swiss chard, 1-2 cups cubed roasted sweet potato, and optional meat of 1/4 cup cooked sausage or cooked bacon. These ingredients are sautéed together and then topped with a fried egg. Maple syrup added around the edge of the plate makes a tasty treat.


Here are some other ideas:


Sweet potato snack: Cooked sweet potato mashed with a fork, covered with a tablespoon of real maple syrup, chopped nuts such as walnuts, almonds or pecans, and warmed in the microwave.


Fast lunch with sweet potato: Cubed sweet potato with 1-2 teaspoons of olive oil, warmed in the microwave and tossed with salad greens and leftover cold chicken or sautéed tofu. This is tasty, filling, and helps avoid sugar spikes.


Sweet potato french fries: For dinner, my kids prefer sweet potato fries, simply made by cutting the raw sweet potatoes into whatever shape works—sliced to be round (fastest) or cut into traditional fry shape. Simply place the pieces on a cookie sheet with 1-2 tablespoons of olive oil and 1 teaspoon of Kosher salt, and bake at 400 degrees until brown or about 30 minutes, flipping the pieces halfway through for evenness.


Sweet potato custard: Mash 2 cups of roasted sweet potato and add 1 beaten egg, 1/2 cup almond or cow milk, 2 tablespoons of maple syrup, and spices such as cinnamon, ground ginger, cloves and nutmeg. Place in a small baking dish or ramekins, placed on a cookie sheet and baked at 350 degrees for 30 minutes. Yum!


Reprinted with permission from Spectrum Health Beat.


PMS and the blues

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Brain chemicals can get a bit wonky from time to time, causing moods you can’t shake. There’s help. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


In the dark days of winter, we all start feeling caged in and sick of the cold.


It is normal to feel moody, irritable, anxious, sad, depressed, less motivated and even overwhelmed. Some days we would just rather stay in bed and hide from the world under the covers.


If you have the misfortune to suffer premenstrual syndrome, or premenstrual dysthymic disorder, the winter will seem even longer.


Many women suffer mild mood changes such as irritability during their monthly period, after the birth of a baby or around the time of menopause.


In a normal menstrual cycle, estrogen drops slowly before the period starts. Mood changes are tied to estrogen level changes and, as another cycle begins, estrogen rises and mood changes go away.


What are not as common are mood changes that affect relationships, work behavior or lifestyle habits such as use of alcohol. This happens to women who suffer from these premenstrual syndromes.


The way this works is our brain chemical balance is influenced by estrogen. We each are unique in our chemistry. Our brain chemical balance is a big part of our personality—how we cope, our sex drive, our behavior in general.

Banking with brain chemicals

A couple of brain chemicals to pay attention to are gamma-aminobutyric acid and serotonin.


Gamma-aminobutyric acid is the brain chemical that helps with concentration. Some brains do not make enough of it and this contributes to symptoms of attention deficit disorder.


Serotonin is the brain chemical many women depend on to feel normal. One way to think about serotonin is like money in the bank. Picture a bank balance sheet. We make serotonin during sleep.


Due to genetics, some women make more serotonin than others. Serotonin goes in the “deposit” column of your balance sheet. Serotonin is “spent” on each life event. Unresolved issues or emotional challenges like elder parent care or a difficult job situation “costs” more serotonin than, for example, being late for work or not having any clothes that fit.


When estrogen is low—right before a menstrual period—serotonin is spent more quickly. Something needs to happen to rebuild your balance.

A real life example

A patient of mine I’ll call Mary came to me at the urging of friends.


Mary’s behavior had changed significantly. At Mary’s appointment, we assessed the situation. Her periods were slightly irregular, but still came every month. She had been noticing more headaches, bloating and fatigue around the time of her period. Overall, she thought she was doing well but agreed her moods had been worse.


I asked her what had changed in her life. Mary confided that normally when she was in a bit of a bad mood, she could still “act happy.” Lately, however, she seemed unable to control what came out of her mouth. She worried about everything, particularly—and needlessly—about money or future plans.


Too many nights she could not sleep because her mind simply would not stop. Her weight and sex drive had changed for the worse. Mary simply did not feel connected and often felt sad and she did not know what to do about it.


