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I love caregivers

I love my caregiver and waiting for her each day.

Though I live with my busy family of grandkids, I have one companion I can lean on.

She massage my aching body, especially my legs as my Parkinson and Dementia are progressive diseases giving me more cramps.

She blends massage oil with ginger, turmeric, eucalyptus oil, olive oil, rosemary leaves and anything she can find in the garden and kitchen.

She prepares a good breakfast for me especially an avocado smoothie with almond butter and soft boiled eggs.

She always remind me of my dietary supplements, if I poop, my liquid Floradix iron with warm prune juice.

She takes me to walks, senior center, dancing shows and library.

She reads the Reader’s Digest and most health blogs that we google each day about health.

She ensures that I am not over-medicated and believes in natural healing.

———–

Motherhealth caregivers in the bayarea 408-854-1883 motherhealth@gmail.com

Inflammatory bowel disease in pets

Inflammatory bowel disease in pets can give us  health cues as humans have similar body functions. Pets do not eat sugar, dairies, trans fat, smoke or stress out like we do.
We can start with cleansing and then nourishment. Do drink raw carrots juice with garlic and ginger. Limit refined foods, sugar, alcohol, smoking and unhealthy fats/trans fat. Email motherhealth@gmail.com for personal health coaching.
Connie
———-
Listen as Dr. Karen Becker discusses the very common problem of IBD in companion animals – how it starts, what to look for, treatment options and how to prevent this miserable disorder in your furry family member.

Dr. Becker’s Comments:

Inflammatory bowel disease (IBD) is a condition of inflammation of the intestines.

There are four common types of IBD, classified by what kind of white blood cells infiltrate the intestine: lymphocytes, plasmacytes, eosinophils and neutrophils. Without a doubt, the most common cause of IBD in pets is lymphocytic-plasmacytic enteritis, gastritis and colitis.

If your pet’s intestines are inflamed long enough, the situation can create a host of other debilitating health conditions.

IBD and Leaky Gut

Both cats and dogs get IBD. Both are susceptible to dysbiosis or ‘leaky gut,’ which means the balance of bad to good intestinal bacteria gets out of whack.

Leaky or permeable gut is a condition in which inflammation weakens the tight junctions of the cells of the GI tract, allowing partially digested proteins and potential allergens to escape into your pet’s bloodstream.

Allergens in the bloodstream trigger a systemic immune reaction – your pet’s body senses foreign invading substances and mounts a powerful defense. The result is allergies or worse – autoimmune or immune-mediated disease. A simple explanation for this condition is that your pet’s body is attacking itself.

IBD Leads to Secondary Infections, Organ Degeneration, Nutritional Deficiencies and Even Cancer

Secondary infections are very common in dogs and cats with inflammatory bowel disease. This is the result of not having a balanced, healthy digestive system.

Over half your pet’s immune function is located in his GI tract, so if the intestines are inflamed and compromised, the immune system is compromised right along with it.

Secondary organ degeneration is common with IBD, especially in the kidneys and liver.

Nutritional deficiencies are also typical in IBD pets because inflammation disrupts the normal absorption and processing of nutrients from food.

With kitties, there’s a correlation between GI cancer (lymphoma of the GI tract) and chronic IBD.

A Common Cause of IBD – GI Parasites

There are a few common causes of inflammatory bowel disease in dogs and cats.

One that is often overlooked is the presence of parasites.

My estimate is the vast majority of puppy mill pets and abandoned/rescued animals left at shelters are positive for parasites – roundworms, hookworms, tapeworms, coccidia, and Giardia. Parasites cause GI inflammation.

Another source for parasite infestation is in litters whose mothers were not tested or treated prior to being bred. Responsible breeders arrange for testing and deworming of females before they are bred, which insures litters will be parasite free.

Less responsible or unknowledgeable breeders don’t take the same precautions and end up selling litter after litter of puppies and kittens that have GI parasites.

The next problem arises at the veterinary clinic, where broad spectrum dewormers are given to infected animals at regular intervals until 16 weeks. At the end of the 16 weeks, the pets are re-checked to see if the parasites are gone.

But here’s the issue: if the specific parasite isn’t identified, it may not be killed by a broad spectrum dewormer. So pets wind up with several weeks of unnecessary medication that doesn’t even solve the problem.

Many dogs I see at my Natural Pet hospital have been dewormed three or four times but are still having problems. When I check fecal samples for these pups, I often find they are coccidia or Giardia-positive. Broad spectrum dewormers don’t take care of these particular parasites. Giardia, for example, causes intermittent diarrhea and chronic low-grade inflammation of the GI tract. It is not responsive to the dewormers most vets prescribe.

A saner, safer approach is for your vet to do at least three fecal analyses one month apart to determine the type of parasite and to confirm your pet is rid of them. Selecting the appropriate dewormer for the type of parasite, and treating the pet until the parasites are completely resolved is a crucial part of decreasing GI inflammation and preventing full-blown IBD.

By the time these unfortunate pups are seen at my practice, they are over 16 weeks old, with intermittent soft stools indicating GI inflammation, and they typically still have a parasite problem which requires treatment before any other symptoms can be resolved.

Another Root Cause – Antibiotics and Steroids

Another of my frustrations is that animals with low-grade GI inflammation are treated with antibiotics by the traditional veterinary community.

Antibiotics are a second common trigger for inflammatory bowel disease.

GI antibiotics kill the healthy bacteria right along with the bad guys. When all bacteria is obliterated from your pet’s gut, the regrowth often results in an imbalance featuring too many gram-negative, unhealthy bacteria or opportunistic yeast and not enough of the friendly variety. This is the definition of dysbiosis.

Now we have a 16+ week old puppy or kitten that has had several weeks of GI inflammation, ineffective deworming treatments, one or two rounds of antibiotics which have obliterated all the bacteria in his GI tract, and no re-seeding of bacteria with an appropriate probiotic to insure a healthy balance.

This little guy is well on his way to low-grade GI inflammation and IBD.

I’ve also seen dogs and cats that at six months of age are already on Prednisone therapy for GI inflammation. Prednisone is an immunosuppressive steroid, which turns the immune system down or completely off, wiping out troublesome symptoms and giving the appearance of a ‘cure.’ Unfortunately, this treatment doesn’t do a thing to uncover the root cause of the GI inflammation and ultimately postpones true healing.

