Who’s afraid of the big Four-Oh? Not me. Men commonly mistake me for someone ten years younger (the single ones who are too desperate to notice the crows’ feet). I can easily keep up with my supercharged sled dog and pentathlon-running pals (just ask my chiropractor). My energy is abun . . . abun . . . (yawn) abundant. Honest.
It’s silly, really, how much weight those two little digits carry. Madonna is forty-one, for crying out loud. Barbie is forty. And nobody’s calling them invisible or over the hill—especially not Madonna.
On the other hand, I know that it’s not the years that matter, it’s the mileage, not to mention whether you’ve had regular maintenance and were built solid to begin with (the Volvo also turns forty this year).
Whatever road you’ve traveled, forty is probably a good age for a total health overhaul. It’s a time for taking stock of what you eat, how you live, how often you sweat, and how happy you are. It’s a time for determining what kind of future you want your body and soul to have. Age forty may be just the right age to make changes that will decide how healthy you’ll be at fifty—and ninety.
First of all, take stock
(and I don’t mean mutual funds)
If you haven’t had a complete physical in the past five years, buckle down and make the appointment. A lot of changes happen between ages thirty-five and forty. Possibly even the beginning of The Change, although if you’re at the tail end of the baby boom like me, you got tired of hearing about menopause before Jane Fonda stopped going for the burn and started going for Ted Turner.
Face up to your dread of the doctor, because doing so could save you money. For example, before you go out and buy a lot of supplements to ward off risks that you only think you may have, or charge into a new exercise plan, it’s an excellent idea to have baseline measurements taken. Such numbers can help you measure your progress; they may even prove that you’re healthier than you think. Heck, it could be that the only thing wrong with you is that you’re overdue for a tetanus booster.
Don’t give in to pressure. However, your doctor might also find something you were unaware of. High blood pressure, for example.
“High blood pressure is a silent killer, because it can be doing irreparable damage to your heart and blood vessels without showing any symptoms,” says Gay Israel, M.D., a cardiac specialist and director of the newly opened Human Performance Laboratory at Colorado State University. It’s not unheard of for people in their early forties to have elevated blood pressure.
Look at your lipids. Another test Israel recommends having done is a blood lipid profile, more commonly known as a cholesterol test. There are four numbers you’ll want to know.
• Your total cholesterol measurement, which should be 200 milligrams per deciliter (mg/dl) or less.
• Your triglyceride level, which should be 120 mg/dl or less.
• Your LDL, the “bad” cholesterol, which should be 130 mg/dl or less.
• Your HDL, the “good” cholesterol, which should be 35 mg/dl or more.
From two of those four numbers, there’s a ratio you’ll want to figure: Take your total cholesterol and divide it by your HDL. You want the result to be 4.5 or lower.
The blood lipid measurements provide a picture of your circulatory system’s health. HDL, the so-called good cholesterol, is the Roto-Rooter of the arteries, Israel says. He describes it as a big high-tech garbage truck taking lipids out of the blood vessels and into the liver where they can be broken down into compounds that can be excreted. LDL, on the other hand, is the broken-down jalopy of a garbage truck that spills hardened cholesterol around your blood vessels, narrowing them.
Triglyceride is simply fat stored in your cells. “If you can grab fat on your body anywhere, grab it,” Israel advises. “You’re grabbing triglycerides.”
If your numbers are higher than they should be, your new health plan should focus on bringing them down. “From national clinical trials, we know that every 1 percent reduction in total cholesterol yields a 2 percent reduction in the risk of heart attack and heart attack deaths,” Israel points out.
And if you think forty is too early to begin thinking about such a morbid topic, think again. Perhaps journalists are a bad sample—too sedentary, too stress-wracked—but two of my colleagues suffered heart attacks in their early forties. One of them died in the ambulance, leaving a widow and three young children.
While it’s true that heart-disease deaths among people forty to forty-four have dropped since the 1980s, “the number-one killer of men and women at any age is still heart disease,” Israel points out. “Currently one in twenty-eight women die from breast cancer. But one in two dies of heart disease.”
Other clues about aging
When you go in for that physical, you may want to consider having additional tests, especially if you are concerned about specific risk factors in your family history, or if you have other symptoms of aging that may signal a deficiency or other disorder.
Listen to your adrenal hormones. “One of the first systems that shows signs of aging is the adrenal gland,” explains Sheila Dunn-Merritt, a naturopathic doctor in Portland, Oregon. This gland puts out hormones that are key measures of aging: one of these hormones is cortisol.
“As we age, cortisol levels tend to increase. Cortisol is a very good indicator of the stress we’re carrying.” A saliva test, involving taking four samples at various points in the day, can tell you whether your body is shrugging off stress or suffering from it. The test is noninvasive and can be done at home, Dunn-Merritt says. Even better, there are a great many natural, inexpensive remedies that can help repair and tone the adrenal glands—solutions that herbal healers have known about for years.
