PowerPoint; Diabetes; Menopause

Production and broadcast of PowerPoint is made possible by a grant from the Corporation for Public Broadcasting and by the National Legacy Foundation, a non -profit organization committed to enhancing, preserving, and restoring the legacy and history of life in America. This is PowerPoint, an Information Age Clearing House for news, issues, and ideas that impact the African American community, the nation, and the world. In the United States, approximately 16 million people suffer from diabetes every year, primarily attacking adults over the age of 45. Good evening and welcome to PowerPoint's Journey to Wellness, I'm Dr. Mary Harris. Diabetes most commonly affects people of color specifically Hispanics, Native Americans, and people of African descent. Over the past few decades, the rate of diabetes in the African American community has tripled, as many blacks may be unaware

of the warning signs unwilling to seek medical diagnosis or have no medical coverage. Up next on PowerPoint, it's uncovering the deadly assault of diabetes. This is PowerPoint and we're back in a moment, but first, we joined Fonda Smith in the PowerPoint newsroom. Good evening. An African study endorses infant formula for HIV mothers, the NAACP, and the FBI Meet, and an experimental drug shows promise in easing the pain of sickle cell crisis. This is The News on PowerPoint, I'm Fonda Smith. A study conducted in Kenya supports the use of formula over breastfeeding by women and poor countries riddled with the virus that causes AIDS. Researchers report that while previous studies have verified that the AIDS virus can be transmitted through breast milk, the new research look for differences in overall death rates or other illnesses, such as pneumonia between breastfed and bottle fed infants. The report finds there is no significant difference in the death

rates or the incidence of various illnesses among babies who are nursed and those who are given formula. Still the study published in the Journal of the American Medical Association supports a previous study that found formula could prevent 44 % of HIV infections in infants of HIV positive mothers. With sickle cell anemia comes periods of acute pain known as sickle cell crisis. Up until now there's been little relief for those in crisis, but an experimental drug may change that. In a study published in the Journal of the American Medical Association, the drug known as CRAO -5861 reduced the time of the painful crisis commonly experienced by those with the inherited blood disorder. Health experts estimate that approximately 2 million Americans carry the sickle cell trait, while another 72 ,000 have full -blown sickle cell anemia. Right now, about 1 out of every 500 African -American children and 1 in every 1 ,100 Hispanic American children are born with sickle cell anemia. The buildings where people contracted

inhalation and thorax remain closed while the Centers for Disease Control tries to figure out the best way to claim them. Dr. Julie Gurdenberg, the CDC's Acting Deputy Director for Infectious Diseases, says there's no threshold of safety, but there is an assumption that workers at infected sites who tracked home a spore or two are not endangering anyone. There are no cases among their household contacts or their family members, so that gives us some reassurance that if we find a few spores in those sorts of environments, we're not experiencing a health hazard even among people who haven't taken proper access. She made her comments before the American Society of Tropical Medicine and Hygiene meeting in Atlanta. Years after medical classes, local doctors have gone back to school for bioterism education, Tom Berg has more. Hundreds of health professionals learned ways to deal with anthrax, smallpox, and botulism. Family doctors and nurses say they have an obligation to the public because they're on the front lines of caring for the population. Some doctors' offices have put up a poster that describes symptoms and treatments for each disease.

I'm Tom Berg, Indianapolis. In what both sides say they hope will be an ongoing dialogue, the FBI and NWACP are addressing the dubious relationship between the federal agency and the African -American community. In a town meeting in Richmond, Virginia, African -American citizens voiced their distrust of the FBI. Many of the older audience members said they were scared by the J. Eger Houger FBI targeting in the 60s and 70s of black leaders, such as Martin Luther King Jr. FBI representatives, appealed to citizens to try to judge the bureau by what it's doing today and not what it did in the past. Agents also appealed for African -American employee recruits. Since 1996, African -Americans in 85 metropolitan markets have made impressive economic gains where remaining the most loyal radio audiences in the US. According to data released by the media audit, the number of African -American households with annual incomes exceeding 50, 75 or 100 ,000 increased dramatically. The number of African -American households with incomes of 50 ,000 or more increased from

24 .5 % to nearly 33%. Household incomes of 75 ,000 or more increased from around 9 % to 15%. Although some of their media habits are changing, their loyalty to the urban radio music format remains the strongest in the nation. More than 53 % of African -Americans rated urban, as their most listened to, radio format. The NAACP has announced the creation of a blue ribbon advisory panel to review the overall progress of election reform in the nation. NAACP President Kwaese and Fumi says tens of thousands of Americans were denied their right to choose their leaders in the 2000 elections. He says the NAACP is committed to ensuring the election atrocities that happened throughout the country in the last election never happen again. New York City Mayor let Michael Bloomberg is vowing to work to put New Yorkers of all ethnic backgrounds on even footing. The incoming mayor told the New York Daily News that fairness would be his operative word in helping level the playing field toward

better jobs, affordable housing, quality education, and safe neighborhoods. Since he won the election, Bloomberg has delivered his mission statements to some of the city's most influential minority leaders, including former Mayor David Dinkins and Reverend Al Sharpton. Forest Whitaker may be expanding his credits as a director with Fat Albert. Variety says Whitaker is in talks to direct the live action adaptation of Bill Cosby's classic cartoon series Fat Albert and The Cosby Kids. The script was written by Cosby himself and Charles Kip. The calls will also executive reduce the pick with his wife Camille. 20th Century Fox is eyeing a summer 2003 release for the film. The hope is to launch a franchise of Fat Albert movies known for a number of acting roles. Forest Whitaker also chopped up a lot of time behind the camera directing hits like waiting to exhale and hope floats. Whitaker recently made headlines for drunk driving charge he recently received in Santa Monica, California. He is due back in court on December 5th. This is The News on Powerpoint this evening. I'm Vaughn DeSmith

and welcome back to Powerpoint. I'm Dr. Mary Harris. I hope you had a great Thanksgiving weekend. We're going to be talking about something that has a very significant impact on the African American community. According to the National Diabetes Information Clearing House, there are 2 .3 million African Americans diagnosed with diabetes. For every six Caucasians, 10 Blacks suffer from this debilitating and deadly disease and are more likely to develop diabetes complications and experience greater disability from the complications. Now, why are blacks and people of color more prone to become victims of diabetes? And what are some of the risk factors and warning signs of this disease? How can African Americans help prevent the

onset of diabetes? To help us answer these questions and give us a lot more information to work with, we have Joining Journey to Wellness by Telephone, Constance Brown Griggs, who's a registered dietician and a consulting nutritionist and a certified diabetes educator. Welcome. Hello, Constance. Are you there? Hi. Okay. Speak up so we'll be able to hear you. Okay. Okay. Great. That's better. And Cheryl Christian, who's a registered nurse and certified diabetes educator and a national board member with the American Diabetes Association. Cheryl, welcome. Hi. How are you tonight? Fine. Thank you. And in the studio, we have Carol Davis, executive director of the Diabetes Association of Atlanta. Good evening to everybody. So we've got three C's. We've got Constance, Cheryl and Carol. Good evening. Girl, great. And of course, we invite our listening audience to give us calls with your questions about diabetes.

I know many of us have family members who are affected with this disease. Our telephone number is 1 -800 -360 -1799. That's 1 -800 -360 -1799. Now we're going to start with Cheryl. Can you tell us what exactly is diabetes? Well, diabetes is actually a group of illnesses that have in common the problem of having high blood sugar or high blood glucose. And essentially the problem is either the body is not making insulin or the insulin the body is making does not work effectively. Now this is what a lot of African Americans refer to as sugar, right? That's right. Okay. And explain to our audience if you will exactly what insulin is and what it doesn't why it's so important that we have the prop have it functioning properly. Well, insulin is a hormone or a special chemical that the body makes in an organ called a pancreas which lies behind your stomach. Okay. And when we

eat, our food is broken down into glucose. Glucose is our body's main fuel. It's like gas for the cards. It would make your body go. And you need insulin in order for glucose to get into the body's cells so that the body can burn that glucose for energy. And when you have diabetes either because you don't make enough or it's not working right, you have a problem where the glucose will remain in the bloodstream and give you the first symptom of diabetes which is high blood glucose or high blood sugar. Okay. Now is there more than one type of diabetes? Yes, there is. There are actually three types. Type one diabetes which is the form that we used to call juvenile onset diabetes. That's the form that where the body stops making insulin all together. It's also known as insulin dependent diabetes because when a person has this form of diabetes, they must take an insulin injection every day of their life in order to live. All right. Now what about the second type? Now

