You don't want to get weaker as you grow older. But it happens. One day you're strong and vital. Then suddenly it's difficult to get out of a chair or walk up stairs. If you want to be strong in your later years, you need to begin today to strengthen your body.

When most people think about staying strong, they think about weight training. While I'm a big fan of weight training and exercise, I've found a key to avoiding frailty that goes beyond exercise. And it works regardless of your age. The secret is to have enough of certain nutrients.

Not many people know this, but particular nutrients can help you get and remain strong and vital. They're key to staying strong. Don't wait. The time to evaluate your need for them is now.

This may surprise you. Frailty comes in many shapes and sizes. It doesn't just hit those who are thin and wispy.

Take Sandy, for instance. She's in her 60s, overweight, and doesn't look frail at all. But she is. She meets four out of the five criteria for frailty syndrome: weakness, walking slowly, feeling exhausted, having a low level of activity, and unintentional weight loss. Sandy has all of these frailty markers except the weight loss. If she doesn't make any changes, she's likely to wind up with poor balance, brittle bones, and weak muscles.

Frailty is a common result of aging. In fact, 30% of people 80 years old or older are frail. So are a surprising number of younger adults. All have three or more out of the five frailty symptoms.

Low hormones and low immunity contribute to frailty as we get older. But low levels of some nutrients can cause weakness at any age. Begin today by evaluating these nutrients in your diet and supplements. If they are low, boost their levels, especially if you're already frail or feeling weak.

"Balance" begins with a "D"

Vitamin D: Along with its many benefits, vitamin D improves your balance. This reduces your risk for falls and broken bones. It also makes you stronger. In one study of adults over 60, those with low vitamin D levels (serum 25-hydroxyvitamin D below 60 nmol/L) took longer to get up out of a chair, and walked more slowly than those with the highest levels.

Some researchers say that 90% of older adults are deficient in vitamin D. Even those who live in sunny places. I agree. Many people don't go outdoors enough to absorb sufficient vitamin D from the sun. And we've been told for years to slather ourselves with sunscreen before stepping outside — even on cloudy days. But using a lot of sunscreen guarantees you'll be low in vitamin D. And more likely to be frail.

In a study out of Johns Hopkins, vitamin D was significantly lower in older frail women. Another study of 1,300 adults found that higher amounts of D meant better performance in a number of neuromuscular activities.

The researchers of another study found similar results. When they gave several hundred healthy older adults 800 IU of vitamin D along with calcium, their posture improved and their thigh muscles became stronger.

There's more. Studies found that 800 IU of vitamin D a day taken for three years could reduce broken bones by 32% to 68%.

Most dietary sources of vitamin D are oily fish and cod liver oil, or fortified foods. Cod liver oil contains too much vitamin A, and fortified foods (like milk), don't contain enough vitamin D to raise your levels. I take and suggest 5,000 IU of vitamin D a day for people over 60, and 1,000 IU daily for other adults. It's safe and inexpensive.

Sweet potatoes and carrots hold the answer

Carotenoids are antioxidants found in vitamin A. People with low levels of carotenoids walk slowly and have less knee, hip, and grip strength. The Johns Hopkins study found that frail women tended to have two or more deficiencies of these nutrients: carotenoids, vitamin E, vitamin D, and vitamin B6. The lower their concentrations, the weaker they were.

The carotenoids that most affect frailty are beta-carotene, lutein, zeaxanthin, and total carotenoids. You can get many of them from a diet high in fresh fruits and vegetables, and boost your levels with a good multivitamin.

While spinach and kale contain carotenoids, they're present in high amounts in carrots (hence, their name), sweet potatoes, and tomatoes. These nutrients are found in red, yellow, and orange fruits and vegetables. If you're not eating a lot of these foods regularly you may want to take a supplement made from spirulina, chlorella, or barley grass.

This may be the only hormone you need

DHEA (Dehydroepiandrosterone) is a hormone that helps your body make estrogen and testosterone. Like all hormones, your body produces less as you age. DHEA is one of the safest hormones you can take. It could be all you need. Among its many benefits, DHEA is associated with muscle strength and mass.

