Think of them as shortcuts or tricks to use when shopping or eating. If you just do these things and nothing else, you will automatically be eating real, fresh food that will prevent, treat and even reverse most of the chronic diseases that drain our energy, stress our families and deplete our economy.   You don’t even have to understand anything about nutrition.  Just follow these goof proof rules for getting healthy, losing weight and feeling great.

1. Ideally have only food without labels in your kitchen or foods that don’t come in a box, a package, or a can. There are labeled foods that are great, like sardines, artichoke hearts, or roasted red peppers, but you have to be very smart in reading the labels.   There are two things to look for: the ingredient list and the nutrition facts.  Check out my special report on “How to Read Labels” for more information.
   Where is the primary ingredient on the list? If the real food is at the end of the list and the sugar or salt is at the beginning, beware. The most abundant ingredient is listed first and the others are listed in descending order by weight. Be conscious, too, of ingredients that may not be on the list; some ingredients may be exempt from labels. This is often true if the food is in a very small package, if it has been prepared in the store, or if it has been made by a small manufacturer. Beware of these foods.
2. If a food has a label it should have fewer than five ingredients. If it has more than five ingredients, throw it out. Also beware of food with health claims on the label. They are usually bad for you – think ”sports beverages.”  I recently saw a bag of deep-fried potato chips with the health claims “gluten-free, organic, no artificial ingredients, no sugar” and with fewer than 5 ingredients listed.  Sounds great, right?  But remember, cola is 100 percent fat-free and that doesn’t make it a health food.
3.  If sugar (by any name, including organic cane juice, honey, agave, maple syrup, cane syrup, or molasses) is on the label, throw it out. There may be up to 33 teaspoons of sugar in the average bottle of ketchup. Same goes for white rice and white flour, which act just like sugar in the body.  If you have diabesity – the spectrum of metabolic imbalances starting with just a little belly fat, leading all the way to diabetes— you can’t easily handle any flour, even whole-grain. Throw it out.
4. Throw out any food with high-fructose corn syrup on the label. It is a super sweet liquid sugar that takes no energy for the body to process. Some high-fructose corn syrup also contains mercury as a by-product of the manufacturing process. Many liquid calories, such as sodas, juices, and “sports” drinks, contain this metabolic poison. It always signals low quality or processed food.
5. Throw out any food with the word hydrogenated on the label. This is an indicator of trans fats, vegetable oils converted through a chemical process into margarine or shortening. They are good for keeping cookies on the shelf for long periods of time without going stale, but these fats have been proven to cause heart disease, diabetes, and cancer. New York City and most European counties have banned trans fats, and you should, too.
6. Throw out any highly refined cooking oils such as corn, soy, etc. (I will explain which oils to buy in Week 1 of the program in my book The Blood Sugar Solution). Also avoid toxic fats and fried foods.
7. Throw out any food with ingredients you can’t recognize, pronounce, or that are in Latin.
8. Throw out any foods with preservatives, additives, coloring or dyes, “natural flavorings,” or flavor enhancers such as MSG (monosodium glutamate).
9. Throw out food with artificial sweeteners of all kinds  (aspartame, Splenda, sucralose, and sugar alcohols—any word that ends with “ol” like xylitol, sorbitol). They make you hungrier, slow your metabolism, give you bad gas, and make you store belly fat.
10. If it came from the earth or a farmer’s field, not a food chemist’s lab, it’s safe to eat. As Michael Pollan says, if it was grown on a plant, not made in a plant, then you can keep it in your kitchen. If it is something your great grandmother wouldn’t recognize as food, throw it out (like a “lunchable” or go-gurt”).  Stay away from “food-like substances.”

That’s it – just ten simple goof proof rules for staying healthy for life. It is a simple recipe for staying out of trouble and automatically leads you to a real, whole foods diet.  And the side effect will be weight loss, energy, reduction in the need for medication and saving our nation from the tsunami of chronic disease and Pharmageddon!

When you make these simple choices you will not only improve your health, and your family’s health, but you will create a “wellness spring” that will shift the demand in the marketplace.  You will not only take back your health, but also help America take back its health.  You vote three times a day with your fork and it impacts our health, how we grow food, energy consumption, climate change and environmental degradation.   You have more power than you think.  Use it!

My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our obesity, diabetes and chronic disease epidemic.

To learn more and to get a free sneak preview of The Blood Sugar Solution go to www.drhyman.com.

Now I’d like to hear from you …

What are your rules for eating heathy for life?