We talked about how brain chemicals and estrogen are closely related. Because of her lower estrogen level right before periods, she spent her brain chemicals too fast. Also because of low estrogen, she couldn’t sleep well before a period, and therefore didn’t make enough brain chemicals.


Mary had fallen into a vicious cycle.


She hesitated to consider taking medication to help. I reminded her that women 75 years ago would have given anything for the medical options we have today. Women now do not have to suffer like in years past. Times have changed for the better.


Mary did choose to take advantage of medicine that raised her brain chemical serotonin. After three months, she felt like her normal self. She was more active, had started walking again every day and wanted to go out with her friends.


So pay attention, ladies: Bad moods can be a symptom of changing hormone levels, but they do not have to be suffered in silence. Please talk to your doctor and get help.


Reprinted with permission from Spectrum Health Beat.

Are hormones safe?

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For many women, a healthy lifestyle is not enough. They want some kind of treatment to help them feel better and get back to feeling like themselves. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Too many women suffer needlessly from symptoms of hormone changes and menopause.


Women want to age with health and vitality, but often are taken by surprise with midlife body changes. It is unfortunate that not enough women know the facts about hormones and options for healthy aging.


We are fortunate these days because there are so many treatment options available.


There has been significant research to help us understand how to individualize these options for each woman depending on her preferences, medical history, stage of menopause and degree of symptoms.

Options abound

The foundation of treatment for the symptoms of menopause is a healthy lifestyle. This is defined by the SEEDS, or seven essential elements of daily success.


Following the SEEDS each day includes:

  • Eighty ounces of water
  • Seven hours of sleep
  • A healthy balance of healthy carbs, protein and fats with only one unhealthy carb treat
  • A multivitamin and vitamin D
  • Exercise and stretching
  • Fiber
  • Calm breathing and gratitude

For some women, this is enough to feel good through menopause. Twenty percent of women get through their transition with only minimal symptoms.


For many women, however, a healthy lifestyle is not enough. They feel so in the hole of symptoms that they want some kind of treatment to help them feel better and get back into good habits. This is when we talk about the most effective treatment for hot flashes, night sweats, pain with sex, sleep and mood disturbances and decreased sex drive.


Estrogen medication works quickly and is safe for many women. There are many fear-based untruths out there that keep women from using medication that can help them feel like themselves again.


A recent study of hormone use showed that the risk of blood clots has a higher association with oral estrogen use, not with transdermal—absorbed through the skin—estrogen therapy. And for oral estrogen use, the risk was higher with equine estrogen, also known as premarin, and not with the bioidentical, FDA-approved form of estrogen.


Now, for women who have taken premarin for years and do not want to stop, the risk of associated blood clots is mainly in the first year. Switching is possible, but for those women who choose not to, the advice would be to minimize other risks for blood clots by maintaining a healthy weight, staying hydrated, and taking a baby aspirin when on long car trips or plane rides. And always talk to your doctor about your risk.


Bottom line, be informed, make decisions based on facts, and get advice from doctors and other health care providers who are menopause certified. Every woman is different and what works for her or is safe for her may not apply to another.

Test your hormone knowledge

True or false? Hormones will make me fat.


False. Menopause is associated with belly fat, hormone medications are not. Studies show that hormone medication may help with sleep and reduce insulin resistance, so if women do the work to stay healthy, hormones can help maintain a healthy weight.


True or false? Estrogen causes breast cancer.


False. In the aforementioned study, women who were on estrogen because they had a hysterectomy had a lower risk of breast cancer. Estrogen does not cause cancer, but if a woman gets breast cancer, we do not give estrogen in the blood (via a patch or pill) because of concerns it could cause a recurrence. We might prescribe vaginal estrogen, but not systemic. The only women in the Women’s Health Initiative study with more breast cancer were older and on synthetic oral progesterone more than seven years. This study helps us understand safe ways to give hormones and which type.


True or false? Prescription medication is not bioidentical.


