A Post-40 Tune-Up
I usually see my doctor about 10 minutes a year. I get my blood pressure checked, and when the nurse asks to weigh me, I politely refuse, explaining it’s bad for my mood. After a Pap, the doctor probes around, asks a few questions — yes, I exercise regularly, do breast self-exams, and practice safe sex — and I’m out the door. I ignore her suggestions to get blood tests for cholesterol or insulin resistance because I’m young(ish) and healthy. Right?
But when I turned 45, my health insurance premiums shot up, and I wondered whether I wasn’t being cavalier. Friends my age have had fibroids, hypertension, breast lumps, celiac disease, and even a brain tumor. Physicians say midlife is the time when lifestyle choices start to catch up with you, and the first signs of cardiovascular and cancer risk may appear.
I was due, I realized, for a major tune-up. Better crack open the hood, rev the engine, and run some diagnostics. I felt healthy, but I had no idea if my bones were strong or if I was at increased risk for heart disease or diabetes (which runs in my family). I wanted to look at the whole picture of my health, lifestyle, and nutrition and make whatever changes I could to stay literally young at heart.
I knew where to go: the Cooper Clinic, in Dallas, which specializes in preventive medicine and early detection. I could have done a similar, if less coordinated, midlife body audit with my own doctor, a personal trainer, and a nutritionist, but I’d already had a complete physical at the Cooper Clinic a dozen years ago, so I wanted to return. They had my charts and could compare the old results with the new ones.
The Change: Mid-30s to Mid-40s
Back in 1994, I spent an entire day getting tested: fast-walking on a treadmill to exhaustion, being dunked in a tank of water to determine my body fat, and having an analysis of my blood labs, urine, stool, blood pressure, hearing, vision, lung function, nutrition, and exercise habits. The results, at age 33, showed I was in terrific shape — the "superior" fitness category — even if 13 pounds above my ideal weight.
Unfortunately, my clean bill of health contributed to my feeling ever since that I didn’t need to bother with medical tests: Why get my cholesterol rechecked when I could say it’s a superlow 135? But a lot can change in 12 years. In my case, I’ve gone from being a vegetarian to a serious carnivore, switched from aerobic dancing to swimming and yoga, developed sore joints, and started having to hold wine lists and dessert menus farther away to read them. Did I mention my jeans are snug?
My daylong battery of tests wasn’t the most fun I’ve had (after fasting the evening before, you wake up at six a.m. for an enema), but the results were revealing. In addition to the exams I underwent at 33, I had my first, probably overdue, mammogram, a flexible sigmoidoscopy to check for colon polyps, a bone density test, and an electron beam tomography (EBT) scan, which can show cholesterol plaque and early-stage tumors. I had hour-long sessions with a physician, a nutritionist, and an exercise consultant (all conveniently in cahoots with one another) to get specific advice about how to make my body and lifestyle healthier.
Despite the fact that I’m more likely to tuck into a steak than tofu these days, my cholesterol was still optimal, as were my hearing, blood pressure, blood sugar, heart rate, and vision (although reading glasses aren’t far in my future). The results prove either that meditation, yoga, and exercise are doing me some good or that I lucked out in the genetics department — likely both. The mammogram was negative and the EBT revealed no abnormalities. My joint soreness turns out not to be arthritis, just muscle strain. My bones are superdense, and according to my physician, Michele Kettles, my colon is "beautiful," although I’m not likely to brag about that at cocktail parties.
All that was a relief. The sigmoidoscopy was no more painful than some yoga poses, and the benefit of early cancer detection obviously outweighs a few minutes of discomfort. For someone like me, with low cholesterol, the EBT scan was probably overkill, especially since it gives you a dose of radiation roughly equivalent to spending a year at high altitude (and I had lived in Denver for 17 years when I was younger). Still, Kettles pointed out that an EBT had found an early pancreatic cancer in a patient in her 40s, who is doing great and might not otherwise have survived. The test is expensive, so it’s an individual decision best left up to you and your physician. (The total tab for the Cooper Clinic tests, I should note, is steep — $1,800 to $3,500 — and not covered under most health insurance plans.)
Fit, but (a Little) Fat
All was going well until, hooked up to electrodes, I got on the treadmill, which tracks how long you can fast-walk on an incline and how your heart reacts while resting, under stress, and recovering. My heart was strong, but I was gasping and exhausted at 18 minutes; 12 years ago, I made it to 21 minutes. Even adjusted for my age, I dropped a fitness category, from "superior" to "excellent."
Then I got weighed. As I suspected, this was bad for my mood. Very, very bad. I had gained eight pounds, and I’d been chubby to begin with. All that time, I thought that if size 12 jeans still fit, I was more or less the same weight, and I didn’t want to start obsessing by getting on the scale. But to be honest, I’d been searching far and wide for size 12s I could squeeze into, and the last ones were stretch fabric and had "tummy tuck" in the description. Reader, at five-foot-six-inches tall, I weighed 176. Please don’t tell my mother — her heart is not in as good shape as mine. To add insult to injury, my body fat percentage had crept up from 27 percent to 31 percent, which is higher than a rib eye steak’s.