type two diabetes is the most common form. About 90 to 95 % of all the people who have diabetes have this form. We used to call this adult onset diabetes because it's usually seen in people over the age of 40. So among African Americans we're seeing it at younger and younger ages, more commonly people are being diagnosed around the age of 30. But in this case, the body is making insulin but it doesn't work effectively. This is also known as non -informed dependent diabetes because this form of diabetes may be treated with meal plan and exercise alone, meal plan exercise and maybe a diabetes pill or meal plan exercise and insulin. Okay. And this is the form of diabetes that we say may be able to be prevented by making changes in lifestyle. Okay. Now what about you said there were three types. Okay. We got one more. This is especially important for women to be aware of

is gestational diabetes. All right. This is diabetes which is first diagnosed during pregnancy and it usually goes away once the baby is delivered. But the important thing to know about gestational diabetes is that about 50 % of the women that have gestational diabetes will develop full -blown diabetes within five years of delivery and with predictive that by the time these ladies are in their 60s, about 75 percent of these women will have developed diabetes. So if you have gestational diabetes, you need to be constantly aware of the symptoms of diabetes and make sure you get checked regularly for it. So let's reiterate this way. If you've got gestational diabetes, there's a very good chance that within five years after that pregnancy you'll have full -blown diabetes. Okay. All right. That's a good piece of information to know. Now, Cheryl, tell

us what are the ways that diabetes can be diagnosed and people and why is early diagnosis of diabetes such a problem for the African American community? Well, diabetes actually is diagnosed very simply by doing a blood glucose test. Okay. And we diagnose diabetes now if you have a fasting blood sugar on two occasions of 126 or higher, normally blood sugar is somewhere between 60 to 120. So 126 or higher fasting would diagnose diabetes or if you're having the symptoms of diabetes and blood glucose is over 200. Classic symptoms of diabetes are thirst, urination, fatigue, and weight loss. Part of the reason I think Dr. Harris, why people are African -Americans aren't getting diagnosed as readily is the symptoms of diabetes, especially type

2 can be rather subtle. You can walk around for years, maybe feel tired and not quite yourself and you're thinking, oh, I'm working hard, that's why I'm tired. All right. It's going to say that's a lot of us walking around feeling tired. Very few of us go to the doctor because we feel tired. Right. The T gets a symptom of illness. Also, I think a lot of it is not enough awareness of what the symptoms of diabetes are and the importance of going for that annual physical. Also, awareness of what your own family's health history is because if you are a person who has a relative with diabetes, you're at risk for developing it. Okay. Just be an African -American who increases your risk. So you should be asking your doctor, what's my blood sugar and please check me for diabetes. So these are two questions. We definitely want to be sure to ask the doctor, even if the doctor doesn't bring it up for us. That's right. We want to bring it up for the doctor. What's what are the questions again?

What is my blood sugar? Okay. Okay. And please check me for diabetes. All right. Good. We're going to go to the phones. We're starting gate calls and we're going to come back and I want to revisit this issue of seeing diabetes in younger and younger individuals. And I want consciousness to comment on whether or not our diet may be responsible for this and what our young people are eating. We're going to take our first call from Barry from Houston. Barry, welcome to PowerPoint's Journey to Wellness. What's your question for our panelists? Well, two questions in the comments. First, I'm just suspect that every problem in the black community is a lack of knowledge, lack of not knowing, no education. What's going on here? All the information is public. If someone really wants to know they can find it. Two questions of this is diabetes follows the people off to immune disease. And what progress have we made toward that group as a whole? Is diabetes an autoimmune disease? Well, actually type one diabetes is considered an

autoimmune illness. We now know that when people develop type one diabetes, it actually something is destroying the insulin producing cells, the beta cells. And we actually are able to test for antibodies against the insulin producing cells. And that's one of the ways that helps the doctors to distinguish between type one and type two. Hopefully, if we can do research, be able to get better at identifying antibodies and using gene therapy, we might be able to reverse that process and perhaps prevent the development of type one diabetes. But type two diabetes, we're not as sure about if they're an autoimmune involvement. We know there's a genetic component because it runs very heavily in families. But we haven't been able to identify antibodies associated with the type two form of diabetes. Okay. Now, Carol Berry had one other question and that was the whole issue of knowledge. And is there

no knowledge that's getting out to the community? What's happening here? He says the information is out there. Why is it that with many of the health problems lack of knowledge and understanding and awareness of the disease seems to be such a problem for the African -American community? And I'm going to let Carol respond to that. Yes. Well, I believe that the information is available however, so many of our people in our community don't have access to the information. You will find that people who have particularly type two diabetes, they don't see endocrinologists, they basically see their internal medicine doctor. And the information is just not as good. If you're not with an endocrinologist, there's so much more that can be learned about how you adjust your insulin, what your diet should be. And you should have a regiment that would include your doctor, a registered dietitian, and a nurse educator so that you

would have the best information possible to control your diabetes. Part of our issue is control of diabetes. Once diagnosed, there are so many things that can be done to help persons to control their diabetes and to prevent long -term complications. Okay. Now, is there anything that's done to make African -Americans in general just more aware of the problem of diabetes in our community? Well, through the American Diabetes Association, one of the programs that we have is our African -American program, which has as one of its features something called Diabetes Sunday. Okay. And Diabetes Sunday are opportunities to go into the churches to give out information about diabetes, to increase awareness of diabetes as a disease, and especially to get people to understand that when we

say that diabetes can occur among African -Americans, to really believe this can happen to me. You know, as often what we do is you say, if you put three people together, and you say point at the person who might get diabetes, people invariably will point to the other guy. Right. But getting people to realize that this could be something that affects you is important. Okay. We also have our website, our African -American webpage. We have a cookbook, called The New Soul Food Cookbook, for people with diabetes, and with our various chapters of the American Diabetes Association, we do programs throughout the year to reach into the community, like I'm in Washington, D .C. And each year, we always give out materials at the Black Family Reunion. Okay. And of course, doing programs such as this is an excellent way to get information out to the community. Well, we thank you for that. We're going to take Barry. Thank you for your call. And I

hope that we were able to answer some of your concerns. Our next caller is David from Houston. David, welcome to PowerPoint's Journey to Wellness. What's your question? Yeah, good evening. David, can you speak up a little bit please? Yes, yes. Good evening. Good evening. Yes. I want to get to the excellent show on regarding the issues of health and pertaining to one being. I would like to get to address the issues of stress, diet, pollution, self -help, solutions as far as for the person who has diabetes. It's fine. It's finger -sixty and one. And the overall, what does it be? One other, one rather real important because I work in a medical field. It has the guess done any studies. I know they've done a general study regarding diabetes. Have they done any specific studies on where diabetes is most prone? Or is there a specific region of the country that African -American more affected by diabetes? And the reason why

I asked that, because I'm listening from the West Coast, and there is a general overall understanding of one's health is paramount in one's life, and this is across the board with all cultures. And I hear a drastic difference here in the south. And they could address the issues of stress, diet, self -help, solutions such as finger -stakes, and specifically if they've done any studies on regional effects regarding African -American throughout the United States, because you have people listening to you all over the country. And one person's illness may be affecting them in a certain area of the country when it's not an issue in another area of the country. Thank you very much. Thank you, David. Well, let's take David's questions in parts. I think we should probably start out with what are some of the risk factors or things that make people prone? What role does diet, for instance, play constants? You want to talk about the role of diet with

respect to diabetes? Sure. Basically, when we are talking about diet, I think one of the major issues is the fact of weight. And particularly with type two diabetes, the average person affected with type two diabetes is overweight and does require some moderate weight loss. So that might be the first aspect that one should look at whether or not they do fall into this category of being overweight and whether or not they do need to lose 10 to 20 pounds, which can have a major impact as far as their blood glucose levels are concerned. Can that lower it enough so that a person would no longer be considered a type two diabetic? Once you diagnose as a diabetic, you're more or less controlled. So in other words, if you lose the weight and then your blood glucose levels come down to normal, you're controlled. You still have that diagnosis of type two diabetes. And certainly, if you regain the weight, then all of those symptoms will return as well. What about this high -carb low -carb diet

that many people are talking about, they go on a very low carbohydrate diet or no carbohydrate diet and it's said to have a very positive impact on many people who are diabetic. There's a lot of controversy surrounding the carbohydrate issue. I think what listeners need to be aware of is typically, most people don't really know what a serving is. What is a serving? Coming right off the Thanksgiving, I think many of us said many, many, many servings. Can you tell me exactly what is a serving? Well, what we consider a single serving, for an example, coming off of Thanksgiving, stuffing, for an example. This is something that a lot of my patients were asking about, well, how do I fit stuffing into my meal plan? A half cup of stuffing will fit pretty much in the palm of your hand. In your hand, if it was cupped. Constances, this is how much stuffing that we should have had for Thanksgiving is a half a cup. No more? Well, the thing

that I tell my patients all the time is that's what we consider a single serving. Whether or not you have two of those or three of those depends on the individual and what your goals are. But certainly, the first and foremost is that each person understand what a single serving is. Many people think two cups of stuffing, for an example, would be a single serving. And that's where the problem comes in. One of the other things with meal planning or to answer the question in terms of prevention is to modify satin take. Typically, as a whole, we're just overdoing it with the satin take as well. Okay. What about sugar insult? Sugar, this is a very good question because what we know now is that one with diabetes does not necessarily have to avoid sugar like the plague. Years ago, we used to instruct people avoid sugars. Stay away from anything with sugar. Now we know it