A simple blood test, DHEA-Sulfate, can tell your doctor whether or not you need DHEA, and how much. Normal levels for women are 130 mg/dL.

One study found a significant correlation between women taking DHEA supplements and increased bone density. In addition, the Woman's Health and Aging Study found that very high or very low levels of DHEA correspond with higher death rates. Women with the lowest levels died of heart disease. Those with the highest levels died of cancer. This is a case right out of the Three Little Bears. You want your DHEA level to be "just right."

You can buy DHEA in health food stores, but don't. I've found many of them contain much less hormone than they list on their labels. Take the smallest amount needed to normalize your levels. Work with your doctor, nurse practitioner, or other skilled health care provider to evaluate your levels and get the best quality DHEA you can.

Get enough "muscle food"

Amino acids and protein. Exercise won't build strong muscles unless you're eating enough protein. Protein is made from amino acids, and you need the full range of "essential" amino acids to build muscle. Animal products contain complete proteins, but most vegetable sources need include a combination of beans and grains.

Few people eat enough protein — especially if they grab a muffin for breakfast and a salad for lunch. Or if they are older women with small appetites. You can either take amino acid supplements, which are expensive, or increase your intake of protein. Aim for 20 grams per meal.

For more information on protein, see my latest book, The Health Detective's 456 Most Powerful Healing Secrets (800-728-2288). I include all the information you need to get plenty of protein.

Getting enough protein and doing resistance exercises 3-5 times a week will protect you from becoming frail later on. If you're already older, start today to increase both your exercising and protein.

Sandy did. She had a nutritional workup and found she needed DHEA. She also needed to eat much more protein. Sandy made these small changes. Then she got smart and found a friend to join her for weekly strength training sessions at her local gym. She and her friend began doing more exercises at home with light weights, as well. It took a little discipline, but Sandy is determined to be active as long as she can. I am, too. And I hope I can encourage you to take the next step toward vitality, and away from frailty.

Cherniack, E.P., et al. "Emerging therapies to treat frailty syndrome in the elderly," Alt Med Rev, September 2007.

Michelon, E, et al. "Vitamin and carotenoid status in older women: associations with the frailty syndrome," J Gerontol A Biol Sci Med Sci, June 2006.

New England Journal of Medicine, 2006.

Parise, G. and K.E. Yarasheski. "The utility of resistance exercise training and amino acid supplementation for reversing age-associated decrements in muscle protein mass and function," Curr Opin Clin Nutr Metab Care, November 2000.

Where to find it: Vitamin D3, 5,000 IU Advanced Bionutritionals (800-728-2288)

How to Avoid the Side Effects of Common Painkillers

You may think that because some painkillers are available without a prescription, they're safe. Well, they're not. Whether obtained by prescription or over-the-counter, these drugs can be dangerous. I've told you in the past about the gastrointestinal complications they can cause, sometimes without warning.

These complications are very serious. NSAIDs send more than 100,000 people in this country to the hospital each year. Between 15,000 and 20,000 of them die annually from ulcers and stomach bleeding. And not surprisingly, older patients are in the highest risk for gastrointestinal bleeding.

Because of these huge numbers, a group of doctors recently came up with a way to avoid these side effects.

The doctors took a long hard look at the cost for hospitalizing patients with NSAID-related bleeding. (NSAIDs – non-steroidal anti-inflammatory drugs – include aspirin, ibuprofen, Motrin, Aleve, Celebrex, and Vioxx). They came up with a solution that would greatly reduce the number of hospitalizations. This solution saves insurance companies money (at least in the short term). But I'm not impressed. Their "solution" does all this at the expense of your health.

Doctors are suggesting that you take yet another drug to treat the side effects from NSAIDs. Less bleeding and ulcers equals fewer hospitalizations.

They want you to take drugs called PPIs (proton pump inhibitors). But these drugs have side effects of their own!