Given that my overall health was "fabulous," as Kettles said, there was no urgent need to get my weight down. For many of her patients, excess weight is a marker for low fitness. Not only don’t they exercise, they also have sedentary lifestyles. They’re heart attacks waiting to happen or latent diabetics, but luckily, in their 40s, they still have time to turn around bad habits.
In my case, extra weight wasn’t affecting my health, because it’s a rare day when I don’t exercise. The Cooper Institute, the nonprofit group affiliated with the clinic, is famous for studies that prove you can be fit and fat. Steven Blair, an epidemiologist and former CEO of the institute — and fairly rotund for a runner — has done several long-term studies showing that fat people who are fit live longer than skinny couch potatoes. But it isn’t a good idea to gain weight steadily through the years, Kettles told me, particularly as you head toward menopause, when your metabolism takes a dive. And even if my weight wasn’t hurting my health, it was, as I mentioned, damaging my mood.
Before the checkup, I’d kept a three-day diary of everything I’d eaten (bear in mind that we’re all a little too good when we know we have to write things down, and perhaps we underreport the amount of dark chocolate we consume). The nutritionist, Jennifer Neily, analyzed my diet. I eat mainly fresh fruits and veggies, whole grains, lean meats, olive oil, and low-fat dairy products, along with the occasional bacon-Gorgonzola burger. Neily approved of my eating philosophy, which is that because I like to eat a lot, I have plenty of salads and other bulky foods that fill me up without being too caloric. The fattening treats I indulge in tend to be small amounts of pecorino cheese, olives, and dark chocolate. I take in more than 100 percent of most nutrients, including calcium (thank you, lattes), get plenty of fiber, and eat hardly any pound-packing simple carbohydrates, trans-fatty acids or saturated fat. Still, mysteriously, I was consuming too many calories.
Then Neily took her red pen and circled the culprit in my otherwise A+ food diary: wine.
I travel frequently in Italy, where a glass or two of wine at dinner is a way of life, and most of my friends inSan Francisco and nearby Napa Valley have a similarly European attitude about the pleasures of wine. Given that red wine, like dark chocolate, is good for your heart, its calories hadn’t crossed my mind. People get beer bellies, after all. But Neily set me straight. I had confessed to having 14 servings of wine per week — about half a bottle a day, unless, you know, I have reason to celebrate; life is short. It turns out that the Cooper Clinic’s idea of a serving of wine (6 ounces) is closer to my idea of a taste. By its calculation, I was downing about 21 servings, or almost 3,500 calories of wine a week. That’s a pound of fat! It was the wine that had turned me into a squishy human goatskin bag. (And lest you think you’re off the hook because you don’t drink, Neily warns that a couple of glasses of soda can have a similar impact on your weight.)
The Sobering (but Easy) Plan
After that revelation, I was in an extremely bad mood. "Don’t worry," said Neily, cheerfully. By merely cutting my alcohol consumption in half, I could lose 15 pounds in no time. Measure the olive oil I drizzle on those salads, she said, along with the walnuts I toss onto my oatmeal, and I could speed the process along. Trade skim milk for the 2 percent I drink in my lattes, and so much the better.
Kettles advised me to cut my wine intake to seven 6-ounce glasses a week, with no more than three in one day. Too much alcohol, she pointed out, puts you at a greater risk for breast cancer, a disease that caused the untimely deaths of my Aunt Maxine and Great-Aunt Belle. I had to admit that seven glasses didn’t sound like deprivation; it was reasonable and doable.
Nervous, I asked Kettles what a sensible weight might be for someone who isn’t interested in being a size 6. She suggested I aim for about 155 pounds and 23 percent body fat. My mood lifted a little. Everyone else I’d ever asked — the people at Jenny Craig and Weight Watchers — had told me 135, but 155 was in the realm of reality.
Marius Maianu, the exercise physiologist at the clinic, told me that my workouts — mainly swimming, yoga, and walking — keep me healthy and flexible but aren’t intense enough to help me lose weight. Swimming takes more time to burn calories. As for yoga, my flexibility and balance are terrific, but you have to do something like an hour of triangle poses to work off one little glass of Cabernet, and strength training isn’t part of the package. Maianu suggested I add strength exercises and throw in some aerobics a couple of times a week. Not only would I be on my way to my formerly superior fit self, I’d also be burning wine like jet fuel.
The Energy Bonus
Since coming home, I’ve kept a little diary to track the number of glasses of wine I drink in a week, and I’ve added more aerobic workouts — vigorous hiking up the hills behind my house in San Francisco, pounding to dance music on the elliptical, and raising my heart rate while staring at the hot Brazilian teacher in Spinning class.
After six weeks, my energy is better; if you don’t have two glasses of wine at six p.m., you aren’t tired all evening or grouchy the next morning. I have already lost the eight pounds I’d gained, and I’m almost halfway to my new ideal weight. My tummy-tuck jeans are sagging in the middle. My real goal, though, is to view this midlife assessment as an opportunity to develop healthy new habits for the long run. I plan to have a more complete annual physical and mammogram, plus another tune-up at 50. And from now on, I’m going to weigh myself. At least once a year.
Originally published in MORE magazine, March 2007.
Next: Flatten Your Belly Fast
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