All posts by Jane Wilkens Michael

About Jane Wilkens Michael

Jane Wilkens Michael is the author of the Long Live You! Your Step-by-Step Plan to Look and Feel Better Than Before, an innovative program designed to enlighten, empower and improve your everyday life. She is the host of the Jane Wilkens Michael Show, a weekly lifestyle program on iHeartMedia's iHeartRadio Talk. Starting with creating the monthly "Beauty Talk" column for Town & Country Magazine and then at the International Herald Tribune in Paris, Jane has continued to contribute her columns and articles to an countless list of publications, newspapers and websites the world over. She has also written Breakfast Lunch and Dinner of Champions, for which she interviewed athletes in ten major sports and discussed their nutritional needs and ideal diets, as well as two spa and beauty books.

Made in the Shade(s): The 411 on sunglasses


In some parts of the Islamic world, women are required to wear burqa’s. Now, this is not a political column so I am approaching this solely from a beauty angle. I believe they are the secret to everlasting youth. Give me a burqa and I will remain ageless forever. I mean, who really can tell how old you are — or if you need to lose a few inches on your hips and thighs — if you are covered from head to toe. Add a pair of wraparound sunglasses and you’ll take off another twenty years. (This sure beats my other suggestion – giving all your friends and business contacts a candle. Since everyone looks infinitely better in candlelight, you’ll finally be able to go out in the daylight!)

Well, being that a burqa is not part of my religious traditions, let’s just talk about the sunglasses. Truth be told, I would wear them morning and night if they didn’t so diminish my vision after dusk. My aim is not to look like an out-of-work actor, hoping to be recognized. Rather, it’s to hide the fact that I could probably use an eye lift —not to mention to actually be able to see since I need to always wear prescription glasses, sun or otherwise. But with endless choices available, how do you know which are the best to benefit both your eyes and your budget?

While status conscious fashionistas might spend hundreds to get the latest look from Tom Ford, Gucci or Prada, others buy expensive glasses simply because they are worried that cheaper shades might not give them adequate sun protection. So I asked Dr. Mirwat Sami, a Houston-based Board-certified Ophthalmologist specializing in Ophthalmic Plastic and Reconstructive Surgery, to shed some light on what to look for when selecting a pair of tinted spectacles — and why.

Dr. Sami explains that, “Excessive exposure to UV light from sand or pavement reflections can burn the eye’s surface. Think of it like sunburn on the skin, and as the damage accumulates over the years, you can do some real harm to your eyesight without even knowing or feeling it.” Indeed, the American Academy of Ophthalmology recommends quality sunglasses as a preventative, provided they screen out 99% to 100% of UV light. So the questions is, are designer sunglasses superior when it comes to providing eye protection?

The following are eight suggestions from Dr. Sami to help ensure that you are making the right choice from every angle. Continue reading

Real Simple: How to singletask your way to success and sanity


Despite the fact that today we pride ourselves on being a culture of multi-taskers, I myself am anything but. For me, multitasking is the art of messing up several things at once. But we all know – and perhaps secretly despise – the woman who can seemingly do it all. And seamlessly, at that! Yes, she’s the one who gets up at 5 a.m., sprints to the gym, then showers, answers all her e-mails, fixes her family a breakfast of steel cut oatmeal with flaxseeds and warm organic maple syrup and is ready to go to the office as soon as she drives her two equally perfect children to school. Her male counterpart is just as Type A and accomplished. Not only does he hold down a high-powered day job, but he is a nationally ranked squash player and on weekends writes poetry when not competing in an Ironman Triathlon. In a pinch, he can re-shingle his roof.

One morning, many moons ago, I decided that I, too, could do it all. On that particular day, I also made my family oatmeal for breakfast and carefully chose my husband’s suit and tie. And as soon as I rushed my older sons off to the bus and took my little girl to nursery school, I hopped in the car and gave him door-to-door service to his office.

An hour later, all missions accomplished, I returned to my office and started to write my column with still plenty of time left to meet my deadline. I sat back in the chair and let out a large self-satisfied sigh, thinking to myself, Who said you can’t do it all? Just then the phone rang. Continue reading

Wheat No More


Nutritionists first suggested avoiding foods with gluten when it started to become known that they were harmful to people with Celiac disease. Indeed, medical researchers discovered that when glutens are ingested, this serious autoimmune disorder, affecting the small intestine, causes the body to mount an immune response that can trigger such side effects as unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, osteoporosis, depression or anxiety and migraines, to name a few.

From that dietary acorn a giant oak of abstinence has grown. For some, it’s due to the fact that non-Celiac disease sufferers have milder but still unpleasant reactions to glutens. Call them gluten-sensitive, if you will. However, a greater and greater number of people also don’t eat anything containing gluten and it has nothing to do with a medical condition. They claim that by avoiding this latest “don’t-eat-du jour,” pain, skin rashes, acne, anxiety and depression, are said to magically disappear. And in their place is increased weight loss and energy, even happiness. Continue reading

Better Than Before: Making the Best of Arthritis

arthritisThe Europeans have it all figured out. At the first sign of any aches they don’t take to bed with a bottle of Aleve. No, they head for the thermae of Italy, the baden of Germany, the baths of England, and station thermales of France The treatments at these detox meccas include water (fresh and sea) and mud therapies that promise freedom from pain — not to mention a cleaner liver. And the concept goes back millennia. After all, Spa is not an acronym for Super Place for Aerobics. Rather, it is named after the town in Belgium favored by Peter the Great. (Yes, that Peter the Great!). They are based, instead, on the restorative and healing powers of thermal and mineral springs and imbibing waters that come directly from those sources.