can be incorporated into the meal plan as part of one's total carbohydrate intake. However, as a rule, going into a physician's office, the physician will tell you avoid sugar. Stay away from sugar, stay away from anything with sugar in it. And to a point that is going to be very helpful, but by the same token, things that don't have sugar, it does not necessarily mean that they're going to be low in carbohydrate. And it's the total carbohydrate that will have an impact on one's blood sugar level. You know what, Constance? I want to come back just a little bit later in the show. And we want to talk a lot more about diet, but I do want to touch on some of the other aspects of David's question, which have to do with some of the things that contribute to diabetes. And I wanted to know if Cheryl could comment on. First of all, the effect of stress on diabetes, and whether or

not there is a high risk region of the country or any studies that have been done to show that diabetes is a lot more prevalent in one geographic location versus another. In terms of type 2 diabetes, I don't really know that there have been actual studies to show that it's more prevalent. We do know that among the Native Americans, diabetes is much more prevalent like among the Pima Indians. But I think my own area of Washington DC is considered to have one of the highest per capita rates of diabetes in the country. I'm going to have to ask you to hold that thought. We've got to take a break. We'll be right back. You're listening to PowerPoint. PowerPoint is funded in part by PowerPoints Affiliate Station Consortium, KTSU FM in Houston, WRVSFM in Elizabeth City, North Carolina, and Baltimore's WEAAFM, PowerPoints Affiliate Station Consortium, committed to the

continuation of quality public radio programming. And welcome back to PowerPoint. Have

you or a family members found out that you've got diabetes? You can call our PowerPoint hotline at 1 -800 -3601799. That's 1 -800 -3601799. We have a lot of calls. We're going to try to get to everybody before the evening is over. I'm going to go back to Cheryl. She was talking with us about any particular high risk region of the country and then she was going to comment about the effect that stress might have on diabetes. Cheryl, please go ahead. I don't really think that there's one area that's more at risk than any other. We do know that diabetes is going to increase in the United States in the next 50 years by a hundred and ninety -five percent. That's the prediction. And among African -Americans, among African -American males, it'll be a three hundred percent increase. And African -American females are two hundred and eighty percent. Why is it going up so much with all this education and all these programs going on? Why would there be such an increase? A lot of it has to do with the fact that America is getting

browner. We're becoming a more ethnically diverse community. But also, we are getting heavier and moving less. Unfortunately, this has turned into the age of the VCR chip, the microchip, and the potato chip. So because of that, we're gaining weight, all of us Americans are heavier. So, and even though the information is out there, we still have to get those messages out very, very consistently and constantly to get people to move more and eat less. Okay. That sounds good. Move more and eat less. I like that. And it's simple things. You know, people should get up in arms when the school budget cuts out gym class. What after school activities? Because this leads to overweight in our kids. What about the diet that's served in the school cafeteria, constantly? What about that, what about the

diet that's served in the cafeteria? Certainly. And some of the school cafeterias that may also be a problem. I don't like to state that all school cafeterias are not you know, serving healthy meals and low fat meals and so on. But that can be a problem and probably more so what the parents are putting in the child's lunch box as well as being a problem. Now, what about stress? We need to talk about that and then we're going to move on because we have more callers on the line. What about stress? Excuse me. I'm so sorry. But I just want to say one thing in terms of the increase in the rate of diabetes. I think part of that Cheryl may also be with the new diagnostic criteria that we are diagnosing people with diabetes a lot earlier on in the illness. And that's the other reason probably for that increase. Picking up on so many people a lot earlier. Okay. Anybody want to comment on the effect of stress on diabetes? Well, when you're under stress, you actually make hormones that increase blood glucose. And this could be

either the physical stress from an illness or emotional stress. In case you actually secrete hormones that raise blood glucose and make you more resistant to the action of insulin. So that if you already have risk factors for the development of diabetes, such as being a member of a minority race, having family members, being over the age of 30, and then you couple it with the things that you do, such as not getting enough exercise. And eating an unbalanced diet, then you factor in stress. That might be exactly the thing that tips you over the scale. Many people are diagnosed with diabetes when they're undergoing a stressor. I know I meet many people for the first time they're in the hospital having just had a heart attack. And they found out, gee, the doctor says, this is how

long if you had diabetes, you notice what caused your heart attack? And they're totally in shock. Okay. All right. We're going to, David, we've tried to answer many of your questions you had a long list. And I will be incorporating issues about self -help and more about diet as we move through the show. We're going to take our next call from Jim from North Carolina. Jim, welcome to Journey to Wellness. What's your question for our panel? Well, I don't have a question. I've got a comment about a book I've read written by a doctor, a Harvard medical doctor. It's called foods that fight pain. Uh -huh. And he claims that if you stop eating animal products, you can have studies that show that 90 % of adult on -set diabetes using oral medication could stop them in less than a month. Now, those taking insulin 75 % no longer needed it. And this is based on clinical evidence? Well, I believe so.

The man is a Harvard medical doctor. Thank you, Jim, for your comment. Cheryl, are you aware of this? Dr. Harrison, if you could repeat his comment, I really couldn't hear him. Certainly. He read a book by a physician who is a Harvard physician who claims that if people would cut out eating animal products that the title of the book is incidentally as foods that fight pain, that the majority of people who are diabetics would be essentially be able to come off their medications. Well, there is something to be said for eating a more vegetarian diet. More fruits, vegetables, beans, and grains. In the diet, our first off, you're going to be eating a low -fat diet and eating lower calories. But for some people, they just can't totally eliminate a

one -hole -food group. But things in moderation, you know, I'm really having a bow to that. I think Constance also can comment on this. About 30 % of your daily intake should come from protein. And of almost 40 % should be coming from complex carbohydrates such as fruits, vegetables, beans, and grains. But I think Constance can comment on this more so than I can. Before we move to Constance, let me just ask this. Is there any any information that would show, it seems to me if this were true that we would see a lower incidence of diabetes among people who were vegetarian, perhaps. Maybe it's the weight issue that tips this and people who are heavier may eat more animal. In type 2 diabetes, certainly the weight is a major factor. And I'm not aware of any extensive research that's been done to support that theory that reducing the animal protein will significantly decrease one's use of

medication in relation to their diabetes. It's probably a little bit more than that. And again, leaning more towards the weight issue. So if we just look at the weight alone, regardless of what one is eating, whether its animal protein or not, from the calorie point of view, if they have a weight loss, then of course that does tend to make the body less resistant to the insulin, which allows the body, you know, to have better blood glucose control. So it's not just protein alone as being the major factor that will say cause that to happen. It's the reduction of weight. That weight loss could have happened by counting grams of fat and leaving the protein exactly as it was originally in that individual. And that still will have the same effect as far as decreasing blood glucose levels, possibly reducing the need for oral medication or less medication, less insulin and so on. But it's just not that straightforward. It really isn't in terms of reducing protein and automatically being able to come off medication. People have to be very

careful of quick fixes and these promises that are out there. And as you were alluding to if that were the case, and it was something that we'd know the American Diabetes Association would be talking about, it would be all over the place, and we'd have fewer people with diabetes on medication by following that type of meal plan. The other thing too, Dr. Hussified could add this is we know that with type 2 diabetes is that over the years of having it, it's a progressive illness. The actual beta cell, the part of the pancreas that actually makes the insulin over the years of having type 2 becomes less and less able to make insulin. So as people go through life with type 2 diabetes, they may eventually, even with following a strict meal plan and weight loss, may eventually require some medication as part of the progression of the illness. Okay. We have a young caller on the phone. We have Jessica from South Carolina. Jessica, welcome to our show. What's your

question? Hi, first of all, I just want to say I've never heard your show before. So far, it's quite good. Well, thank you. And I'm 16 years old, and my grandma, my great grandma, when she was back way back in her day, she died from diabetes and had her legs amputated before then. Yes. And my uncle, who was about 28 now, he was diagnosed with diabetes about two years ago. And I have a few symptoms that I think might be diabetes, but I'm not sure. And so I want to know if I'm like, even though I'm quite young, should I worry about it? Absolutely. I think that's an excellent question. And Cheryl, what would you advise for Jessica to do here? Hey, again, Dr. Host, could you repeat a question? I'm not hearing you. You're not hearing the question. Cheryl has had relatives that have diabetes, grandmother, or great grandmother, died from diabetes. And she has other relatives in the family that have diabetes. And even though she's 15 years old, she worries that she may also have diabetes. And

she feels that she has some of the symptoms. And I was asking what kind of advice you could give her in terms of taking steps to alleviate her worry? I think the first thing she should do is ask her parents, have her parents take her to her family physician and to forecheck up? And sit down and talk with her doctor about her concerns about diabetes and let them know what her symptoms are. And her family history as well. And her family history, because we now know that young people can develop as young as she is, can develop type 2 diabetes. But she's still at the age where she's that would fit into the category for developing type 1 diabetes as well. So she's having thirst and urination, fatigue, weight loss. You need to go get checked out. You can start with a visit to your doctor. Is weight loss always a symptom? Well, often what happens in the beginning, you're losing weight because of the fact you're losing a lot of calories with all that urination, because you're not getting the

benefit of the food you're eating. But weight loss isn't, if many people, when they come in, they might say, well, I've lost about 5 pounds, but usually in a young person, they can have quite a bit of weight loss in a matter of a very short time. Okay. So she needs to get in to see her family physician, discuss her history and talk about her symptoms if she's having any, should she have a blood test? Oh, definitely, because that's the way the doctor was being able to distinguish if she does have diabetes or it's perhaps something else going on. Carol, what programs are there to help young people learn about this disease? Are you familiar with anything that might be useful for our young African American listeners? Okay. Well, one thing is through the American Diabetes Association, again, we do have a webpage now for young people.