Get the full-body picture. There are other tests you and your doctor may discuss, depending on your condition and your family health history—mammograms, prostate exams, and others. Whether you take such tests (and whether your health plan will cover them) may depend to a great degree on your doctor.
Dunn-Merritt suggests two in particular for women entering their forties. The first is a female hormone profile, another saliva test that may help determine whether you’re entering perimenopause or have other hormone imbalances. Dunn-Merritt also recommends a new, noninvasive bone scan called a Dexa scan, which measures bone density in the lower back and hip. If osteoporosis is a health concern for you, this particular test will allow you to check for bone loss as soon as you begin experiencing menopausal symptoms.
Test your doctor, too. Speaking of tests, forty is a good age at which to decide if you’re really comfortable with your primary health practitioner. Can you ask him or her questions? Do you get in-depth answers to help set your mind at ease? Do you feel you can find out what to do to maximize your health and prevent disease, instead of getting a cursory once-over to verify that you’re not currently sick? If the answer to any of these questions is no, it’s a sign that your search for better health in your forties must begin at the beginning: with a search for a reliable guide.
The closest thing to a cure-all
There is one important thing you can do while you’re looking for the right doctor. Are you sitting while you read this? Well, stand up. Walk. March in place, walk the dog, walk the stairs, walk on a treadmill. Health experts from pharmacists to aromatherapists agree: exercise, even moderate exercise, is the single best preventive step you can take.
“Of the ‘big six’ major risks for heart attack, sedentary lifestyle is number one,” Israel says. Smoking comes second, but all of the others—high blood pressure, high blood cholesterol, obesity, abdominal fat distribution, and Type II diabetes—can be improved or even removed by focusing on getting more exercise, he says.
“People know that we’re more sedentary than we used to be, but they have no idea how much more sedentary we are,” he says. “Even a gear-stick car without power steering forced us to use some muscles.” Becoming more physically active is the easiest way to raise HDL and lower LDL. And it will dramatically lower triglycerides.
Give yourself half an hour. Israel recommends trying to accumulate at least thirty minutes a day of physical activity. “Park as far from the door of the store as you can. Buy a lawnmower that you have to push.”
And give another. So if my hyperactive husky already takes me for a thirty-minute drag every day, I don’t have to change anything, right? Wrong. “Try to squeeze in another thirty minutes,” Israel says. Apparently even more health benefits accrue for those who can exercise for an hour a day, or bump their half-hour of moderate exercise to vigorous exercise (measured by how close they come to a preset heart rate). “That’s why at noon, whether I’m done here or not, I’m going to run for an hour,” he adds.
For women, making such exercise a lifelong habit carries an extra bonus. Before menopause, women tend to have much higher HDL than men. But after menopause, levels of this protective blood chemical drop, except in women who remain active or become active after menopause, Israel says.
But make it fun! Becoming active isn’t easy, Dunn-Merritt acknowledges. “We’ve made it so that exercise is another job; it’s work. We each have to find for ourselves ways to make it fun.” Your way won’t be the same as anyone else’s. It’s worth your while now to figure out whether you prefer exercising alone or with a group, at home or at a gym, and outdoors or inside. Enjoying your exercise is the key to making it a habit instead of a chore.
Garbage in, garbage out
For nearly forty years, I’ve been able to stay slim on the Journalist Junk Food Diet of whatever was handy and looked yummy. That is, until last December 17 at about 2:23 p.m.
At that moment, there was suddenly more Susan. I looked in the mirror and saw those night-shift dinners of Coca-Cola and Cheese Combos coming back to taunt me.
But perhaps they were really there, sapping my overall health, all along. Thin doesn’t necessarily mean healthy, the experts say. Although any given forty-year-old may not be technically overweight, it’s metabolic fitness that counts, not whether you’ve jumped a size in your favorite brand of blue jeans.
“It’s not about being a Vogue cover model or an elite athlete,” Israel says. “Metabolic fitness is about a positive blood lipid profile, the health of your arteries, your sensitivity to insulin, your health as opposed to your looks.”
However, if you are overweight, you’re not alone. In the 1990s, more than half of both men and women in their forties were overweight. Many of the experts interviewed for this story mentioned an obesity “epidemic.” It’s a problem for which exercise is part of the solution, but only a part.
Even if not all of us turning forty need to lose weight, we all need to eat better. So what’s a good way to start?
Fixate on good fats. First, says Nancy Brillault, a Tucson, Arizona-based herbalist and educator, ditch the junk foods that tend to be packed with empty carbohydrates, saturated fats, and trans-fatty acids, compounds that lurk in the hydrogenated oils used in processed food such as crackers and desserts. Boost healthful oils from cold-water fish, and add a tablespoon of flax oil a day.
