Understanding Menopause and Hot Flashes

Flickr/Ryk Neethling

Flickr/Ryk Neethling

Menopause is defined as one year without a period. However, menopausal symptoms can begin to develop 5 to 15 years before the onset of menopause. This is called perimenopause. During this time your estrogen levels begin to decrease. This lack of estrogen creates a constellation of signs and symptoms including hot flashes, vaginal dryness, mood swings, libido changes, sleep disturbances and more.

One of the most troubling symptoms of menopause or perimenopause is hot flashes. Hot flashes are a sudden sensation of intense heat, which causes the face, neck, or upper body to become flushed and sweaty. A hot flash can last 30 seconds to 5 minutes. A hot flash during the night often requires that you change your night clothes as they are all wet.

How do we treat these debilitating symptoms? There are 3 options: Do nothing and live with them, treat them with prescription medications, or treat them with herbal preparations.

Pharmacologic or prescription medicine for the management of hot flashes consists of hormonal and non-hormonal options. The hormonal option is estrogen and it can be taken as a pill, a patch or a cream. This is successful in relieving 99% of hot flashes. It is the most effective treatment. Its major disadvantage is that it may cause blood clots, or increase your risk of certain cancers, including breast cancer. It is generally a safe option for the first 5 years following menopause.

The most common non-hormonal treatment for control of hot flashes is antidepressants. These medications can decrease the number of hot flashes by approximately 80% and they are well tolerated. Their major side effect is loss of libido. These are other prescription medications such as blood pressure pills, migraine medications, and antihistamines, which have small success rates.

For patients who prefer a natural alternative, there are multiple herbal preparations, which can decrease hot flashes. The Chinese herbs like Black Cohosh and Dong Quai have been studied the most. While the data is conflicting, there still is a large body of evidence, which suggest that these herbs may improve hot flashes. Isoflavones and soy are plant-derived substances called phytoestrogens. These herbs appear to “mimic” estrogen and appear to reduce hot flashes. There are multiple studies showing improvement of hot flashes and other menopausal symptoms while taking soy isoflavones. Other herbal products, which seem to help include yams and red clover.

The ultimate decision on the correct treatment varies from woman to woman. It is important that you discuss the side effects, the risks and the benefits of each class of treatment and decide the best treatment for you. There are many health professionals and knowledgeable people who can help guide you through this process.

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-Dr. Robert Feldman M.D. – Obstetrics and Gynecology


The Truth About Gluten

Flickr/Slacker Mark

Flickr/Slacker Mark

It seems that the most popular thing these days is something called gluten allergy. It is the hottest thing on the lips of everyone from health gurus to nutritionists to fitness junkies, but what does that actually mean? And is it really worth all the hype? Celiac disease, or its more scientific name – Gluten intolerance – is in reality a very uncommon disease that stems from gastrointestinal inflammation and inability to digest gluten – a common nutrient in most breads, pastries, pasta and anything made from wheat. Unfortunately humanity has perfected its skills at whipping up amazingly delectable goodies in all forms and shapes that involve ground wheat grains and a bit of sugar and yeast… Hence, it is everywhere!

Luckily, as I stated before – real gluten intolerance is truly rare. Symptoms range from bloating, to headaches, weight loss and nausea/diarrhea, skin rash is commonly seen, joint pain and swelling may occur, and patients generally feel sick. The only way to truly diagnose this condition is by upper endoscopy and mucosal biopsy, but there are a few blood test that may be helpful in the diagnosis. Treatment of the condition involves complete avoidance of all gluten intake – a real challenge as it is in everything we consume. The kicker here however, is the evolution of a concept known as gluten sensitivity (not intolerance as in true celiac disease). It is a condition that is marked by milder symptoms than in true celiac disease, and is typically more challenging to diagnose due to frequent absence of positive blood results and uncertain results on mucosal biopsy of the intestinal tract. Never the less – patients feel uncomfortable and it effects their quality of life. Some report general discomfort after consuming high gluten foods (here comes the pastry reference again), while others may suffer from headaches and skin lesions. Some child psychologists even feel that it may contribute to ADHD… It is still very much an evolving concept and we are not quite sure of the full ramifications of this condition. So if you feel that breads, pastas, baked good are making you feel sick or bloated it may be worth your time to avoid all wheat products for a month to see if you feel any better – just don’t expect it to be easy!

