Lifestyle

Q: My mother is developing age-related macular degeneration. She is scared that she won't be able to read or drive. What is it exactly and what can we do about it? Thanks! -- Stephen Y., Akron, OhioA: Age-related macular degeneration (AMD) is the leading cause of vision loss in the U.S. in folks age 60 and older. Around 11 million Americans contend with vision problems that range from blurring and blind spots in their central vision to severe vision loss, making reading, driving and recognizing faces impossible. This is caused by damage to the macula, a tiny oval area 1/4 of an inch wide in the center of the retina at the back of the eye. It contains photoreceptor cells called cones and rods that let you perceive fine detail and colors.We are not sure of all the causes, but we know AMD is associated with smoking, uncontrolled high blood pressure, diabetes, and obesity. Also, if you have a parent or sibling with AMD, you have a 50% chance of developing it. Early dry AMD has three stages with the last causing extensive blurring in the central area of vision. Wet AMD is more severe. In it, blood vessels form in a layer in or around the retina, destroying vision. About 10% to 15% of folks with dry AMD develop wet AMD.Once AMD is diagnosed, it's important to have regular eye exams and stick to an anti-inflammatory diet loaded with foods like spinach, kale and collard greens. Another smart move, especially for those with wet stage AMD, according to the National Eye Institute AREDs 2 study: Slow progression of dry AMD with a daily supplement formula. The supplements contain 500 milligrams of vitamin C; 400 IU of vitamin E; 25 milligrams of zinc; 2 milligrams of copper, 10 milligrams of lutein; 2 milligrams of zeaxanthin; and 1,000 milligrams of omega-3s. And check out the iHerb.com blogs: "A Quick Guide to Lutein and Zeaxanthin" and "Top 15 Supplements for Vision Support." Also, for wet AMD, laser therapy or treatment with VFEG drugs can block the growth of new blood vessels. * * *Q: A lot of folks in my family are getting cancer. What can I do to reduce my risks? Thanks! -- Katie R., Greenville, North CarolinaA: The National Cancer Institute and the American Cancer Society say many cancers are caused by modifiable lifestyle choices -- and you can slash your risk! The risky choices include: obesity, smoking anything and using tobacco (tobacco has 69 cancer-causing chemicals), excess alcohol intake (even light drinking ups your risk for a variety of cancers), unmanaged stress, being sedentary, lack of good nutrition and eating fried foods and red meats, unprotected exposure to the sun, not getting the HPV or Hep B vaccine, and exposure to cancer-causing chemicals (like some weed killers on your lawn). These risk factors cause chronic inflammation, may lead to hormone dysregulation, and can set you up for cancer-related infections. Chronic stress and a poor sleep routine can also up your risks. MD Anderson Cancer Center says chronic stress hormones make it difficult for your body to control diseased cells and keep them from spreading. And years of shift work and chronically poor sleep can raise your odds of breast, colon, ovarian and prostate cancer, according to Johns Hopkins Medicine. Overall, if you upgrade your lifestyle, the World Health Organization says up to 50% of cancers are preventable! For more tips on reducing your cancer risks, check out the American Cancer Society's Guideline for Diet and Physical Activity for Cancer Prevention; sign up for Longevity Playbook's free newsletter that offers science-backed ways to promote healthy longevity; check out iHerb.com's blog, "Low Immune Function;" and enjoy Dr. Oz's interview, "How to Reduce Your Cancer Risk" at nj.com.As for cancer risks that you can't control, such as genetic predispositions and age-related risks -- that's what makes it important to get regular mammograms, pap smears, colonoscopies, skin cancer checks (annually) and lung cancer screenings (for folks who smoke or have quit within the past 15 years).* * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR. ROACH: I recently read a book where a person who suffered from anxiety and depression found that Adderall gave relief from the effects of anxiety and depression. My initial thought was that this could help a person focus and perform, almost like a stimulant. Currently, Xanax is a nice option that appears to help with my anxiety issues. What are your thoughts? -- M.B.ANSWER: Anxiety and depressive disorders sometimes go hand in hand in the same person. Even though they may seem to be opposites, both anxiety and depression symptoms respond to similar medications, which suggests similar brain mechanisms.Adderall, a combination of dextroamphetamine and amphetamine, is, indeed, a stimulant. Stimulants have been proven to be useful in a minority of people with depression that has been resistant to other treatments. As a primary care doctor, I generally do not prescribe these kinds of medications, and I refer patients to a mental health expert, like a psychiatrist, whenever possible. Unfortunately, we have been living through a mental health crisis for years now, and many of my patients are simply unable to get expert psychiatric care. So, primary care doctors, like me, have to do the best we can, sometimes in consultation/liaison with a psychiatrist.Also, stimulants can make anxiety symptoms worse, so I am especially cautious about using stimulants in a person with both anxiety and depression. Clinical judgment and experience is even more important in this