Doctor’s Orders

Expert advice on maintaining muscle, heart, brain, skin, bones, and mind

If, as they say, an idle brain is the devil’s workshop, then it’s interesting to note the idea (supported by recent research) that an active brain can prevent against Alzheimer’s disease and dementia.

We picked the brain of Henry Ford neurologist Dr. Rhonna Shatz, who explains: “There’s a network in the brain that’s constantly active. It takes a lot of energy, and it’s one that’s constantly reformatting as we add new memory. The more you know, the more you are physically building up more links. So anything that breaks down a link (like dementia) is going to have less net effect.”

Can you share some tips for maintaining a healthy brain?

Prevention is best. It’s important to avoid diabetes, because we know diabetes is one of the biggest things that can cause memory problems later in life. Another is stroke, and all the things that cause stroke are what cause a heart attack. So if you do the things that keep your heart healthy, you keep your brain healthy.

What’s the most common misconception about brain health?

[The] inevitability that as you get older you get memory problems. That really isn’t true. A group of people develops Alzheimer’s disease, but it’s not something that is part of aging alone. That’s important to note, because that means that there might be some things that can be done to prevent it.

What are some symptoms or warning signs to look out for?

If you’re finding that you are more distractible — that you constantly feel that in the middle of doing a task you’re forgetting what you’re doing. It may not mean anything, but it bears a checkup.

What about those in their 20s and 30s, who aren’t paying attention to their health. What advice do you have for them?

Get out there and move. Park far away and walk. Go up the stairs instead of the elevator. Do as much as you can to be physically active. Maintain your ideal body weight. Get that cholesterol checked. And be engaged. Besides this cognitive aspect of maintaining this network, there also is a very powerful set of genes that we have that have evolved for socialization.

A 2006 article in The American Journal of Clinical Nutrition titled “The underappreciated role of muscle in health and disease” posited the importance of maintaining muscle mass for reasons other than the obvious ones. The author, Robert R. Wolfe, concluded that healthy muscles help prevent obesity, as well as diabetes and osteoporosis. Wolfe also argued that because muscles play a central role in protein metabolism, healthy muscles contribute to reduction of stress.

“The stronger the muscles are, the less stress there is on the joints,” explains Dr. Ronald Taylor, chairman of the department of physical medicine and rehabilitation at Beaumont Hospital. “And the better someone is going to feel.”

The U.S. Department of Health and Human Services recommends adults — even those over 65 — perform muscle-strengthening activities at least twice a week. Taylor takes it a step further: “Thirty to 45 minutes, four to five days a week — no excuses. Except one: If you have pain.”

The doctor cautions those who haven’t been recently active to start slowly, with two to three minutes of a low-impact exercise such as biking, before working up to the prescribed regimen.

According to the American Academy of Orthopaedic Surgeons, there are four main factors that contribute to muscle strain: tightness, imbalance, fatigue, and poor conditioning. So it’s important to warm up before exercising, to condition the muscles equally, to let an injury heal before getting back to activity, and to stretch before and after working out. Taylor, though, isn’t the fiercest advocate of the last one. “I think stretching is grossly overrated,” he says. “You don’t need a lot of stretching unless you’re having a problem.”

What’s more important, Taylor says, is keeping a routine. “People think that as they get older, they can’t exercise. In fact, the older you get, the more important it is to use your muscles. Whoever put us together did a good job. And we weren’t made to only walk from the couch to the refrigerator to the car.”

Dr. David Altman, of St. Joseph Mercy Ann Arbor, offers these suggestions for maintaining healthy skin and preventing cancer of our largest organ.

Ray ban: Take precautions against sun exposure all year, especially between 10 a.m. and 4 p.m., when ultraviolet rays are strongest and most damaging. “Wear sunscreen every day,” Altman says. “Rainy, cloudy, sunny — it doesn’t matter.” Research shows that melanoma accounts for about 3 percent of skin cancers, but causes more than 75 percent of skin-cancer deaths.

No-bake: “Don’t go tanning. Don’t go and look for extra vitamin D through the sun, but do it orally [through a supplement],” Altman says. Ultraviolet radiation (UVR) is a proven human carcinogen, the U.S. Department of Health and Human Services reports. Studies show that your first exposure to a tanning bed as a youth increases your melanoma risk by 75 percent.