For more daily health enhancing tips please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition

-Dr. Olga Kromo M.D – Rheumatologist

The Health Benefits of Black Pepper

Flickr/Brandon Grasley

Flickr/Brandon Grasley

One of the most popular spices, black pepper, has often been misunderstood as the pauper of the spice world.  An equal opportunity culinary player, paper packaged for fast food consumption and freshly grounded in haute cuisine, as it turns out it not only spices but also heals.

Is it possible to consider a spice as medicine? Different cultures have used their native plants for their botanical pharmacological healing properties for millennia. Ancient Indian Ayurvedic tradition has used Piper nigrum for centuries particularly to help with upper respiratory infections, improve breathing, help with cardiac health, gastrointestinal issues and diabetes.

Modern medical research findings seems to align with these findings, as some research has shown that a water extract of black pepper has potential immune-modulating and anti-tumor activities in vitro and other studies showed that an oil extract of black pepper had strong antioxidant effects.

Include pepper in your next culinary adventure and it will not only invigorate your taste buds but possibly benefit your health!

-Dr. Jackie Miodownik-Aisenberg M.D. PhD – Internist

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What is the Human Microbiome Project?

Image/Data Analysis and Coordination Center (DACC) for the National Institutes of Health (NIH)

Image/Data Analysis and Coordination Center (DACC) for the National Institutes of Health (NIH)

The NIH has spent over 100 million dollars on The Microbiome Project which is a study to evaluate how healthy and unhealthy humans interact with micro-bacteria. The 5 anatomical areas that interact both positively and negatively with bacteria include the skin, gastrointestinal tract, mouth, vagina, and respiratory tract. The project will study the genetic make up of the bacteria that make up the Microbiome.

The ultimate goal will be to determine how the interaction between the bacteria and host  can effect an individual’s health. Many scientist believe that bacteria can have both a positive and negative effect on an individual’s health. We have always thought bacteria cause illness but we have learned with Probiotics that some bacteria can treat or prevent disease. Who knows what other application bacteria may have to treat diseases in the future.


-Dr. Howard Schwartz M.D. – Gastroenterologist

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Mindful Eating: Easy Tips to Get You Started

Flickr/Arya Zai

Flickr/Arya Zai

There is something to be said for behavioral influences on our food choices as well as mood states. Mindless eating includes how food psychology and environment influences what and how much we eat. The probable foremost authority on Mindless Eating is Dr. Brian Wansink of Cornell University Food and Brand Lab. His 2006 book, “Mindless Eating; why we eat more than we think” is still considered a classic and an important read of behavior. This column today will cover Dr. Wansink’s latest research and how the results may be helpful on an individual level.

The latest research finding is that if you think about your future before you make daily food choices, the better food choices one will make. What is also realized now, is there is more to stress eating than simply emotion (many more things influence food decisions than just mood alone). More often than not, those in a bad mood will choose to eat junk food while those in a good mood, chose healthier food choices. Scientifically, we can measure affective regulation and temporal construct. Simply said, this research is measurements in how people react to their moods/emotions and perspective of time.

In a study using Parent Teacher Associates (PTAs) (211 of them) determined that those in a positive mood compared to controls, did better and earlier evaluations of foods to select, thus picked healthier foods. The researchers strongly noted that ability to think about the future was strongest in relationship to making healthy food choices. In a follow up study of 315 collegiate students, the same result occurred. Those in a positive mood made more nutritious choices.

The take home from this research to me is simple. Make your food choices when you are in good spirits, therefore keep a log or use the proper app to do your priority lists and food choices review.

In addition, Dr. Wansink shared from his lab the following tips for dealing with Mindless Eating:

  • Keep counters clear of all foods but the healthy ones
  • Never eat directly from a package – always portion food out onto a dish
  • Eat something hot for breakfast within the first hour of waking up
  • Avoid going more than 3-4 hours without having something small to eat
  • Put down your utensils between bites to slow down your eating

If you can start with the productive healthy mindset, and follow the tips shared, not only better control of your nutrition can be a result, perhaps a healthier longer future is also in your future.

-Douglas Kalman PhD, RD

Please follow us on Twitter @Miami_Nutrition  and @dougkalmanphdrd


  1. http://en.wikipedia.org/wiki/Mindless_Eating
  2. www.foodnavigator.com/content/view/print/883545 Accessed February 19, 2014
  3. http://foodpsychology.cornell.edu/outreach/mec.html Accessed February 23, 2014

Do I Have ADHD?



