Midlife Health Clinics allow for whole health approach to women’s care

052915_insider_healthYounger women typically rely on their gynecologist as their only physician, says Dr. Katharine Taber, director of the Women’s Wellness Center at Northwest Hospital, “but at midlife that really changes.”

A single doctor can’t realistically provide all of the specialized services needed for midlife health, she explains, but women’s clinics have a network of expertise to draw upon, “and we try to work together and communicate well, so that the whole patient is really addressed and taken care of.”

According to the American Congress of Obstetricians and Gynecologists (ACOG), by 2020 approximately 46 million women in the U.S. will be older than 55, and an estimated 6,000 women will reach menopause every day, the average age of which is 51.

It’s no surprise then that Taber cites some of the top concern of patients, ages 45 to 65, visiting the Women’s Wellness Center, are about perimenopause and menopause transition.

Dr. Neil Rosenshein, medical director of the Weinberg Center for Women’s Health and Medicine at Mercy Hospital agrees.

“This is a dramatic change for the individual and for the family, and I think that’s an important life landmark for these women,” says Rosenshein. “This is one of the more common issues our group deals with, and there are a variety of issues [that arise with menopause]. But the most important thing we try to relay is that this [life transition] is normal, this is natural.”

Since about half of all women who reach age 50 are expected to live to age 80 or even older according to ACOG, women may spend 40 percent of their lifetime in a post-menopausal stage.

“So when you have someone in their 60s and they have potentially 20 good years” and good quality health is their desire, says Rosenshein, “our job is, to the best of our ability, to make sure they achieve that.”

Which is another reason why Taber likes to take a holistic approach to health.

Though women may initially visit a women’s clinic to voice concerns about menopausal symptoms, she says, doctors also look at the patient’s weight, blood pressure and whether they’ve kept up with health screenings such as mammography, colonoscopy, Pap smears and  routine blood work.

“We look at those because most women will die from heart attack or stroke, so these are the risk factors,” that we want to see maintained at normal levels, says Taber.

A significant decrease in estrogen hormone — a common signal of menopause — can cause myriad changes in a woman’s health ranging from libido fluctuations to hot flashes to depression. During menopause, women may also become more susceptible to some cancers, which, after heart disease, is the second most common cause of death for women.

“Part of the overall process as women get into this [life stage] is also cancer awareness, says Rosenshein, who is also director of the Institute for Gynecologic Care and the Lya Segall Ovarian Cancer Institute at Mercy. He stresses the importance of cancer screenings and “paying much more attention to family history.” In some cases, he says, a patient may be advised to get genetic testing or evaluation, which he asserts, will become more important in cancer prevention and early detection.

Taber cannot stress enough that for women at midlife or any age, “it’s about maintaining a good weight, exercising, eating healthy and getting enough sleep,” which she outlines, along with other health tips that range from daily flossing and laughing to bladder control advice, in a comprehensive pamphlet she designed for patients. “Those are really the fundamentals.”

But, she admits, “health education is complicated,” and though she lauds the knowledge some patients acquire, she warned that the Internet can provide unreliable information.

“I think that women who come in [to the clinic] in this age group are much more informed and savvy about their health issues,” says Rosenshein.

“But there are many messages out there that are conflicting,” says Taber, “so it’s important to have a good physician you can trust to get accurate and up-to-date information.”

mgerr@midatlanticmedia.com

Sweetness of Freedom Memorial Day weekend welcomes Shavuot

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(Photo ©Stock photo/Catherine Lane)

Memorial Day brings the holiday weekend that ushers in the beginning of everything summer. And Shavuot occurs at the same time, reminding us of the Exodus from slavery in Egypt. The Torah was given to the Jews, as their journey was one from misery to a country flowing with milk and honey. So, eating dairy on Shavuot commemorates the sweetness of freedom and the new life of the Jewish people.

And food is no exception for both celebrations. Fresh berries are making their early appearance, making me think about using them in dishes from light to hearty entree salads. What about making some good sandwiches for picnics at outdoor games? Don’t forget to try adding sun-dried tomatoes and a pesto spread for your regular turkey or even tuna sandwiches. Bring along some soft pita pockets, peasant bread slices, fresh sprouts, the filling and set up a mini-sandwich bar at your picnic!

Strolling through the produce, I see early strawberries and blueberries, but it’s those blackberries that really catch my eye. They are such a simple fruit — dark and juicy, and there is no question about their ripeness. Easy pickings. Eat them, bake them, and cook them, or simply garnish a fruit tray with them. It’s one of the “short harvest” things such as Honey Bell oranges in winter, fiddleheads and fresh peas. So grab them when you see them.