One size fits all: “Is there a different toothpaste for a 20 and 40 or 60 year old?” Altman asks. Like toothpaste, sunscreen and vitamin A are the answer for all ages and ethnicities. “The biochemistry is pretty darn similar [among races],” he says. However, melanomas in African-Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 75 percent of tumors occurring on the palms, soles, mucous membranes, and nail regions.

Go easy: When a “doctor says you don’t have to be scrubbed squeaky clean, they are 100-percent correct,” Altman says. “Overdoing it can actually irritate the skin and make it harder to use good acne medications.”

One-two punch: Sunscreen and Retin-A, “that’s the gold standard that everyone needs,” Altman says. “To help slow the breakdown of collagen … to really, truly help with the fine lines and wrinkles, Retin-A has been proven to do all of that.”

Expert advice //

Drink up: Xanthine, which is found in coffee and tea, is an antioxidant that has been shown to “quench UV-induced hydroxyl radicals and reduce oxidative DNA damage.”

You are what you eat: Researchers in Korea recently discovered a naturally occurring fat (phospzhatidylserine) in such foods as edamame (green soybeans), tuna, and mackerel that can fight wrinkles caused by sun damage and natural aging. Vitamin B–rich yeast extract has anti-inflammatory properties, making it a great post-sun skin soother.

Scent-free: Fragrance is the most common cause of skin-care related allergic reactions. If you’re sensitive, be sure to choose fragrance-free products.

Working hazard: It’s estimated that more than 13 million Americans are potentially exposed to chemicals that can be absorbed through the skin at work. Make sure you know your company’s methods to limit the risk and exposure.

Facts //

1. Up to 90 percent of visible changes commonly attributed to aging are caused by the sun. 2. Melanoma accounts for up to 3 percent of all pediatric cancers.

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Illustrations by Jacqui Oakley

Taking care of the 206 bones in an adult body can seem like an overwhelming task. Most of us understand the message of the “Got Milk” (milk mustache) ad campaign. But for real advice, we turned to Dr. Ted Jones, chief of obstetrics at Hutzel Women’s Hospital in Detroit.

Get going: “Exercising and dieting are the two big things,” Jones says. If you exercise regularly as a child, you are more likely to reach your peak bone density than those who are inactive; most people reach their skeletal mass at the age of 20. Fitness activities for healthy bones include walking, jogging, dancing, stair-climbing, racquet sports, and hiking. “Exercise as often as possible, every day if you can. Even if it’s just walking a few blocks or taking a longer route from the parking lot to your job,” he says. “Those who partake in weight-bearing exercise seem to have a better chance of retaining their bone mass once they get older.”

Milk really does “do a body good.” We don’t produce calcium; it must be absorbed through food. Sources include low-fat or nonfat milk, cheese, yogurt, and leafy green vegetables. Calcium-fortified foods include orange juice, cereal, bread, soy beverages, tofu, and almonds. If you’re not getting enough, Jones suggests taking a calcium supplement.

Catch some rays. Without adequate vitamin-D levels, your body is unable to absorb calcium from food. Vitamin D comes from two sources: through the skin following direct exposure to sunlight and from the diet.

Avoid smoking and excessive alcohol. Smoking can lower estrogen levels, which can lead to earlier menopause, increasing your risk for osteoporosis.

Prevention. “Talk to your doctor, and make sure your preventive measures are sound,” Jones says. “As you get older, moving closer to 65, you can have testing [DEXA scan] that measures the bone density that you have.”

Baby bones. “Mother Nature does a good job of making sure babies receive calcium that’s more than adequate for their needs,” Jones says. Even if the mother has a poor calcium supply, this won’t raise the risk of the baby’s being born with poor bone structure [unless there’s an underlying disease]. Women who plan to breast-feed should keep their diets rich in calcium, Jones says. Lactation can drain a mother’s calcium source.

Facts //

1. We’re born with more than 300 bones, but as we mature, some of the bones grow together, leaving us with 206.
2. A broken bone typically takes 12 weeks to mend.
3. An estimated 44 million Americans are affected by osteoporosis and osteopenia, a condition defined by low bone mass.
4. Every second, our bodies produce 2.4 million red-blood cells. Those cells are produced in bones, inside the nine ounces of bone marrow our bodies contain.


When the economy turned downward, doctors noticed a rise in anxiety and depression. “Stressful times seem to trigger more of these conditions,” says Dr. Abdallah Zamaria, a psychiatrist with St. John Providence. Zamaria says there are signs that may indicate a loved one is suffering. Below, he offers a basic outline and suggestions for care.