False. It is biochemically identical to the estrogen the ovary makes before menopause. We prescribe FDA-approved estrogen and progesterone, meaning it is the same every time you place a patch or take a pill. There is no batch-to-batch variability like in the compounded medications. Insurance will cover the FDA-approved medication.

Hormone guidelines to consider

If the below criteria describes you, hormones could be a safe option:

  • Less than 10 years from last period
  • No history of breast cancer
  • No vascular heart disease (heart attack, or high risk for heart attack)
  • No history of blood clot in the leg or lung
  • No prior stroke
  • No dementia
  • No metabolic syndrome (combo of high blood pressure, central obesity, high blood sugar, high cholesterol)

These are only guidelines. If there are any questions regarding risk, your provider will bring in partners from cardiology, diabetes, hematology, and cancer care to help guide decisions.


Reprinted with permission from Spectrum Health Beat.

Conquer your sleep issues

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Sleep well with these doctor-approved techniques that calm the mind… and hormones. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum HealthBeat

 

Many of the women who come to our midlife and menopause clinic have a common problem: sleep issues.

 

As an OB/Gyn doctor who still delivers babies, I admit I don’t always get as much sleep as I should, but I do strive to get my seven to eight hours most nights.

 

Also, as a doctor, I am well aware of the problems people often encounter as a result of poor sleep habits: decreased cognitive function (also known as brain fog), difficulty remembering things, decreased job performance, and an increased chance of having a vehicle accident.

 

If you aren’t sleeping well, your overall quality of life suffers, and you may feel less motivated to follow a healthy and active lifestyle. This, in turn, can cause mood disturbances such as anxiety and depression. You may not suffer from major depression, but even having an underlying sense of dread or being in a bad mood is not a healthy way to live your life.

Having a hard time sleeping?

It may make you feel better to know that you’re not alone. In fact, about 69 percent of people have sleep problems, and women have 50 percent more problems with sleep than men.

 

Nearly 20 percent of people have chronic sleep issues that can cause serious medical risks, especially if they average less than six hours per night and have poor quality sleep. Some of these health threats include an increased risk for high blood pressure, heart disease, stroke, Type 2 diabetes and obesity.

 

These are serious health issues for people of all ages, but for women who are also navigating their way through menopause, sleep issues add more stress to an already difficult time in their lives.

 

So, why do sleep problems become worse during midlife and menopause, and what can you do to start getting more (and better) sleep?

 

The answer to the first question has to do with hormones. My experience with helping women in midlife and menopause has shown that a common pattern develops in women during this time, especially as their hormones start to change.

 

Even if your periods are regular, as you get older, your hormones can change three days before your period, causing night sweats. Early in the transition, you might not even think you are having night sweats, but waking three nights in a row in the middle of the night can actually be a slight nighttime hot flash.

 

Unfortunately, what happens to we busy women is that we turn a simple night of waking up into a catastrophe that may look something like this:

 

“OMG—I’m awake! I cannot afford to be awake. Oh geez, I have to pee, but I don’t want to get up to pee. Now I really have to pee, but if I get up, I might not be able to fall back asleep. What should I do? Oh, I will just lie here. Well, that is not working. Toss, turn, toss, turn. Fine—I will get up! Now that I’m up and can’t sleep, maybe I should clean, or check email, or watch TV, or check Facebook. Maybe then I will feel tired.”

 

Of course, then you fall back asleep at 4:30 a.m. or so, and the alarm goes off at 5:30 or 6 a.m. You wake up and you feel stressed, cranky and craving sugar.

 

Does this scenario sound familiar? If so, you know how poor sleep makes you feel, and it’s not good. To make matters worse, as women progress into perimenopause and then into menopause, the symptoms can stretch from happening three days a month to every night.

 

The result is what I call a hot mess.

What can I do about it?

Don’t fret. There is hope.

 

There are several treatments for sleep disorders, but it really comes down to how well you follow the recommendations and treatment guidelines from your physician. It’s important to treat any medical conditions, such as snoring, sleep apnea and obesity, that may be causing your sleep issues to worsen.

 

I talk to patients about using hormone replacement therapy for improving sleep issues. Such therapy is not a sleep medicine, but it can reduce hot flashes and night sweats, thereby reducing nighttime waking events.