Alas, we in America may be hard pressed to find these types of cures closer to home as there are only a handful of natural hot springs indigenous to this country. And, truth be told, most people don’t even know they exist. Just ask someone in your office to name a liquid that makes you feel really good. I doubt hot, bubbling water would be the first thing that comes to mind. In fact, make mine a kale and celery smoothie — and a Dirty Margarita for The Lawyer.

Does this mean, though, that we have to suffer such inflammatory ailments as arthritis in silence? After all, about 50 million Americans have been diagnosed with one of the seven common forms of Arthritis. Yes, I am one of them. But limited space will not allow me to regale you with stories about my recent hip replacement! (Call me!) Curative spas aside, it is important, therefore, for patients and care givers to understand the potential impact of the disease and how best to manage it. It can be a critical part of making the decisions to make good on your intent to live a healthier lifestyle that is Better Than Before.

Let’s start with learning a little more about the illness itself. For this I turned to Phyllis Crockett, a specialty-trained pharmacist in the Accredo Rheumatoid Arthritis and Inflammatory Disease TRC.

“Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions,” she says. “Although common belief is that arthritis is a condition affecting the elderly, two-thirds of people with arthritis are under the age of 65, including 300,000 children. Also, arthritis affects people of all ethnicities.”

According to Crockett the vast majority of sufferers, about 27 million Americans, have what I have, Osteoarthritis (OA), which is characterized by a breakdown of joint cartridge. A vast majority of OA patients are elderly. (But it could be genetic, and the result of what sets in after you’ve sustained an injury! Hellooo!!)

The rest of arthritis sufferers have the more severe form: Rheumatoid arthritis. “Rheumatoid Arthritis (RA) is characterized by inflammation of the membranes lining the joint. Although it can strike at any age, women are typically diagnosed between the ages of 30 and 60, while male patients are usually older. There are about 1.5 million affected individuals in the United States. Finally, Juvenile Arthritis (JA) is a term used to describe many autoimmune and inflammatory conditions that can affect children ages 16 and younger.”

The disease takes a heavy toll. “Each year, arthritis accounts for 44 million outpatient visits and over 900,000 hospitalizations. In fact, it’s the leading cause of disability in the United States and is a more frequent cause of activity limitations than heart disease, cancer or diabetes. By some estimates, 67 million Americans will have arthritis by 2030.”

So what do we do?

“Managing the disease so that patients can continue to live normal lives is important,” Crockett continues. “Each patient is different and a physician can help determine the best treatment plan, including pain management and managing the symptoms of arthritis.”

She shared with me some tips that she offers her patients, starting with exercise. “It is a valuable tool in the fight against arthritis. OA and RA patients particularly can benefit from both endurance and resistance training.”

Maintaining a healthy weight and protecting against joint injury can help prevent OA. “Every pound of weight lost reduces the pressure on each knee by 4 pounds. Even a small weight loss can be a big help in fighting it.”

Apart from lifestyle modifications, there are also many drug therapies available for arthritis patients—and doctors and specialist pharmacists can help identify the best one for you.

For patients who already are on medication to treat the condition, adherence – taking medications as prescribed – is critical to healthier outcomes.

“But do not self-medicate!” she cautions: “Combining over-the-counter medications with prescription medications can be risky, and can cause side effects such as an increase in GI irritation or a GI bleed. And don’t adjust doses or making changes to the medication regimen without checking with your health care team.”

“Watch for drug interactions: Some common medications like acetaminophen can have a drug-drug interaction with arthritis medications. Limit intake and remember that acetaminophen is often a component in common sinus, cough/cold and pain medications.”

Opt for an anti-inflammatory regimen like the Mediterranean diet – you know the drill, easy on the acidic foods like sugar, white flours, and alcohol, and sticking with leafy greens, whole grains, and lean proteins. “But some foods and beverages can block the effects of arthritis medications,” Crockett concludes. “These include grapefruit, apple and orange juice as well as milk and yogurt. Wait at least four hours after taking medications. Exact times can vary depending on the disease and the treatment. Check with a trained clinician.”

I can assure you from very painful, personal experience that if arthritis does go too far, surgery may be the only option. So if your intent is to help avoid – or at the very least, prolong – this possible outcome, be aware that lifestyle modification and medication may be the answer.


Better Than Before: Thinner for (Holiday) Dinner

holiday dinnerNext week brings us Passover and Easter. And just these two holidays alone can spell diet disaster. If you’ve ever eaten matzoh, you know that it stays in your system for all eight days, unable to find a way out! And matzoh balls can sometimes weigh as much as a Mack truck. An Easter brunch menu offers similar regimen wreckers as Thanksgiving fare, plus the obligatory chocolate eggs. And we haven’t even gotten to the rest of the barbecues and feasts found on Mother’s Day, Father’s Day, Memorial weekend, July 4, and at June weddings, to name just a few. So what are we to do if our intent is to still be able to fit into a bathing suit this summer?

Since there doesn’t seem to be any end to opportunities to pile on the pounds, I asked Jacqueline B. Marcus, a Nutrition Consultant and Owner of Jacqueline B. Marcus and Associates Food and Nutrition Consulting in Highland Park, Illinois, if it’s possible to be Better Than Before weight-wise in spite of it all. Happily, Jacqueline devotes an entire chapter to healthy weight management in her new book, Culinary Nutrition: The Science and Practice of Healthy Cooking.