A Third Culprit: Food Intolerance

In my practice I see many pets brought in for intermittent soft-to-watery stools, a situation many pet parents dub ‘sensitive stomach.’

Typically, this ‘sensitive stomach’ means the dog or cat cannot undergo any sort of dietary change without major GI consequences. This isn’t what nature had in mind when it built your favorite furry friend.

Just as you are designed to eat different foods at every meal without GI disturbance, pets with healthy, resilient GI tracts should be able to tolerate changes in the food they eat without negative consequences.

Probably more than half the pet owners I talk to assume it’s normal for their dog or cat to have GI sensitivity to changes in diet. But what’s really going on is the animal’s gut is in some way compromised and therefore cannot withstand dietary variety. It could be a low-grade inflammation that has been present for weeks, months or even years by that time.

Food intolerance or sensitivity can begin with a poor quality, non-species appropriate diet – one that is high in unnecessary carbohydrates. Processed pet food containing a lot of corn, wheat or rice can create inflammation in the gut of your carnivorous dog or cat, designed to digest meat – not grains.

I also have clients that feed a raw, species-appropriate diet without carbohydrates, which is wonderful, except they feed the same protein source for weeks, months or years.

Many animals (including humans) develop hypersensitivity to a food they eat over and over again. Inflammation is the result and can lead to IBD.

So overfeeding too much of even the right foods can lead to problems in the digestive tract.

Testing for IBD

There are two different diagnostic tests that are commonly done to detect IBD.

One test is what is known as a ‘confirming’ test, in which a biopsy is taken to assess morphologic characteristics common in the GI tracts of animals with inflammatory bowel disease. This is not my first choice because it’s expensive, invasive and involves anesthesia and the inherent risks that come with it.

The other test, which I use often in my practice, is a functional gastrointestinal test using a blood sample.

What we’re looking for with this test is two types of B vitamin absorption, the first of which is folate. Folate is a water-soluble B vitamin that is not easily absorbed in the small intestine unless it is deconjugated there.

If your pet’s small intestine can’t deconjugate folate, meaning it can’t break it down into an absorbable form, she can end up folate-deficient, in which case her blood test will show low or suboptimal levels of folate.

A low folate level means either your pet’s assimilation and absorption of nutrients is poor, or her body is challenged by the deconjugation process, indicating a disease or disorder of the small intestine.

If your pet’s folate is high rather than low, it indicates another type of problem. Your pet’s small intestine contains a small amount of bacteria critical for the production and assimilation of certain B vitamins. If this bacteria blooms into an overgrowth, your pet can wind up with high folate levels and a condition known as SIBO – Small Intestinal Bacterial Overgrowth.

The second blood test I use to assess GI function involves another B vitamin called cobalamin, which is bound to protein.

Cobalamin is released from protein through a complex series of events that starts in the stomach and finishes in the small intestine.

If cobalamin levels are low, we can assume this complex process is not occurring optimally. Cobalamin levels are a measure of digestion. This condition of maldigestion can sometimes also involve the pancreas. The disorder is called EPI – Exocrine Pancreatic Insufficiency and can be diagnosed via another GI blood test called a TLI (Trypsin-like Immunoreactivity).

If you suspect your pet has IBD but you’re not interested in doing a biopsy at this point, ask your vet to perform functional GI testing to determine a diagnosis.

In my practice, I also do two additional functional tests, TLI and PLI, which assess pancreatic function. Secondary pancreatitis is a very common condition in IBD patients, so assessing your dog’s or cat’s pancreatic function is also important.

These functional GI tests are available through the gastrointestinal lab at Texas A&M University.

Dietary Recommendations for IBD

Upon diagnosis, your veterinarian will probably tell you to feed a bland diet if your pet is symptomatic with vomiting, diarrhea or soft stool with mucus and/or blood.

My idea of a bland diet is different from a traditional veterinarian’s. I recommend ground cooked turkey and canned pumpkin or cooked sweet potato. I don’t recommend the traditional beef and rice. Beef is high in fat, which can exacerbate GI inflammation and pancreatitis.

Rice is a complex carb which can be fermented in the GI tract, causing gas, which can lead to additional digestive upset.

I recommend a grain-free, bland diet because in my experience it’s more suitable to pets with active symptoms of IBD.

While feeding your dog or cat a bland diet, you should be thinking about what’s next for her in terms of nutritional requirements. Bland is fine for a short time, but balance in the diet is crucial

I recommend you work with an integrative veterinarian to select a novel protein source — one your pet has either never consumed or hasn’t for a long while. This will give the GI tract and your pet’s immune system a good rest.

You’ll also want to select a novel vegetable or fiber source as well, to create an anti-inflammatory menu that will facilitate healing within both the large and small intestine.

An integrative vet can help you build a comprehensive protocol for your pet that addresses not only dietary issues, but also vaccinations, the use of drug therapy, and any potential toxins in your pet’s environment or lifestyle that could be contributing to unaddressed inflammation.

Connie’s notes: We start with cleansing and then nourishment. Do drink raw carrots juice with garlic and ginger. Limit refined foods, sugar, alcohol, smoking and unhealthy fats/trans fat. Email motherhealth@gmail.com for personal health coaching.

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NANO CARROT

Mental Preparation of High-Level Athletes by Kayt Sukel

brain conditioning

Baseball Hall of Famer Yogi Berra is credited with saying that “90 percent of the game is half mental.” Over the years, the line has been appropriated beyond the world of baseball to explain the importance of factors like focus and motivation to all high-level athletic performance. Shannon Miller, an Olympic Gold Medalist in gymnastics, agrees that mental preparation is key to success—and she says she couldn’t have gotten to the Olympics on physical ability alone. “The physical aspect of the sport can only take you so far. The mental aspect has to kick in, especially when you’re talking about the best of the best,” she says. “In the Olympic games, everyone is talented. Everyone trains hard. Everyone does the work. What separates the gold medalists from the silver medalists is simply the mental game.”

For the past few decades, sports psychologists have studied the psychological factors that affect athletes—from beginners taking part in their first team sports to elite athletes at the top of their field. Today, neuroscientists are getting into the mix and attempting to understand the brain’s role in that mental game.