Eliminate empty calories. Many doctors and nutritionists are urging people to rid their diets of as much white flour, sugar, and empty starches, including soda, crackers, pasta, and potatoes, as possible. Even trail mix turns to fat unless you’re actually on the trail burning its sugars—or you’re one of those very few people who have trouble keeping weight on.
Don’t skimp on protein. Cascade Anderson Geller, a Portland, Oregon-based herbalist, says many holistic practitioners are switching their focuses to making sure people get enough protein, even if they’re avoiding meat.
“A lot of the herbalists who were tight vegetarians have had to switch over to getting more animal protein,” Geller says.
It’s because their schedules have changed, not their ethics. It’s more difficult and time-consuming to prepare vegetarian meals that properly combine the right amino acids. Animal foods have these combinations built in.
Consuming enough protein, whether it comes from animal or vegetable sources, shows up in your overall health, Geller says. “When you look at people, the ones who eat a lot of fruits and vegetables and who get enough protein tend to have good skin and hair.”
For the purposes of this article, and to avoid having to buy new jeans, I tried cutting sugars and starches and adding more protein to my diet. Into the second week, I had not only lost a few pounds but felt my energy levels evening out across the day. My skin felt less dry, my moods more stable. But at the same time, I came face to face with the power of my own sugar habit. I had to lock a jar of chocolate-covered raisins in the garage.
It’s not uncommon to backslide on any new eating routine, Geller points out. “It won’t stick all the time. But if you can do four to five days a week for two or three months, you’ll make the jump” to better health.
Sure, you’re eating, but are you absorbing?
I have vivid memories of my best girlfriend and former housemate occasionally forgoing her usual breakfast of gingersnaps for prunes or oatmeal. “It’s a fiber thing,” she said. “You’ll discover it when you’re forty.”
And here I am, knocking at the door of the metabolic Discovery Zone. But natural healers have found that the body’s digestive machine undergoes changes at forty that are more complicated than just a general slowing down.
As a nation, “our digestion is shot to hell,” Brillault says. She finds that with her clients forty and over, “there’s a normal decline in hydrochloric acid production; we’re also usually looking at supplementing with digestive enzymes.”
Monitor acid levels. If you find yourself feeling bloated, burping, or passing gas after meals, it’s likely that such supplements can help, Brillault says. Hydrochloric acid, or HCL, is available without a prescription and should be taken ten to fifteen minutes before a meal. “If it burns, reduce the dose,” she says.
Get enzymes from plants. Brillault also suggests ginger and the enzymes papain, from papaya, and bromelain, from pineapple. “I like to use plant-based enzymes, because I think the animal-based ones tend to tell the pancreas that it can slack off.” You can also try to eat more fruits and vegetables. Some practitioners advocate only raw veggies, but Brillault believes that gently cooked ones—steamed or stir-fried, for example—work just as well. What’s important is that they’re fresh.
Learn to love bitter herbs. Some people may also benefit from bitters—preparations of bitter herbs that stimulate secretion of digestive fluids. Brillault prefers that her clients get bitters in food form.
“Try arugula and other spring greens. You can even grow them year-round with lights.” Eat bitter salads before your main meal for maximum benefit, she says.
Develop better listening skills. More than anything else, Brillault advises listening to your body and eating foods that are in tune with it and with the seasons. If you’ve spent the first half of your life ignoring those messages, you may need a nutritional practitioner’s help to uncover them.
The type you don’t want to be
I had an ulterior motive for experimenting with that low-carbohydrate diet. One of the health risks in my own family history is adult-onset diabetes, also known as diabetes mellitus, Type II diabetes, or non-insulin-dependent diabetes mellitus. My grandfather developed it when he retired from walking a mail-carrier’s route in Chicago and became a desk-riding Florida realtor. My grandmother had it, too, but her symptoms were so mild the family suspected that she was just keeping my grandfather company.
Israel’s research experiences shed new light on this family myth. My grandmother kept physically active. She swam, gardened, and chased after her grandchildren and her husband. Chicago-raised, she cooked a lot of Southern desserts for her Texas-bred husband, but she never ate much of them herself.
More exercise. Fewer carbohydrates. Milder Type II diabetes. My grandmother outlived her husband by ten years.
“Type II diabetes shows up first as what’s called hyperinsulinemia,” says naturopathic doctor Dunn-Merritt. “Americans eat so many refined carbohydrates that they tend to put on weight easily. They’re sensitive to blood sugar levels because of a diet that’s so high in sugar, much of which is hidden in food processing.”
Estimates of how many Americans have Type II diabetes vary. About 6 percent, or 7 million people age 45 or over, have been diagnosed. The Endocrine Society, a research organization of endocrinologists, estimates that another 6 percent have the disorder but are undiagnosed, and an additional 6 percent have prediabetic symptoms.