situation.Xanax is an effective medication for anxiety, but the body can get used to it quickly. Similar to Adderall, it has some potential for misuse. I only prescribe benzodiazepine medications like Xanax for the short-term or for very occasional use, although, again, my colleagues in psychiatry sometimes do prescribe them. I have patients who have done very well on stable doses of benzodiazepines for years.However, I have seen too many cases where people become dependent on these drugs and have extreme difficulty getting off of them. Finally, the way the body gets used to these drugs can lead to some people developing withdrawal symptoms, even when taking a stable dose. Most people do very well with safer medications for anxiety disorders.DEAR DR. ROACH: I am a nearly 90-year-old female in relatively good health. I have osteoporosis, for which I'm given Prolia injections twice a year. I brush and floss regularly, and I have excellent teeth. I've always had my twice-a-year cleaning, which my dental insurance pays for. However, my dentist has recently recommended professional cleanings every three months. Do older patients require more frequent cleanings? -- C.H.ANSWER: For most older adults and most people taking antiresorptive medicines for osteoporosis (Prolia, Fosamax, Actonel, etc.), a cleaning every six months is appropriate. These drugs have a rare side effect called osteonecrosis of the jaw, and regular dental evaluation and cleaning may further reduce this small risk (approximately 1 case per 10,000 patients who were followed for one year).If your dentist has recommended cleanings every three months, they may have found a dental issue they are concerned about. While I would listen carefully to their recommendation, it is certainly worth asking why.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I was prescribed iron for a low iron level due to "microcytic anemia." I couldn't tolerate oral iron because of constipation and hemorrhoids, so my doctor prescribed iron infusions. But I had an allergic reaction, and I continue to have sore places all over my body.I am not in great pain, but I'm curious as to whether this is going to be worse as I age. How do I know if this has affected my internal organs in any way? I have read that iron overload disorders can lead to the buildup of iron in tissues and organs. This can cause an increased risk of arthritis, cancer, liver problems, diabetes and heart failure. I was tested for hemochromatosis (which I do not have), so he does not know why my iron level remains so low. -- F.M.ANSWER: "Microcytic anemia" means that your blood count is too low and that your red blood cells are smaller than they ought to be. Iron deficiency is a very common cause of this, but there are many other causes. The diagnosis of iron deficiency must be confirmed by iron studies, including your iron, transferrin and ferritin levels. These are all used to suspect the diagnosis of iron deficiency, although a definitive diagnosis can be made by a bone marrow biopsy. I'm going to assume that your doctor has confirmed your iron deficiency.The main concern I have is your low iron. There are three big categories why that might be: Either you aren't getting enough iron in your diet, you aren't absorbing it, or you are losing it faster than you are absorbing it. Most people get adequate dietary iron, so the most common issues are normally insufficient absorption or excess loss.Multiple conditions can prevent iron absorption, but the most common ones (apart from the surgical removal of part of the intestine) are celiac disease, atrophic gastritis, H. pylori infections, and medicines, especially antiacid medicines (proton-pump inhibitors, H2 blockers, and antacids like Tums).Iron loss is the most dangerous case because undiagnosed blood loss, especially from colon cancer, can go unrecognized for years. Menstruating women often get mild iron deficiency, but any man or postmenopausal woman with iron deficiency must be considered for colon cancer.Reactions to new iron formulations are rare. (Anaphylaxis in 2-7 cases per 10,000 is reported, but this may be an overestimate.) I have never seen a case of persistent body pain after an iron infusion.Finally, you don't need to worry about iron overload. If you don't have hemochromatosis, your body won't absorb iron if you don't need it. Still, your doctor should only be treating you with iron as long as your iron levels are low.DEAR DR. ROACH: My significant other will use the same toothpick to clean his teeth after several meals. My suggestion to replace it after each use has gone unnoticed. Your thoughts on this would be appreciated. I will let it go if you advise as such. -- R.L.ANSWER: There probably isn't much risk of infection, but toothpicks are cheap. He can afford to use a new one every time.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