“When you are an elite athlete, one of the best in the world, the physical differences between you and your peers are very, very small.” says Scott Grafton, a researcher at the University of California, Santa Barbara and a Dana Foundation grantee, who studies action representation, or how the brain organizes movement into a goal-oriented action. “So what really determines success? The way athletes are approaching their sport at the cognitive level.”

Let the Body Do the Work

Leading up to the 1996 Olympic Games, Miller and “Magnificent Seven” teammate Dominique Moceanu practiced six to eight hours a day, six days a week. Even on days of competition, Miller says she would practice her routines up to ten times before performing for the judges. “We did a lot of repetitions. It was important to help perfect your routines, of course. But it also helped with the mental game,” she says. “With that much practice, you knew when you got into a competition situation, and you were a little bit nervous, you wouldn’t blank. You could count on your muscle memory taking over simply because you had done the routine so many times.”

That practice is key. Grafton’s lab has found that action representations rely on a dedicated brain network, called the action/observation network, which includes the temporal cortex, frontoparietal cortex, and motor cortex. This network allows an athlete to mentally rehearse movement, to learn from observation and to sense subtle actions in other athletes. It also aids in breaking down movements into simpler “chunks” to facilitate learning. Over time and extended practice, other areas including the basal ganglia combine movements into longer chunks. This is critical for allowing athletic performance to become automatic.[i] 

“We talk about muscle memories but, of course, muscles don’t have memories,” he says. “But this brain network helps us to not just remember the movement, but also to help us accomplish new goals and recognize actions in others. It also allows athletes to take more of an external focus and not overthink things.”

And, according to Moceanu, not overthinking things is important. “Right before I would go up on any apparatus, I would just say a little prayer and then let it all go,” she says. “I let it go to autopilot and let my training take over. Because if you try to think too much, you overwhelm yourself and end up making uncharacteristic mistakes.”

Grafton says this is very common—and it’s because the brain’s motor systems process information much, much faster than our verbal ones. “The speed at which we talk, at which we think verbally is no better than an old 56K modem dial-up,” he says. “If you think about how fast things are going when you make a golf swing, or hit a baseball, or do some gymnastics, you just can’t think and expect to not interfere with your body. As soon as you think about it, and try to make adjustments on the fly, you’ll see your performance degenerate.”

Going with the “Flow”

Some refer to this place of athletic automaticity as a “flow” state. Dana Foundation grantee Charles Limb, an otolaryngologist and musician at Johns Hopkins University, studies the “flow” state in creative individuals. And while he says that “flow” may differ between artists and athletes, they do share some basic tenets.

“This is a state of mind in which you can perform with a certain ease and automaticity, and some other researchers would add that there is a significant level of joy implicit in it, too,” he says. His research suggests that achieving “flow” results in a deactivation of the prefrontal cortex, the part of the brain responsible for executive control, and a heightened activation in the sensorimotor cortex, a region implicated in the planning and control of voluntary movements. [ii] [iii]

“The brain is, in a sense, inhibiting some of its self-monitoring to mitigate the detrimental effects of overthinking and excessive caution. The brain may be allocating more resources towards data processing and output,” says Limb. He argues that when athletes refer to “muscle memory,” they are really talking about a certain state of optimal neural coordination. “With practice, you are really training your brain to send out motor impulses with greater efficiency and optimization. While there are physical changes that accompany practice, in the end, it’s the brain that’s getting better and better.”

“Flow” may also help the brain get to a state that helps maximize attention and self-regulation while downgrading stress.

“This is an issue of expertise. If you’re an expert at a particular field, you have a lot of information about that field and you can anticipate what comes next, what your opponent might do and so on,” says Michael Posner, a neuroscientist who studies attention at the University of Oregon and a member of the Dana Alliance for Brain Initiatives. “That means you can deal with things in that field that people without that expertise can’t. It allows you to deploy your attention faster and in a different way.”[iv]

In addition, Posner says some studies have shown that one difference in athletic performance is the ability to maintain an alert state, one aspect of attention. “Elite athletes begin to prepare for the next trial as soon as they made their response to the last trial. Non-athletes relaxed after the last trial and waited for the next waiting signal,” he says. “The athletes are always ready for what comes next.”[v]

Even with that vigilance, high performance athletes remain cool under fire. Miller credits practice for this ability—not just in the gym, but in competition. “You get there by competing every weekend, understanding what it means to be in a competition, to have the audience there and to learn to block out all the things that are going on around you no matter what,” she says. “I was doing competitions every weekend starting when I was very young. By the time I was 15, and certainly by the time I was 19 at the Olympics, I could really focus.”

Bruce McEwen, a neuroscientist at Rockefeller University and Dana Alliance member, says that practice may result in changes to hormones and brain chemistry that help athletes better deal with stress. “Studies suggest that biochemicals like testosterone and hormone neuropeptide Y help Special Forces-type people and NFL Quarterbacks keep cool and perform well in high-stress situations,” he says. “And so they could also be important physiologic factors that influence the brain function of these top-tier athletes under the stress of competition.”[vi]

Motivation and the Teen Brain

While Limb says there’s some debate whether joy is part of the “flow” state, it’s clear that the right amount of motivation is not. “The skills you learn during practice are critical to reaching an elite level. Athletes have a lot of expertise in the particular field in which they perform,” says Posner. “And you have to be really motivated to do the amount of practice to reach that level of expertise.”

Moceanu, the youngest member of the 1996 U.S. Olympic Gymnastics Team at 14, says that she was very motivated—enough to give up a normal teenage social life to pursue her dream of Olympic gold. “It was my dream since I was nine years old and someone called me an ‘Olympic hopeful,’” she says. “That was it. I wanted to be the best. I wanted to be an Olympic champion. And I was going to do whatever I could to get there.”

Dana Alliance member Abigail Baird, a neuroscientist who studies the teenage brain at Vassar College, says the teen years may be the best time to foster that kind of motivation and mental focus.

“What’s better than being on a winning team? In teens, we’ve learned that it’s not so much about delivering the reward as it is about anticipating the reward,” she says. “The nucleus accumbens is really sensitive to the anticipation of that reward. I would assume that a lot of athletes need that to make the kind of commitment that elite sports require,” she says. “There’s also a huge social component of what motivates adolescents to perform their best. There is a huge neural buzz associated with being included and liked by your peers during adolescence. Few things accomplish that as well as being a star athlete on a team with your friends. When you put all of that together, I don’t think there is a better situation to build up the kind of motivation that will elevate great athletes to truly exceptional levels of performance.”