“Yes,” she began, “you can end the nonsense and regain control, if you simply stop, look and listen.” By that she means to stop the negative self-talk about your body and willpower, to take a hard look at yourself in the mirror and the numbers on your scale, and then to listen carefully to her advice to achieve and maintain your “true weight,” no matter what the temptations.

If you are invited to dinner, first up is to call ahead and ask your host: “What’s cooking?” If the answer is a collection of calorically-challenged courses, propose to augment the repast with BYO. Offer to bring a favorite dish to share the cost of a holiday meal. (You don’t have to mention that it is –horrors!—healthy.) If you happen to have a green thumb in cooking rather than gardening, there is no rule against buying something rather than risk poisoning your friends.

Of course, not all (or that many) social occasions will lend themselves to a non-insulting offer to bring your own food to someone else’s dinner party – or even an inoffensive query as to the menu. So Jacqueline suggests that if friendship or propriety trumps your diet concerns, eat a little lean protein or veggies beforehand to lessen your hunger.

Jacqueline also shares some general suggestions for keeping up with your weight management program any time of year. “Think Clean, Lean, Attractive, Simple, Small and Yummy.” In other words C.L.A.S.S.Y! “Choose small servings of simply prepared food without fat or skin and leave sauces on the side. Large, over-dressed portions are always no-no’s.”

Focus on selecting delicious lean proteins, brightly colored vegetables, fiber-rich whole grains, wholesome legumes and flavorful fruit. “Healthy food prepared with care can be enormously satisfying. Nix the extra fats and sugars from fried appetizers, snacks and sweetened drinks. If tempted, make do with just a nibble or sip.”

I always like to make half my plate just salad and vegetables. (It helps, of course, that I actually like salads and vegetables.) On the other hand, the Lawyer’s worst nightmares usually start with a dish filled with Swiss chard. He therefore might disagree with Jacqueline’s prescription for delightful dieting. (But don’t go by him for health advice. He likes Cronuts.) “Nothing beats the color, crunch and aroma of garden-fresh vegetables,” Jacqueline continues. “If steamed or lightly dressed, you can pile non-starchy vegetables like D-L-G’s (deep-leafy greens) pretty high on your plate for lots of vitamins, minerals and fiber. Then add some lean protein and wholesome grains or legumes.” (Check out The Dukan Diet at for great recipes, meals and diet recommendations.)

It is also important to practice what Jacqueline refers to as tradeoffs. “Want that starchy side? Forget the breadbasket. Dreaming of dessert? Skip the appetizer. Love those creamy sauces? Just dribble over protein-rich foods or steamed vegetables. Fried foods your temptation? Save those fat calories for something delicious and nutritious—like velvety nonfat yogurt or ricotta cheese.” (Sounds great to me; but cue the eye rolling by The Lawyer and his ilk.)

Water, not mixed drinks, should be your beverage of choice. “Mixed drinks may add a wallop of calories!” (Boo!) “If you must imbibe, stick with lower calorie and alcohol options, such as light wine or beer. And, of course, always exercise control.”

Speaking of exercise, “try the free track at the mall, park district or gym,” she suggests. “And while you’re there, use the stairs, too. It takes a lot of exercise time to balance any indiscretions. Body fat below the waist is particularly stubborn.” (Sigh!)

Furthermore, it’s important to maintain records. “By doing so, you commit on paper or screen (like on a smartphone) and then confront what you see or do. Record your biggest obstacles and greatest successes. Write positive affirmations and prominently place them where they will motivate you: Your bathroom mirror, the scale, fridge or closet.  Keep a weight loss chart so that you can monitor the way down.”

Practicing positive self-talk is essential. “Ditch the negativism. Dieting is hard, but there are no excuses for “I can’t”, “won’t”, “should have” or “would have.” Also, remove the words “failure”, “cheat” and “loser” from your vocabulary. “No dieter is perfect all of the time. Just focus on your successes one day at a time and get back in charge ASAP.”

It’s also fine to reward yourself along the way or when you reach your “true weight” and maintain it. “Just do it without food. Buy yourself a new pair of all-purpose athletic shoes for your new commitment to walk ‘30 in 30’ –30 minutes of daily walking for 30 days, or a jump rope to burn more calories, or even light weights to tone your muscles. (A new outfit also works, as do Louboutin pumps. Trust me!)

It’s easier if you don’t attempt to do it alone. “Reach out and connect with someone who knows how challenging it is to lose weight and keep it off. They can be your dieting or exercise buddy. “Just make sure that they’re really your pal throughout the ‘thick and thin’ of weight loss and weight maintenance.”

Finally, focus on your intent to be a Better Than Before you. “Downsize! Raid your pantry and part with the oversized packages of foods and beverages high in sugars, refined carbohydrates and sodium. Likewise, raid your closet and discard any too big, old clothes,” Jacqueline concludes. “When you think smaller and take baby steps in the process, you’ll celebrate each little accomplishment along the way.”

And when it comes to seconds on matzoh balls, remember the chorus of that ancient Passover song. Dayenu! (Enough!)

Better Than Before: The Highs and Lows of Cholesterol

cholesterol“I’ll have the steak,” my husband with the three coronary artery stents announced to the waiter. “A fillet mignon, medium rare,” he added, with a look of self-satisfaction on his face. He was obviously proud of himself because he didn’t order what he really wanted—the marbled prime rib.

“While you’re at it, dear, why don’t you have cheesecake for dessert,” I suggested, “just in case you have any arteries left unclogged.”