How have you transformed your health with food?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, MD

In the fall of 2010, I had dinner with Rick Warren, the pastor of the 30,000 strong Saddleback Church in Southern California. He came to see me to get healthy – and he got religion about health. Over a healthy dinner of beet and cabbage autumn soup and a salad, he described his extraordinarily successful experiment for sustained personal growth and change. Rick encouraged his congregation to form 5,000 small groups that met every week in their community to study, learn and grow together.

In a flash, in that moment, I envisioned using those same small groups as a means of creating healthy lifestyle change.  Out of that meeting, with Drs. Memhet Oz and Daniel Amen, we created The Daniel Plan, a roadmap for physical and spiritual health and renewal that would be delivered through the small groups.    Rick named it “The Daniel Plan” after the first health support group created by Daniel and his friends who resisted the temptation of the King’s rich food and were healthier for it.

On the day we launched The Daniel Plan at Saddleback Church on January 15, 2011, over 8,000 people signed up to participate in small groups, track their progress and be part of a research study. Within a week over 15,000 had signed up.  The groups are supported by a weekly curriculum, learning objectives, videos, webinars, seminars and online support.  In the first year the congregation has already lost over 250,000 pounds and it changed the entire culture of the church almost overnight.

Community: The Best Medicine for Change

The seed of this idea started in my mind when I went to Haiti after the earthquake in January, 2010.  Paul Farmer and Partners in Health have created a powerful and successful model for treating drug resistant tuberculosis and AIDS in the most impoverished nations in the world.  The brilliance of the vision wasn’t coming up with a new drug regimen or building big medical centers, but from a very simple idea:  The missing ingredient in curing these patients was not a new drug, but the community.  They needed someone to “accompany” them to get healthy.  Recruiting and training over 11,000 community health workers across the world he proved that the sickest, poorest patients with the most difficult to treat diseases in the world could be successfully treated.   The community was the treatment.

The same vision can be applied to our current diabesity epidemic.  Solutions are not coming from governments, health care institutions or corporations.  What has been proven to work over and over, in different settings—workplaces, community centers, faith-based centers, schools—is building a community-based support system to guide people toward sustainable behavior and lifestyle change.

The cure for obesity and diabetes is not a mystery, just as the most effective drug regimen for tuberculosis or AIDS is not a scientific mystery.  Knowing how to effectively get it to the individual has eluded most experts.  But the data is in about lifestyle change, we know how to deliver the information and make it stick.  We have to help each other, not look for outside solutions from large institutions.

What the Research Shows: Community Support Works Better then Medication

Here’s what the data show to date with more studies coming in every day. Community is more effective than any medication, even though many still use less than optimal and outdated nutritional advice and lifestyle interventions.  I believe much more could be accomplished by translating the latest science into effective treatments and community-based support groups as I have done in my new book The Blood Sugar Solution.

The landmark 2002 study based on the Diabetes Prevention Program[i] and a ten year follow up study[ii] sponsored by the National Institutes of Health proved that lifestyle intervention is much more powerful than any other treatment such as medication to prevent diabetes in those with prediabetes.  With regular lifestyle support and education, participants lost 5 percent of their bodyweight and reduced their risk of diabetes by 58 percent.  This lifestyle-based approach was also proven very effective in the large Finnish Diabetes Prevention Study.[iii]

The current Look Ahead Study funded by the National Institutes of Health is a 13-year study of 5000 people comparing an intensive group lifestyle change program for diabetes prevention and treatment has been show to be remarkably more effective in lowering weight, cholesterol, blood sugar, and blood pressure than conventional medical care.[iv]  Once this study is completed, it will completely change our way of thinking about how to treat disease. Group models of intensive lifestyle change like the one modeled by Dr. Dean Ornish for heart disease[v] and prostate cancer, [vi]are more effective and will save more lives and more money than using medication and surgery for diseases caused by lifestyle and environmental factors.

Many other community-based programs have been proven to work better than our current conventional treatment approach based on one on one counseling visits with diabetic educators or registered dietitians.

Here’s what some of the studies showed:

1. The Montana Cardiovascular Disease and Diabetes Prevention Program[vii] proved diabetes prevention research could be applied successfully in real world setting in groups of 8 to 30 people supported by a trained health care team.   Education was delivered in 16 weekly classes and optional twice a week exercise classes.  The average weight loss was 7 percent of body weight, and blood pressure, cholesterol, and blood sugar all dropped significantly.
2. The Healthy Living Partnerships to Prevent Diabetes (HELP PD)[viii] study in North Carolina trained community health workers (patient’s peers) to support long-term lifestyle change.  The community health workers received a 36-hour training program given by registered dietitians. It’s a train the trainers model. These community health workers help groups of patients succeed in a 16-week core curriculum using videos, handouts, a treatment manual, and a toolkit.  After the initial 16 weeks of meetings, there is weekly phone support for 8 weeks and monthly support for 18 months. The program addresses not only nutrition, exercise and lifestyle, but ways to transform obstacles to behavior change rooted in beliefs and attitudes about self-efficacy and self-care. The initial results of this National Institute of Health sponsored study of 300 people found that the people who had the usual care of individual counseling lost only 1 percent of their body weight compared to 7 percent of body weight for people who were in community health worker supported groups.  The cost to deliver this program was only $400 a year.
3. The DEPLOY study[ix] successfully partnered with local YMCA’s, trained their staff and started group programs based on the Diabetes Prevention Program.
4. Group programs have also been delivered with success via a large academic hospital.[x]
5. The Logan Healthy Living Program[xi] successfully used telephone delivered support for dietary and physical activity to socially disadvantaged patients with type 2 diabetes and high blood pressure. They provided a workbook and 18 calls over 12 months.
6. The Healthy Lifestyle Change Program [xii] in California found that in over 400 developmentally disabled participants with obesity or at high risk for diabetes they could achieve significant improvement in weight, waist circumference and an increase in physical activity in a seven-month, twice weekly group education program.  What was most remarkable was that peer “mentors” led this group intervention.
7. The PATHWAYS study[xiii] delivered a 14-week weight loss program aimed at diabetes prevention for African American women at risk for diabetes delivered through churches and led by lay health facilitators (or community health workers).    The women lost an average of 5 percent of their body weight, enough to reduce their risk of diabetes by 58 percent.
8. In other studies scientists also effectively implemented a group model for diabetes prevention and weight loss using both volunteer health care professionals[xiv] and lay people[xv] in African American churches.
9. Group school lifestyle change programs in the poorest, most overweight states like Mississippi have shown significant improvements in weight, body, fat, fitness level and eating habits.[xvi]

Building Connection and Community to Create Health

This movement is starting to spread.  Doctors frustrated with the failure of medication to treat their patients with chronic illness, obesity, and diabetes are starting small groups with 8 to 30 patients and meeting weekly to teach them about nutrition, cooking, shopping, exercise, stress management, and more.

Two Portland doctors came up to me after a lecture I gave and told me about their program for poor undocumented Hispanic women with chronic symptoms, obesity, and diabetes.  For very little money (about $15 per person), they successfully guided these women to health in a program they called Reclamado su Salud (or reclaim your health) using the program based on The Blood Sugar Solution (which I have taught at many medical conferences). Their group of 20 women met weekly for 5 classes, then every two weeks for a total of 8 three-hour classes.  The weight loss ranged from 5 to 20 pounds, blood pressures dropped an average of 10-20 points and depression and inflammation scores dropped significantly.

Much can be done with a little help from your friends.

These examples represent just the beginning of what is possible when we work together.  We are social beings and thrive with connection.  I met with human resource and benefits executives at Google to advise them on creating a healthy workforce.  A survey of their “Googlers” discovered that most of them wanted more ways to connect with each other.

Social networks and groups are spontaneously sprouting as a support system for lifestyle change.  Facebook and Twitter cannot only help facilitate democratic revolution in countries like Egypt, they can link communities together in a common purpose to reclaim their health. Think “Occupy Health Care” or “Wellness Spring”.

With the shift in health care policy prohibiting insurers from excluding sick patients (or cherry picking), canceling insurance and the mandate for universal coverage, they can no longer shift responsibility for prevention and health promotion.  Large insurers like United Health Care[xvii] and CIGNA are scrambling to create innovative community based programs to address the tsunami of disease and costs they can no longer avoid.

This community based group approach solves many enormous obstacles to reversing this epidemic faced by the health care system.  Even though doctors are the main place where people receive health care with diabesity, they have no training in lifestyle change, lack the time, resources, and support team, and they do not get paid for helping patients create sustainable lifestyle change. Currently physicians and health care organizations have nowhere to refer patients and have no clear, well documented proven solution to provide their patients.  Telling their patients to eat better and exercise more is just not enough.

You need to build yourself a support system to succeed long term.  You need a team working together toward the same goals.  It might be just one person, a self-guided support group, one led by a health coach, wellness champion or community health worker, or a health professional, or even an online community that can support, encourage and guide you.

I strongly recommend you develop this kind of community for yourself for two reasons.

1. Success requires it. As we have seen, studies show that the best way to overcome diabetes and obesity is through groups and community support.
2. Our world needs it. If we don’t do something about the diabesity epidemic, our world will suffer for it. Remember, projections suggest that by 2020 half of the population will have prediabetes. We have to work together to avert this disaster.