Then there's our African American program information that's also on our website. And our website is diabetes .org. Okay. There are things through not the American Diabetes Association, but juvenile diabetes foundation that she may find helpful. And also by visiting the website for NIH for the NIDDK. Right. We have a lot of those websites listed on the iHealthRadio .com. That's our website for the show. And people can go there and they can simply click on the links and it'll carry them right to it. And the other thing that I would like to suggest is that she contacts her local American Diabetes Association office. Okay. And get in touch with some of the folks in her local. Carol, would you add something you wanted to add something? Yes. There are a lot of associations around the United

States that help people who suffer with diabetes. There are many chapters of the American Diabetes Association. However, there are also many independent associations. Our association here in Atlanta, the Diabetes Association of Atlanta, is an independent association. And we aggressively go through the community throughout the community doing screenings. We've screened over 5 ,000 people. Do you encourage the young people? Not so much as young people. We basically in our screenings do the older African -American communities, the 30s and ups because we're there in corporate surroundings, health fairs at jobs, that type of thing. We also offer self -management courses which help people with the diabetes to understand just that it's important to take your blood sugars many times a day, at least four times a day. Understand how your diet and exercise fits in with your lifestyle to

help you control your diabetes. And our program in Atlanta is unique and we're proud of the fact that we have the capability of giving some medical assistance to people who are in need of diabetes supplies, insulin syringes, that type of thing. With our economy today, a lot of people are between jobs. It's important for them to have their insulin syringes so they can take control of their diabetes. And we're here to help them do that. Great. Okay. I understand that we lost a collar ivory. Hope you'll give us a call back. We'll certainly try to get to you. John from North Carolina, John, welcome to Journey to Wellness. What's your question for our panel? Well, my question is really, I guess, not a question as much as a bit of a devil's advocate position about the American Diabetes Association, the American Diet and the American Dietitian Association, who is for the most part their mantra, has been, well, weight

loss, that I certainly agree that weight loss is worthwhile. But type two diabetes is mostly driven by insulin resistance. And, of course, the insulin resistance occurs in large parts in response to the carbohydrates in the diet. The excessive carbohydrates in the diet lead to the insulin resistance and insulin becomes the poison. And the comment that your guest had made about sugar being in the diet, I think the American Diabetic Association, back about six years ago, perhaps five years ago, discovered the glycemic index. The glycemic index is a, there are three different studies to my knowledge that have been published on the glycemic index. One, and basically what that is, is where individuals are tested, are given an individual food feeding of 50 grams of carbohydrate and their blood sugars are monitored and all the different responses to the blood sugar elevations were averaged and grafted out and put on the

specific index with bread being 100 arbitrarily. And the sugar rises above or below that are less than that. And, of course, sugar is or bread was less than sucrose. For instance, sucrose on that scale was in 89 and one of the scales and breads 100 and so the American Diabetic Association, instead of concluding that it's okay, that we shouldn't have been telling people to eat bread all along. They said, well, it's okay, so we've been saying it's okay to eat bread, so therefore it's okay to eat sugar. Sugar drives and all carbohydrates convert into sugar. Sugar drives the insulin levels up. And their insulin resistance, the insulin converts the sugar into fat. That's the people metabolic fat. John, so let me ask you, is your question for our, for our panel whether or not sugar should be included in the diet is a, well, I guess I'm, it's not as much of a question as an observation. I happen to be a physician who treats many diabetics. And I

think that it's important for diabetics, type two diabetics to know that they're, for the most part, the important patients who have mild to moderate disease, it can be reversed if they reduce their carbohydrate intake, the very foods that require insulin from metabolism. I see. That's my major point. Well, thank you, John, for the comment. We appreciate your call. Okay. We're going to take a break now and you're listening to journey to wellness. We're talking about diabetes and we invite you to give us a call with your questions. We'll be back from the break in just a few moments. And welcome back to PowerPoint. Our

hotline number is 1 -800 -360 -1799. That's 1 -800 -360 -1799. And if you'd like to get information on the website, you can go to our website iHealthRadio .com and we have many of the links that we talked about that have been mentioned on the show to give you additional information about diabetes. I do have a question about the complications of diabetes because African -American seem to suffer disproportionately from those things. We have eye complications. We have more amputations. We have in -stage renal disease. Our kidneys fail us. I think someone told me that the majority of the people on dialysis in Washington DC are African American women who are diabetic. All of these statistics trouble me and I would really like for our guests to comment if you will on how we can manage and ward off some of this because this disease seems to really have the African

-American community about its throat really. Well, Dr. Harris, one thing is when it comes to the complications, we know that good blood glucose control helps to prevent our delayed onset of the complications, the eye disease, the nerve damage, the amputations, and the kidney disease. But so it's important that people get diagnosed early. Many people by the time they're diagnosed with type 2 diabetes have already had it 10 years. Before they even come to diagnosis, which means that they may be at the time of diagnosis already be showing signs of complications. But then getting adequate treatment about when an important part of treatment is in addition to taking your diabetes medication, is education about testing your blood sugar, about what to look for, and making sure that you get into see your doctor at

least three to four times a year. Okay, it's an important part in the prevention of complications and better knowledge of what we call the ABC use of diabetes control. And what are those ABCs? Okay, the A stands for A1C, your hemoglobin A1C test. This is a test done in the doctor's office. It shows what your average blood sugar has been for the past three months. And the goal is your A1C should be below 7%. All right, the B is for blood pressure control. Blood pressure for a person with diabetes should be 130 over 80 or less. So if you have hypertension, you got to take care of your hypertension as well as your diabetes. And the C is for cholesterol control. All of these things, and in terms of just total cholesterol, what we're aiming for is for cholesterol, total cholesterol less than 200. And we want your HDL, your

healthy cholesterol at 45. And we want your LDL below 100. Okay, that allows the cholesterol. Because all of those factors come into play with the development of the complications of diabetes. What about foot care among people who have diabetes? Why is that so important? Well, the reason is what causes the complications is damage to the blood vessels. And often that blood vessel damage takes place at the part further away from the heart, which is down on your lower extremities and your legs and feet. So one of the best ways to prevent an amputation is by something very simple. Checking your feet every day. And what you're looking for is are there any sores? Are there any corns or calluses? Okay. And people with diabetes have nerve damage, so they don't feel an injury on their feet. So that daily checking is important. And please, if I can tell people this, please no

bathroom surgery. Then that's taking out the razor blades, cutting your own calluses or anything like that. You want to go to a doctor and have those things attended to. All right, we've got three more calls holding and so we'll try to go through them as quickly as possible. We're going to pick up with Ivory, who we lost a little bit earlier. Ivory, welcome to PowerPoint's Journey to Wellness. What's your question? Go ahead, please. Ivory, go ahead. Hello. Hi, go ahead, Ivory. Yes, I'm an Ariane and I live here in South Carolina. Right now, I'm working at an adult daycare center. Yes. And you know, and I was working at Tumey Hospital before. Most of my patients are diabetics. And that was also the Caucasians. And I was wondering if in reality, the cultural eating habits had an awful lot to do with the two. I had eight patients out of the eight. Six of them were

diabetics. Okay, we're going to we're going to ask for concerns to address the question. She the main thing I wanted to tell you about is that I get the R and magazine. Yes. And there's an article in my July issue by Josh Rohn and Goldberg, who is a dietician as well. I have some masters and she's saying that they're getting into the carbohydrate counting now because they felt that instead of just during the calorie count, she was saying that the consistent carbohydrate diabetic meal plan, she said that that seemed to be more consistent. And the reason for that was that she said that there was a better connection, a consistent connection between

the food, the physical activity, and the medication. And I just wondered, you know, if you had any comments about that. Yes, this is kind of one of the things the meal planning approaches that we do use is carbohydrate counting. And what that does is it enables an individual to determine the amount of carbohydrate that they can best tolerate and still maintain their blood sugars under good control. And in terms of, you know, the foods of the south and someone our soul food, if you will, that in many cases is I won't say that the food itself is the problem, it's the misunderstanding of how the food fits into the meal plan. And one of the things that I've done as an educator is developed the diabetes soul food pyramid, which categorizes the foods based on their carbohydrate content. And also, it's categorizing soul food. One of the problems as an educator that I ran across

was most of the educational tools did not address soul food. So typically an individual looking at the pyramid, whether it's a diabetes pyramid or whatever, the first thing is, well, I don't see foods that I eat. How do I fit colloquines into my meal plan? How do I fit cornbread and so on into the meal plan? So the diabetes soul food pyramid does address that and categorizes the foods based on their carbohydrate content. In constants quickly, how can they get a copy of this? They can actually go to my website for that, which is www .cbrnutrition and surprises one word .com. And they can get a copy there. I'd like to thank all of our guests. We have callers still on the line and I apologize that we weren't able to get to you this evening. Diabetes is a problem that's so common in our community. Cheryl, thank you so much, Carol. Thank you for coming in.