Over the past several years, we have seen an increase in adults coming into our practice wondering whether or not they have attention-deficit/hyperactivity disorder (ADHD).  This is not surprising, given the amount of stress that people are under, as well as all the “attention” that ADHD has received recently.  However, many things besides ADHD can produce poor attention, so it may be helpful to review some chief characteristics that are required in order to determine whether an adult meets the criteria for ADHD.

Attention is a complex cognitive process that is regulated by various brain regions and neurotransmitter systems.  Effective attention can be thought of as a two-step process:  We must be able to focus our attention on a primary source of interest (e.g., reading a book), while at the same time blocking or tuning out meaningless distractions.  Many things can cause poor attention, the most common ones being fatigue, stress, depression, and even certain medical conditions (e.g., hypothyroidism, fibromyalgia).

ADHD is thought to represent a certain degree of inefficiency in the frontal lobes, the brain region that is responsible for controlling attention and behavior.  Not only do people with ADHD have difficulty with focus and attention (e.g., distractibility, forgetfulness, procrastination, poor time and task management), they can also have problems with hyperactivity (e.g., restlessness, feeling fidgety, always “on the go”) or impulsivity (e.g., lose temper easily, interrupt others, impatient, difficulty awaiting their turn).  A critical element to make the diagnosis of ADHD in adults is that several of these behaviors must have been present during childhood (before the age of 12) and had to have caused some level of difficulty at home and at school.  It is estimated that 30% to 50% of children with ADHD will continue to manifest symptoms into adulthood, so it certainly is possible that adults presenting with attention and focusing problems have ADHD, but again, there must have been ADHD behaviors present during childhood.

If you present any of these symptoms, it is important to seek a consultation with a qualified health care practitioner.

Dr. Rafael Rivas-Vasquez PsyD – Psychologist

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Better Sleep: Insomnia

Insomnia as a condition characterized by any combination of difficulty falling asleep, staying asleep, or awakening too early in the morning and feeling unrefreshed.  According to the National Sleep Foundation, almost half of adult Americans reports they experienced difficulty falling asleep at one point in their lives.  Insomnia is the most common sleep disorder, affecting about 12% of the population at any given time, or about 32 million people.  More women than men are affected.  Older adults become less efficient with her sleep and can experience more frequent insomnia.  Transient, or short-term insomnia, can often be treated quite easily or may resolve spontaneously on its own.  Chronic, or long-lasting insomnia, is often more difficult to resolve.  It is often associated with many other medical and psychological illnesses, including depression.  It can also occur in patients with other sleep disorders such as restless leg syndrome, sleep apnea, (difficulty breathing during sleep with associated snoring), and narcolepsy (an illness associated with excessive daytime sleepiness).

Symptoms of insomnia may include anxiety, fatigue, difficulty concentrating, drowsiness, forgetfulness, irritability, headache, low energy, weight gain and increased blood pressure. Often, treatment entails simply embracing better sleep hygiene, or better sleep habits.  Often, only a brief course of over-the-counter or prescription medication is necessary.  For chronic insomnia, the best treatment is often a combination of medications and cognitive behavioral therapy (relaxation techniques and reinforcement of better sleep habits).  A sleep specialist can advise what is best for your individual case, including the risks and rationale of various medications and supplementations.

In order to ensure good sleep, it is important to have good sleep habits.  Often simple changes in your daily routine can improve your sleep.

Here are a few simple tips:

•           Avoid caffeine within 10 hours of bedtime.  Avoid alcohol and smoking, especially one or 2 hours before bedtime.

•           Exercise regularly.  Strenuous exercise should be avoided 3 hours before bedtime.

•           Don’t take naps, or limit them to 30 min.

•           Establish pre-sleep rituals, like a warm bath or reading.

•           Go to sleep only when you are sleepy and use your bed for sleep only, not as an office or place to watch television.

•           Get up about the same time every day, regardless of when you fall asleep.

•           If you can’t sleep, don’t stay in bed fretting.  After 10-15 min., go to another room and read until you feel sleepy.

Contact your physician if you:

•           Remain unable to fall asleep.

•           Can’t stay asleep.

•           Sleep at night but consistently feel sleepy during the day. You may have a separate medical problem that is preventing normal sleep patterns.