DEAR DR. ROACH: I recently lost a brother to non-small cell carcinoma in his lungs. He was 82 years old. He was a heavy smoker in his younger years, but quit smoking 31 years ago. He worked many years in the construction trade as a union carpenter and also worked with roofing materials. He had been exposed to many toxic materials during those years.My question is: Is it possible that he may have come into contact with materials such as asbestos, or any foreign material that may have caused lung cancer in his later years? Would the pathologists who studied his cancer find cells that would have indicated this? -- C.S.ANSWER: I am very sorry about your brother. I can't answer which risk factor -- smoking or occupational exposure -- was responsible for him getting lung cancer. They have additive effects, which makes understanding the relationship more complicated.Many people in different occupations are exposed to asbestos, but the occupations most likely to result in lung cancer include ship repair, building construction, and some types of electrical work. It is entirely possible that he was exposed to asbestos, especially when he was working as a young man when there were fewer or no regulations. I always ask about prior military service, since this is another possible exposure to asbestos.Pathological evaluation of lung cancer tissue often finds asbestos fibers among those who have had occupational exposures, and some expert groups feel that this is a major criterion for determining whether the cancer was due to asbestos exposure. This should have been part of the pathology report that made your brother's diagnosis of non-small cell lung cancer.DEAR DR. ROACH: I have read and heard recently that long-term use of the medication pantoprazole leads to a 33% increased risk of dementia. I am concerned because I have been using this medication for approximately eight years, and lately, I get really concerned every time I can't recall a name or place.What have you heard about this? And if this is true, is it a risk for everyone? Are there any over-the-counter medications that might work as a substitute? -- L.G.M.ANSWER: It is true that some studies have shown an increase in dementia risk with people who take proton-pump-inhibitor drugs like pantoprazole or omeprazole. It is also true that other studies haven't shown an increase in risk.Some experts think the apparent increase in dementia risk may be explained by an issue called confounding. People with early dementia may be more likely to be prescribed these kinds of medications due to other reasons, like the known increased risk of heart disease whose treatment sometimes calls for proton-pump inhibitors to be prescribed.Early work has suggested a plausible mechanism (a change in metabolism of the amyloid and tau proteins thought to be responsible for Alzheimer's), so it is possible that there is a real interaction. A different type of study design is necessary to answer the question definitively.In the meantime, because of the possible effects of dementia and the known harms of long-term proton-pump-inhibitor risk, these drugs should only be used long-term when they are really necessary, such as in people with Barrett's esophagus or people who have severe erosive damage to the esophagus.Many people with occasional heartburn due to gastroesophageal reflux do very well with OTC medications like Zantac or Pepcid, which are less likely to cause long-term harm.Finally, having difficulty with recall is a common phenomenon that does not necessarily indicate dementia.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: I want to do everything I can to avoid dementia. What do you recommend in terms of diet?-- Dorthy T., Gainesville, FloridaA: You know the saying, "It takes a village"? Well, sometimes it takes a metropolis! At least that's true when it comes to using food to help protect your brain from premature aging and dementia. The trillions -- yes, trillions -- of microbes that live in your digestive tract impact the back-and-forth communication between your gut and brain and are hugely influenced by the foods you eat. When you feed them well, they help protect your brain power, and according to the Cleveland Clinic, positively affect everything from your hunger, satiety and cravings to your mood, behavior, sensitivity to pain and cognition.To nurture good-for-your-brain microbes and hold harmful ones in check so they don't damage brain neurons and cognition, several new studies stress the benefits of eating whole, unprocessed foods. Research published in npj Aging found that the key nutrients that support healthy gut-brain communication include fatty acids, antioxidants and carotenoids, two forms of vitamin E and choline - similar to what's provided by the Mediterranean diet. The researchers also saw that folks 65 to 75 years old who consumed foods providing a good dose of those nutrients had slower-than-expected brain aging. Carotenoids are in spinach, kale, orange bell peppers, tomatoes, watermelon, cantaloupe, broccoli, and carrots. Antioxidants are in fruits, vegetables, whole grains, nuts, seeds, herbs and spices, and cocoa. Fatty acids are found in olive oil, fatty fish, walnuts, and leafy greens. Choline is in salmon and shitake mushrooms and vitamin E is in salmon and avocado. In addition to adopting a plant-based diet, research also shows the brain-loving benefits of supplements that provide pre- and probiotics. The prebiotics feed good-for-you probiotics and the probiotic supplements reinforce your brain-supporting gut microbes. For more information, read iHerb.com's blog, "What Are Prebiotics?" And consider the benefits of taking probiotics to bolster your healthy gut biome and help protect your brain.