I should say, however, that The Lawyer — dietary deviations aside — is in very good shape for a man his age and is extremely aware of what constitutes a healthy lifestyle. But that doesn’t always mean he makes the wisest menu choices when it comes to his heart. Indeed, out of my sight and left to his own devices he may just grab a hamburger — or horrors! — that deadly croissant-doughnut hybrid known as “cronut!”

He, of course, swears that a genetic predisposition—and my constant nagging—are the primary culprits for his coronary clogs. Therefore, I must remind him (always, of course, in calm, constructive tones), that while genetics may load the gun, lifestyle still pulls the trigger.

The reason I worry about what he eats, is cholesterol, a big component of all those unhealthy foods he likes to eat, and a known factor in heart disease. And while my husband’s cholesterol isn’t particularly high, every journal article I read seems to say that it should be lower!  It seems, too, as if practically everyone I know, the Lawyer included, is on a statin of some sort or another – 25% of all Americans over age 45, according to the National Center for Health Statistics. But do statins lower all cholesterol? How do you keep the HDL (high density lipoproteins — think “happy” ones) level high while lowering the LDL (low density, think “lousy”).  So my intent for this column is to help readers have a cholesterol ratio that is Better Than Before.

To advise, I turn to an expert, Ed Dannemiller, a specialist pharmacist, in the Cardiovascular Therapeutic Resource Center at Express Scripts and a recent guest on my new show for Clear Channel’s iHeartRadio Talk.  I started by asking just how bad is bad cholesterol.

Turns out it is very bad. “High cholesterol levels are the major controllable risk factors that contribute to hardening and narrowing of the arteries,” he says. “This is known as Atherosclerosis and it is the most common cause of cardiovascular disease, heart attacks and strokes. And as blood cholesterol levels rise, so does the risk of coronary heart disease, which is the Number one killer in America. “

But not all cholesterol is bad, and Dannemiller adds, it is important to understand the differences between the two types. High levels of HDL’s actually protect against heart attack and stroke, while low levels increase their risk. Too much of the “lousy” one circulating in the blood form thick hard deposits called plaque that narrows the arteries and makes them less flexible. Plaque that suddenly ruptures forms clots can result in and heart attacks and strokes because of the arterial blockage.

I have always been a firm believer in lifestyle modifications and Dannemiller agrees that for most people, those can help attain a healthy cholesterol balance.“LDL cholesterol is especially affected by diet,” he stresses. “Eat a heart healthy diet rich in fresh fruits and vegetables, and low in salt, fat, and cholesterol.”

He points to a Florida State University research study that found that eating an apple a day can reduce LDL cholesterol an average of 23%. “Apples are rich in pectin, a soluble fiber that blocks cholesterol absorption and prevents the body from storing it. Other LDL-lowering foods include oats, barley, beans, unsalted nuts and seeds, eggplant, okra, and fatty fish such as wild salmon.”

The main culprits for high cholesterol, he says, are fat. Hmm. What do you suppose they fry Cronuts in to  make them so tasty?  The Lawyer would obviously like to think it’s first-press, extra virgin olive oil! “Avoid saturated fat,” Danemiller cautions. “This includes fats from red, processed and organ meats, dairy products, and some plant products like coconut and palm oils.”

Processing liquid vegetable oil to make a solid fat creates the dreaded trans fats found in stick margarine, vegetable shortening, and some cookies, crackers, cakes, fried foods, breads and snack foods like chips, candy, and microwave popcorn, he explains. “Read your labels closely: Monounsaturated and polyunsaturated are the ‘good ones!”

Danemiller has a few other tips:

• Trim all visible fat from meat before cooking

• Broil rather than pan fry meats

• Prepare stews and soups a day ahead of time and refrigerate. Skim off the hardened fat from the top.

• Choose white meat chicken, lower cholesterol organic eggs and low-fat cheeses, milk, and yogurts.

• Lose some weight. As little as 5 to 10% of body weight can significantly reduce LDL levels.

And here’s the one The Lawyer particularly dreads — exercise. “Exercising is essential,” Dannemiller insists. “Just thirty minutes of moderate intensity aerobic activity, like brisk walking, five days a week, or 25 minutes of the more vigorous jogging or running three times a week, can help your body to produce more HDL’s.”

Sometimes, though, lifestyle modifications just aren’t enough, and genetics may have a lot to do with it. “Cholesterol comes from two sources,” Damemiller continues. “The body itself makes about 75% of blood cholesterol, and the rest comes from food ingested. That means that some people are more prone to high cholesterol levels based on genetics. For them, medication treatment can be essential. Drugs like niacin are effective in raising HDL levels, but the workhorses in the medication class are the statin drugs which can decrease cholesterol by 30% to 40% or more, decreasing heart attack and stroke risk by 45% to 60%.”

Statins have some side-effects, including muscle pain. But Danemiller contends that statin drugs are so effective that it is worth working through these issues. “A lower dose of the same medication, a switch to another drug in the class, or changing the frequency of administration can help. If the statin drug is stopped, the muscle pains should subside within two weeks. If it persists after that, it may be caused by unrelated activities like other medical conditions such as arthritis, or possibly even low vitamin D levels or too much exercise.”

But didn’t I read somewhere that statins have been linked to memory loss?

“Studies found no evidence of this. In fact, long-term statin use can have a protective effect on memory and cognition.” Dannemiller says.

Also in the news last year, were reports that statin drugs increased the chance of developing type 2 diabetes, I challenged.

