• Safe Sun Exposure

• Watch Dr. Nelson on NBC Later Today

• Reader Questions and Answers
• What can I do about my underactive thyroid?
• What about isoflavones and perimenopause?
• Are twisting postures safe?
• What about risky sports and osteoporosis?

• From the Mailbox - Success Stories

• Recipe - Summer Berry Desert

SAFE SUN EXPOSURE

In the northern hemisphere we are in mid summer and for most of us the sun is shining bright. While sun exposure helps our bodies produce vitamin D - too much sun can cause wrinkles, dry skin, age spots and skin cancer. Our bones require vitamin D in order to remain healthy and strong. Vitamin D is needed for the absorption of calcium in the gut and for the proper mineralization of bone. Our skin can make vitamin D once it is exposed to the sun. How much sun exposure should you get is a question that many women have asked. Here are some guidelines for gaining the benefits from the sun without increasing your risk of skin problems:

• Always protect your face from the sun. Wear a hat or put sunscreen of at least SPF 15 on your face. Your face has fragile skin and is very susceptible to sun damage of all kinds. Nothing will age your face faster than having it exposed to the sun. So cover up to keep you face safe and young.
  
  
• During the day, expose your arms or legs to the sun during a walk or any time you are outside for about 10-15 minutes. This short amount of time is enough to get your daily dose of vitamin D.
  
  
• For any amount of time greater than 15 minutes, cover your skin up with clothing or sun screen of at least SPF 15. Even if there is a light haze in the sky, cover up -- the sun's rays can penetrate through and cause damage.
  
  
• Protect your eyes by wearing good quality sunglasses and a hat! The ultraviolet rays of the sun can damage your eyes as well.
  
  
• Never allow your skin to get burned!

Remember to talk with your doctor about any changes in your skin such as new moles, moles that have become an odd shape or discolored or other variations in your skin. These changes may be a sign of skin damage from the sun, which can result in skin cancer. Most forms of skin cancer are easy to treat especially if you have it treated quickly.

Enjoy the rest of the summer. And keep your skin young and healthy by getting the right amount of sun exposure!

More power to you -
Miriam E. Nelson

MEDIA WATCH

Dr. Nelson is scheduled to be a guest on NBC's "Later Today" on August 7 between 9:00 and 10:00 am Eastern time (times in your area may vary so please check local listings). She will be talking about her new book Strong Women, Strong Bones.

QUESTIONS AND ANSWERS

Q: I have an underactive thyroid and have been taking Synthroid for a year now. Recently I walked everyday for two months and did some resistance exercises at home. I ended up gaining weight instead. What must I do to lose weight?

A: Many women who have an underactive thyroid have a difficult time maintaining ideal body weight - even when they take medications to correct the problem. I doubt that the weight gain was caused by the walking and resistance exercises. Because it can take over a year to get your thyroid levels stabilized and normal, I would suggest that you talk with your doctor about having your thyroid hormone levels checked again. If your thyroid hormones are still even slightly low, this may be contributing to the weight gain (the difficult issue here is that you also don't want your thyroid hormones to be too high as that can contribute to loss of bone and muscle). Certainly continue with your walking and resistance exercises. In order to lose weight you are also going to need to make a conscience effort to eat a little less each day and to exercise a little more -- Strong Women Stay Slim has a complete weight control program that includes a healthy diet plus exercise. I know that you can do it. Make sure that you work towards losing no more than 1 pound per week and that you set realistic goals for your end weight.

Q: I am 53 years old and in the perimenopausal stage of life. I am confused about the benefits of soy products. How many isoflavones are recommended on a daily basis? Or is it the isoflavones that are important? Are tablets as effective as soy protein drinks? Thanks for your help.

A: Different cultures around the world eat varying amounts of foods made from soybeans. Asian cultures certainly eat the most soy foods. Asian women also report having many fewer symptoms such as hot flashes as they go through menopause. Scientists believe that isoflavones - estrogen like compounds - within soy foods are responsible for the reduction in menopausal symptoms. Isoflavones act as "weak" estrogens in the body. They seem to exert the health benefits of estrogens but do not exert the negative health consequences such as increased risk of breast cancer. It is unclear if taking isolated isoflavones in tablet form will have the same effect as eating a diet that is rich in soy foods, such as soymilk, tofu, edamame, etc. There is also some question about the possible negative side effects over time of taking isoflavones in pill form. Until more research is completed on the use of isolated isoflavones I recommend that you work towards eating more soy foods.