A Strong, Powerful Mind

McEwen cautions that there is still a lot we don’t understand about what Miller calls “mental game” from the neuroscience perspective. But given the number of studies showing that physical activity makes profound, healthy changes to the brain, it’s something worth studying. [vii]

For example, Moceanu says that her mental game has been very beneficial to the rest of her life. “Sport is a model for life and it’s helped me with my entire life, with my focus, discipline, and reaching my goals,” she says. “You learn how to budget your time, to work hard, and to balance things. It’s invaluable.”

The biggest question remains as to whether there is something innate about elite athletes’ brains that allows them to reach that high level of performance or whether anyone can achieve that kind of expertise with the right training. Miller says it may be a combination of the two. “A certain amount of it may just be who you are and how you look at things,” she says. “But I think a great deal can be learned through good training as well.”

Moceanu agrees. “I’ve seen so many gifted athletes not make it because they couldn’t handle the sport mentally. It’s such a huge part of gymnastics—really any sport once you get to a certain level. Only those with a strong mind are going to compete at a high level. Only those with a strong mind are going to win.”

MEDICATIONS TO AVOID that worse PD (Parkinson’s disease)

tramadol meds

Some medications can worsen movement symptoms of PD, including slowness, stiffness, tremor and dyskinesia. These drugs, listed below, are used to treat psychiatric problems such as hallucinations, confusion or gastrointestinal problems, such as nausea. The stress of your illness, hospital stay or new medicines can increase your risk of hallucinations while hospitalized. Common anti-hallucination medicines to be avoided are listed by generic or chemical name followed by the trade name.

ANTI-HALLUCINATION MEDICINES TO AVOID

Note: the anti-hallucination medicines Quetiapine (Seroquel) or Clozapine (Clozaril) can be used. The following should be avoided:

aripiprazole (Abilify), chlorpromazine (Thorazine), flufenazine (Prolixin), haloperidol (Haldol), molindone (Moban), perphenazine (Trilafon), perphenazine and amitriptyline (Triavil), risperidone (Risperdol), thioridazine (Mellaril), thiothixene (Navane)

ANTI-NAUSEA MEDICINES TO AVOID

metoclopramide (Reglan), phenothiazine (Compazine), promethazine (Phenergan)

MEDICINES TO AVOID IF YOU ARE ON RASAGILINE (AZILECT) OR SELEGILINE (ELDEPRYL)

Pain medicines – Meperidine (Demerol), Tramadol (Ultram),Antispasmodic medicine Flexeril , Dextromthorphan and St Johns Wort.

This is not a complete list of medicines to avoid. If you have questions about other medications, ask your pharmacist or doctor.

Any medication that blocks dopamine in the body can cause Parkinson’s symptoms.

By Louis Neipris, M.D., Staff Writer, myOptumHealth

You may have heard of Parkinson’s disease (PD), a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.

The cause of Parkinson’s disease is mostly unknown. Some people develop Parkinson’s-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism (DIP) or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinson’s disease.

Any medication that blocks dopamine in the body can cause Parkinson’s symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.

Other types of medications that may cause drug-induced parkinsonism are:

* Some antidepressants
* Certain anti-nausea drugs
* Some drugs used to treat vertigo
* Certain drugs used to treat epilepsy
* Some anti-arrhythmics (used to treat irregular heart rhythm)

Not all drugs in these classes will cause symptoms of parkinsonism.

What’s the difference?

Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinson’s disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinson’s.

Unlike Parkinson’s, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have “unmasked” underlying Parkinson’s disease.

Who is at risk?

  • Female: Women are twice as much at risk as men.
  • Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinson’s disease.
  • Those with a family history of Parkinson’s disease.
  • People with AIDS.

What to do to prevent drug-induced parkinsonism?

The most common drugs linked to this condition are two used to treat schizophrenia or psychotic symptoms of dementia. They are haloperidol (Haldol) and perphenazine (Trilafon). Ask your doctor about parkinsonism if you or a loved one is concerned about a drug, especially these two drugs.

In general:

* Make sure you or a loved one are on the lowest effective dose.
* If you already have Parkinson’s disease, then tell your doctor if the symptoms appear to be getting worse since starting the drug.
* Never stop taking a drug on your own. Talk to your doctor about any concerns.

SOURCES:

* Parkinson’s Disease Society. Drug-induced parkinsonism.
* Albin RL. Parkinson’s disease: background, diagnosis, and initial management. Clinics in Geriatric Medicine. 2006;22(4):735-751.
* Alvarez MV, Evidente VG. Understanding drug-induced parkinsonism Separating pearls from oysters. Neurology. 2008;70(8):e32-e34.

http://www.wrex.com/….asp?S=10707421

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Connie’s notes: Neuro meds common side effects include dizziness,nausea,headache,vomitting and sleep disorders

Contact Motherhealth Inc for holistic caregiving for homebound bayarea seniors: 408-854-1883 motherhealth@gmail.com

Antipsychotic drugs, called neuroleptics

Drug-induced parkinsonism is due primarily to drugs that block dopamine receptors, particularly the D2 receptors (Shin and Chung 2012). These drugs are most often the antipsychotic drugs, called neuroleptics, such as haloperidol, chlorpromazine, and trifluoperazine, but include metoclopramide, a gastrointestinal motility enhancer, and the antiemetics prochlorperazine and droperidol. In addition, medications that block synthesis of dopamine, such as alpha-methyl para-tyrosine and alpha-methyl dopa or deplete dopamine (such as tetrabenazine and reserpine, which block dopamine’s entry into the vesicles that are released into the synapse) also induce parkinsonism. In these cases the pathophysiology is presumably due to diminished dopamine receptor stimulation, resulting in a pharmacologic state closely resembling Parkinson disease.

However, the atypical antipsychotics also block D2 receptors. Yet there is no apparent correlation between the degree of this blockade and the risk for inducing parkinsonism. The explanation for this is uncertain. One current hypothesis is the “fast off” theory, postulating that the duration of the D2 blockade, rather than the percentage of receptors blocked, determines the likelihood of parkinsonism (Seeman 2002). A competing theory is that the ratio of 5 HT-2a receptor blockade versus the dopamine D2 receptor blockade is critical because of the interplay between the serotonin and dopamine systems in the brain. An older theory relating extrapyramidal side effects to anticholinergic activity is considered untenable because the concomitant use of anticholinergics does not eliminate the problem.