-Dr. Tim Grant M.D. – Neurologist and Sleep Specialist

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Traditional Medicine and Ashwagandha



The daily stress of life can be hard to handle sometimes.  Besides the occasional soothing tea, plants can help us fight stress. Some contain helpful phytochemicals, which are substances that can affect us physically, mentally and emotionally.  Ashwagandha, a popular medicinal plant used in Ayurvediv Indian medicine for generations is a good example. It has been used for centuries to help resist stress and promote a balanced mood.

Ashwagandha is a member of the Solanaceae family, also known as the nightshade family, which includes potatoes, tomatoes, peppers and tobacco. Most Ayurvedic texts suggest mixing ashwagandha root powder with milk before bed to help with stress, anxiety and sleep.

Some modern day research has found that ashwagandha may have free radical scavenging capacity and thus work as an antioxidant, as well as have anti-inflammatory, anti-tumor, anti-stress, and immunomodulatory properties. The mechanisms of action are not fully understood and more definitive research is needed.

Ashwagandha, translated from Sanskrit, means the smell of a horse because its roots smells like a sweating horse. Don’t let that discourage you… this maybe a horse worth riding!

-Dr. Jackie Miodownik-Aisenberg M.D. PhD – Internist

For more daily health enhancing tips, please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition

Will Going On A Cruise Endanger Your GI Tract?



Norovirus  is a very contagious virus that can be transmitted from an infected person contaminated food, water, or surface. The virus causes the stomach, intestines or both to get inflamed causing pain diarrhea and vomiting.

Treatment and is supportive as there is no medicine to treat the virus. It is important to stay hydrated and take anti-emetic and anti-diarrhea medication as needed. Finally it is important to use good hygiene not to infect others

The virus seems to be in the news every week for causing outbreaks on cruise ships.  Outbreaks are also common in restaurants, schools, summer camps, and cruises. It is common where a confined group of people eat together. It is quite important for food handlers to wash their hands and where gloves. One should be careful with leafy green such as lettuce, fresh fruits, and shellfish.

The best way to enjoy your cruise and not worry about the virus is to carefully wash your hands with soap and water after using the bathroom and before eating or handling food. Alcohol sanitizers are ideal to help prevent the spread of viruses. Make sure fruits and vegetables washed thoroughly and seafood is  cooked through.

Be smart and enjoy your next cruise.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Healthy Food Shopping Made Easy



Some athletes will say that nutrition is 80 percent of their training and preparation for their particular sport. While you and I may not be in the current Winter Olympics, this does not mean we cannot learn from how these athletes and many other people approach the food aspect of their lives. For many, how they choose what they eat is not dictated by having a certain goal in mind or by an event that has a particular deadline, but rather food decisions are influenced by hunger levels, taste of the food, social and environmental factors and others aspects as well. Part of the goal of this Blog is to share health promoting and healthy topics and information that can help you take better charge of your life, making goals that much easier to obtain.


  1. Never go food shopping when hungry – this may sound like a no brainer, but how many of us have went to the supermarket for a “quick shop” or our real shopping when hungry thinking it would not influence what we put in the cart? How many of us have taken a taste of a food while shopping and rationalized that it was ok because we were hungry? We weren’t stealing, we were sampling (because we were hungry). Ok, it is true, that when hungry, for the most of society our ability to control what we grab and eat is not so strong. To counter-act this “hunger-gene”, it is best to stick to a schedule that includes eating before you go food shopping.
  2. Time of day matters – Research has shown that the time of the day one food shops affects the types of foods chosen. Yes, this is true; in the study subjects bought a higher ratio of high-calorie foods to low-calorie ones in the hours leading up to dinnertime compared to earlier in the day. Therefore, if possible, one strategy to help keep your weight, waist and health in check, is to shop earlier in the day.
  3. Shop the perimeter – in almost supermarket the healthiest foods are along the perimeter of the market. Fruits, vegetables, fresh meats, seafood, juices, dairy and such align the perimeter, while most of the aisles are littered with canned, packaged or otherwise processed foods. Thus, try to make your food-shopping list to be mostly fresh foods. If you like preformatted lists, try this link http://www.webmd.com/diet/printable/healthy-grocery-shopping-list or this great website and App http://get.ziplist.com If you are really tech savvy, the website and App: Fooducate can help you prepare food shopping lists as well as a grading system for the choices you wish to make or have already made: http://www.fooducate.com check it out.


The goal of today’s blog was to share useful tips for healthier shopping along with affecting behaviors to help you make the choices for making obtaining your goals that much easier.


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To follow this author, see @dougkalmanphdrd