 

We also discuss sleep hygiene, which includes developing a regular sleep schedule, avoiding stimulation such as caffeine or screen time before sleep, avoiding naps longer than 20 minutes in the afternoon, and keeping a regular exercise schedule of at least 20 minutes per day.

 

Probably the most effective recommendation I make for my patients is to make time each night before bed for metered breathing.

 

If you’re not familiar with this technique, here’s a quick explanation: Find a peaceful place in your house, outside of the bedroom. I call this your Zen spot. Turn on a low light and get into a comfortable position. Close your mouth, open your eyes, stare at a particular spot in the room, and just breathe. Breathing should not deep or forced. It should be relaxed.

 

Be aware of the sound of your breath. As you are aware of your breathing and focused on one visual stimuli, your mind will become still. If an annoying thought or worry enters your mind, simply think about it for a second and then go back to the sound of your breath.

 

Do this for five minutes, then go straight to bed, close your eyes and enter dreamland.

 

It may take several nights of practice before it works effectively. If you wake in the middle of the night and can’t fall back asleep, go to your Zen spot and do your metered breathing.

 

You will be pleasantly surprised how well it works.

 

Reprinted with permission from Spectrum HealthBeat.

Don’t let anxiety or depression take control

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Break through the fog of depression. You can do it! (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

Depression and anxiety are both common and potentially serious health issues.

 

In fact, approximately 10 percent of us suffer from one of these disorders, with anxiety being more common in women than in men.

 

The symptoms of anxiety and depression can go away and come back throughout life if left untreated, and many people find it difficult to admit they have anxiety or depression, thinking there isn’t a cure for what they are experiencing. Fortunately, this couldn’t be further from the truth.

 

A few months ago, a patient I’ll call Cindy came to see me for her annual visit. She started to talk about her life and how she was feeling down most of the time. She didn’t understand why she was feeling this way—everything seemed like it should be nearly perfect.

 

Cindy is married, has three great kids and a part-time job she enjoys. She also has a strong group of friends at church and her parents live nearby, so she really feels like she has a good life.

 

As I probed a bit further with questions, she admitted she had been feeling down for about three months and wondered if she would ever feel like her old self again.

 

Her kids are doing well, but they are becoming busier with sports, church and school. Of course, this meant that Cindy is becoming busier as well. Although she generally isn’t feeling stressed or anxious, she started noticing some changes in herself: doubting how well she could handle her busy life, losing interest in playing games with her kids, making excuses to avoid going out with friends, cooking less (something she once loved to do), losing interest in sex, and exercising less.

 

When I asked Cindy about her extended family, she said that her mom had suffered from depression during Cindy’s childhood, and she remembers her mom withdrawing and spending quite a bit of time in her bedroom.

 

Cindy felt that her mom didn’t really know her and was never supportive of anything she wanted to do. In fact, when Cindy wanted to join the cheer team in high school, her mom would not take her to practice, and never encouraged Cindy to practice on her own or exercise to stay in shape. In addition, her mom always seemed sad and unusually quiet, her dad worked long hours and was never home, and her brother kept to himself most of the time.

 

Cindy obviously didn’t have a perfect childhood. She once had big dreams of attending college, but those dreams never materialized. She hadn’t thought about her college dreams in a long time, but talking to me about her childhood stirred up some old memories.

 

On a positive note, Cindy doesn’t drink much alcohol, never smoked, and eats a fairly healthy diet. She also walks the dog around her neighborhood daily, but she didn’t follow an intense workout program. Although she feels OK with her weight, she admits that she would feel better if she lost a few pounds.

 

Cindy just wanted to know how she could feel better. I certainly understand Cindy’s frustrations, and I was anxious to figure out why she was feeling this way and help her develop a plan to move forward.

 

I talked with her about anxiety and depression. We first looked at common risk factors of both: genetics (family history), low self esteem, prior traumatic events, abuse or neglect, substance abuse and early onset of anxiety and depression.

 

Cindy obviously had at least one of these factors in her life. We also talked about other reasons people struggle with these issues.