Q: I have read that forward bending postures in yoga are dangerous for women who have osteopenia or osteoporosis. Are twisting postures safe?

A: While there is little research in this area, some practitioners believe that unusual twists or bends (especially forward) can create enough torque on fragile vertebra to cause fractures in someone with osteoporosis. Recommendations for someone who has osteopenia (low bone density) are different. Because they are at reduced risk for spontaneous fractures, they can do more exercises that involve bending and rotating the torso. It is important to focus on bending and rotating in a smooth and controlled manner as opposed to "twisting" and being very careful not to move too quickly or to progress too rapidly with yoga poses. The key here is to progress slowly and to realize that your bones take much longer than your muscles to get strong. Finally, if someone has osteopenia or osteoporosis they need to talk with their doctor about a complete treatment plan, which may include medication management, the recommended amounts of calcium and vitamin D along with exercise as the best way to reduce the risk of fractures.

Q: My wife was diagnosed with osteoporosis last winter and is on a medically-supervised weight-bearing exercise program at a local gym, as well as taking Fosamax.….One activity she looks forward to a great deal is bicycling. We are also members of the Appalachian Mountain Club, which promotes skiing, snow shoeing, climbing, hiking, etc. As you can imagine, all of these activities involve occasionally FALLING, and that prospect alarms me with my wife's BMD of ~2.8 SD's below normal, hip, lumbar spine, and wrist. She's more cavalier about it, but really, neither of us have any hard data about whether these are ill-advised or not for osteoporosis sufferers. Does she need to give up biking, cross-country skiing, or mountain hiking or are these still OK for someone with osteoporosis to do?

A: This is a difficult question to answer. The guidelines from the major health organizations advise individuals who have osteoporosis to NOT engage in activities that put them at risk for falling. These activities include the ones that you and your wife enjoy participating in. I agree with these recommendations as being sound public health policy. However, as a person who enjoys these activities, I understand that to remove these sports from your lifestyle is basically removing one of your life's greatest pleasures. The advice that I give older women who enjoy these sports and have participated in them for a long time is as follows. First, make sure that you are doing regular strengthening exercises so that your muscles are strong. The strength training routine outlined in Strong Women, Strong Bones is a targeted strength training program for women who are at risk for osteoporosis and for women who already have osteoporosis. If you decide to continue to participate in activities that do put you at risk for falling, you need to understand the consequences of what might happen if you fall. You DO have a greater risk of having a fracture if you fall. Use your head and don't participate in the sport if the conditions are poor - i.e., don't ski if it is icy or if the cover is poor and you might hit rocks! And don't participate in the sport if the people you are doing it with are not at your level. Basically, use your head. Certainly it is safest not to participate in risky sports - but you also need to live!

Be sure to check out the other questions posed to our experts at: http://strongwomen.com/faqs/faqs_001.htm

FROM THE MAILBOX

Here are excerpts from a few of the inspiring letters we've received recently. If you enjoy reading them, check out the collection of reader mail on our web site at: http://strongwomen.com/success_stories.htm

"About two years ago, I purchased both Strong Women Stay Young and Strong Women Stay Slim. I read both on a regular basis. I especially like the fact that Strong Women Stay Young has the corresponding exercises for use at a fitness center with machines. I am morbidly obese. Since September of 1999, I have lost 40 pounds. With the combination of walking and the exercises from SWSY, I feel much better. Thank You. I hope that when you do a revision of SWSS, that you will add to it the corresponding exercises for use at a fitness center."

- Mary

"Thanks for your reply to my question [about exercise intensity]. Since asking the question, I stepped up my days to 5 days a week plus weekend gardening and am beginning to see results. I did feel better but that was it. I have already begun all of your suggestions and am convinced this program will work for me. My key was in not exercising every day and at the intensity level I need. Evidently I am stronger than I thought and was -- working up to 8-10 lb weights and should have been going toward 12-15 lb, which I am now using for some exercises… So, as I learn more about my own body, I'm making progress. Thanks again for your help."

- Karen

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