Here is a “buffet” of sorts to choose from that could enhance or create the holiday weekend menu.

Tips
• Enhance roasted cauliflower with a little sprayed olive oil and curry powder. Serve with fresh peas garnish.
• Warm two serving plates for hot foods by placing on top of your toaster oven while heating something.

YE OLDE BLINTZE SOUFFLE

FRESH BLACKBERRY COBBLER

GRILLED SALMON PESTO WITH ANGEL HAIR PASTA

TUNA, WHITE BEAN AND ESCAROLE SALAD

Post-Passover Palate

ROLLED STUFFED EGGPLANT

ROLLED STUFFED EGGPLANT

Ah, Pesach! At first the matzah delights us with its spiritual symbolism and its culinary versatility: farfel, cake meal, matzah brei and more. But by the end of Pesach, we call out “Dayenu!” Enough with the matzoh. Time to return to our leavened life and cleanse our palate so that next spring our bellies pine for matzah.

But Pesach awakens another appetite for me: the hunger for tradition. Last week, a real “oldie but goodie” caught my eye at Seven Mile Market: gribenes — crispy chicken “crackles.” To make gribenes, simply slice excess raw chicken skin into small pieces, fry them until brown and crispy; then fry diced onions, and toss it all with salt and pepper.

Popular with Ashkenazi Jews, gribenes is often mentioned in old stories. It probably fell out of favor due to our emphasis on low-fat foods, but as in all things, try moderation. You can find gribenes recipes and videos online. Eat it as a snack, or serve it as a side dish with rye bread or challah. In the South, Jews add gribenes to jambalaya in place of shrimp. A new twist is serving sides of gribenes with frozen vodka — gribenes shooters. Here are some of my favorite post-Passover, nontraditional recipes. Enjoy, but don’t forget to add a little gribenes to your life. A little tradition — or a bissel schmaltz — couldn’t hurt.

Vegetable Paella

Rolled Stuffed Eggplant

Chocolate Pepsi Cake

 

Tips & Tricks
• Go easy on flour when rolling pastry. Just use enough to keep dough sticking. Too much will make dough tough and dry.

• Score an entire eggplant from top to bottom with a fork. This makes the skin tender.

• The edge of a serrated grapefruit spoon easily grabs elusive bits of eggshell.

 

Ilene Spector is a local freelance writer.

Pesach Egg-citement

032715_food_ilene_amaretto-cookiesMy family used to joke that whether you identify yourself as Reform, Conservative, Orthodox or any other variety of Judaism, on Passover we all become gastronomical Jews!

Food is definitely the main event at Passover, and whether you are preparing an entire Seder or only one dish to contribute to a larger meal, eggs can be your best friend. The roasted egg on the Seder plate symbolizes the sacrifice that was offered in the days of the Second Temple. And eggs in general remind us of the “circle of life” and new beginnings. No matter how you connect the egg spiritually to the Seder, they are the rock stars of Pesach to me.

You’ll notice more chefs topping poached eggs on sandwiches, salads and entrees. If you can get farm fresh eggs, do it. They are well worth the difference in cost, especially for your matzo brei recipes. Farm fresh eggs are available at farmers’ markets.

Some cooks go the traditional route and serve whole hard-boiled eggs, but there are many options. A friend of mine scoops out the yolks and then stuffs each half with egg salad. Others serve different types of deviled eggs with mini matzah crackers.

My newest addition for gefilte fish is “marbling” three kinds of defrosted frozen fish (one salmon and two plain that I season with different herbs) in a loaf pan. The results are beautiful slices for each serving. Just place globs of each fish in the loaf pan before baking. Yum.

My favorite new Passover cookbook is “The New Passover Menu” by Paula Shoyer. I have been trying many of the recipes and really loved the Peruvian Roasted Chicken with Salsa Verde. I am not a cilantro fan, but I used parsley instead. It was fantastic. She has already revolutionized Kosher baking with her previous book, “The Kosher Baker.” Shoyer lives in Maryland with her husband and four kids. In this unique book, Shoyer organizes the recipes into eight menus — one for each night of Passover. She also gives daily lunch recipes. The eight different menus include the Updated Ashkenazic Seder Menu, the International Seder Menu, the Italian Vegetarian Menu and four more. Her recipe for Banana Haroset is gluten free and makes enough for 25 portions. This is definitely a Passover cookbook for the 21st century — and that’s no yolk!