Constance, thank you for joining. Joining us this evening and thank our listening audience. Stay tuned. We're going to be talking about menopause. You've been listening to Journey to Wellness. Stay tuned for the next hour. Healthcare reporting on PowerPoint is funded by the National Speaking of Women's Health Foundation, educating women to make personal decisions about personal healthcare and well -being on the web at speakingofwomen'shealth .com. PowerPoint is funded in part by the Corporation for Public Broadcasting and the National Legacy Foundation. This is PowerPoint, a production of WCLK FM, a broadcast service of Clark Atlanta University. Production and broadcast

of PowerPoint is made possible by a grant from the Corporation for Public Broadcasting and by the National Legacy Foundation, a non -profit organization committed to enhancing, preserving and restoring the legacy and history of life in America. This is PowerPoint, an information -age clearinghouse for news, issues and ideas that impact the African -American community, the nation, and the world. Some women don't like to talk about it and most men shiver to discuss it. However, there is information to help everyone get through it. What is it? Menopause, or more politically correct term, midlife. Good evening and welcome to PowerPoint's Journey to Wellness, broadcasting live from Atlanta, Georgia. I'm Dr. Mary Harris. Do African -American women experience menopause differently from other women? The answer is yes, according to an issue of menopause, the journal of the

North American Menopause Society. But there are solutions and resources for women and their midlife health concerns, and it's helpful for men as well. Preparing for the change, your guide to midlife health and wellness up next on PowerPoint. But first, we join Fonda Smith in our PowerPoint newsroom. Good evening, I'm Fonda Smith. According to law enforcement statistics, traffic crashes are the leading cause of death among African -American kids, Senate approved tax relief for attack victims, and the University of California plans a change in their admissions requirements. This is the news on PowerPoint. The smallpox vaccine may soon be a weapon, not only in the event of a bioteer attack, but also in the battle against cancer. Doctors at Britain's Cancer Research Campaign are trying to determine if a modified version of the vaccine

can trigger an immune reaction against cells infected with HPV, a virus linked to most cases of cervical cancer. If the vaccine proves successful in clinical trials, women with cervical cancer or pre -cancer cells may be saved for more painful procedures like surgery and lasers. Cervical cancer claims lives of about 300 ,000 women across the globe each year. Early detection and treatment dramatically increases a woman's chance of survival. Millions of American women light up every day, and they're running some major health risks. Since the 1950s, there's been a 600 percent increase in the number of women smokers in America. The University of Kentucky chief of pulmonology, Dr. Dennis Darty, says studies have shown that kicking the habit is harder for most women than men. Women's lungs and airways are smaller than those of men, which may make them more vulnerable, the harmful effects of tobacco, spent in lead to the development of COPD. But the struggle to quit can pay off in the

end, stopping smoking reduces a person's chances of developing lung cancer and chronic obstructive pulmonary disease or COPD. The surge in general calls smoking the most preventable cause of premature death in this country, and the leading contributor to COPD, which is the fourth leading cause of death in the US. While the holidays are here, law enforcement officers are hoping to help save lives on the roadway, especially the lives of African American children. More than 10 ,000 agencies are taking part in a national safety program known as Operation ABC Mobilization. According to law enforcement's statistics, traffic crashes are the leading cause of death among African American kids. Police say Black youth grades 9 to 12 are 50 percent less likely to buckle up compared to white or Hispanic children. Law enforcement officers are looking to reduce that statistic this holiday season by cracking down on seatbelt laws and drunk driving. Police estimate that 40 percent of all African American children are riding

unbuckled. The Senate approved legislation that will weigh the income and payroll taxes for two years for victims of the September terror attacks. The legislation will also provide relief from federal and state -to -state taxes, death benefits, government retirement benefits, and disability benefits will also be excluded from taxation, as well as any money received by victims' families from employers to help pay living and funeral expenses. In addition, the legislation will make it easier for charitable organizations to make disaster relief payments to the victims' families. One day after Chicago's Black Alderman called the daily administration on the carpet for an ever shrinking percentage of city work going to black contractors, the mayor said percentages don't tell the whole story. Alderman, like third -ward leader Dorothy Tillman, called the move from 9 to 10 percent on contracts in two years a disgrace during budget meetings. African American contractors through September 30th of this year were awarded 153 million in contracts, less than the 194 million

awarded Hispanic contractors, lumped together the city awarded 41 percent more work to women or minority contractors than in 2000. The 15 Auburn University students who dressed in KKK costumes and blackface at a controversial Halloween party have been suspended indefinitely from the school. Auburn spokesman Jim Jackson says the decision was justified. He cites the university's code of student discipline that states if the students continue presence disrupts the school, then action may be taken to rectify the problem. Jackson also says the university hasn't ruled out the possibility of an all -out expulsion. The students were part of two fraternity organizations on the Alabama school's campus. Both fraternities involved have made public apologies. They are no longer recognized by Auburn or their national chapters. The NAACP has filed a racial discrimination complaint on behalf of the Concord, California family of an African -American first grader who claims a classmate choked her with a jump rope while

saying this is how you hang people. Moussavel Turner says Almonte Elementary School officials exhibited sloppy reaction to the September attack on his six -year -old daughter, which he feels was racially motivated. The contract cost of times reports Turner said the classmate could have picked any child in the class instead of the one black kid to demonstrate how to hang a child. School officials say there was an investigation and one child was disciplined. The University of California's Board of Regents is expected to approve a big change in admission policies that would deemphasize grades and test scores. UC is one of the largest university systems in the country. The Los Angeles Times reports the new admissions policy would put greater weight on a prospective student's personal achievements. Critics say it's a way to bring back race -based preferences that were banned by California voters. Supporters say that under the current system, Abraham Lincoln will be Goberg and Albert Einstein would be rejected for admission. A show of support for the city, the NAACP, has announced it

will hold its annual Board of Directors meeting in New York next February. The Baltimore -based civil rights organization last held its annual meeting in New York in 1998. N .D .A .C. President and CEO Kwaesi M. Fumi says by moving back to New York, the city of our birth, the N .D .A .C .P honors the men, women and families touched by the terrorist destruction who are resolved to defend the ideals of a free and open society. M. Fumi added the N .D .A .C .P. stands united with the efforts to restore New York. Researchers at the Cleveland Clinic now say that thinking about a workout may be all you need. A three -year study shows that persons can think hard about flexing muscles and then contract them and the effect on the brain is the same as if you actually worked out. Theoretically, the middle workout could do the same for your body as a workout at the gym. Researchers say the technique can be helpful to stroke victims trying to regain control of paralyzed muscles. This is The News On Power Point. I'm Fonda Smith

and welcome back to Power Point. I'm Dr. Mary Harris and this is Journey to Wellness. If you're someone that thinks menopause is only about hot flashes, then this is the program for you. Consider the physical, emotional and spiritual aspects involved in this midlife health condition. Just because you're experiencing menopause doesn't mean you have to suffer, nor do the people who live and work with you have to suffer. You can navigate your way through midlife and still be comfortable. Our panel tonight is going to tell you about it. Joining Journey to Wellness, we have two outstanding women authors. They are authors of a book entitled Primetime, The African American Woman's Complete Guide to Midlife Health and Wellness.

I want to tell you that this book is terrific. We don't normally do book reviews, but when I saw this book, I thought this is something that we have got to let the women listeners in our audience know about. It is really wonderful. First, we have the former assistant surgeon general and current director of the Bureau of Primary Health Care, Health Resources and Services Administration, Dr. Marilyn Hughes -Gaston, and clinical psychologist and principal research analyst for the American Institutes for Research Dr. Gail Porter. They are the co -authors of the book. Also joining us, we have Dr. Andrea Price from New Jersey's Women Caring for Women. As always, we invite you to join in our conversation on our PowerPoint hotline number. That's 1 -800 -360 -1799. That's 1 -800 -360 -1799. Good evening to all of our guests and thank you for joining us this Thanksgiving weekend.

