The Benefits of Daily Exercise after Menopause


Women experience menopause with lost ovarian function due to aging or surgical removal. Loss of estrogen in the postmenopausal state affects the body in both obvious and subtle ways. Obvious effects are hot flushes, thinning hair and skin wrinkling, but there are many more silent harmful effects.

Early menopause contributes to osteoporosis. Gradual weakening of bones occurs without the estrogen stimulus to calcium metabolism and bone strength. Further bone loss may evolve to fractures and disability.

We also know the effectiveness of high-density-lipoprotein (HDL), the “good” blood fat, is reduced without estrogen effect. This transporter molecule is responsible for removing cholesterol buildup in arteries. HDL particles without the effect of estrogen are less efficient and the risk for heart attacks increases in women following menopause. Postmenopausal women can offset some of this effect by eating healthy and staying active. Statin medication to modify abnormal blood lipids may also be needed.

A study reported at the North American Menopause Society stated women after menopausal tend to weigh more, have larger waist lines, and a higher percentage of body fat than younger more active premenopausal women. Sedentary behavior correlated with a larger waist size – no surprise. But their findings showed regular exercise brought benefit to both pre- and post-menopausal women. When women increased their daily exercise – energy, mobility, and bone density all improved, along with reduction in waist size. Increased activity and weight control can also reduce the risk of developing Type 2 diabetes.

Last year, a journal of the American Association for Cancer Research reported a four year study examining women who walked the equivalent of thirty minutes per day had a lower risk of invasive breast cancer. The exact mechanism is unknown, but we do know exercise carries many positive benefits. Researchers stressed the benefit of lowered risk of invasive breast cancer was lost when exercise stopped — so daily exercise is key.

Walking daily can become a positive routine and is as important to overall health as brushing your teeth. Dogs love to walk. Our dogs provide encouragement to take a hike even in the rain. If you don’t have a dog, find a friend to join you. Exercise and social relationships correlate with happiness and longer life. Find a route that makes you smile and take a daily walk.

Some good advice from Dr. Seuss:
You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.

20151018_142608Betty and Bev

Alcohol, Women and the Economy

k9293041Alcohol abuse has ruined many lives and relationships. There are few families without these problems. Child abuse, partner abuse and self-abuse are all intertwined when it comes to the use of mind-changing substances. Some people are successful occasional users, many are not.

Recent research articles and experiences with alcoholic friends stimulated this series of blogs on the topic. This will be our last one for now, but I wanted to end with recent information on the topic to help you analyze your own behavior and possibly intervene when you see dangerous behavior occurring.
Microbreweries and small distilleries have become popular everywhere. Tasting a “flight” of either beer or hard liquor samples may put you over the safe driving blood alcohol limit of .08. A designated driver is essential. One in ten deaths among working-age Americans between the ages of 20-64 is caused by excessive alcohol. Drunk driving kills.

Two days ago, a report from the Centers for Disease Control and Prevention (CDC) released a study showing alcohol consumption and costs have accelerated. The economic costs are due to reduced work productivity, the cost of treating people for health problems related to alcohol, and crime. These statistics did not examine the pain and suffering from alcoholic behaviors.
We all understand why pregnant women must be wary of alcohol and its harm to an unborn child. Fetal Alcohol Syndrome, also called Fetal Alcohol Spectrum Disorder (FASD) is a constant reminder that mental and physical changes are attributable to a mother’s behavior while pregnant. There is no amount of alcohol consumed while pregnant that has been proven safe. The primary concern is that small amounts of alcohol could negatively affect the developing fetal brain. Each woman has to decide. Our advice to pregnant women is to wait and have a glass champagne to celebrate after the birth of your child.

Many have a glass of wine for social reasons. Others drink to get drunk, or are addicted and don’t stop until their blood alcohol level causes them to pass out. Tragedies happen every day due to alcohol. Think twice before you drink, and never drive after drinking.

Betty and Bev


The National Highway Traffic Safety Administration has determined the legal alcohol intoxication level as anything exceeding 0.08. A breathalyzer test will determine your Blood Alcohol Concentration (BAC). The legal limit in all states in the United States is a number below .08.

This is 80 mg per deciliter and is sometimes stated as 80 mg% or .08 BAC.
Alcohol can be measured in the blood within minutes of consumption due to rapid absorption. Food in the stomach helps to slow absorption. In fact, a person is more likely to fail a breathalyzer test if they have not eaten.

A common question is: “How many drinks can I drink before I reach the .08 level?” The answer is: “The number of drinks varies by individual.” In some cases, it may take only one drink to put a person into the “Driving Under the Influence” (DUI) category.