Simply speaking, PPIs are antacids. They prevent irritation from NSAIDs by inhibiting the secretion of stomach acid. These medications include Nexium, Prilosec, Advil, and Aleve — drugs commonly prescribed for acid reflux and indigestion. PPIs are the strongest inhibitors of acid secretion you can find. That's what makes them so dangerous — as well as effective.

You see, long-lasting antacids prevent the absorption and utilization of calcium, magnesium, protein, iron, and other nutrients. That's not all.

A study published in the New England Journal of Medicine discovered that you need stomach acid to utilize the thyroid medication thyroxine. So while PPIs may reduce your bleeding from NSAIDs, you can end up being deficient in important nutrients and create other health problems. My advice is, don't take PPIs — unless you're well informed, have tried other safer solutions, and are convinced they're your best course of action.

So, just what are your options? After all, NSAIDs do reduce inflammation, and inflammation is both painful and at the root of most chronic diseases. In fact, a recent study out of Kaiser Permanente in Oakland, California, found that breast cancer patients who took ibuprofen or other NSAIDs three times a week or more had a statistically significant decreased risk of having a recurrence (cancer is an inflammatory disease).

But there are other ways of accomplishing this — without any nasty side effects.

Safe ways to avoid the cascading side effects from drugs:

Use painkillers sparingly. Side effects occur most often in people who take NSAIDs throughout the day, every day. An occasional analgesic for a headache won't give you an ulcer or cause bleeding unless you're particularly sensitive.

Tell your doctor or pharmacist which medications and supplements you take and how much. This includes over-the-counter pain medications. One-out-of-five people under-report their use of NSAIDs. They don't think that commonly used medications are important enough to mention, especially if they weren't prescribed. Your doctor can't help you if he or she doesn't know what you're taking. Make sure you're not at risk for any dangerous drug-drug or drug-nutrient interactions.

Reduce your consumption of sugar, trans fats, animal fats, and refined grains. All of them promote inflammation. Boost your intake of fish, fish oils, or flax oil. These omega-3 fats fight inflammation — and its pain. Bottom line: eat a healthful diet with plenty of fresh vegetables, fruit, whole grains, and fish.

Try taking natural anti-inflammatory nutrients for pain. These include ginger, turmeric, and holy basil. I've found two formulas containing these and other natural ingredients that successfully reduce pain from inflammation: Zyflamend (found in many health food stores) and InflaThera (ProThera – 888-488-2488). InflaThera is nearly twice as potent and half as expensive as Zyflamend. The folks at ProThera say you can double
the recommended dose, if needed.

For more information on alternatives to NSAIDs, check out my many past articles on the subject on my website. And pick up Carol Simontacchi's excellent and inexpensive little book, Natural Alternatives to Vioxx, Celebrex, & Other Anti-Inflammatory Prescription Drugs (Square One, 2005, $5.95). It's packed with good suggestions and is small enough to slip into your purse.

Centanni, M., MD, et al. "Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis," NEJM, April 27, 2006.

Kwan, M.L., et al. "NSAIDs and breast cancer recurrence in a prospective cohort study," Cancer Causes Control, August 2007.

"Risks and health-care costs of common pain killers underestimated," Annual Scientific Meeting of the American College of Gastroenterology," October 2007.

A Reasonable Approach to Your Health Problems

Several years ago, I was talking to a doctor of integrative medicine who was extolling the benefits of a particular Chinese herbal formula. I knew that some Chinese herbs were tainted. In fact, some formulas contain prescription drugs illegally. And most are not listed on their labels.

So I asked this doctor, "How do you know it's safe?" His answer shocked me: "Because their sales representative said it was."

This wasn't a reasonable answer. "Because every batch is tested by a top laboratory to ensure its purity" is the kind of answer I was looking for.

When it comes to your health, it's important to have reasonable expectations and answers. It's reasonable to ask for an analysis of a product conducted by an independent laboratory to ensure its safety. It's not reasonable to trust your health to someone with a vested interest in selling you a product. And it's definitely not reasonable to believe anyone whose claims are not backed by science.