 

Anxiety and depression can be related to life events (past and present), but they can also be caused by chemical imbalances in the brain. The analogy I use to explain our brain chemistry goes something like this: brain chemicals are like money in the bank—we only have so much to spend before we run out. We make brain chemicals when we sleep, and genetically (linked to many genes), some of us make more than others. We spend brain chemical on life events, which can cause our supply to get low.

 

For Cindy, life events (busy kids, busy husband, busy household) were causing her to use her supply of brain chemicals. She also had unresolved issues come to the surface: her kids getting to do things she never did in her childhood, her husband working long hours (just like her dad did), and thinking more about her earlier dreams of college. Add to all of this a little weight gain, and you can imagine the stress Cindy felt.

 

When we have unresolved issues on our minds (like Cindy did), they cost brain chemicals. Sometimes we may not even be aware of some of the things that are floating around in our head. So, when our friends ask us out for coffee or it is time to make dinner, we don’t have enough brain chemicals to propel us forward. We slowly start to shut down, and life starts to pass us by. Depression can set in and affect not only ourselves, but our family, friends and co-workers as well.

 

There are several common symptoms of depression that you can look out for, including feeling down most days, losing interest in usual things, sleeping too much or not enough, losing or gaining weight, feeling unable to concentrate or think clearly, and thinking you are not good enough.

 

If depression is left untreated, other issues can arise, such as anxiety, diabetes, heart disease and thyroid disease.

 

In order to help Cindy, I first ordered some lab work, which included her blood count, thyroid levels, body chemistry function, vitamin levels, and sugar levels. All came back normal. My hope was that we could work together to treat her symptoms.

 

Cindy felt a sense of relief just getting her worries off her chest, and she became hopeful when I told her she wasn’t crazy. Her experiences are normal, common and treatable.

 

I first recommended that she see a therapist who practiced Cognitive Behavioral Therapy to help her sort out issues from her past. I also suggested more exercise in her daily routine, even if it is in small amounts (like 10,000 steps per day).

 

And, finally, I recommended a short-term course of medicine from a group called SSRIs (Selective Serotonin Reuptake Inhibitors). These drugs increase the brain chemical levels so there is “more money in the bank” to help people like Cindy get back on track and stop the downward spiral.

 

Cindy came to see me two months later, and she felt much more like herself again—hooray!

 

She had seen her therapist several times and had started a very low dose of the medication. She also developed a meal and exercise plan that worked well. Her kids and husband had noticed, and commented that they had missed having fun with her and were happy to have her back.

 

Cindy started to think about her part-time job and maybe quitting so she could go back to school. She had coffee with a friend and realized how good it felt to stay connected and laugh again.

 

I have no doubt that Cindy will be fine, but she will always have to be aware of her feelings, or even ask a friend to check in with her if she notices any new symptoms Cindy might be displaying. Cindy will inevitably experience stressful events in her future (we all will), so she will always be at risk for starting a downward spiral at some point.

 

However, with treatment and awareness, she should live a happy, connected and fulfilled life.

 

Reprinted with permission from Spectrum Health Beat.

 

Kick dreaded belly fat to the curb

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Avoid the accumulation of dangerous belly fat. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum HealthBeat

I’ve told all of you about my mantra—lean and ease of movement—in some of my earlier blogs.

My plan to help me achieve this mantra is to eat small, frequent meals of complex carbohydrates and protein, plus one simple carb treat each day.

How many of you came up with your own mantra to help you make good decisions every day? I ask that question because I really believe everyone needs a little help to make smart choices, especially during middle age and menopause.

One of the most important reasons to choose what you eat wisely is because of the relationship between middle age, menopause and belly fat.

Even if you have always had a flat stomach, or mostly gained weight below your waist, you may have noticed that has changed as you’ve reached middle age (and beyond). A common complaint I hear from women who visit my practice is that they gain belly fat easily and have a difficult time losing it.

Why is belly fat so bad? There are several reasons, including both medical and personal issues, with belly fat:

  • Belly fat makes you feel unhealthy.
  • Belly fat can change your mood from cheerful to irritable.
  • Belly fat greatly increases your risk for heart disease, diabetes and overall weight gain.
  • Belly fat adds more insulation, which can cause or worsen hot flashes and night sweats.