Good evening. Anything great for having us. Oh, listen to my pleasure. I'm so excited about this. I'm going to start out with the book authors and I guess I'll start with Dr. Gaston just to get somebody talking. What prompted you to write this book? Well, you know, there were a number of reasons. It really started about four years ago. It's taken us four years to get the book out. It's been out since May. Okay. We were asked to participate on a panel that Black Entertainment Television had, BET, here in Washington, DC. We're both from Washington. Okay. And the panel was about the Black Women in Midlife and on the panel was Sharon Pratt, Kelly, who you know was the previous mayor of DC. Yes. And also the movie stars name Pam Greer. Pam Greer. And then the two of us. And it was a wonderful exchange. Well, afterwards we were both just very surprised because we were delused with calls from all across the country with people

wanting more information. Men and women. Yeah. And we went out. We promised we'd find more information for them. We went out and of course we didn't find a lot in terms of African American women. And so it was clearly a void. And that's when we first decided we really needed to try to fill the void. But probably even more importantly, as you said, I'm a physician and Dr. Porter is a psychologist. And we have been looking at the disparities or the differences in our health outcomes as Black women when compared to white women for a long time. I started seeing them when I was in medical school. I've seen them throughout my whole career as assistant surgeon general in the public health service. And the not only are they very startling in terms of the fact that we are dying as Black women at rates that are greater than any other any other group of women in the nation from heart disease, from the cancers, from stroke, and from diabetes. Greater than white

women, greater than Hispanic women. We die at greater rates than Native American women and Asian American women. That's the bad news. So we wanted African American women to know that. But the good news is that we can do something about it that allows these deaths can be prevented. And there's things that we can do to take charge of our own health. And that's what we wanted to do with the book. And we wanted it to involve not only the physical health, but also our emotional health too. Now, can this be sort of like a midlife tune up, if you will? In fact, what we often talk about, this is Dr. Porter as an opportunity to make mid course corrections. Okay, mid course corrections. That's a good terminology. And what is that going to entail? Well, it entails really looking at all aspects of our lives. I mean, the physical and the emotional are very important. But we have a whole chapter devoted

to what we call the miracle of you to our spiritual selves. Okay. And that runs throughout the book because we truly believe that unless you take a holistic approach, a mind, body, spirit approach, and really spend time doing kind of an assessment so that you can start making the changes that need to be made, and also celebrating all that is going well in your life. I mean, we're concerned that frequently we don't stop to really appreciate how much we've accomplished, how many things are going well in our lives. So we see these middle years as an opportunity to do this kind of mid course checkup, make the corrections that are necessary because this is an ideal time to do that. But also to really just stop and look at where else do we want to go and where else do we want to go in

terms of our mind, our bodies, our spirits. I really like the fact that this is a holistic approach because so often when we hear a discussion about women in mid life, we focus primarily on the physical. They're having hot flashes, they're losing their hair, they're gaining weight. It's always the physical, very little is devoted to a holistic approach to this time in our lives. So I think that's something that really helps to set the book apart and it gives it a fresh and unique approach to how we're going to handle our lives during this time. Now one of the things I really, really like to know, I think we need to start there. When are you in mid life? What's mid life? Well, the literature, it talks about mid life in a number of different ways, but there's no question that I think the opinion is unanimous that mid life starts somewhere around 40. Yes, ladies, it does start at 40. That's the

time it starts. It also is just not only the year that it starts, but it's a frame of mind. It's a phase. It actually is almost a passage. In fact, Gail Sheehy, who has written a lot about passages, calls it the middle lessons and says that it's adolescence the second time around. Okay. So, indeed, we now know that it's such a transforming period in all of our lives. It's the time, as Dr. Porter said, when you begin to take stock, you begin to look at where you've been, where you're going, where you're headed. You now begin to prioritize a lot better. I'm sure that many of the listeners know that once you reach 40, you're a lot better able to say no and define your own boundaries in terms of what you're willing to do. So, it's a time of major transformation. It's a time when, and as I said, they compare it to adolescence in terms of

growth. All right. And so, we wanted to be ever present during this mid -life correction period as people were looking at their health and changing lifestyle behaviors, and that's what it's all about. And we wanted to provide some assistance in aid to our sisters that were trying to do that. All right. So, we're going to get busy and start dispensing some of that aid. And if you have calls for our guest, our telephone number is 1 -800 -360 -1799. That's 1 -800 -360 -1799. Okay. So, let's get right to it. Now, what kind of physical symptoms can we expect in menopause? Let's start there. Maybe Dr. Price would like to share those with us, and then we'll go to Dr. Porter, who can talk about some of the psychological changes that women begin to go through. Well, there are a myriad of changes that take place during the period of life known as menopause, and one thing to keep in mind is that menopause is not one specific time. It

is encompassing a period of years, and perimenopause can actually begin in the early 40s, and perimenopause is defined as the year surrounding menopause. Basically, what happens during that time is you may notice that your periods become increasingly irregular. You may not be ovulating as frequently, therefore your cycles may be heavier, they may be lighter, they may be more erratic. At the same time, many women begin experiencing the beginnings of hot flashes or vaginal trinus. They may all respond to the libido. The average age that menopause is complete is 50, and this is defined as not having periods for a period of six months, but as Dr. Huesgas pointed out, it is not just a time of physical change. It is also a time of change in relationships and the way

of relating to others as well. For example, many women during this time are experiencing children going off to college. The focus is put back on perhaps your marriage relationship as you're forced to deal with each other without children as a buffer. You are also forced to confront issues of aging parents, perhaps caring for parents. All these things are all part of the right of passage that I refer to as pregnant applause. Dr. Porta, do you want to add anything to this in terms of the psychological aspect of this period of our lives? Well, I think that the two issues that Dr. Price mentioned are certainly important for a number of women, but I also think that for African American women, probably some of the major stressors, we did focus groups and really talked to over 200 black women and what they said was that. There are those changes that start

taking place in terms of our bodies, where you aren't quite sure when you get up in the morning if everything is going to get up with you and that we start to look at even our physical appearance. It was surprising to us how many women said they looked in the mirror and they were surprised at what they saw in comparison to the images that they had held onto. Financial issues are a major problem for us as black women often, because we're far less apt to be married, more of us are single, either because we've never married or because of widowhood or divorce, and we certainly are more apt to be caretakers. As black women, we not only take care of our biological relatives,

but big hearts. There are a number of stressors that we encounter that can be a problem for women of other races, but don't seem to be as much of a problem, particularly when it comes to the financial peace and to the living alone peace. Women talk about this being and also our jobs. I mean that our jobs are often a major source of satisfaction for us, but for those of us who are in administrative positions, it can be very difficult trying to be the manager and again, you're in the middle, you've got your own bosses to take care of, but you've got subordinates. So this can be a time when there are multiple stressors, and in fact in the book, it's a workbook so women actually write at it, but we have what we have called the black

woman stress test that grew out of the comments that women made to us, and we also have a life event assessment so that women can really stop and look at the multiple stressors that are going on at this period and then start to prioritize what are those that I need to most focus on, and then of course we have strategies about what do you do, you know, because it's one thing to know it, but then the most important piece is once you have the information, what can you do with it? Now, you make a very good point about the book being a workbook for women, and I want to encourage our listening audience to call with your questions about Menopause 1 -800 -360 -1 -799 -1 -800 -360 -1 -799. The book is in seven different parts, and why did you

decide to pick those seven areas? Tell us what the seven areas are and briefly why you decided to focus on those seven areas. Well, the first part of the book is the first area is dealing with the time, that this really is our prime time, and that even though there are a lot of challenges that you just heard about in the last few minutes, there are a lot of opportunity. There's no question, and also a lot of how women feel as they begin to age is related to how they think about aging, and you know, we live in a society that is youth oriented. Exactly. And so for us to be aging, especially as women is very difficult, and so the first part of the book is about talking about prime time, also putting the statistics in there, we talk about the miracle of youth, also reframing your priorities, looking at your self -esteem because for us to begin to take care of ourselves better than what we're doing now,

we have to believe that we're worth it, and that we are a child of God, and that our bodies are temples of God, and that our self -esteem is very important in how we think and believe in ourselves. Also confronting anger and attitude that frequently we as black women might not be real assertive in certain areas, and then we're angry about the way that we're being treated, and that we're unable to deal with it as an example. But that is something that we think is very important. So the whole introduction to the book is trying to establish a mindset that is positive, and because that's what's going to build the foundation, life changes you decide to make. Then we move into putting self -care in action, and that is really emphasizing the power of prevention, because to change these statistics, we really have to move into a daily life of