“While data suggests some statins may increase the risk of diabetes this risk is outweighed by the cardiovascular benefits for most patients.”

Lifestyle modifications and statin medication, if needed, are important elements to achieve optimal cholesterol levels. Just watch out for those Prime Rib and Cheesecake combos.


Better Than Before: Recovering from a Cruise Excursion

cruise buffetA few weeks ago, I was invited to go to an 80th birthday party. Among the select group of fellow guests were important political figures, judges and lawyers. Now, one would naturally assume that this distinguished assembly of New York City notables would have preferred something equally elegant, say a staid steak house or an upscale Italian eatery. Nope. The destination of choice was, wait for it, a ‘Cruise to Nowhere.’ That translated to one night on the Norwegian Cruise Line’s Norwegian Gem, a massive modern ship that normally sails to the Caribbean, Canada and the Bahamas. On this voyage, however, the ship simply goes a few miles out to sea – and back. Enough distance, though, to be able to gamble and shop at a duty-free store. Who knew that sailing to New Jersey (or at least safely offshore from the Garden State) could have such lucrative advantages – and be considered “international” waters?

There was one minor problem, though — I have been known to get seasick in a hot tub if the jets make too many waves! So I was understandably hesitant to accept this invitation. But then I read the trip’s description on NCL online: “Leave all your cares on land and slip away for a cruise to nowhere,” it beckoned. “Enjoy dinner and dancing, take in a show, win big in the casino, party the night away or spend some time in the spa to relax and rejuvenate!” It had this overly stressed journalist who hasn’t had a vacation in years at “leave…” So off I went – with my own Lawyer in tow (not that he needed a lot of convincing to take part in something that pretty much promised an open buffet for the entire time). Besides, I was determined to prove to my readers that it is possible to go on a cruise – and return in shipshape, no matter what the temptations. While 18 hours on board isn’t much time to get out of shape,  I still considered this an opportunity to test the waters for the longer lasting versions. Detective Beauty was on the case!!

We have all heard horror stories about these types of trips. As one would naturally assume with something informally known as a “booze cruise,” they either attract the college crowd who stay up all night and drink wherever they are, or those who could be deemed the “Real Housewives of 7-Eleven.” And upon boarding and looking around, I had to admit that this particular excursion lived up to that reputation. There were drinks of every form offered on practically every deck – for an extra fee. Even though it was only 1pm in the afternoon, it seemed as if many cruisers had already had a few — or ten. Of course, when somebody dressed in a full dolphin costume came over and put his or her (hard to tell) arm around me to pose for a ship photo and I happily submitted; smiling broadly at the ridiculousness of it, it no doubt appeared to others that I might have knocked back a few myself.

Let’s skip to lunch. Unless you want to go to a specialty restaurant onboard, which is also extra, it’s basically what you’d expect for cruise food – and lots and lots of it. That means unlimited amounts of whatever is on the menu, much of it not terribly good for your health. Suffice it to say, though, that The Lawyer was in seventh heaven. Restaurants with All-You-Can-Eat buffets, you see, usually have to check with their bankruptcy counsel whenever he and our sons descend upon them. “Jane, should I have a steak?” he asked, knowing that I was sitting next to him and would kibosh the order, but decided to see if I mellowed in the negative ions of the ocean air. Here’s a tip: Look for the options with checks in front of them signifying that they are ‘heart healthy.’ Okay, maybe not what you would get at, say, Sweet Greens organic salad bar, but good enough to not gain ten pounds or fill any arteries left unclogged. And order triples on vegetables. That was all I actually ate, but the waitress nonetheless commented that I had a “hearty appetite.”

There is a long list of possible activities that my group of women and I scanned during our meal. I strongly suggested for them, and for those of you who follow this nautical path, a visit to the gym and spa. Every top-of-the-line ship has them and they are a perfect way to while away the hours instead of going to a bar or playing afternoon Bingo. The gym is open from 6am to 11 pm and offers everything from Thighs, Buns and Tum hour, to Fab Abs, yoga, Pilades, body shaping and all things in between. Everything you would find at a full service gym is right there. I loved the TRX workout, a revolutionary method of suspension training that is brought to us by the Navy Seals, and will make it a point to find a class here in the city that offers something similar. So take advantage of a unique opportunity to try different exercise options.

Finally, visit the spa. This cruise had a particularly gorgeous one — the Mandara. Splurge on a hot rock massage, an oxygen facial, acupuncture, or a cleansing thermal wrap. (And if you’re not Gwyneth Paltrow, how many of us realistically have all those hours to devote to detoxing?) I knew where The Lawyer would be – undoubtedly at the afternoon buffet — so I didn’t have to worry about him honing in on my “me” time. I still remember one year when I was certain that he was at the marina of a French resort taking note of the topless human condition, I called down to the hotel spa to arrange for a treatment. “Impossible, Madame,” was the reply. “Your husband is at this moment on the massage table about to start the very last appointment.”

Yes, I was a little sick to my stomach; but it was because the waters were particularly choppy, not the fact that I caught the dreaded Norovirus. But, at the end of the day, I disembarked the morning after looking and feeling Better Than Before. And if you just plan your cruise activities accordingly, you can, too. As for The Lawyer, he’s still annoyed that I didn’t let him eat any birthday cake. 

Better Than Before: Why are Adult Women Using ADHD Meds?

