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Dr. Tieraona Low Dog Discusses Women's Health— Age 40 & Beyond

In the following interview, Dr. Low Dog gives advice to doctors—which we can all use—about how women can best navigate through the aging process. Excerpted from "What Women Need—A Conversation with Tieraona Low Dog, MD"

Q: By age 40 and above, stress is a major factor when juggling careers, family, and a desire to stay healthy as perimenopause may be approaching. How can physicians play a role in helping women achieve mental and physical balance?

DR. TIERAONA LOW DOG: The very first thing clinicians must do is evaluate how well they are balancing their own lives! Have YOU achieved mental and physical balance? Patients/clients have a radar for hypocrisy and it feels incredibly inauthentic when someone whose own life is in chaos preaches balance to others. Women in particular, want a clinician that they can talk to and partner with to achieve the health goals they have chosen for themselves. This requires the clinician to listen to her. Ask her how she sees her life in 5 years and in 10 years. What will she be doing? Working? Caring for parents, children, or grandchildren? In a relationship? When she looks to the future, does she have any fears or concerns? Is there anything she would like to change about her life? How would she go about making those changes? How can you help? It is through these conversations that she will be able to self-reflect and choose what steps she wants to take to have the life that she envisions.

Q:By 50 and 60, women recognize that aging is inevitable, but healthy aging is a choice. What are three goals that can help women age gracefully and healthfully?

DR. TIERAONA LOW DOG: I use the analogy of a 401K when speaking to patients about investing in their health. Just like you invest financially for your retirement, you need to make regular deposits into your health account. You can only obtain the quality of life you are hoping for by continually investing in yourself throughout your lifetime. Life is not a sprint—it is a marathon. Plan accordingly. Most women easily make this connection. Clinicians can then talk with their patients/clients about where they are in terms of meeting their health goals. Think body, mind, and spirit. Weight gain is also common within this age group, as the body composition changes and abdominal obesity increases.

The diet should be wholesome, rich in phytonutrients, and include good sources of protein. Walking and resistance training are also essential. Tai chi and/or yoga can be useful for maintaining balance and flexibility. What do they enjoy? Do they like to take classes or are they more interested in finding exercise routines that can be done alone or at home? The mind should always remain active and engaged.

Many women enjoy meditation and guided imagery at this time of their lives. There are many books and online audio/video resources available, in addition to local classes. Also, assess her relationships and inquire about sexuality. Women often have questions about their libido or may be experiencing discomfort due to vaginal dryness. There are options for her.

In addition, there are some key supplements that should be considered. A basic multivitamin for a woman over 50 (no iron, higher B12, adequate vitamin K, etc.) should be considered foundational. Vitamin D should be monitored and serum 25(OH) D levels kept at a minimum of 30 ng/mL (75 nmol/L)—with an optimal target range of 30-50 ng/mL. Evaluate her calcium intake. She needs 1200mg per day from all sources, so she might need to supplement. Glucosamine and chondroitin may also be indicated if she is having signs of osteoarthritis. Omega-3 fatty acids taken several times per week can also be supportive if she doesn't regularly consume fish.

In addition to all the information already discussed, it is important that clinicians ensure women keep up-to-date with regular screening exams (e.g. heart disease, diabetes, osteoporosis, colonoscopy, mammograms, skin, eyes, immunizations, etc.). Also be mindful of signs of depression, neglect/abuse, STDs, painful intercourse/loss of libido, and substance abuse. Prevention and early detection remain a core part of care for this age group.

Q:After spending decades putting others before themselves, what are the major changes women over 50 should make for themselves to stay healthy and well? How will their relationship with their practitioner change at this age?

DR. TIERAONA LOW DOG: When you are getting ready to take off on an airplane, the flight attendant will say something to the effect, "If we should experience an unexpected loss of cabin pressure, an oxygen mask will drop down from overhead. To start the flow of oxygen, pull the mask towards you. Put on your own face mask before assisting others." Why? Because if you pass out you'll be of little help to anyone else! Women should always take care of themselves FIRST! No matter what age they are.

By now, patients 50 and above know they are strong, capable, and have learned SO many things throughout their lives. They develop more courage, become less fearful, and know that life can change in an instant. I generally emphasize the following: Be patient and try not to worry so much about the wrinkles, but more about the way you feel! Women want to have the energy, strength, and health to do the things that bring them happiness. This means walking, stretching, keeping your muscles strong, and eating food that is nutrient dense, NOT calorie dense! A low glycemic load, Mediterranean style diet is a wise choice for most. Above all, stay close with your family and friends. Social isolation is dangerous for both physical and mental health. Be a good friend. Be merciful with yourself and others. Do good whenever possible. Practice gratitude.


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