Bipolar: This brain disorder (also known as a manic-depressive illness) causes shifts in moods. “The highs are energy phases where a person feels that they are getting younger,” Zamaria says. “They can do anything, they don’t get tired, and make quick decisions with money.” A person with this disorder spends more time feeling depressed.

Depression: Zamaria says this condition is typified by the loss of interest in simple things that one formerly enjoyed. “They don’t feel well, or like themselves, tired, irritable … and not doing as much as they used to do before,” he says.

Obsessive-Compulsive Disorder: The disorder has two parts. Obsession occurs when thoughts, words, numbers, or music are constantly replayed in a person’s head over and over. “It’s unlike the popular definition of being obsessed, meaning you like something,” Zamaria says. Someone has “something so annoying [in their head] and they can’t get rid of it.” With compulsion, the second aspect, an example would be “someone who washes his or her hands 10 to 20 times before eating … the cleanliness begins to affect your life,” Zamaria says.

Panic Disorder: Zamaria calls this the “most severe type of anxiety,” so severe that that the person feels as though they are going to die. “At the same time,” Zamaria says, “they’re experiencing physical symptoms that make them feel like they really are dying.”

Schizophrenia: “A person has unusual thoughts and perceptions on what is happening around them,” Zamaria says. “They spend a lot of time by themselves. They have new interpretations of what is happening around them.”

What should a family member do if they suspect a loved one has a mental-health issue or psychological condition?

“The best first step is to take them to a family doctor, who is usually more readily accessible than mental-health professionals. It’s a good idea to make sure there’s no medical illness behind the symptoms,” Zamaria says. “Also, family members need to show support and empathy. They should not jump to conclusions.”

The American Journal of Psychiatry reported that more psychiatric conditions are now being treated with drugs only and that talk therapy by itself or in combination with medication is on the decline. Why do you feel that is?

“Nationally, as a trend, it’s probably true — and there are many reasons for it,” Zamaria says. “One reason is the lack of availability of good psychotherapists. The second is the cost.  The third: Psychotherapy takes time.”

Are there any preventive measures that could help people avoid these illnesses?

“Exercise is so important; aerobic exercise in particular seems to help with anxiety and depression and other symptoms like insomnia and even forgetfulness,” Zamaria says.


According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in America. Fortunately, plenty of research has been conducted on its causes and how it can be prevented. Here are a few tips on how to keep your ticker’s best interests at heart.

Listen to your mother. Eat your fruits and vegetables while limiting intake of saturated fat and trans fats. Choose carbohydrates rich in dietary fiber: beans, oats, root vegetables, and whole grains. Consume less than 2,300 mg of sodium daily. And don’t forget the potassium.

“Most people don’t have to avoid specific foods, unless you have a problem,” says Dr. W. Douglas Weaver, head of cardiology at Henry Ford Hospital in Detroit. “I think the most important thing is just mainly trying to maintain your weight.”

Stay active. The Surgeon General recommends 30 minutes of moderate-intensity exercise for adults most days of the week.

Be a quitter. “If you smoke, stop,” Weaver says. “Michigan’s smoking rate is still really high compared to many other states. Quitting reduces the instances of heart disease very quickly.”

Drink. But only in moderation, particularly if you’re younger. Alcohol provides few health benefits until middle age, when men older than 45 and women older than 55 may reduce the risk of coronary heart disease by tipping back a glass (just one!) a day.

Don’t keep the doctor away. “Just a simple, general examination from your primary-care physician — talking and doing a couple of tests — can determine whether you have any issues, and can give you guidance,” Weaver says.

He, along with the U.S. Preventive Services Task Force, recommends yearly blood-pressure screenings for adults. “Just because it was normal when you were 25 doesn’t mean it will be when you’re 55.”

Check it out. Get your cholesterol checked at least every five years. In addition, men should begin regular screenings for lipid disorders at 35 and women should begin at 45, as long as they’re not at increased risk for coronary heart disease for other reasons. In that case, screenings should begin at 20.

Pop a pill. Men over 45 should talk with their doctor about taking aspirin to reduce the risk of heart attack.

Stay in school. A 2008 CDC study found that as educational level increased, the percentages of adults with heart disease and hypertension decreased. Those who obtained at least a bachelor’s degree were less likely to smoke than those who hadn’t.

Read the signs. If you experience pain or pressure sensation in the chest during exercise that goes away a few minutes after stopping, or an unexplained shortness of breath, Weaver says, see your doctor right away. These could be the first signs of blocked arteries.

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