Cholinesterase inhibitors, widely used to treat dementia

Cholinesterase inhibitors, widely used to treat dementia, may cause worsened parkinsonism, primarily increased tremor (Anonymous 2007). Large double-blind trials of rivastigmine, a cholinesterase-inhibiting drug, in both dementia with Lewy bodies and Parkinson disease dementia have demonstrated that rivastigmine is well tolerated without significant worsening of motor function overall, although tremor may increase (Emre et al 2004). The other cholinesterase inhibitors have been less well studied but appear to have similar benefits and side effects.

Serotonin reuptake blocking antidepressants fluoxetine, sertraline, and paroxetine

Several other medications have been reported to cause drug-induced parkinsonism and to worsen parkinsonism in people with Parkinson disease, including the serotonin reuptake blocking antidepressants fluoxetine, sertraline, and paroxetine. Two calcium channel blockers available in Europe and South America (flunarizine and cinnarizine), which are piperazine derivatives, are thought to cause drug-induced parkinsonism by blocking dopamine receptors. Reports of parkinsonism induced by other drugs, such as lithium and amiodarone, are so rare that only after parkinsonism has developed should the possible drug effect be taken into account. Because lithium is not known to block dopamine receptors, another mechanism is likely. Some animal data implicate an effect of lithium on intercellular signalling via G-protein coupled receptors (Beaulieu et al 2008). One antidepressant, amoxapine, has dopamine receptor-blocking properties and, therefore, may induce parkinsonism. Parkinsonism as a transient (lasting days to weeks) side effect of alcohol withdrawal has been reported without later development of Parkinson disease, but it is unknown how common this is (Shandling et al 1992).

Valproic acid

Valproic acid has been reported to induce parkinsonism in the majority of patients whose serum levels are over 40 (Armon et al 1996). Although subsequent reports support the association between valproate and parkinsonism, the frequency appears to be uncommon in some reports (Hauben and Reich 2005; Masmoudi et al 2006) but affecting about 5% in others (Jamora et al 2007; Zadikoff et al 2007). The mean dose of patients with valproate-induced parkinsonism was 750 mg/day, and the syndrome was 5 times more common with valproic acid than the other anticonvulsants.

Tetrabenazine, approved for treatment of chorea in people with Huntington disease, is also widely used to treat tardive dyskinesia. Oftentimes, especially in elderly with tardive dyskinesia, one must choose between reduced dyskinesia or increased parkinsonism.

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Many Cancers Heal on Their Own by Dr Mercola

mushrooms

Another important study was published in November 2008 in the Archives of Internal Medicine.2 This study followed more than 200,000 Norwegian women between the ages of 50 and 64 over two consecutive six-year periods. Half received regular periodic breast exams or regular mammograms, while the others had no regular breast cancer screenings. The study reported that those women receiving regular screenings had 22 percent more incidence of breast cancer.

The researchers, as well as another team of doctors who did not take part in the study but who analyzed the data, concluded that the women who didn’t have regular breast cancer screenings probably had the same number of occurrences of breast cancer, but that their bodies had somehow corrected the abnormalities on their own.

“Of course, this makes complete sense, because your immune system is set up to recognize and destroy cancers in the right environment,” Dr. Northrup says. “The right environment, of course, is enough sleep, a low-glycemic diet, enough vitamin D, and also regular handling of resentments, anger, grief, and loss.

I think what I want women to know is that your breasts are not two potentially pre-malignant lesions sitting on your chest. The problem with our paradigm – whether it’s tomosynthesis or mammograms – is that it will find things that were never going to go anywhere. And then you’re out there wearing a pink ribbon and running for the cure, thinking that you were going to die of breast cancer when you never will, and never would.”

What are Your Breasts Telling You?

Dr. Northrup is a firm believer in the innate wisdom of the body, and you can apply a certain measure of symbolism to various body parts. Your breasts, for example, were designed to feed and nurture your children, as well as for pleasure. According to Dr. Northrup, women who tend to be most at risk for breast cancer are those who have difficulty nurturing themselves and receiving pleasure…

“The first thing you need to understand is you have to learn how to receive – how to receive rest, how to receive pleasure – and that’s going to be the primary intervention that I would do. This is the biggest stumbling block for women: we’re so afraid of appearing selfish.

Here’s what we do to get the nutrients of pleasure and receiving that we all need for optimal brain health – the beta-endorphin or the feel-good chemicals in the brain: We import it through alcohol and sugar, when we can import it directly through self-love, meditation, exercise, and good sex, which you can do with yourself,” she says.

Bernie Siegel, a pediatric surgeon from Yale, was co-president of the American Holistic Medical Association with Dr. Northrup in the early ’90s.

“Bernie used to say, ‘I have come to see that the fundamental problem most patients face is the inability to love themselves,'” she says. “I remember thinking, ‘God, Bernie, that seems pretty simple to me.’ And you know what? He’s right. The older you get, the more you realize this.”

So how do you love yourself when you feel unlovable? Dr. Northrup suggests a paradoxical strategy she picked up from Gay Hendricks, who is a pioneer in relationship transformation and body-mind therapies. Simply meditate on, or use the mantra:

“I don’t feel lovable, so I’m going to love myself for that.”

Another powerful strategy that we use in my practice is a form of energy psychology known as the Emotional Freedom Techniques (EFT), which also uses the affirmation to love and accept yourself unconditionally. This really is a powerful healing affirmation that can have a profound influence. I’ve worked with tens of thousands of patients, and it can seem like nothing short of magic when unconditional love and self acceptance is integrated into a person’s neurology. In many cases, it can resolve physical symptoms quite rapidly.

According to Dr. Northrup, part of this healing is due to the increase in nitric oxide, which is found at high levels in your nasal pharynx. This is one of the reasons why you should breathe through your nose (opposed to mouth-breathing).

