If you are over 40 and giving yourself any of these easy outs, you could be headed for health trouble.
Improve Your Health Over 40
Until now, we may have been able to skate by on good luck and good genes. But when we turn 40, reality sets in. As Judi Chervenak, MD, of New York's Montefiore Medical Center, says: "Women should do everything possible to maximize their health before they start the menopause transition, because that is when the risk for so many chronic -- and life-threatening -- conditions increases."
It's time to stop avoiding checkups and the health advice we know, deep down, we should heed. Listen to what health experts told MORE are the most common excuses of patients over 40. We realize, even as we hear our own voices echoing those rationalizations, that we can no longer afford to believe them.
1."I don't need to see a doctor if I'm not sick."
"Skipping annual exams means you may be neglecting routine tests that might detect a problem early -- like a blood pressure check for hypertension or a lipid profile that could identify heart problems," Chervenak says. "Caught early, these conditions are not only more treatable, but often curable."
Even if you're feeling fine, now's the time to start monitoring your vital statistics. "Most women don't realize they begin the perimenopausal phase before they turn 50," says family practitioner Laura Burlen, MD, director of the Balencia Wellness Spa, in Luna Pier, Michigan. "Screening for high cholesterol, thyroid disease, high blood pressure, certain cancers, and bone loss should begin early so problems don't escalate." Getting screened in your early 40s gives your doctor a baseline -- a reference point to work from if you start experiencing symptoms later. In addition, Burlen says, establishing baseline hormone levels before they change significantly can greatly help you make the transition through menopause.
You should also start looking at medical tests differently. "Disease testing shouldn't be cookie-cutter medicine," Burlen says. "Discuss your risk factors with your physician to decide how often you need to be screened for various conditions, no matter what the guidelines say." For a basic template of recommended screening tests, go to the Web site of the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality.
2. "It's probably just menopause -- it'll go away."
Think all that ails you can be chalked up to fluctuating hormones? "Such problems as fatigue, chest pain, and flushing could be hormone related, but they could also signal other medical conditions, including diabetic or cardiac issues, that should be actively pursued," Burlen says. "Menopausal women shouldn't minimize their symptoms." She also cautions that symptoms of thyroid disorders and parathyroid tumors can mimic those of menopause: insomnia, anxiety, distracted thoughts, and a racing heart. (A calcium blood test and a TSH blood test can screen for these problems.)
Many vague symptoms, such as headaches and fatigue, have benign causes like tension or allergies. Still, isn't it best to rule out catastrophic illness? "If you've already assumed the worst, things will most likely only improve after you've been examined by your doctor," says Dawn Calderon, DO, of the Deborah Heart and Lung Center, in Browns Mills, New Jersey. "You can put your mind at ease. Or if there's bad news, you can often fix things before they aren't fixable."
Good Genes, Good Health?
3. "I'm thin, so I don't have to exercise."
Being slim doesn't necessarily mean you're fit: A recent Italian study found that 20 percent of women with a healthy body mass index had an unhealthy amount of body fat -- 30 percent or more. A level this high increases your risk for inflammation, which is a factor in many serious diseases, including heart disease and diabetes. (Ask your doctor to run a high-sensitivity C-reactive protein test to assess your inflammation level.) "It's not a matter of fitting into a size 6," Calderon says. "With exercise, you can be healthy at many sizes." The benchmarks of good health are a blood pressure below 120/80, normal cholesterol and triglyceride levels, normal blood sugar, and a resting heart rate of 80 to 90 beats per minute.
Exercise is also a powerful weapon against aging and disease. "Arteries have muscles in their walls that allow them to open or constrict. When we exercise, we strengthen those muscles so the heart pumps more efficiently," says metabolism and nutrition expert Jana Klauer, MD, of New York City. "As we age, our respiratory capacity diminishes, and exercise counteracts that too." It also keeps bones strong as we approach menopause. "Daily weight-bearing exercise, like walking and jogging, maintains bone mass and balance," Klauer says. "We start to lose balance perception as we get older, so falls and fractures become more likely."
4. "Serious diseases don't run in my family."