Some people don’t need much alcohol at all to be considered legally drunk. Weight, gender and body fat percentage, plus alcohol tolerance, all factor into the equation. So, if you are concerned about how many drinks you can have before driving, the best answer is “zero” – do not drink and drive. Whether or not you consider yourself “drunk,” the law considers you to be an offender if your BAC is above .08%.

A level of 0.05 is significantly below the legal intoxication level of 0.08, but can slow reaction time and result in sedation. As blood alcohol levels increase, common effects include:
0.08 – Legal intoxication with increased impairment in thinking and reaction time
0.10 – Poor coordination, slowed thinking and speech impairment
0.20 – Trouble walking, nausea, vomiting
0.30 – Memory loss, cool body temperature, may lose consciousness (pass out)
0.40 – Coma, trouble breathing and possible death
0.50 – Death

The rate of metabolism of alcohol in the body also varies but an estimate follows:20151007_151522
A 150 pound woman who consumes one “standard” drink over one hour will attain a BAC of 0.03. After two hours, her BAC will be 0.00. One “standard” drink consists of 12 ounces of beer, or a 5% alcohol cooler (5 ounces of 12% alcohol wine), or 1.5 ounces of spirits such as 40% vodka or whiskey.

If a woman weighs 100 pounds and consumes two standard drinks in one hour, her BAC will approximate 0.08, producing legal intoxication.

Alcohol quickly lowers inhibitions and impairs thinking. About 50% of Montana motor vehicle fatalities are alcohol related. These statistics support a zero tolerance for drunk driving and encourage designated sober drivers in all situations.

Betty and Bev

PALCOHOL: Powdered Alcohol

Palcohol labelIn March 2015, the Alcohol and Tobacco Tax and Trade Bureau (TTB) approved the use of powdered alcohol in the United States. It appears it will eventually become available in both consumable and non-ingestible industrial forms, but when and where it will be available for purchase is yet unknown. The General Foods Corporation made powdered alcohol as early as the 1970’s by absorbing ethyl alcohol/ethanol into a carbohydrate powder. Many patents exist on the product, but powdered alcohol is still not readily available and some believe that is a good thing.

Turning water into alcohol drinks by just adding powder has generated fear of abuse. Some parents and legislators believe the ease of concealment of powdered alcohol would encourage use among underage drinkers. In spite of liquid alcohol being readily available, some legislators are considering banning the sale of the powdered form. Some states have already banned sale of the product.

Mark Phillips with Lipsmark have recently obtained the TTB’s approval, but authorities are not clear on how to tax the product. Labels have been approved and it appears it will be available soon. Lipsmark, LLC, located in Tempe, AZ, produces six varieties of palcohol including vodka, rum, and four cocktails.

Lipsmark’s products so far include:
“R”- rum, made from cane sugar
“V”- vodka, made from grain
Cosmopolitan cocktail
Lemon Drop
Powderita, a margarita-like drink

The Lipsmark website states the reactive legislation is based on misinformation regarding misuse and abuse. Inappropriate use, including snorting the powder is one concern but the company reports it would be difficult to snort, and a very ineffective way to feel alcohol effects. It would take a long time to sniff the equivalent of one shot of vodka up your nose. The powder on mucus membranes generates the harsh burn of alcohol.

In Japan, a powdered product producing a 12% alcohol brandy-like drink is made by Sato Industries. The company released this alcohol drink in 1981. In Germany, a powdered alcohol product sells for about $3 US dollars per drink. The Netherlands also sells a product called Booz2Go.

There are a variety of potential beneficial uses for non-ingestible forms, including: military and industrial applications, medicinal topical use, and a fuel source. Other benefits of the powdered product include its light weight and potential use by back-packers, and for consumption on weight-limited airliners.

The ease of carrying the powder into public events, plus the possibility of covertly spiking the drinks of unsuspecting individuals, generated enough concern for Maryland legislators that they quickly banned the sale of powdered alcohol. Alaska, Delaware, Louisiana, South Carolina and Vermont followed suit.

Failures of Prohibition have not deterred more legislators from considering a ban that could move Palcohol to the black markets. Taxing and controlling its sale would stop that trend. Mark Phillips emphasizes the decisions to ban are based on ignorant speculation. He reminds people of the failure of Prohibition.

We remind people to always drink sensibly and drive sober.

For additional information directly from Phillips’ site consult: For additional information from a legal source consult:

Betty and Bev

I’ll Drink to That!

Some water flowing in high mountain streams is pristine enough to drink without the need of additives to kill or filter out disease-causing microbes. But, in many places on planet earth, water clean enough for consumption is in short supply. In California and other drought-ridden locations, plants and animals are dying due to insufficient water. In many areas around the world, dysentery from drinking contaminated water is prevalent and life-threatening.