health promotion and disease prevention, and it talks about that. What the what the checkup is about when you go to your health care provider, how to do that, how to develop your own prime time wellness plan, how to look at your own risk factors for various things, and then how to begin to change them. And she said there is a workbook so that each reader can determine their own risk factor for heart disease, their own risk for stroke, their own risk for stress and depression, for diabetes, and then once you see your risk factors, and then we give strategies on how you begin to reduce those risks. But then there's a part on all of the major killers for us as African -American women, as heart disease, cancer, stroke, and diabetes, how to deal with prevention of each one of those. There's a whole chapter on staying sane in a world that can seem insane, where stress and

worry and fear and anxiety and depression is dealt with. There's a whole chapter on coping, I mean, a whole part that deals with coping with midlife's passage, that's where we talk about menopause, but also midlife common concerns. For instance, one of the biggest ones we all have is we age as our memory. Are we really getting Alzheimer's? Right, a lot of people say that, they call it CRS, it's just yes. But when do you worry about it? When is it just a normal issue around stress? In fact, you got so many other things you're doing, you can't remember anything. Our whole issue with urgency in terms of urination that's a midlife common concern. And then a whole section on love is a midlife slender thing. Our sexual wellness is very important at this time, and this is a time when we've been to wonder, are we losing our disease? A lot of women are. A lot of the attractive as we used to be, and you know, all those things. Dr. Gaston, I'm going to have to ask you to hold your point.

We've got to go to a break, and when we come back, we'll answer some phone calls and you can continue to dispense good advice for us. We're, you're listening to PowerPoint's journey to wellness, we're going to take a quick break and we'll be right back. PowerPoint is funded in part by PowerPoint's Affiliate Station Consortium, KTSU -FM in Houston, WRVSFM in Elizabeth City, North Carolina, and Baltimore's WEAAFM, PowerPoint's Affiliate Station Consortium, committed to the continuation of quality public radio programming. And welcome back to PowerPoint as we continue to talk about

women's midlife health concerns. Tell us your thoughts. So call our PowerPoint hotline at 1 -800 -3601799. That's 1 -800 -3601799. And Dr. Gaston, you were sharing with us just the various chapters in the book, and then we're going to move from there to talk about some things that women can actually do to help them get through this period of life. But I think you had a few more chapters you wanted to tell us. Well, we end the book with an important chapter on navigating the health care system that gives advice in terms of, you know, it can be very difficult trying to get through our health care system, especially right now. And women in our focus groups told us they needed to know what to do. And so it talks about what to expect in terms of our relationship with our health care providers, the fact that we recommend having a team of providers. Do we need to change doctors at this point in our lives? Yes, when we give advice to on when that might

be advisable, that if the relationship is not working in your best interest, then it's time to change. But, you know, we give a number of suggestions on how to do that in a number of situations when that might be important. The whole point of this chapter is to help empower women to, again, feel like they have to be a full and participating partner in this relationship with your health care team. Now, you mentioned something that's very, very important because a lot of women don't consider themselves as partners in their health care. And a lot of women have male doctors. And regardless of the gender of the doctor many times be it male or female, the doctor gives the orders and the patient follows it. There's no discussion. And I'm just wondering since we're talking about a holistic approach to moving through midlife in the best possible way,

what, is there a team of doctors that women should pull together? We need a psychologist, we need a psychiatrist, do we need a good OBGYN? What would be the idea next? And we need someone at home to help us get all the work done at home. Yeah, and hopefully you have a good primary care provider that's coordinating all of that with you, that you also provide some coordination. So it's okay for us to ask for us, you know, I'm feeling stressed, is there a psychologist that you can refer me to that can help me through this? What, what would be the ideal mix in your opinion? The ideal mix is all those folks that you recommend it, you know, a good dentist. And our age, especially anybody that has diabetes, needs a good ophthalmologist, although if our age, whether we have diabetes or not, you need a good eye person to look in there because eye problems start as you age. You also need to have a pharmacist that

you're involved with over time because as you're aging, you're increasing in your medication probably. The medications that you're taking and somebody needs to help you follow that. We also talk about providers that are complimentary alternative medicine providers. So if women want to have a naturopath or an herbalist or an acupuncturist, a massage therapist, somebody that can help you with a Roma therapy, that kind of thing, those are very appropriate members of the team. One of the main points that we make, Mary, is that as you pull together a team, the team, all of the team need to know who the members are so that if you are using an herbologist or a naturopath, your internist or your family doctor or your OB -GYN provider needs to know that. And so does the naturopath need to know the other members of the team and you have to share with all of them when

you're on certain therapies that one might give you so that you're not on something that a naturopath has you on and the internist doesn't know about it and they're providing something else and then you have these conflicting medications. So it's real important, you know, we have to get over the hurdle that, you know, the data now show that a lot of women, especially, and we need more information about us as African -American women, but a lot of women are using alternative methods, but they don't tell anybody. And they go to their regular doctor and everything is a secret and that can be dangerous. And so we're trying to get women past that. The other thing that's so important in general, right? Yes, I'm sorry. Go ahead. Of having available to you, mental health professionals is that again, if we don't know and if we're not

comfortable talking about our emotional state and far too many of us as black people, but certainly as black women, we're much more comfortable talking about being angry and upset and tired than we are talking about feeling sad or down because we're strong black women and as strong black women, we're often not encouraged to believe that it's okay to feel sad. And so one of the things that we really stress in the book is that we have to recognize the differences in some of our signs as African -American women, we are more apt to talk about feeling angry, being tired, having these physical symptoms that don't get better even though we've had a thorough checkup than to describe the usual signs of depression. We're more apt to overeat when we get depressed or stressed than to stop eating.

We don't have that information when we go to our primary care person and we start describing how we're feeling. He or she might not recognize these as symptoms of depression because generally in medical schools, a different symptoms are taught. So it becomes very important for us as women in general, but as black women in particular, to realize and to recognize these different signs. So in every chapter, we list the common signs of everything from cardiovascular disease to depression, but we also, wherever possible, focus on some of the different signs that we need to know so that we're more prepared to be a full partner with our provider. Now, isn't it possible, though, that a lot of African -American women would spend more time

talking with their girlfriend rather than saying, you know, to a close friend, oh, I'm so depressed or I'm so upset, rather than seeking out a mental health professional? Oh, there's no question. And even with a girlfriend or a mom, we still might not be comfortable really using terms like I'm feeling depressed. We're still more apt to say upset, but the problem with that is while our girlfriend or our mom or our spouses or partners can be wonderful support systems, most of us would not think that our girlfriend or our husband or our partner or even our mama was the best person to treat our diabetes. Right. There is a certain level of depression or of anxiety or of even stress that we get to when we need to feel that we have the right and the responsibility

to get help from people who are trained to do it. We need to pray and we say that for everything, but that God has given us a brain so that we can both pray and talk to somebody who has, as his or her job, taken care of us. Okay. And so it becomes very important for us as as women who are so used to taking care of everybody else. And in fact, I've had patients whom I've said, now for this week, I want you to treat yourself like you would treat your daughter or your son and they come back and they say, Dr. Porter, it was scary. I found time to eat breakfast because I'd want my daughter to eat breakfast. I found time to exercise because that's what my mama to exercise. Right. So we have to start feeling comfortable doing for us what we would do for other people.

I think that's a really good advice because so often we are spending time taking care of everyone else and we do neglect ourselves. I'd like to ask Dr. Price, when you talk about women's midlife health conditions, we think about hormone replacement therapy and the whole issue of estrogen. Can you give us some information about that are common on whether or not this is a good thing for women or not? Overall, I think that estrogen replacement therapy can be a very good thing for women. However, each case has to be taken in an individual basis and while it may be the right solution for some women, it's definitely not the right solution for every woman. And just following up on what Dr. Gaston was talking about earlier as far as having a team approach, this is extremely important. One thing that I do want to bring up is that many times that we can be assertive with our loved

ones or our family that we may have assembled this wonderful team of doctors, but if we don't express our concerns and make sure that we are understood, it's all for not. Many times I find that my African -American patients are very reticent. They see the physician as an authority figure and they are very hesitant to ask questions or to make sure that their concerns are completely understood so that I just wanted to bring up how important it is that they do make sure that their questions are answered and they do make a special effort to express their concerns. Well, you mentioned the fact that hormone replacement therapy is not for everybody. What are some of the things that women can do if they're not interested in taking hormones? Well, first of all, if you have a history of breast cancer hormone replacement

therapy would definitely be contraindicated or perhaps you get a history of blood clots of the veins. However, there are many new approaches currently. There is a class of drugs right now, for example, that you can take to protect your bone density and bone health preventing osteoporosis but they do not stimulate breast or uterine tissue as estrogen might. So that would help protect against osteoporosis? Right. A lot of African -American women don't think they're prone to, is that right? That's right because most of the studies that have been done on osteoporosis have been done on Caucasian women and it was just assumed that since African American women start out with more bones than to begin with that we are not as prondiosteoporosis but this is completely untrue there. Now, if somebody's actually looked at it, they're finding that African -American women are much more prondiosteoporosis than they ever thought and we should be having bone density screening as we hit them in a puzzle years just as Caucasian