“Think about what happens when you do that. You get an increase in nitric oxide in every blood vessel in the body. And remember: a capillary is a micron away from every cell in the body. Nitric oxide is produced by the endothelial lining of every blood vessel in the body. It’s increased in all situations of health: self-love, aerobic exercise, antioxidant, vitamins, eating your vegetables. Nitric oxide is the molecule of life force. It also balances all the neurotransmitters instantaneously – serotonin, dopamine, beta endorphin, and all those things for which one in 10 Americans is on an antidepressant.”

Dr. Northrup’s Top 10 Health Tips for Women

In this interview, Dr. Northrup shares her top 10 tips for women’s health:

  1. Get enough sleep: Proper sleep is essential for optimal health, and it helps metabolize stress hormones better than any other known entity.
  2. Meditate for at least 3-12 minutes each day, to calm and soothe your mind.
  3. Begin your day with a positive affirmation.
  4. Exercise regularly. Ideally, aim for a comprehensive program that includes high intensity exercises and strength training along with core-building exercises and stretching.
  5. Breathe properly. When you breathe in and out fully through your nose, you activate your parasympathetic rest-and-restore nervous system, which expands the lower lobes of your lungs, and therefore engages the vagus nerves.
  6. “Relax the back of your throat. So many women have thyroid problems – it’s from chronic tension here; because you’re pretty sure your feminine voice isn’t going to be heard. It hasn’t been heard for 5,000 years. You’re not alone. But it’s being heard now,” she says.
  1. Practice self love and unconditional acceptance. Dr. Northrup suggests looking at yourself in the mirror at least once a day, and saying: ‘I love you. I really love you.’
  2. “After 21 days, something will happen to you. You’ll see a part of you that looks back at you, and you begin to believe it. “I love you. I really love you.”
  1. Optimize your vitamin D levels. Get your vitamin D level checked. Ideally, you’ll want your levels within the therapeutic range of 50-70 ng/ml. According to Dr. Northrup:
  2. “Sunlight is not the enemy. It’s lack of antioxidants in your diet that is the enemy. Natural light is a lovely source of vitamin D; you can’t overdose. But many people – to get their levels of vitamin D into optimal – are going to need 5,000 to 10, 000 international units per day. So, vitamin D is important. You can get your level drawn through MyMedLab.com without a doctor’s prescription.”
  1. Just remember that if you take high doses of oral vitamin D, you also need to boost your intake of vitamin K2. For more information on this, please see my previous article, What You Need to Know About Vitamin K2, D and Calcium.
  1. Cultivate an active social life; enjoy some face-to-face time with likeminded people.
  2. Epsom salt baths (20 minutes, three times per week) are a simple, inexpensive way to get magnesium into your body.
  3. Keep a gratitude journal. Each night, before you go to bed, write down five things that you are grateful for, or five things that brought you pleasure.

“Remember: every emotion is associated with a biochemical reality in your body. So, you want to bring in the emotions of generosity, pleasure, receiving, and open-heartedness. The same things that create heart health create breast health.”

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For dietary supplements:

http://www.teamasantae.com/clubalthea/

Sports Nutrition by Dr Mercola

When scientists at the University of Florida realized their student athletes needed a quick source of energy and hydration, the carbohydrate-loaded sports drink Gatorade was born.

In the 40 or so years since then, a boatload of carbed-up diet plans and so-called performance-boosting drinks and foods have hit the market, all espousing the benefits of carbohydrates and the concept of carbohydrate-loading. The idea is to saturate yourself with carbs so your muscles will have plenty of glycogen to go on while you exercise.

This worked fine for really fit athletes that were intensely working out and sweating copiously, as they needed to replace those fluids and carbs. However, it is totally inappropriate to transfer this to the vast majority of non-athletes that exercise casually, or just to get healthy, in which they are typically losing large amounts of sweat or burning carbs during their workout.

In fact new research shows there’s more to it than just stuffing yourself with carbs. Proteins, glutamic acid, leucine, and other essential amino acids also play a part in energy and sports nutrition―and there’s a certain timing of consumption that goes with them to assure that you’re getting the best results for your efforts.

The featured article in Functional Ingredients discusses the use of carbohydrates, protein and amino acids, caffeine, beta-alanine and creatine in sports nutrition.

While I agree on many points, such as the importance of whey for stimulating muscle protein synthesis, I strongly disagree with the article’s stance on using multiple types of sugars to replenish glycogen stores. As I’ll discuss below, the focus on carbs is one of the most detrimental pieces of advice that is still widely promoted to athletes and non-athletes alike.

Additionally, the article does not review the exciting new research on the potential benefits of intermittent fasting to boost exercise benefits, which I will expound upon below. This is an oft-ignored factor that can have a potent impact, although it’s not necessarily recommended for everyone, or for every circumstance.

Sports Nutrition—Going Beyond Carb-Loading

The food you eat has an immense impact not only on your general health, but on the benefits you will ultimately reap from your workouts. What you eat can either add to or detract from your exercise benefits, and if you’re devoting the time to exercise, you’d be well advised to harness your meals to support your goals, not detract from them.

First and foremost, contrary to popular advice, to maximize the benefits of exercise, you’ll want to avoid fructose and other sugars unless you are engaged in intensive and prolonged cardio exercises that will allow you to burn these sugars, especially fructose, and not store them as fat.

This means that most casual exercisers and those seeking to improve body composition and optimize health and fitness rather than boost athletic performance or competitiveness, need to ditch the energy drinks, sports drinks, most energy bars and even “healthy” drinks like vitamin water, as these will effectively sabotage your exercise benefits. Fructose, which is found primarily in the form of high fructose corn syrup, is particularly detrimental as it tricks your body into gaining weight by turning off your body’s appetite-control system.

This happens because fructose does not appropriately stimulate insulin, which in turn does not suppress ghrelin (the “hunger hormone”) and doesn’t stimulate leptin (the “satiety hormone”). The end result is that you end up eating more causing uncontrolled accumulation of sugar metabolites in your liver, which then leads to insulin resistance. Fructose also rapidly leads to decreased HDL (“good” cholesterol), increased LDL (“bad” cholesterol), elevated triglycerides, elevated blood sugar, and high blood pressure—i.e. classic metabolic syndrome. And if that’s not bad enough, fructose has shown to increase the levels of TNF-α, a pro-inflammatory cytokine known to inhibit fat burning and promote muscle wasting.

Exercise, which in and of itself improves insulin sensitivity will NOT compensate for excessive use of fructose.