We take water purity for granted in the US where chlorinated water pours from our taps. But, during much of the past 10,000 years, before the availability of pure water, the only safe liquid to drink contained alcohol. Today, we see alcohol through many lenses, with both good and bad views.

Alcohol is the metabolic byproduct of the natural process of fermentation that occurs when yeasts metabolize sugars. In the Middle Ages, alcohol was called “the water of life,” aqua vitae. They learned to make wine from grapes, and beer from fermented grain. People of all ages, including children, drank alcoholic beverages as their primary consumable liquid. The alcohol destroyed many microbes causing disease and made it safer to drink than water. The processes for making wine and beer are simple. Today, many people make them for fun. Microbreweries have sprung up everywhere. There are many suppliers, even health food stores carry the products.

All alcohols are not consumable. Some can cause blindness and death. Disinfectant alcohol is applied to surfaces of the body prior to medical procedures, and is the primary ingredient in liquid hand purifiers. Windshield cleaners spew various colored fluids containing alcohol. There are many industrial uses.

20150626_195841The drinkable form is ethyl alcohol. It is used in celebratory toasts, paired with elegant dining, and has been shown to contribute to cardiovascular health. Undisciplined drinking carries health risks and tragedy. Alcohol is a sedative drug and a toxin. Excessive consumption contributes to loss of mental function, also causing addiction and liver failure. Alcohol has become a common social drink and a problem for many who drink to excess.

Our next blog will review a new powdered alcohol product called palcohol. Additional blogs will provide information on health and social issues related to alcohol consumption, common early signs of problematic drinking, and will discuss blood alcohol determinations.

Here’s to safe drinking, designated drivers, and moderation in all things.

Betty and Bev


Influenza is a respiratory illness caused by a virus.

In 1918 a deadly outbreak of influenza known as Spanish Flu occurred. The disease killed about 50 million people around the world. Recent research done on preserved lung tissue from people who died showed the lung damage seen with bacterial infections, not viral. Researchers concluded the Spanish Flu virus caused a severe respiratory illness, complicated by bacterial infection before effective antibiotics were available.

Seasonal flu remains a serious health problem carrying the greatest risk in older people and those with lung conditions such as asthma and chronic lung disease. Ninety percent of deaths occur in people over the age of sixty-five. A bacterial pneumonia is a common occurrence with influenza. The “pneumonia shot” only prevents one type of bacterial pneumonia, pneumococcal, and is recommended for adults 65 and older.

Today, each year in the US more than 36,000 people die and 200,000 are hospitalized with the flu. Anti-viral drugs are available and shorten symptomatic periods by a couple of days. Antibiotics reduce fatalities from complicated pneumonias that often follow influenza. Getting a “pneumonia shot” only prevents pneumococcal pneumonia.

Each year the flu vaccine is formulated to stimulate immunity to the influenza viruses most likely to be present in the upcoming season. The vaccine usually covers 3-4 different viruses. While the Centers of Disease Control and Prevention (CDC) researchers do their best to match the annual vaccine with the anticipated viruses, the vaccine may not prevent all influenza illnesses because the viruses mutate and change each year.

“The CDC notes that around 70% of this season’s H3N2 viruses have been identified as “drift variants” – viruses that possess antigenic or genetic changes that make them different from the virus included in this season’s flu vaccine, meaning the vaccine’s effectiveness is reduced.”

 “… the CDC estimates that the flu vaccine has reduced an individual’s risk of visiting a doctor due to flu by 23%. This result remained after accounting for patients’ age, sex, race/ethnicity, self-reported health and the number of days between illness onset and study enrollment.”

The best way to prevent the flu is to get your immunization every year. Once you have been immunized it takes about two weeks for the body to generate a response to prevent the disease.Medicine.5

“Despite the low effectiveness of the 2014-15 flu vaccine, the CDC continues to recommend that all people aged 6 months and older receive the vaccine, as it may still prevent infections from some circulating influenza A H3N2 viruses and reduce severe flu-related complications.”

What to do: To protect yourself from influenza, avoid people with respiratory illnesses, avoid hand shaking, use good hand washing technique and utilize alcohol hand purifiers. Early Person Washing Hands with Soap in Washbasinsymptoms are typically muscle aching (myalgias), fever and worsening respiratory symptoms. Isolate yourself if you develop the symptoms. Antiviral drugs must be started within 48 hours of onset of symptoms to have benefit. Call you physician for advice if you are not improving or develop shortness of breath.

Best wishes for health and avoidance of influenza.

Betty Kuffel, MD

Broken Heart Syndrome

Takotsubo Cardiomyopathy

broken heartLosing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. InSTEMI addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).


The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The largeHeart superficial vessels coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

YogaTechniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.


Lipstick Logic
Betty Kuffel, MD