It's not reasonable for you to spend your time and money on hype or half-truths. Or on recommendations for products based solely on anecdotes from companies that sell them. You deserve the best, most reasonable information currently available. Good, sound, scientific studies, preferably conducted on humans (and preferably on women). That's what you'll find in all of my newsletters and books. If the information is not based on good science, you won't find it here.

Take a reasonable approach in all aspects of your health. For instance:

It's reasonable for you to ask your health team to give you copies of studies to back up their treatment recommendations. And to explain them to you if necessary. You should feel comfortable taking the medications and supplements they suggest, not just take something because the doctor says to. After all, the doctor might be listening to a drug-company rep for his information.

It's reasonable to ask your doctor to give you enough time to answer your questions without feeling rushed. You need to understand and agree with your treatment plan. When you make your next appointment, explain that you have questions. Write them down. Keep your questions simple and to the point, and don't leave until you feel comfortable with the answers.

It's reasonable to ask for a yearly review of all of your drugs and supplements to make sure there are no negative interactions. There may be more recent information on their safety, your health may have changed, and you may need fewer, or different, drugs and vitamins. If your doctor doesn't help you, ask your pharmacist.

It's reasonable for you to participate fully in your health program. You can't expect a positive outcome if you don't eat foods that support your health and get regular exercise. The proper exercise for your condition, done four or five times a week, will result in better heart and lung function, better balance, and strong enough arms and legs for you to remain mobile at any age. Insufficient exercise, like strolling through the mall once a week, won't do much at all. Don't fool yourself.

Bottom line: Both conventional and integrative medicine have become more and more complex. And doctors have less time than ever to spend with us. To get the best results from your doctor and your treatment, you need to be pro-active ... and reasonable.

"Adverse drug events reported to FDA appear to have increased markedly," Archives of Internal Medicine, September 10, 2007.

Health Detective

Why You Must Take Vitamin B6 if You Have Arthritis

You may know that you need vitamin B6 to ward off depression. But did you know you need to take vitamin B6 if you have a chronic illness?

While any chronic illness is enough to depress you, there's a more important reason to take the vitamin.

A recent study found that the inflammation accompanying rheumatoid arthritis (RA) depletes vitamin B6. The researchers in the study followed B6 levels in both animals and humans. They found that vitamin B6 (pyridoxal 5-phosphate) is significantly lower in people and animals with rheumatoid arthritis. More than 50% lower, in fact.

It's not because the arthritis is causing your body to excrete the vitamin at a faster rate. It's not. Nor is the deficiency due to a lower dietary intake. What we think is happening is that your body is using co-factors of vitamin B6 to meet the increased demands caused by inflammation in certain tissues. This includes your muscle tissues where B6 is usually stored.

The study has much wider implications, as I'm sure you can see for yourself. If inflammation in RA causes a vitamin B6 deficiency, the same mechanism most likely affects other inflammatory diseases. And the pain that accompanies them.

I've explained before that inflammation is at the root cause of numerous chronic illnesses. Insufficient B6 can lead to a weak immune system, irritability, weakness, and depression.

So, what should you do if you have RA or another inflammatory illness? Make sure you're getting a lot of B6 in your diet from eggs, fish, brewer's yeast, beans of all kinds, and walnuts.

Take a multivitamin with 100 mg of B6. Years ago, researchers reported toxicity in some people who took 200 mg or more of vitamin B6 a day, but not in anyone who supplemented with the entire vitamin B complex. So, don't take B6 alone. For more information on inflammation, see my past articles, available on my website.

En-Pei Chiang, et al. "Inflammation causes tissue-specific depletion of vitamin B6," Arthritis Research & Therapy, 2005.

Rare Lung Disease Found in People With Blood Transfusions From Women

If you ever need a blood transfusion, don't ask your best friend, especially if she's ever had children. Instead, ask her husband. Or any male.