* * *Q: I have arthritis in my knees and I'm afraid to jog anymore -- the pounding seems to make it worse. What can I do at age 57 to stay active and help my knees? -- Dwayne J., Terra Haute, IndianaA: Knee pain from arthritis and joint injury is very common. Almost a third of people ages 18 to 39 are bothered by it as a result of physical activity. Among older folks, it is also the result of being overweight and having obesity and osteoarthritis. Around a quarter of folks ages 55 and older experience at least one episode of knee pain annually.But it does not have to sideline you, not by a long shot. A new study in Medicine & Science in Sports & Exercise reveals that bicycling -- indoors or outside -- may help prevent arthritis and knee pain. Researchers found that folks who were cyclists at some point in their lives were 17% less likely to have knee pain and 21% less likely to have osteoarthritis. And for folks who already contend with those conditions, the benefits also apply. Building up your muscles around your knees and on your thighs helps cushion and protect knees from damage and energetic movement of the joint helps drive nutrients and stem cells into knee cartilage -- your buffer against pain.If you want to optimize the results, another study suggests interval training. Adding variable-intensity periods to your cycling workout is a more effective way to improve your fitness level and battle the effects of aging than doing a workout at a consistent intensity, according to Harvard Medical School. And another recent study found that doing two 20-second sprints with 160-second recovery between your more intense efforts may be the best variable-intensity pattern for building leg muscle strength -- and protecting your knees.To protect your cartilage, in addition to cycling, investigate the benefits of hyaluronic acid in the iHerb.com blog, "Support Your Joints." And sign up for Dr. Mike's free newsletter at LongevityPlaybook.com. * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

Q: I used to have a lot more get-up-and-go than I do now. It's not that I've gained weight or have some serious chronic condition. At age 57, I want to feel more energetic! What will work? -- Gayle T., Burlington, VermontA: There is no doubt that life is more enjoyable when you have the energy you need to deal with whatever comes your way. That calls for both emotional and physical reserves. When it comes to overcoming physical weariness, you want to banish sedentary behavior. Getting more physical activity can improve respiration, enhance bone strength, tone muscles and increase stamina -- and it does triple duty by also helping quell energy-zapping inflammation, chronic stress and depression. There are other energy-zappers you want to avoid. Nicotine is a stimulant that can promote insomnia, leaving you tired day after day. And even moderate alcohol intake can s-l-o-w you way down. Lousy nutrition is also an energy thief. Empty calories in ultra-processed foods and sugary beverages do not give you the nutrients you need to get going and keep going. You want to concentrate on eating high-fiber 100% whole grains and vegetables, nuts like walnuts and almonds, and healthy oils such as olive oil. You also want to work on building emotional strength that can give you the energy to live fully. That comes from cultivating a posse and a purpose. A posse helps you manage stress and buddies can inspire you to be more active. Join a walking group or get a cycling or pickleball partner. A purpose energizes your spirit and that also relieves stress. To prevent emotional turmoil from wearing you down, it can also be helpful to get talk therapy, join a support group, practice meditation or yoga, and/or talk with friends or relatives about your feelings. And to increase your energy even further, check out iHerb.com's blog, "4 Natural Ways to Enhance Energy Levels." * * *Q: I frequently eat too much -- but at the time it doesn't feel that way. As a result, I am putting on weight. What's going on? -- Jossie R., Hanover, New HampshireA: That's a good -- but complicated -- question. Overeating happens because of an unchecked impulse to eat and a lack of being able to feel satiated. One reason may be that you aren't getting the necessary regulation you should from a hormone designed to help control hunger: Leptin is made by and released from white fat in your body. It alters food intake, controls energy expenditure and helps you recognize when you're full. But it takes time for the message to get to your brain, so eating slowly helps. Also, you can develop leptin resistance if you have obesity. It causes your body to stop responding to its signals so that you overeat. Depression and nonalcoholic fatty liver disease (it affects almost a quarter of U.S. adults) can also lead to leptin resistance. Certain medicines can also cause overeating. For example, if you have Type 2 diabetes, insulin (and associated insulin resistance) and sulfonylureas like glipizide can boost appetite. But many times, overeating has a psychological component. The Mayo Clinic says stress, anger, fear, boredom, sadness and loneliness can lead to eating when you are not physically hungry. Depression can also trigger overeating and bingeing. And a new study in the Journal of Personality and Social Psychology offers another intriguing psychological reason for overeating: distraction. Because of constant interaction with our phones and social media platforms, few folks focus on the bite they're taking. They're more interested in what's biting online. As a result, folks enjoy their meal less, want more to eat and snack more later in the day.Whatever the cause, you can help keep your overeating in check by keeping a food diary -- it actually helps curb your appetite; addressing stress using exercise, meditation/yoga, and talk therapy; and clearing bad-for-you, hard-to-resist foods out of the house. Also, check out "From Resetting Appetite to Blood Sugar Control" at iHerb.com.* * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.