ADHD pillsI read with great interest the other day a story on the rising use of ADHD medication among women. While the new mantra for women is that to succeed they need to “lean in,” to be more assertive and seek greater authority at work and at home, the added pressures to do it all may be driving them to use these prescriptions to help them attain that superwoman status. Consider, if you will, the competition out there. We all know that classic A-Type tornado — the woman who gets up at 5 a.m., sprints to the gym, then showers, answers all e-mails, fixes her family a breakfast of flaxseed banana waffles with hot maple syrup and is ready to go the office as soon as she drives her four equally perfect children to school.

I must confess that when my kids were little, I too, thought I could be the perfect woman. But that notion didn’t last very long. Indeed, I recall rushing my older sons off to the bus, taking my little girl to nursery school, and even giving The Lawyer a ride to his office. An hour later, all missions accomplished, I, Wonder Woman, űber wife, returned to my office and started to write my column still with plenty of time left to meet my deadline. I sat back in the chair and let out a large self-satisfied sigh, thinking to myself: Who said you can’t have it—and, most important, do it—all? Just then the phone rang.

“Mrs. Michael,” stated the voice on the other end, “this is Mrs. Butters at the nursery school.” Pause. “You seem to have sent your daughter to school in her pajamas.” Bam!

Until recently, the regular evening (and/or lunchtime) calmative of choice for professional women was almost always a glass (or two, or three) of white wine. But nowadays, more and more women are turning to prescription medication to help them focus and become more productive. While virtually all of us in the health advice arena recommend other modalities such as healthier diets, sound fitness programs and meditation, for example, a pill, alas, seems so much easier! In fact, according to a report just released by Express Scripts based  on an analysis of prescription claims that was the latest and most comprehensive look at ADHD medication trends in the U.S., adult women’s use of ADHD medications has risen so far and fast that it far outnumbers those taken by adult men.

The report also finds achievement demands may be impacting increasingly younger women. Surprisingly, the number of females ages 19-25 on these medications is 27 percent higher than girls ages 4-18, countering trends seen in males, whose ADHD medication use drops sharply after age 18. Furthermore, the greatest surge in ADHD use has been in the adult population – climbing 53 percent overall and an alarming 84 percent for those ages 26-34.

“The rapid increase in adult use of these medications is striking, especially since there is very little research on how these treatments affect an older population,” says David Muzina, M.D., Express Scripts’ Vice President of Specialist Practice. “It signals a need to look more closely at how and why physicians prescribe these medications for adults, particularly women, who may turn to them, or experience symptoms of attention disorders, as a result of keeping up with the multiple demands on their time.”

Other findings from the research include:

• The percentage of boys ages 12-18 using ADHD drugs reached 9 percent in 2012, a nearly 18 percent increase from 2008.

• The southern region of the U.S. has the highest concentration of ADHD medication use, with South Carolina showing the greatest prevalence overall: 14 percent of 12-18 year olds there are on an ADHD drug treatment program.

• The prescribing of anti-psychotic treatments is exceptionally high among those treated for ADHD (12 percent vs. 4 percent of non-ADHD medication users); however, the number has been declining in recent years.

Continues Dr. Muzina: “While ADHD medications can be extremely beneficial, they can still be dangerous for patients with heart problems, and may cause serious interactions with other prescriptions, as well as conditions such as bipolar disorder.“

That is why, according to the doctor, these types of drugs require judicious prescribing. To that end, patients with ADHD can benefit from the expertise and experience provided through Express Scripts’ Neuroscience Therapeutic Resource Center®, where specialist pharmacists with advanced training in behavioral treatments oversee their care. These experienced clinical specialists are very familiar with the complex medication-related issues associated with ADHD and its treatments, are well equipped to recognize medication issues and can effectively counsel patients on the proper use of these drugs.

With ADHD medication abuse a growing problem, specialist pharmacists are also on the lookout for any indications of potential abuse. If this is suspected, Express Scripts’ Fraud, Waste and Abuse program can investigate and, when necessary, will refer the matter to the proper legal authorities.

The net-net is that ADHD medications should be carefully prescribed and monitored. While so far it is mostly through anecdotal reporting, it seems as if there is a growing concern throughout the U.S. that these drugs are frequently being liberally administered without the proper testing. There certainly are plenty of credible defenders of this surge in growth of their use, but the Express Scripts Report is certainly sobering support for those who are alarmed by the recent upward trend. To access the full report, please visit

Better Than Before: Is Juicing Worth the Squeeze?

juicingWhen I was growing up, my mother believed that eating liver was essential for good vision. Animal livers, she insisted, stored vitamins, in particular A and B complex. These essential nutrients help keep the retina in good shape, the visual purple strong, and the eyes well-lubricated. In any event, my mother took it one step further and gave it to us in the most palatable way she could think of – run through a blender (by a housekeeper with nose plugs) until it became juice. Suffice it to say that my brother and I wouldn’t touch the glass, let alone drink the stuff in it, so we discreetly discarded it out the window. Alas, today we both need glasses, but 17 floors below our old kitchen in New York City is the healthiest tree you’ve ever seen.

Liver juice aside, today on almost every corner in Manhattan there’s a bar touting the ‘juice du jour.’ For me, that’s way better than say, Burger King. To The Lawyer, it’s a shameful waste of good real estate, since the thought of kale juice has about as much appeal as, well, a kale anything else. But he does listen to the experts, other than his wife of course. So I asked Michael T. Murray, N.D., renowned natural medicine expert and bestselling author of more than 30 books, including his latest one, The Complete Book of Juicing, Revised and Updated: Your Delicious Guide to Youthful Vitality (Clarkson Potter, 2014) to weigh in.