In addition, belly fat is extremely powerful because it is inside your abdominal cavity, not just under the skin like fat elsewhere on your body.

When fat is so close to your liver, it can cause a condition called “insulin resistance.” This means that your insulin receptors on your cells require more insulin to make the sugar go into your liver, muscle or brain cells. Thus, as insulin increases to meet this demand, it increasingly makes you crave sugar and promotes fat storage.

When you answer the craving and eat sugar, the sugar goes directly to the belly fat and makes it bigger, which then makes your insulin increase even greater. You get the picture: The belly fat has a voice that says, “Feed me.” That “voice” is insulin, and the only way to shut it up is to starve it of simple sugar.

So, what’s the answer?

It’s simple: Get off the sugar.

There are simple carbs all around you every day, but you need to figure out how to stay away from them without feeling cheated. I was at a baseball game recently, and you can imagine how many simple carbs were right next to me—blueberry muffins, licorice, hot dog buns, slushes.

Here’s what I did before I went to the game: I had a late breakfast of brown rice, poached egg and mixed greens. Plus, I took a baggy of frozen grapes to munch on during the game. I was completely satisfied and had no craving for that blueberry muffin next to me.

You can’t always avoid simple sugars, but you can make smart choices.

Ice cream with the family? Choose a baby cone and throw away the cone (or get the ice cream in a dish).

Heading to a party or a baseball game? Eat a healthy meal or snack before you go and take a sweet snack (like frozen grapes) with you to help you avoid the cravings before they start.

And, keep repeating your mantra—whatever it may be. If you do not feed the fat, you will take back your power to be healthy.

Reprinted with permission from Spectrum HealthBeat.

Weather your perfect storm

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Are you ready for menopause? Or even perimenopause? The storm is coming, so now is the time to act to make it less of a tempest. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum HealthBeat

 

So many women come to see me when they are experiencing what I call the Perfect Storm.

 

Their bodies are changing and they are faced with night sweats, increased belly fat, irritability, depression, lack of energy, irregular or heavy periods and decreased sex drive. That’s quite a list!

 

The Perfect Storm occurs when two fronts collide and cause havoc with your body.

 

The first front is caused by changing hormones, which then leads to an array of symptoms: night sweats, hot flashes, disturbed sleep, anxiety, irritability, decreased motivation and sex drive, and cravings of sweets and simple carbs. The second front is the change in your body chemistry, including changes in hormone levels.

 

The result? Good cholesterol levels go down, bad cholesterol goes up, insulin resistance increases, belly fat builds up and brain chemicals drop.

 

To more fully understand the Perfect Storm, it helps to know the three phases every woman goes through in adult life: reproductive phase, perimenopause and menopause.

Here’s a brief summary of each phase:

  • Reproductive phase—Many women in this phase feel normal and experience regular periods. This is the time we really don’t have to think about our hormones, and our body just makes sense. Toward the end of this phase, symptoms such as menstrual migraines, night sweats, mood changes and sugar cravings sometimes start. These symptoms are predictable and occur the three days before your period starts.
  • Perimenopause—This stage is sometimes referred to as midlife, and it’s also where the Perfect Storm occurs. Your periods start to become irregular, closer together and heavier, and symptoms like night sweats, sleep difficulties, mood changes and belly fat weight gain can become worse. You may even skip some periods and then begin having regular periods again.
  • Menopause—This phase means you haven’t had a period in 12 months—yeah! However, it’s important to note that if you go three months without a period and then you get one, the clock starts all over again. Approximately 80 percent of women experience symptoms during menopause, which typically last between two and five years after the start of menopause. The good news is that women who seem to handle the symptoms the best are the ones who continue to kept their weight in the healthy range, remain active, drink plenty of water and get plenty of sleep each night.

After menopause, it is very difficult to alter the course you are on, so if you want to weather your Perfect Storm and keep your symptoms in check, you need to make sure you are on a healthy path right now. What happens during the storm will determine the course of the rest of your life, so ask for the help you may need to sail through your Perfect Storm.

 

Reprinted with permission from Spectrum HealthBeat.