PERUVIAN ROASTED CHICKEN WITH SALSA VERDE

AMARETTO COOKIES

FABULOUS PASSOVER “NILE RIVER OF  FUDGE” CAKE

Beating the ‘Matzah Diet’ Your holiday Haggadah to staying healthy during Passover

Passover is the time of the year when Jews celebrate our freedom from slavery in Egypt. But the endless monotony of eggs, potatoes and matzah for eight days may leave you feeling like a slave to your chametz-free diet.

However, the avoidance of bread and certain grains and legumes doesn’t have to limit the wealth of healthy and nutritious options available to you during this festive time. Consider this your primer to managing the stresses of Passover eating — your Haggadah to staying healthy throughout Passover while still enjoying family, friends and holiday festivities. Who knows? You may even find yourself making an exodus from your current pant size!

Before the Seder
Passover marks the return of springtime, and what better way to welcome back the warm weather than to peruse your local farmer’s market for the bountiful spring offerings such as asparagus, sugar snap peas and artichokes to make the centerpiece of your Seder meal.

If you’re a guest at someone else’s Seder, offer to help out by contributing a healthy dish. Your host will appreciate the gesture and you benefit from knowing there is at least one healthy option at the Seder table.

The Seder itself is a marathon, not a sprint, and like any athlete, you need to prepare beforehand. As it may be a while before you actually sit down to the meal, eating a snack with protein and fiber prior to the meal can stave off your hunger and help you make more nutritious choices at the main event. Some smart snack choices include Greek yogurt with blueberries or raw veggies with a small handful of almonds.

During the Seder
Rather than plain matzah, opt for whole wheat or spelt matzah, which are higher in fiber content. Fiber keeps you more satiated and helps relieve those digestive issues that often plague us during Passover.

When it comes to your meal, avoid black and white thinking; it’s perfectly okay to enjoy some of the foods that you wouldn’t have the opportunity to eat any other time of year. Try to fill your plate up with mostly nutritious options such as veggie-based dishes and lean meat or fish, and pick a few small portions of more indulgent dishes that you love. If you avoid feeling deprived of your favorite foods, you will be much less likely to overeat and feel much more satisfied with your meal overall.

Pace yourself with the vino! Four glasses of wine at the Seder is a lot. Not only does wine impair your judgment toward making healthier choices, it also adds up those liquid calories quickly. Instead, switch to half glasses of wine. Maximize the health benefits by opting for red wine, which contains the antioxidant resveratrol. Studies have demonstrated this antioxidant may promote heart health and decrease stroke risk.

After the Seder and beyond
While tradition may dictate that we recline at our Seder table, there’s nothing wrong with starting your own active family tradition. Try taking a walk after the Seder meal or join your kids in the search for the afikomen.

As for the rest of the holiday, your best bet for sticking to a nutritious diet is experimenting with fresh veggies and fruits as the center of your meal. This will also help you to regulate your digestion, which is a common symptom of the “matzah diet.” Try to avoid those prepackaged special Passover foods and instead, get creative with your meals. Below you will find a few recipes to help get you started.

Beef and quinoa meatballs

Cinnamon-Dusted spaghetti squash kugel with dates, apples and walnuts

Feeling Panicked? It Could Be in the Genes

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In designing and testing theories on how the body programs its 19,000 genes, Moshe Szyf, a geneticist and molecular biologist at McGill University in Montreal, has expanded the notion of Jewish guilt.

Sure, we might feel bad about passing along hereditary genes that raise our baby’s future risk of breast cancer, obesity or depression. But now, thanks to Szyf’s research, we must contend with the possibility that our experiences early in life could shift how those genes are expressed for generations to come.

Thus young stockbrokers who escaped from the tumbling towers of 9/11 might be raising preschoolers a decade later who are prone to panic when they smell burnt paper or fireplace ash. Those who crash dieted during teenage years might wind up with grandchildren with slower metabolisms designed to better handle starvation.

Researchers studying the children and grandchildren of Holocaust survivors have found that they have higher rates of post-traumatic stress after enduring car accidents, possibly due to modifications in their stress hormone system inherited from their survivor parents.
Szyf, however, prefers to take an optimistic view of his field, called behavioral epigenetics.

“It introduces an element of freedom and responsibility,” Szyf says. “With a deterministic genome, we can’t decide what kinds of mutations we pass on, but if experience is important in building a healthy genome, it gives us a feeling of some level of control.”

In his current research, Szyf is attempting to determine whether tinkering with environmental conditions, like diet or stress levels, could alter the way in which certain genes function, specifically those involved in cancer.