JWM: We do know the benefits of drinking fresh juices. But many of my readers and listeners have asked me if it’s better to just eat the whole fruit or vegetable. Why juice?

Dr. Murray: Well, if you think about it, the body actually converts the foods we eat into juice so the nutrients can be easily absorbed. So juicing it before you consume it saves the body energy, resulting in increased vitality. It also delivers more soluble fiber faster and in an easier-to-digest form.

JWM: A lot of bottled juices claim to contain vitamins and minerals. Is fresh always better?

Dr. Murray: Yes! Fresh juice contains many more vitamins, minerals, and other nutritional compounds, such as enzymes and flavonoids–than its canned or bottled counterparts, which have been cooked (pasteurized) to keep them on the shelves longer. Cooking can cause the loss of up to 97 percent of water-soluble vitamins (B vitamins and C), and up to 40 percent of the fat-soluble vitamins (A, D, E, and K).

JWM: Do homemade juices have increased antioxidant and anticancer properties as well?

Dr. Murray: They do! In fact, a study comparing commercial apple juice with freshly juiced apples found that fresh, raw juice had more antiviral compounds than the store-bought versions. Another study found that fresh, raw apple juice and berry juice (especially raspberries and blackberries) has more ellagic acid, a potent anticancer and antioxidant compound that is stripped from juice when it’s been processed.

JWM: I’ve heard that some fresh juices also help get rid of toxins. How do they work?

Dr. Murray: Speaking just of fresh fruit juice…fruit contains ample glutathione, a small protein composed of 3 amino acids, which are also manufactured in our cells, which aid in the detoxification of heavy metals such as lead, as well as the elimination of pesticides and solvents.

JWM: Talk a little about raw juicing and weight loss, if you will!

Dr. Murray: To begin with, it’s a phenomenal way to reach the goal of ingesting 60 percent of total calories from raw foods. Diets containing a high percentage (up to 60 percent of calories) of uncooked foods are associated with significant weight loss and lowering of blood pressure in overweight individuals.

JWM: Any quick recipe to share?

Dr. Murray: For a delicious, nutritious fruit juice, put two whole apples, sliced in quarters, and 1/2 cup each of raspberries and blackberries through a juicer. Drink it up right away for a blast of energy and nutrients.

JWM: Dr. Murray, leaving the topic of juicing for a moment, I have been aware of your work for many years. And you have been a vocal proponent of natural medicine and healing. Yet, as a society, we seem to be surrounded by illness in epidemic proportions. Why has there been such a lack of acceptance of natural medicine thus far?

Dr. Murray: Thank you for asking that! For the last 30 years I have done my best to educate and inspire others to utilize the healing power of nature. I feel that the biggest factor for this lack of acceptance and use of natural approaches to health and healing is the current financial model of medicine. It is a complex scenario based upon companies and people profiting from a disease-oriented approach. The whole system is based upon the treatment of disease instead of the promotion of health.

JWM: I agree. And like my mother, you were way ahead of your time. What was the inspiration for the first edition of your book, The Complete Book of Juicing, back in 1992?

Dr. Murray: In 1992 there was a tremendous renaissance in the appreciation of fresh fruit and vegetable juice in promoting health. It was really the result of infomercials touting new juicer technologies. My goal in writing the first edition was to use it as a platform to educate people on the factual benefits of drinking fresh fruit and vegetable juice as opposed to the unsubstantiated overstated benefits that were flying around at the time.

JWM: You recently released a revised edition, The Complete Book of Juicing, Revised and Updated: Your Delicious Guide to Youthful Vitality. How pertinent is it for today’s deteriorating lifestyle habits?

Dr. Murray: Gaining the benefits of drinking fresh fruit and vegetable juice is even more important today than it was 20 years ago. The reason for the update of the book is to deal with the explosion of new information on the important healing and health benefits produced by the simple incorporation of drinking fresh juice into a person’s daily habits.

JWM: Cynics aside, over the last three decades, have you seen a growing inclination/awareness/adoption toward alternative medicine? Do you feel social connectedness is a major contributor to this?

Dr. Murray: There has definitely been a tremendous increase in the awareness of many aspects of what is now considered alternative medicine. In fact, in the last 30 years we have seen the acceptance of many truths that were self-evident back then, but were widely argued against by conventional medicine.

JWM: For example?

Dr. Murray: First of all, the notion that dietary factors were the major determinants of many forms of cancer was viewed as being unfounded from a scientific perspective. Now that link is irrefutable, and the link between diet and many other health conditions is also much better understood today than it was then. The health food industry has been the incubator for many changes in our popular culture. For instance, 30 years ago who outside of the health food industry would have heard of probiotics, antioxidants, gluten, omega-3 fatty acids, glucosamine, and herbs like ginkgo biloba?

JWM: I think there are a lot of explanations for the enlightenment of the consumer toward natural health and natural products. But at the end of the day, I don’t think the awareness is the result of some huge advertising campaign. People are actually experiencing positive results from natural medicine and spreading the word to their family and friends. And that’s a good thing. That being said, any final pearls of wisdom for the benefit of Intent readers, so they, too can become Better Than Before?