Good genes are a plus, but they're not an insurance policy. Surprisingly, genes have little to do with longevity. Knowing how long your mother or father lived cuts the uncertainty about when you'll die by just three percent. "Just because your ancestors didn't have heart disease or cancer doesn't mean you're off the hook," Burlen says. "Women over 40 are faced with more risk factors than their ancestors, like stress, inactivity, and eating processed foods."
Moreover, there are newly documented sources of risk. According to the American Lung Association's State of the Air report, particle pollution (soot) and ozone pollution (smog) are linked to heart and lung disease, as well as premature death. Breast cancer has also been linked to environmental causes. "The vast majority of breast cancer has no family history, so women over 40 need annual mammograms, no matter what," says Cheryl Wesen, MD, director of breast care services at St. John Hospital and Medical Center, in Detroit.
Unhealthy Habits
5. "All my good habits cancel out my one or two bad ones."
You may eat right and exercise regularly but sneak a few cigarettes. You may abstain from alcohol during the week but polish off a bottle of wine on Saturday night with friends. "It's not like you get a get-out-of-jail-free card for your good behavior," Chervenak says. "Some habits, like cigarette smoking and heavy drinking, have a direct negative effect, no matter what healthy things you do to compensate."
"The single worst thing you can do for your health is to smoke, even if it is just occasionally," Calderon adds. Other factors can be almost as insidious. "For women over 40, chronic stress and lack of exercise are two of the most dangerous habits for your health," she says.
For help quitting smoking, visit quitnet.com›
6. "I've gained only a few pounds."
The average weight gain for women in their 40s is about a pound a year. "That can add up to a lot of extra weight over time, which puts you at risk for type 2 diabetes," says registered dietitian Christine Gerbstadt, MD, of Altoona, Pennsylvania. "People think it's natural to gain weight as you age, but there's no physiologic reason that has to happen."
In midlife, women's metabolic rate drops by about one percent a year. "When your muscle mass decreases, your caloric needs decrease, so you gain weight even though your diet doesn't change," Gerbstadt explains. "But if you maintain muscle mass, you can prevent the decrease in metabolism and calorie needs." So strength train at least twice a week to torch all the calories you can.
Sun, Sleep, and Your Skin
7. "The damage to my skin has already been done."
Just because you wallowed in the sun wearing baby oil as a teen doesn't mean you can't prevent future skin problems. "Most of your sun exposure happens before you're 18, but you continue to get cumulative damage every day, particularly during the midday hours," says dermatologist Diane Madfes, MD, of New York City. "All it takes is a few minutes of exposure a day. That's what leads to basal-cell and squamous-cell carcinoma, the two most common types of skin cancer." Not to mention premature lines and wrinkles.
Every day, skin cells die and new ones grow, which helps the skin repair itself. But that won't happen as efficiently if you absorb too many ultraviolet rays. Using a moisturizer or foundation with sun protection can be a safeguard, provided you apply enough of the product. "You need a teaspoon to a tablespoon on your face and neck, and wear at least an SPF 15," Madfes says. For the beach or any prolonged exposure, she recommends sunblocks containing mexoryl, a new ingredient that offers the most complete UVA and UVB sun protection. Annual skin checks are also a must, since mutations from prior sun damage can take 30 years to appear.
8. "My body can function on a few hours' sleep."
Over-40 women face a number of sleep obstacles: insomnia, frequent nighttime awakening, a snoring partner. "As we get older, our sleep quality deteriorates," says Carol Ash, DO, director of the Sleep for Life Center at Somerset Medical Center, in Hillsborough, New Jersey. "People think they need less sleep as they get older, but we're genetically programmed for a certain amount; that doesn't change." She notes that studies link sleep deprivation to weaker immune systems, obesity, and diabetes.
Menopause is also a major sleep disrupter (which you already know if you've ever been awakened by a hot flash). And over-40 women are more prone to sleep disorders, such as sleep apnea and restless legs syndrome.
Take sleep seriously, which means reserving your bedroom as a sleep sanctuary as much as possible. How will you know if you're actually getting enough sleep? You won't be over reliant on caffeine and alarm clocks, for starters.
Dental Health and Diet
9. "I floss...occasionally."