DEAR DR ROACH: I'm a 68-year-old female with osteopenia. My doctor wants me to take a bone medication such as Boniva or Fosamax. I've read that folks with esophageal issues may be harmed by taking these. Can you explain why? -- C.M.C.ANSWER: First off, we don't usually treat isolated low bone mass (osteopenia) with powerful medicines like the ones you mention, which are both bisphosphonates. These medicines have the potential for harm and should only be used when the benefits clearly outweigh the risks.A person with low bone mass and a history of a fragility fracture has osteoporosis, regardless of their bone density. Some people with low bone density may be at such a high risk for fracture (based on their FRAX score) that treatment is indicated. Many authorities recommend a 10-year risk of a fracture to be 20% or higher (or a risk of a hip fracture to be 3% or higher) before treating someone with medication. You should find out your FRAX score.The issue with the esophagus is that if pills get stuck in the esophagus, they can cause severe damage to it. So, people with esophageal disorders -- such as achalasia, esophageal stricture or varices, or Barrett's esophagus -- should not take these types of medicines by mouth. People with reflux without these complications can take oral bisphosphonates as long as they can comply with staying upright for 30 minutes after taking them.DEAR DR. ROACH: My boyfriend got cancer from HPV. He was successfully treated. Is he capable of transmitting it to me? -- S.ANSWER: HPV causes different types of problems. Warts are all caused by HPV, but only a few strains of HPV can predispose people to cancer.The most common HPV-related cancer in men is head and neck cancer. HPV is now the leading cause of head and neck cancer. Most of these cases in men occur from sexually-acquired HPV infection. Men are at a higher risk for HPV-related head and neck cancer than women, even though women are at a much higher risk for the overall HPV-related cancers, since cervical cancer unfortunately remains common.Once a person has had HPV, they can potentially spread the virus, even without any visible signs of infection. Condoms reduce but do not eliminate the risk of transmission. Close skin-to-skin contact is necessary for transmission, and although sexual contact is a common way of transmitting HPV, it is not necessary. Most people cure themselves of the virus within a few years.By far, the best way to prevent HPV transmission (apart from never having close contact with anyone) is vaccination. The HPV vaccine is highly effective at preventing infection if it is given before the onset of sexual activity, but it may still be fully or partially effective after the onset of sexual infection.The HPV vaccine prevents infection but it is not recommended for treatment. The recommendation from the Advisory Comittee on Immunization Practices (ACIP) is to vaccinate at the age of 11 or 12, up to the age of 26. But it is approved up to the age of 45. I have rarely given individual patients the HPV vaccine even after that age, based on their particular circumstances, but insurance typically will not pay for it in the United States.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Dear Eric: My husband and I just celebrated our first anniversary, and we cutely decided to give each other a gift in keeping with the antiquated anniversary gift themes. The first year is paper or clocks. Smartly and thoughtfully, my husband gifted me a clock made of paper he had seen me looking at in a museum gift shop. But this thing is huge, and it makes noise! We live in a tiny apartment!

Dear Readers: Before I leave this space at the end of June, I’m taking advantage of my senioritis and re-running some of my favorite columns.