There's a newly detected injury to the lungs called TRALI (transfusion-related acute lung injury) that seems to be caused by immune cells in women who have been pregnant. And while TRALI strikes only a few hundred people each year, some of them die from it, gasping for breath.

These immune cells don't harm a pregnant woman or her fetus. In fact, the only time they cause a problem is when the person receiving a transfusion has white blood cells that recognize and fight with the donor's antibodies. While this is rare, it happens.

The immune cells that cause the lung problems appear to have a strong affinity for plasma. In fact, 60% of TRALI fatalities were a result of plasma transfusions.

Three years ago, doctors in Great Britain decided to separate male from female plasma for transfusions. Plasma from men was used in transfusions, while plasma from women went into the manufacture of clotting factors or immune globulin. No plasma was discarded.

The result was amazing. Cases of TRALI dropped significantly.

Now blood banks in this country are using more male-donated plasma for transfusions. But not all of them are. If you or someone you know needs a blood transfusion, be sure to ask for plasma donated by a man. Or by a woman who hasn't had children.

If you're a woman with children who donates blood, don't stop. Yours is needed as much as ever. Perhaps just not for plasma transfusions.

Neergaard, L. Associated Press, January 23, 2007.

Ask Dr. Nan

Q: I'm confused about blood test levels. The numbers you quote are different from the ones my doctor and the laboratory show. I'd like to know the optimal levels for blood tests, and which tests I should ask my doctor to order. — S., Bend, OR

A: First, let me explain why there's a difference in blood test norms. The normal levels given by laboratories are old numbers that were initially based on illness, not wellness.

In effect, they're saying, "When your blood level for a test is above or below these norms, it means there's a disease process we can identify and name."

But many of us don't want to wait until we're sick. We'd like to know when we're heading toward illness so we can prevent it. When you're looking for optimal health, you'll find the norms are narrower than those shown on laboratory report forms.

There's an excellent book on this subject, Normal Blood Test Scores Aren't Good Enough, by Ellen Cullen, RN (YFH Press, 2004, $13.95). It explains each blood test in detail including the reasons for abnormalities. It also gives a list of blood tests to get if you have or think you're getting a specific illness. It's an excellent book to help you understand blood tests, and to show to your doctor.

Optimal health takes a lot of work. But at least with the information in this book, you can know in which direction you're heading, and whether or not you're improving.

Q: Are power drinks like Red Bull helpful or harmful? – R.S., San Luis Obisipo, CA

A: Mostly, they're harmful. Red Bull and other energy soft drinks including Jolt, Mountain Dew, Coke, Pepsi, and the like are filled with sugar and caffeine. Red Bull just happens to have the most caffeine: 80 mg in one can. This is twice as much as you'll get in a can of Coke.

What makes Red Bull different from Coke and the like is a smattering of vitamins and a full 1,000 mg of taurine. Taurine is an amino acid that prevents weight gain. It also improves physical workouts by reducing muscle fatigue and allowing people to push themselves harder.

Interestingly, although it's a major ingredient in energy drinks, no one has ever shown that taurine increases energy.

One study of energy drinks found that Red Bull and others could raise blood pressure and heart rates. They're safe only for very healthy people. In fact, the ingredients in Red Bull could reduce the effectiveness of some medications. If you're taking any drugs, ask your pharmacist if it's safe to mix them with any of these beverages.

If you need more energy, start looking at why yours is low. Then address your specific nutritional and lifestyle needs.

You may be tired because your body is trying to repair itself. If you've been stressed, consider taking pantothenic acid (250 mg three times a day) for a few days. This B vitamin can give support to your adrenal glands and help you feel better.

Next, consider a little caffeine. Not as much as you'll find in a cup of coffee, but the amount in a cup of green or black tea. Just enough to feel a little better. When you have a little more energy, remember to conserve it. Don't spend it all in one place and exhaust yourself.

Just avoid the energy drinks that tend to be high in caffeine and sugar. They may make you feel better temporarily, but eventually you'll crash. www.reuters.com/article/domesticNews/idUSN063794320071106.