Start by finding people who will do the program with you.  Create a small group, even if it is just one friend, who can support you through the process.  Ask your friends, family, coworkers, and spiritual community members to join you. You can still be successful following this program by yourself, but it will be more fun, powerful and sustainable when done with others in community.

My new book The Blood Sugar Solution, which comes out at the end of February is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society.  Obesity and diabetes is a social disease and we need a social cure.

My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.

To learn more and to get a free sneak preview of the book go to www.drhyman.com.

Mark Hyman, MD
January 25, 2012

__________________________________

[i] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346 (6):393–403.

[ii] Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.

[iii] Ilanne-Parikka P, Eriksson JG, Lindström J, Peltonen M, Aunola S, Hämäläinen H, Keinänen-Kiukaanniemi S, Laakso M Valle TT, Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group. Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish Diabetes Prevention Study. Diabetes Care. 2008 Apr;31(4):805-7.,

[iv] Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group.cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010 Sep 27;170(17):1566-75.

[v] Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7.

[vi] Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD, Marlin R, Simko J, Shinohara K, Haqq CM, Carroll PR.  Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74.

[vii] Amundson HA, Butcher MK, Gohdes D, Hall TO, Harwell TS, Helgerson SD, et al. Translating the diabetes prevention program into practice in the general community: findings from the Montana Cardiovascular Disease and Diabetes Prevention Program. Diabetes Educ 2009;35(2):209–4. 216.

[viii] Katula JA, Vitolins MZ, Rosenberger EL, Blackwell C, Espeland MA, Lawlor MS, Rejeski WJ, Goff DC. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Contemp Clin Trials. 2010 Jan;31(1):71-81.

[ix] Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med 2008;35(4):357–363.

[x] McTigue KM, Conroy MB, Bigi L, Murphy C, McNeil M. Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ 2009;35(2):199–204. 208.

[xi] Eakin EG, Reeves MM, Lawler SP, Oldenburg B, Del Mar C, Wilkie K, Spencer A, Battistutta D, Graves N. The Logan Healthy Living Program: a cluster randomized trial of a telephone-delivered physical activity and dietary behavior intervention for primary care patients with type 2 diabetes or hypertension from  a socially disadvantaged community–rationale, design and recruitment. Contemp Clin Trials. 2008 May;29(3):439-54.

[xii] Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D; WRC Project Oversight Team. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009 Dec;37(6 Suppl 1):S201-8.

[xiii] McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban Aftrican-American women.  Diabetes Educ 2001; 27(2):231-238

[xiv] Quinn MT, McNabb WL. Training lay health educators to conduct a church-based weight-loss program for African American women. Diabetes Educ 2001;27(2):231–238

[xv] Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: results of translational research. J Public Health Manag Pract 2008;14(1):29–32.

[xvi] Greening L, Harrell KT, Low AK, Fielder CE.  Efficacy of a School-Based Childhood Obesity Intervention Program in a Rural Southern Community: TEAM Mississippi Project. Obesity (Silver Spring). 2011 Jan13.

[xvii] United Health Center for Health Reform and Modernization, The United States of Diabetes, November 2010 (accessed online)

It inspired me to find ways to build community based solutions for the epidemic of chronic lifestyle driven disease – an epidemic that now kills twice as many around the world every year as infectious disease. Chronic disease is a slow motion disaster, a tsunami of suffering whose global cost will be $47 trillion over the next 20 years.

I realized we had to decentralize healthcare, and put patients and communities at the center of the solution empowering them to create health, not simply treat disease.  I realized that if you were sick, the best place to create health might not be the doctor or clinic but your own community.

Our Global Obesity and Diabetes Epidemic

One in two Americans has pre-diabetes or diabetes—that is every other person in America.  Twenty five percent of diabetics and ninety percent of pre-diabetics are not diagnosed.  Caring for them will cost $3.4 trillion over the next 10 years. One in three Medicare dollars is spent on treating diabetes.

This is a global problem.  From 1983 to 2011 world-wide diabetes prevalence increased from 35 million to 366 million and is projected to grow to 552 million in 2030.  Ninety five percent of diabetes is lifestyle induced type 2 diabetes.  The world’s best-selling blockbuster diabetes drug, Avandia, has killed nearly 200,000 people from heart attacks since it was introduced in 1999 – the very disease that kills most diabetics. The solution to our diabetes epidemic will not come from within the health care system.  It will not come at the end of a pill bottle or the blade of a scalpel.  We cannot bypass the fact that this is a lifestyle disease and cannot be solved by better or more medication.