Flossing can significantly help prevent gum disease, a common dental problem of over-40 women. And inflamed gums can actually lead to heart disease down the road. A 2006 study in the Journal of Periodontology found that people under 60 with advanced gum disease (marked by bone or tooth loss) are at greater risk of developing coronary artery disease. The two may be related because they're both inflammatory. "Gum disease is inflammatory, which is similar to plaque buildup in the arteries of the heart," says Brett Kessler, DDS, of Denver. In another study, the pathogens most frequently found in severe chronic gum disease were also found in coronary vessels.
Once you're in your 40s and 50s, regular flossing is more critical: You produce less saliva to wash away the bacteria that cause gum disease. And some prescription drugs, like blood pressure meds, also diminish saliva output.
If for no other reason, preserve your gums to protect your smile: More adults over 40 lose teeth to periodontal disease than to cavities.
10. "My diet is healthy, so I don't have to be strict about portions."
"I see women every day who think that if a food is healthy, they can eat as much of it as they want," says nutritionist Katherine Tallmadge, RD, author of Diet Simple. Depending on your size and activity level, you should eat 1,700 to 2,100 calories a day to maintain weight, and 1,500 to 1,800 to lose. To get a handle on serving sizes, measure and weigh your food at home until you develop an instinct for the right amount. Keeping a food journal will also lay bare your true habits. "Leave a notebook in your kitchen to record what you eat within 15 minutes of doing it," she says. "Particularly at this age, those little details can be the difference between losing weight and not losing it."
Too Busy to Be Healthy?
11. "I don't have time to sit down for meals."
Eating on the go is a recipe for dietary disaster. "You have to eat healthy food to burn food healthily," Gerbstadt says. Skipping breakfast should be out of the question, since the meal sets the pace for your metabolism all day: "Your brain won't function well, your cells will be deprived of nutrients, and you won't burn calories." Opt for a day-starter of 300 to 500 calories, with eggs or a lean meat, a whole-grain cereal, fruit, and yogurt or cottage cheese.
Women who skimp on lunch or dinner aren't faring much better. "If you're not eating every few hours, your body starts shutting down unnecessary functions like muscle repair and hair and skin rejuvenation, which can result in less muscle tone, dry skin, and dull hair," Gerbstadt says. Eat a little bit of lean protein with every snack or meal to control blood sugar and stay energized. Eating more meals means eating smaller meals: "Divide your number of daily calories by five or six, and see what that means for each time you eat. Then you can mix and match it."
12. "I'm too busy to work out."
Lack of time is the number-one excuse for midlife women who skip exercise. So think small. "Everyone has 10 minutes a day," says fitness expert Tamilee Webb. "By the time you brew coffee in the morning, you could have fit in a strength or stretching session." (Webb has created a series of DVDs, Tight on Time, which present 10-minute exercise programs.) "Even if you do 10 minutes in the morning, 10 at lunch, and 10 in the evening, you'll still get benefits," Webb says. "And you will have done 30 minutes of exercise."
Buy Tight on Time workout DVDs›
13. "I'll snap out of it."
Other than mothers in their 20s and 30s experiencing postpartum woes, midlife women are the most likely group to suffer from depression. You might chalk it up to hormonal upheaval, but whatever the cause, get assessed and get treated. "Major depression is the second-greatest cause of debilitating illness and death, after heart disease," says Eve A. Wood, MD, author of 10 Steps to Take Charge of Your Emotional Life.
How do you tell serious depression from a bout of the blues? "Your sad mood must be accompanied by other symptoms, like a lack of motivation, appetite disturbance, concentration problems, guilty thoughts, or a decreased sex drive for it to be a true disorder," Wood says. Depression is hard to self-diagnose; talk to a mental health professional if your symptoms persist for at least two weeks.
If you're not ready for a shrink or Prozac, you do have options. Regular aerobic exercise can banish moderate depression, and exposure to light can help those who are affected by shortened days. "Women over 40 are also sensitive to nutritional issues," Wood says. "Your mood may lift if you watch your alcohol and sugar intake, and make sure you eat every three or four hours."
Originally published in MORE magazine, July/August 2007 as "Are We Fooling Ourselves?"