Don’t dismiss subtle symptoms. What’s so bad about Type II? It increases your risk for heart-attack death, first of all. It can also cause nerve and kidney damage, poor circulation, even blindness and stroke. It diminishes the body’s ability to heal from wounds or surgery. In short, it can radically reduce your quality of life in later years.
Right now, in your forties, you may be like the people showing up at Dunn-Merritt’s clinic with symptoms that they don’t necessarily connect to blood sugar.
“They’ll say, ‘Hi, I’m really tired. I get up tired and achy and at three o’clock I can’t keep it together. I feel exhausted and depressed.’ That could be so many things, but if a doctor prescribes an antidepressant for it, that can mask hyperinsulinemia.”
Consider testing. There are several ways of testing for early signs of blood sugar problems. One is called a fasting blood glucose level, done eight to twelve hours after a meal. Another is a saliva test for insulin resistance. A third is to present your health-care provider with a complete family history and an analysis of your diet for a week.
“Low-fat fad diets have thrown a lot of people’s metabolic systems off,” says Dunn-Merritt. “Sometimes we just look at what people eat and make changes for two weeks and see what happens with their symptoms. But testing is best, because then you have something very objective to measure by.”
Let’s face it: At forty you’re not going to get much reprieve from the breakneck pace of life.
Support yourself with supplements. To improve blood sugar for those who are changing their diets, Dunn-Merritt recommends considering chromium picolinate, B-complex vitamins, and magnesium as supplements. She also advises licorice to help the body adjust to new food routines. Adding fiber to your diet helps prevent the constipation that eating more protein can cause; psyllium is a good source.
Don’t let your genes win. Israel, whose father had Type II diabetes, says it’s important to know that a family history of the disorder doesn’t mean that it’s an inevitable part of your future. “Whether or not I have that gene, I can suppress it by remaining at my appropriate weight and staying physically active. I think there’s incredible data to back that up.”
When waking up is hard to do
Ever spend the entire workday waiting for the caffeine to kick in? Well, I’ve got bad news. After forty, the energy cavalry probably isn’t going to come to your rescue anymore.
“Maintaining energy is always at the top when people list their major problems with a midlife transition,” says John Maynard, founder of SPIRE Health Consultants, a firm that counsels individuals and companies about midlife issues. “Metabolism definitely slows at midlife.”
Like the digestive system, the body’s adrenal system and endocrine glands start to show some wear and tear at forty, some of it normal, some of it influenced by each individual’s reactions to stress and reliance on stimulants, such as that morning double-espresso latte.
Susan Taylor, Ph.D, an Ayurvedic teacher at Naropa University, addresses this energy slump with breathwork, movement, and nutrition. “I talk about building a foundation for vital energy. When you hit forty, or even earlier, suddenly you can’t pull all-nighters. What’s happening is, your system has developed too many leaks. So we talk about how to build anew the foundation, seal the leaks, and maintain the flow of energy.”
Because let’s face it: At forty, you’re not going to get much reprieve from the breakneck pace of life. Stress itself—caused by work, family, traffic, injuries, children, divorce, remarriage—is not going to go away.
Many midlifers are in a triple bind, Maynard says. “Suddenly they have injuries, their children are still dependent on them, and their parents become dependent.”
All you can do is change your response.
Make relaxation routine. That, says Taylor, often means scheduling regular stress relief, whether it’s meditation, a new hobby, a movement class, or a habit of affirmations. “Identify the habits you want to create,” Taylor says, “not the old habits that you want to change. Focus on nutrition of the mind as well as nutrition of the body.”
Cut way back on the stimulants. Taylor suggests switching from black tea to kukicha twig tea, which according to Ayurvedic principles is more harmonizing than stimulating. Brillault urges coffee drinkers to try yerba mate, a South American herbal beverage that contains less caffeine than coffee but also packs vitamins and adaptogenic compounds.
The wisdom thing
Remember all those people who told you life begins at forty? They lie.
At least, they do when the subject is physical aging. “Heck, after age twenty-five, everything deteriorates,” admits Herb Pharm founder Ed Smith.
“No matter what you do,” Geller says, “you’re not going to be young again. It takes you longer to get over things.”
Ask yourself this question as you blow out those forty candles: Do you really want to erase the first half of your life? I thought not. Whatever abuse you’ve heaped on your health, you probably have done something good for yourself as well, whether it’s a daily walk, quitting cigarettes, or creating and enjoying a nurturing family. That’s worth building on, not assigning to the personal-health scrap heap.
“The body mirrors the habitual,” Geller says. “What you see in the mirror is what you do on a daily, regular basis. Herbs are great, but what really tows the line against aging is food, lifestyle, and love.”
Susan Clotfelter edits herb books for Interweave Press. She turned thirty-nine, quit sugar, and joined an exercise class while writing this article.