Now, in terms of its impact on your fitness, it’s important to realize that consuming fructose, including that from processed fruit juices, within two hours of your workout (before or after) will also decimate your natural human growth hormone (HGH) production.

Increasing your HGH level is a major benefit of exercise, provided you’re using high-intensity interval training, which is the primary way to boost HGH naturally (you can also use super-slow weight training to accomplish similar results). HGH is also known as “the fitness hormone,” and some athletes pay a lot of money for HGH injections. There are significant drawbacks to doing that, and the combination of eliminating fructose and using high-intensity interval training while fasting is definitely the preferred way to optimize your HGH.

Three Factors of Effective Fitness Nutrition

Fitness expert Ori Hofmekler, author of Maximum Muscle Minimum Fat, and Unlock Your Muscle Gene, was responsible for first enlightening me to the curious paradox of boosting muscle building by exercising while fasted (meaning on an empty stomach). As it turns out, amino acids and protein serve not just as building blocks for tissues and muscle. Certain amino acids can also signal genes in your muscle to grow and to build protein, and they do that even during times of food deprivation as long as these amino acids are circulating through your blood stream.

Moreover, scientists have found that the ratio between protein and carbohydrates is critically important, especially as you age. Many make the mistake of eating too many carbs in relation to protein and fat. Research shows that high-carbohydrate diets fail to build muscle, even in younger people due to their detrimental effect on insulin. Again and again, it’s the high-protein/high-fat/low-carbohydrate diet that proves the most effective both for muscle building and weight loss.

To summarize, there are three primary factors involved in effective fitness nutrition, to which you can then add the strategy of exercising while in a fasted state to further boost results:

A high-protein, low-carbohydrate diet. Keep in mind that most people need between 50-70 percent healthy fats in their diet, which take the place of the carbs you’re eliminating. In order to build muscle, you clearly need calories, but there’s compelling evidence showing that calories from fat are far better than calories from carbohydrates

Certain amino acids, the most notable of which is leucine (others can also be useful. Beta-alanine/carnosine, for example, has been found to improve performance in high intensity exercise and can help reduce muscle soreness). But remember that it is crucial that you avoid amino acid supplements of leucine. It is far better to get it from whole foods. Note that as free form amino acids, leucine has shown to disrupt insulin activity and cause insulin resistance.  The highest source of leucine is high quality whey protein that is minimally processed and not whey protein isolate, which is overproccessed, and typically yields a  massive distortion of protein and a loss of nutritional co-factors.

Whether you choose to exercise on an empty stomach or not, your post exercise meal is crucial to stop the catabolic process in your muscle and shift the process toward repair and growth.

If you fail to feed your muscle at the right time after exercise, the catabolic process will go too far and can potentially damage your muscle. The correct time to eat is within 30 minutes after your workout. Your meal should include fast-assimilating proteins, such as high-quality whey protein with no sugar added. To learn more, please see this previous article that discusses the use of whey protein for optimal muscle building

If you cannot exercise in a fasted state due to fatigue, or simply opt not to for some other reason, you can also consume whey protein before exercise. It’s an excellent breakfast choice. A 2010 study published in the journal Medicine and Science in Sports & Exercisei demonstrated that consuming whey protein (20g protein / serving) 30 minutes before resistance training can boost your body’s metabolism for as much as 24 hours after your workout. It appears as though the amino acids found in high-quality whey protein activate certain cellular mechanisms (mTORC-1), which in turn promote muscle protein synthesis, boost thyroid, and also protect against declining testosterone levels after exercise.

In practical terms, consuming 20 grams of net protein from quality whey before exercise and another serving of 20-30 g net protein afterward will most likely yield the double benefit of increasing both fat burning and muscle build-up at the same time. Again, not everyone will need to eat something prior to exercise, but if you do, a high-quality whey protein is your best bet. It’ll curb your hunger while still optimizing fat burning.

The only exception is if you are doing strength training, as when you are fasting for 14-18 hours you typically deplete most of you glycogen stores so it is difficult to lift your maximum weight to failure. Hence, if you are doing heavy lifting to failure, you may want to avoid training while fasting on those days. In these cases it is likely helpful to consume some healthy slow releasing starchy carbs the night before working out so your glycogen stores won’t be depleted in the morning. Then, have whey protein as a pre-exercise meal to grant sufficient supply of branched chain amino acids for optimum muscle fueling during your workout.

Boost Fitness Results with Intermittent Fasting

Exercising on an empty stomach has been shown to have a number of health and fitness benefits. It may even be a key to keep your body biologically young. This is most easily accomplished if you exercise first thing in the morning, before breakfast. Part of the explanation for why exercising while fasted is beneficial is that this regimen complements your sympathetic nervous system (SNS) along with your capacity to burn fat. Your body’s fat burning processes are controlled by your SNS, and your SNS is activated by exercise, and by lack of food.

The combination of fasting and exercising maximizes the impact of cellular factors and catalysts (cyclic AMP and AMP Kinases), which force the breakdown of fat and glycogen for energy. This is why training on an empty stomach will effectively force your body to burn fat.

Regardless of when you choose to exercise, remember that you need to eat 30 minutes after your workout, which will effectively break your fast. If you exercise in the late morning or early afternoon, you could break your fast by including 20 grams net protein from a fast-assimilating source like a high-quality whey protein concentrate 30 minutes before you start your exercise, and then have another recovery meal 30 minutes after.

Exercise and fasting yield acute oxidative stress, which keeps your muscles’ mitochondria, neuro-motors and fibers intact. You may have heard of oxidative stress before in a negative light, and indeed, when it is chronic it can indeed lead to disease. But acute oxidative stress, such as occurs due to short intense exercise or periodic fasting, actually benefits your muscle.

As explained by Ori Hofmekler:

“. . . it’s essential for keeping your muscle machinery tuned. Technically, acute oxidative stress makes your muscle increasingly resilient to oxidative stress; it stimulates glutathione and SOD production in your mitochondria along with increased muscular capacity to utilize energy, generate force and resist fatigue. Hence, exercise and fasting help counteract all the main determinants of muscle aging. But there is something else about exercise and fasting. When combined, they trigger a mechanism that recycles and rejuvenates your brain and muscle tissues.