“I’m interested in identifying early markers of adversity to see if they can be altered with lifestyle interventions or drugs,” Szyf says.
Born in London and raised in a family of observant Jews, Szyf headed to Bar-Ilan University in Israel to study political science and Jewish studies, but parental encouragement to learn more “practical” subjects pushed him to transfer to dental school at Hebrew University. While working on his doctoral thesis with an Israeli epigenetics researcher in the late 1970s, he found his real passion and says he has never regretted his decision to abandon dentistry.

For the past two decades, Szyf and his McGill colleagues have been studying methyl groups that attach at various points to long strands of DNA. Szyf refers to the methyl groups as “punctuation” that mark genes in certain places to determine how they work to help cells manufacture proteins — akin to changing the meaning of a sentence by swapping out an exclamation point for a period.

“These methyl groups make out the language of our DNA, and if they go awry, you’re in trouble,” Szyf says.

Epigenetics researchers initially believed such changes in genetic programming occurred only during fetal development, putting even more pressure on expectant mothers to eat nutritiously, manage stress and avoid environmental exposures with potential risks to their developing babies.

But recent landmark studies conducted by Szyf and others suggest that methyl groups could be added to DNA in adulthood — at least in rodents — due to changes in diet or environmental toxins. Those epigenetic additions could be passed on to future generations, causing permanent changes in gene function.

In a study published last year in the journal Nature, researchers from the Emory University School of Medicine found that mice exposed to a particular odor along with small electroshocks developed a fear of that smell and later gave birth to offspring that also had a high stress response whenever they were exposed to the odor. The researchers also found methylation changes in a smell receptor gene in both the mothers and offspring.

In other experiments, Szyf and his research group examined the DNA of rat pups raised by mothers who neglected them. They found that genes controlling the production of stress hormone receptors had high levels of methyl groups attached to them compared to genes from pups raised by attentive, nurturing mothers. Pups raised by inattentive mothers also acted more hyper and skittish in response to stress.

The researchers then studied another litter of rat pups from the same mothers, but this time they had the nurturing mothers raise pups from inattentive mothers and vice versa. They found that the extra methyl groups were again added to the pups raised by the neglectful mothers and that these pups had an overactive stress response.

Both sets of pups with the extra methyl groups passed them on to their offspring.

“While the genome can take centuries to change, with epigenetics the physiological response can be immediate but also with lasting effects,” Szyf says.

That’s unless an intervention is found to shift things back. Szyf and his colleagues found such an intervention in the form of a drug designed to remove methyl groups. Szyf was able to reverse the extra methylation in rats born with it and also change their behaviors back to placid tendencies.

Just how much such epigenetic changes impact human behavior remains largely unknown, researchers acknowledge.

“We certainly know that human experiences affect how our genes are expressed,” says Rachel Yehuda, a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai Hospital in New York, who has performed epigenetic studies on Holocaust survivors. “But we don’t know for sure how this process works and how strong a contributor epigenetics really is compared to other things like genes.”

Life experience capable of shaping perceptions and reactions even without touching DNA. In studies published over the past decade, Yehuda has found that children of Holocaust survivors have altered stress response systems and differences in methylation on the gene that regulates the number of stress hormone receptors. She also found that these alterations were complex and dependent on a mother’s age when she went through the Holocaust and whether a father experienced it, too.

“Do uniquely Jewish experiences from the past — like the pogroms our great-grandparents escaped — affect the way we behave today? I think that’s a valid question,” Szyf says.

“Jews that left Europe were highly self-selected for their survival skills and perseverance,” he adds, which might have been due to their genetic tendencies rather than epigenetic changes.

In the end, though, it may not matter whether inherited genes or inherited methylation of those genes or plain-old nurture plays the dominant role.

“Jews have always tended to lead lives that emphasized education, family structure and religious values,” Szyf says. So it should come as no surprise that these values have been passed on.

Deborah Kotz writes about health and science for the Washington Jewish Week.

Purim Change of Pace Choose chocolate as a flavored dough

Triple chocolate hamantaschen would make a wonderful treat in coffee-themed Purim baskets.

Triple chocolate hamantaschen would make a wonderful treat in coffee-themed Purim baskets.

Hamantaschen talk is always about the filling: prune, poppy, apricot and strawberry, just to name a few favorites. I love being creative with the fillings, but this year I wanted to change up things with a flavored dough rather than just a fun filling. And what better ingredient to include than chocolate.

Once you have made your chocolate dough, you can still be creative with the fillings, although I recommend two combinations: triple chocolate, which is filled with nutella and drizzled with white chocolate, and chocolate mocha. You could also try filling the chocolate dough with raspberry jam, peanut butter or even halvah.

The key to making and working with this dough successfully is making it several hours in advance — even a day or two — so that it is properly chilled. It will feel sticky, so add flour as you roll it out to make sure it holds its shape.