Dr. Murray: There is no single magic bullet for turning your life and your health around. It requires focusing on all areas of your life. Each component has a powerful effect on the whole system. And, it goes beyond a health-promoting diet and lifestyle. It also requires being a guardian of your attitude and self-talk in order to program yourself to be more positive, adaptable, and committed to life. I do believe that there is a purpose to our lives, and taking care of our body, mind, and spirit is critical in achieving that purpose. So, we need to be very good to ourselves and those around us.

photo by: Food Thinkers

Better Than Before: A Hypochondriac Discovers von Willebrand Disease

 von Willebrand DiseaseThe worst thing you can tell a hypochondriac such as myself, is that there is another illness out there waiting to be experienced. Case in point: The little-known bleeding disorder, von Willebrand Disease (vWD). While it sounds like something you can only catch from effete German aristocrats, it is, in fact, named after Erik Adolf von Willebrand, a Finnish pediatrician who first discovered it in 1926. And the only reason I am writing about it now, is that it turns out that I know someone who actually suffers from it, and she recently described her symptoms to me. (Note: When innocents start doing this and my husband, The Lawyer, is present, he desperately, tries to stop them before I personally start to manifest the symptoms!) Amazingly, it is remarkably common – if not well understood – and by some estimates, affects as many as 1 in 100 people. A genetic disorder, it is non gender-specific, meaning men and women are afflicted equally. Most cases, though, go undiagnosed because the symptoms tend to be very mild.

In order to find out more about vWD, I consulted with the specialty-trained clinicians in the Express Scripts Bleeding Disorder Therapeutic Resource Center, offered through Accredo, who have disease-specific expertise. They help patients understand and manage their condition and treatments. In other words, they are good for me to get to know. (Both the experts and the treatments, that is!)

Here is what Leslie Oygar, a clinical nurse liaison in the TRC, tells me:

Von Willebrand factor (vWf) is one of the key components of the process that helps blood clot. It is produced in the bone marrow and the lining of the blood vessels, where it is also stored. In 99% of us, VWf is released into the blood when an injury occurs and works with platelets to start the clotting process, which ultimately stops the bleeding. If the supplies of vWf are inadequate, it can result in uncontrollable, or poorly controlled, bleeding.

There are three types of vWD. Fortunately, a vast majority –roughly 75% – of patients have Type 1. These patients typically experience less severe symptoms. Type 2 is caused by a qualitative dysfunction of the vWf. There’s enough clotting factor but it does not function the way it should. Type 3 is the most serious, and rarest, of vWD. These patients have a a severe deficiency of clotting factors, and experience significant bleeding –including joint bleeding. Type 3 requires treatment with an intravenous clotting factor containing vWF.

Now for the scary part as far as I’m concerned! That would be the actual symptoms. According to Oygar, these can range widely depending on the person’s gender and type of vWD.

“They can be as minor as light bruising or small knots under a bruised area,” Oygar says.

The more alarming ones include bleeding from the gums and prolonged bleeding after a dental extraction, blood in the urine (kidney bleeding) or bleeding in the stomach or intestines. Female patients, as one would imagine, can have additional signs including prolonged or excessively heavy menstrual bleeding, which are in some cases very serious, requiring blood transfusions until it is under control. Postpartum bleeding is of concern as well.

The good news? vWD is treatable, Oygar points out. How? Glad you asked, because Oygar has answers.

• Symptoms of Type I and some forms of Type 2 are often treated with an intranasal spray, Stimate, also offered in injectable form.

• Oral medications, like Aminocaproic acid and tranexamic acid, are available to help prevent the clot formed from breaking down after the bleeding stops. They are often used before and after dental procedures.

• Some other forms of Type 2 and Type 3 may call for an intravenous plasma-derived clotting factor.

For patients with any form of vWD, however, below are six useful medication management tips to help ensure that their condition is well controlled. They are important suggestions to keep on hand on your journey to feeling Better Than Before:

1) Be on the alert: If you have vWD, as with so many conditions, the first step is prevention. Similar to people with hemophilia, obviously avoid activities that can lead to cuts and internal bleeding. Less obvious is food-intake related actions. Sharp-edged foods, such as corn chips, may scratch or pierce the soft tissue inside your mouth and cause bleeding. Chewing gum can lead to biting your tongue. And if you are already bleeding, avoid hot foods and beverages, as they can cause vasodilation, causing bleeding to worsen.

2) Have First-Aid handy: Keep popsicles in the freezer as a first line of care for oral bleeding until medication can be administered as ordered by the hematologist. The ice-cold treat aids in vasoconstriction, which is part of the first stage of coagulation. Ice packs for topical use on other areas of the body should be in the freezer as well.

3) Cover all contingencies: Especially in the case of your children who may have vWD, have a plan and discuss it with the school nurse or teachers, and other caregivers. Ensure that medication is available in the school clinic for any episodes of bleeding.

4) Use as directed: Nasal sprays, injectables and intravenous medications for vWD require a hematologist’s supervision and approval and should be used exactly as prescribed. Over-dosing or under-dosing can be dangerous and potentially fatal. Always consult a hematologist or an appropriate clinician for questions about dosing changes. Missing doses or discontinuing the medication could cause the bleeding to resume.

5) Monitor fluid intake: Over-hydration in patients on a nasal spray or injectable form of medication can cause seriously low sodium levels which could lead to seizures.

6) Talk to your clinician: Heavy menstrual bleeding can be dangerous and must be reported to the hematologist or clinician. Let your hematologist know at least 2 weeks prior to surgery or dental work. Be sure to report any symptoms or changes.

As for me, I’ve decided that from now on I probably should stay away from sharp knives; and just to be sure, all cooking utensils! The Lawyer will just have to fend for himself in the kitchen. (Who cares if the odds are 99 to 1 that I don’t have vWD!)

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