Growing evidence indicates that fasting and exercise trigger genes and growth factors, which recycle and rejuvenate your brain and muscle tissues. These growth factors include brain derived neurotropic factor (BDNF), Insulin Like Growth Factor (IGF-1), and muscle regulatory factors (MRFs); they signal brain stem cells and muscle satellite cells to convert into new neurons and new muscle cells respectively. Incredibly, BDNF also expresses itself in the neuro-muscular system where it protects neuro-motors from degradation. This means that exercise while fasting signals your body to keep your brain, neuro-motors and muscle fibers biologically young.”

Amino Acids—Essential Building Blocks to Strengthen Muscles

As mentioned earlier, the amino acid leucine is one of the most important for fitness. It’s part of branched-chain amino acid found in certain foods, and serves multiple functions in your body, one of which is signaling the mTOR (Mammalian Target of Rapamycin) mechanism, which signals protein to be created and builds your muscle. But that’s not all.

Ori Hofmekler explains:

“Leucine has shown to promote the anti-inflammatory cytokine interleukin 15 (IL-15), which has been regarded as the most powerful fitness promoting protein produced by your muscle. IL-15 acts as an anti-inflammatory, anti-obesity, muscle-regenerating signaling agent with unmatching effects on body transformation and anti-aging.

Furthermore leucine along with calcium blocks the obesity promoting effect of excess Vitamin D calciferol in adipose tissues (excess of vitamin d in fat cells induces central obesity which can be blocked by calcium/leucine intake such as from dairy, particularly whey protein). Finally, leucine/IL 15 anti-inflammatory actions have been linked to mitochondrial biogenesis, increased thermogensis, and increased energy utilization efficiency probably via activation of the longevity gene SIRT-1.”

Leucine also indirectly promotes the increase of glutathione in your body, as its anti-inflammatory actions can help spare glutathione molecules that would have otherwise be recruited to counteract inflammatory processes.

However, in order to be effective, you need far more than the recommended daily allowance (RDA) of leucine. The reason for this is because even though leucine is relatively abundant in our food supply, it does not appear in high concentrations, and is often wasted as an energy substrate or used as a building block rather than an anabolic agent. This means that to establish the right anabolic environment, you need to increase leucine consumption beyond maintenance requirements.

That said, keep in mind that using leucine as a free form amino acid can be highly counterproductive as when free form amino acids are artificially administrated, they rapidly enter your circulation while disrupting insulin function, and impairing your body’s glycemic control. Food based leucine is really the ideal form that can benefit your muscles without side effects. The highest concentrations of leucine and other branched chain amino acids (BCAA) are found in dairy products; particularly whey protein. and quality cheese.

Based on nitrogen-balance measurements, the requirement for leucine to maintain body protein is 1-3 grams daily. To optimize its anabolic pathway, you need an estimated 8g – 16g of leucine daily. The following chart presents leucine content in common foods. As you can see, whey protein is ideal for getting sufficient amounts of leucine in your diet. You only need three ounces of whey protein, compared to a pound and a half of chicken to get 8 grams of leucine:

Leucine Content in food / per 100g

Whey Protein Concentrate 8.0g
Raw Cheddar Cheese 3.6g
Lean Beef 1.7g
Salmon 1.6g
Almonds 1.5g
Chicken 1.4g
Chick Peas 1.4g
Raw Eggs 1.0g
Egg Yolk 1.4g
Sheep Milk 0.6g
Pork 0.4g
Cow Milk 0.3g

What’s Your Goal? Fitness or Longevity?

In closing, I want to share some additional insights from Ori Hofmekler with regards to intermittent fasting. It’s important to realize that when it comes to diet and exercise, you actually have to tailor them to your end goal—either maximum fitness, or maximum longevity. You cannot accomplish both at the same time… This is even more pronounced for women, who also trade extreme fitness for their reproductive capacity. Below, Ori expounds on these issues.

By Ori Hofmekler

Gender is certainly an important factor in human and animal studies. Female-specific responses to fasting raise an interesting scientific phenomenon. Researchers have been finding evidence that there is indeed a tradeoff between virility and longevity of organisms. Apparently the same genes that promote human longevity may trigger biological mechanisms that suppress female reproductive capacity. Hence, fasting and intense exercise protocols, known to promote longevity, also lower estrogen level and thereby modulate body composition and suppress female reproductive capacity.

This is apparently part of an early adaption mechanism to primordial conditions of food scarcity and hardship, which requires increased strength and durability on the account of reproductivity. Hence, hard conditions are not biologically suitable times for pregnancy and child bearing.

I discussed this issue with Dr. Marc Mattson, Prof. of Neurosciences at Johns Hopkins University a few years ago. According to Mattson, women who fast or are on calorie restriction, have the tendency to get leaner, become increasingly addicted to physical exercise, and lose their menstrual cycle. Nonetheless, they seem to gain substantial improvements in all main biological markers of longevity – i.e. increased insulin sensitivity, increased GH secretion, improved lipid profile, improved anti-inflammatory cytokine profile, improved cognitive function, etc.

Note that fasting triggers the longevity gene SIRT-1, which regulates mitochondrial energy production along with the gene transcription promoter protein PGC-1α, which increases mitochondrial biogenesis and density in the muscle.

Yes, mitochondrial energy utilization efficiency is a key to longevity.

One of the most notable benefits of fasting is its profound anti-inflammatory effect. Fasting increases production of anti-inflammatory cytokines while suppressing pro-inflammatory cytokines such as TNF-α and IL-6. Note that pro-inflammatory cytokines produced by fat cells (adipokines) are associated with insulin resistance, obesity, metabolic syndrome, and a shorter life span; whereas anti-inflammatory cytokines, such as adiponectin and IL-15, are associated with improved insulin sensitivity, increased thermogenesis, decreased fat storage, increased muscle regeneration and increased life span (this probably deserves another article).

Finally, in view of the current epidemic of excess estrogen in females and males, caused by estrogenic chemicals and foods (such as petrochemicals and soy), fasting and IF can be used as an effective therapeutic strategy to balance estrogen and prevent related metabolic disorders and cancer.

To sum this up, the female-specific response to fasting or intermittent fasting is no different than the female response to intense exercise. There is indeed a tradeoff between benefits and side effects. And the question “should women fast” raises the same issues as the question “should women exercise intensely”.

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