Most hamantaschen bakers know that one of the keys to making a cookie that doesn’t fall apart during the baking is to pinch the three points very carefully. Another tip is to lay out all the folded and filled cookies on a baking sheet and then pop them into the freezer for five to 10 minutes before baking. Chilled cookie dough simply bakes better.

If you enjoy the custom of handing out mishloach manot, or Purim baskets, in your community, these chocolate hamantaschen would go great with a coffee-themed package: include a small bag of high-quality coffee, a little bag of chocolate-covered espresso beans and the hamantaschen inside a big mug.

Triple chocolate hamantaschen

 

Hearty Delights Five interesting foods to explore on date night

020615_valentinesWhether you live for culinary adventure or unfamiliar items on your plate make you nervous, trying new foods is a worthwhile endeavor. But even avid foodies don’t have the time to try everything.

So how can you prioritize your food bucket list?

Enter “1,000 Foods to Eat Before You Die,” a new book that presents the globe’s must-have foods into one master list of the best dishes, ingredients, restaurants, markets, books and movies that everyone should experience.

To whet your appetite, author Mimi Sheraton, former New York Times restaurant critic and award-winning cookbook author, shares five food must-haves originating from five regions of the world. Try any of these the next time you go out:

Tagine

White Asparagus

Egg Cream

Congee

Vegemite

 

Holiday Lessons Keeping the old while bringing in the new

012315_holiday_lessons_blueberry_cakeSome things never change, and I’m so glad. From the mouth-watering brisket at Edmart Deli to Rosendorf’s challahs, most Baltimore Jews go back to their traditional buying habits, even if they had indulged in “new” cuisine over the New Year. I spend my food shopping days purposely seeking out new things. But I forgot the old saying that “everything old is new again.” I hadn’t been to the Knish Shop in decades, but someone mentioned they have great sushi and cookies. And their chocolate chip cookies are as good, if not better, than my own homemade.

It’s hard to find fault with any kosher dishes at David Chu’s, especially its eggplant and sushi selections. And the service is A-plus. I’ve never been to Serengeti’s, although I hear it is wonderful. I’m just glad that finally Baltimore has decent kosher choices when dining out or in. I’m awaiting a kosher Mexican restaurant with some real authentic dishes.

So what are we expecting as far as 2015 food trends? Roasted beets, pears and duck recipes will become much more popular as will pulled brisket sandwiches. California, as usual, is ahead of us. When visiting my sister in December, we went to a favorite restaurant and found a new item on the menu, brisket sliders — pulled brisket served with a choice of chipotle-cherry or habanero-peach barbeque sauce on the side. When making your own, try some spice rubs, which can flavor and tenderize many cuts of meat.

Most importantly, presentation, even in an ordinary recipe, can enhance any Shabbat table. Here are a few new twists I discovered during the holidays.

Orange Marinated Olives

Sephardic Chopped Salad Drizzle

Fresh Blueberry Cake With Crumb Topping

 

Making Thanksgiving Jewish

112114_foodHow do we make Thanksgiving Jewish? Many scholars believe that the secular American holiday, first celebrated in 1621 by the pilgrims, was deliberately modeled on Sukkot. There are myriad ways to make the meal kosher and also stretch the food to enjoy through Shabbos. In addition to roasting one whole turkey, make one large turkey breast, too. This provides plenty for Shabbat meals. Who doesn’t want to keep Thanksgiving going? On Shabbat, sprinkle some fresh cranberries around the turkey breast or in your regular Shabbat stuffing. Ever hear of a Tzimmes cake? I tweaked the recipe below to add another touch of delicious Yiddishkeit to the Thanksgiving table. Simply search online for the phrase “Kosher Thanksgiving recipes,” and you will find numerous links to sites (such as The Kosher Channel) that give a veritable cornucopia of kosher Thanksgiving ideas.

As for annual pumpkin pie, if your filling shrinks upon cooling, disguise it: Sprinkle edges with chopped pecans, crushed gingersnaps or piped whipped cream around the edge. I think the pilgrims would have loved pareve pumpkin pie!

Tips & Tricks

  • When stuffing a turkey, try sealing the opening with a small raw potato.
  • Unsalted butter can be stored in the freezer indefinitely if it is wrapped and sealed airtight.
  • Just before carving a turkey, carefully remove the skin in  pieces as large as possible. Cover the carved turkey with pan juices and the roasted skin to help it stay moist and warm.

  • Click below to view the recipes:
    DIJON TURKEY BREAST
    FROZEN PUMPKIN PIE
    TZIMMES CAKE