women and Asian women do. Okay. All right. But getting back to some of the things that women can do so they can take a drug that will help them with their bone health. Right. Anything else? What about the hot flashes? Well, as far as hot flashes are concerned, there's a lot in the news right now about herbal therapy or natural estrogen replacement therapy and herbal can be very, very beneficial as far as helping to control some of the menopausal symptoms. For example, black coaches, one that you may hear about a lot and there have been studies that show that this is actually effective. The danger comes in when we don't know the source of our herbals. There is no regulatory body for herbal medications so we must be very careful that we're actually getting from reputable companies so that we know that the active ingredient is there in the amounts that it's supposed to be in. The other issue is that no one really knows yet the

effect of many of these estrogen type herbal medications such as soy or yam on the uterine tissue. Does it make you more prone to uterine cancer? Does it have any effect on breast tissue? So although we do know that it's very effective in improving the symptoms of the cell, the jury is still out on safety. Okay. Now, are there some things? And I throw this question out to all of our panelists, are there some things that women can do to help to ease themselves into this midlife period to make the transition a lot smoother? What would you say? I'll start with you, Dr. Gaston, that top two things that women should do to ease themselves into this? Well, I think once again I go back always to the state of mind that it depends on how women are viewing aging, how they're looking at their life ahead and they see life

as full of opportunities rather than without just emphasizing on all of the challenges that it's going to, you know, sexual page had a wonderful quote. He says, you know, life is a matter of mind over matter. If you don't mind, it doesn't matter. That indeed, you know, it's how we look at this. And, you know, for instance, let me just add two, that the Asian -American women, especially the Chinese women, have very few problems with hot flashes in menopause. And in fact, the literature says they don't have a term for hot flashes. Well, right. Not only are they dying of high and soy, but again, their whole mentality in terms of aging is very different from ours. Which is? Well, you know, they respect the elderly. Aging is something of value. They focus more on

their elderly a lot of times than they do on the youth, but the older members of society are very valuable because of their wisdom and their experience and their age. And so, you know, the thought is that they really look at it very differently than we do. I think, you know, one of the top things is how do you look at it? And then the second thing again, it's just basic health that you're going to do. You're going to live a healthy life that's where you're exercising, where you're eating nutritiously, where you're sleeping, you're drinking water, you're de -stressing, you know, all those healthy things also impact on how you're going to get through the middle years in terms of menopause etc. You know, you raise a good point too when you speak about how your mindset going into this. I know that there have interviewed older models, women who were models when they were young, who

are now modeling for some of the publications as mature women. And one of the things they say is that you can see it in their face. There are a lot more at peace with themselves. But I think for a lot of women, it must be very difficult to come to terms with being at this time and you're like, when perhaps you're not looking your physical best and you're not feeling your physical best. How do you restructure that mindset so that you do feel positive when everything around you is saying you need to be thinner, younger, prettier, smarter, faster, and you're pretty much headed in the opposite direction. Well, I think this is Dr. Porter. It's very important to start early developing what we call habits of health and of course that involves habits of emotional health. And I think that it has to be done on a daily basis

as well as on planning long, short -term, long -term. One habit to develop in terms of just how you see yourself is to start early practicing, looking at a mirror every day and saying to yourself, I am beautiful. I am a child of God. I am loved and I am loving. Dr. Porter, I want you to hold that thought. We've got to take a break. We'll be back to you after break. For our audience, you're listening to a PowerPoint's Journey to Wellness and feel free to call us with your questions at 1 -800 -360 -1799. We'll be back in a moment. And welcome back to PowerPoint's Journey

to Wellness. We're talking about women's mid -life health care and we invite you to give us a call at 1 -800 -360 -1799. That's 1 -800 -360 -1799. And Dr. Porter, you were sharing with us before we went to break ways in which we could feel good about ourselves as we enter into this phase of life. So we need to look in the mirror and say, you are beautiful. And you're a child of God and that you are loved and loving. And the reason it's important that we start doing these things for ourselves is that it means that as we change and change is a part of living, we're not then a subject to what society thinks about us. I mean, what I look in the mirror today, the fact that I'm 56 instead of 26 is not for me a negative. I still see myself as a

beautiful, loving child of God. But if I depend on what a magazine or TV show says as to whether I'm beautiful or not, as a black woman in America, I might not have ever felt beautiful. So I think that that's first that every day we have to develop habits that affirm for us our basic beauty and goodness that are not dependent upon how many gray hairs we have or what society says. I think the other thing is that we do have to have skills that help us to negotiate with other people. We need to learn how to be assertive, not aggressive, not passive. And so one of the things we talk about in the book are ways that we can actually give an assessment of how assertive are we. Another thing is that we truly believe that we have to have purpose in life,

that we have to develop. If you don't like the job that you're on, get career counseling. If you are worried about money, get financial counseling, you know, buy the best health care that you can buy. But what if you don't have any money to buy the best health care you can buy? I mean that's good for people who have health insurance and who can pay. What about you may not, you know, a person may not be in that position. Well, let me just say this and I have said it before. I was on the faculty at Hopkins for five years and I had wonderful health benefits because I was on the faculty. Well, finally Hopkins decided to give it to give really good benefits for $20 or more a month more to all of its employees. I got my staff all the other staff and I said, okay, now $20 more cradle to

grave at Johns Hopkins best health care you can buy. A couple of my staff said, oh, Dr. Porter, I can't afford $20 more. I said, let me see your fingernails. I said, let me see your hair. I'm going to tell you as a black woman, I love the fact that as black women, our hair and our fingernails and our dress is so diverse. But what I'm saying to you is that I have found that we often make choices about money and how we spend it that don't reflect the fact that we truly believe that our health is the most important gift that God has given us. So we don't make it a priority like we should. I make it a priority. And of course there are there are some people who truly many people who are struggling, but there are health centers that they can go to. Yeah, let me jump in. I'm going to jump in on that too that for

people that are uninsured, Mary. Yes. There are more and more programs that are available for free that are excellent programs. And you know, the Bureau of Direction, we have over 3 ,000 health centers across the country and we will double them over the next five years. If we don't double, we'll get off a close to it. Sure. That are seeing all kinds of people, especially their design, to take care of poor people, to take care of people that do not have insurance at the same time they're taking care of pain and insured people so that they are available in everything. How do they find that doctor gay? What they need to do is call their state health department and ask for their primary care organization and they can find one that's within their vicinity so that they can they can find a quality place of health

care, even without insurance. So that again, the bottom line for us is that once you begin to prioritize your health first, you not only can find a way to get quality health care, but there are a lot of people helping you do that. Okay. So we need to make this a major priority right up there with hair nails and clothes. No, no, no, right. Before hair nails and clothes. Okay. All right. Then fine. Would you like to add anything to this doctor price in terms of the most important things you think a woman can do to help get herself through this period and prepare for this period? Yes, just relating to the first half of the show in the discussion on diabetes. Yes. The same one's true as far as women in midlife suffering disproportionately from the effects of disease that are preventable, treatable, if caught early with simple health screening practices such as pap smears, mammograms, bone density, exams.

It all has to do with putting yourself first. Once you feel that you're centered, that you're in the right place, that you're ready to do good things for yourself, then your health does become a priority. And there is no reason that we as black women still need to be dying of cervical cancer, that we still need to have a much higher mortality rate for breast cancer, for uterine cancer, or varying cancer, just about any disease that you can imagine. And a lot of these start to show up in midlife, right? Right. Right. And pap smears is a prime example. The majority of the women that I see with invasive cervical cancers are women that have not had a pap smear in three to five years. Simple screening tests very treatable in those early stages. The same goes for colon cancer, testing of the colon, for blood, or at your yearly GYN exam, mammograms, breast cancer. Okay. I want to

ask that we say the name of the book one more time, Dr. Porter. Well, it's called Pride Time, the African -American woman's complete guide to midlife health and wellness. And if I could just really restate. We have to say quickly. Okay. Please, please believe that we have a right and a responsibility to prioritize ourselves as women. And it doesn't mean that we're selfish. It just means that we are taking good care of ourselves and can role model that behavior to others. I want to suggest, I want to thank all of our guests, Dr. Price, Dr. Gaston, and Dr. Porter. This is a very, very important area. I'd love to have you guys back so that we can talk more about women's midlife health concerns. I hope you'll be able to come back and talk with us. We love that. Okay. You're very welcome. You've been listening to PowerPoint's Journey to

Wellness. Tune in next week with Carmen Burns. Thank you for listening. This is PowerPoint, a production of WCLK FM, a broadcast service of Clark Atlanta University.