Doctors graduate medical school knowing more about treating malaria than treating obesity  — or what I call DIABESITY – that now accounts for most the patients they see. We need to rethink medicine and rethink health care.  When the collective cost of diabesity related disease – heart disease, cancer, dementia, strokes, infertility, depression and more is accounted for, it is the single biggest contributor to our health care costs and our national debt.  Seventy percent of our federal budget is spent on Medicaid, Medicare and Social Security.  It is unsustainable.

In the face of those seemingly insurmountable statistics, I had an insight after working with Paul Farmer in Haiti where he built the model of accompaniment – community health workers and peer support that created the conditions that led to health.

The insight was this – that the community could be the cure.

I realized that getting healthy is a team sport!

An Unexpected Solution to Diabetes, Obesity and Chronic Disease

So one year ago, on January 15, 2011, in partnership with Rick Warren from Saddleback Church in Orange County and two other doctors (Dr. Daniel Amen and Dr. Mehmet Oz), we launched The Daniel Plan – a social experiment to learn if community support was more effective than medication or conventional medical care for treating and reversing disease and creating health.

The Daniel Plan is a wellness program delivered through small groups in the church. Rick Warren’s church of 30,000 met every week in 5,000 small groups.  That was the secret sauce.  The program is named after biblical story of Daniel and his small group of men who refused to consume royal food and wine. By eating vegetables and water, “they looked healthier and better nourished than any of the young men who ate the royal food,” according to Daniel 1:15.

In the first month 15,000 people signed up, and over the last year they have lost an estimated 250,000 pounds – or the equivalent of 10 tractor-trailer trucks loaded with soda. Over 6,000 people spontaneously joined from around the country. There have been over half a million visits to our Daniel Plan website from 189 countries.   Hundreds of churches from around the country have called to participate and build programs for their own churches.  Rick cast a vision to scale this through faith based communities to 1 billion people.

The results appear to be more effective than conventional medical care for chronic disease. The program is based on functional medicine – a way of treating chronic disease through lifestyle based systems solutions – not just treating symptoms. It is the science of creating health, not treating specific diseases.  Disease goes away as a side effect of creating health. That delivered within small groups via The Daniel Plan was the lever than moved mountains – of donuts, ribs, soda and more!

Not only were there estimated weight reductions of 250,000 pounds but also equal reductions in medication use, hospitalizations and doctors visits. And it was free.

In a survey after 10 months of the program, participants reported the following:

• An average weight loss of 13.5 pounds (and 18 pounds for those who said they followed the program closely)
• 72% of those who wanted to lose weight did
• 53% reported increased energy levels
• 34% reported better sleep
• 27% improvement in blood work
• 20% reported improvement in blood pressure
• 11% reported reduction in medications
• 31% reported improvement in mood

Those who did the plan together lost twice as much weight as those who did it alone.

People like Chiquita Seals lost 125 pounds and Kendall Rock reversed his diabetes.  Others got off their insulin, heart disease and diabetes medication.  Hear them share their stories.

This past weekend at one of our rallies which highlighted healthy cooking demonstrations with pastors and doctors and chefs on stage, a man come up to me after the event and said that in the previous year he was in the hospital four times and on nine medications and this year he stayed out of the hospital and is only on one medication.

Here was the big insight for me: the community is the cure and the group is the medicine – not just a delivery system for health education.

We created an interactive curriculum delivered through multiple media – online education, videos, articles, recipes, webinars all done in small groups and community events. We did this at Saddleback by changing the culture – changed what was served at bible breakfasts, the menus in the refinery and even what people served in their homes and their small groups. People learned to create health together — to shop, cook, eat, exercise and play together.

We didn’t treat disease.  We didn’t create a weight loss program.  We taught people self-care and combining that with caring for each other they created a small miracle – something heath care or health care reform has not been able to achieve.  In the most unlikely place, a large Church in Orange Country, led by Pastor Rick Warren and a Christian, Jewish and Muslim doctor we showed that community based solutions are more effective at treating and reversing chronic disease than our health care system.  People helped each other create health.

As Chelsea Clinton suggested we need to turn the world upside down. We need a disruptive strategy from outside health care and conventional channels. This is the seed of a bigger possibility. In our own communities, in our homes and schools and workplaces and our faith based organizations we can support each other to take back our health.

Innovative community based models also can change our default choices for how we live, move, eat and play.  If the things that create health are easy to access and things that create disease are hard to get to, extraordinary change occurs. In Albert Lea, Minnesota a pilot project was created to create healthy choices or invisibly limit bad ones. For example, by not allowing kids to eat in hallways and classrooms their weight went down 10%. In Thailand, a community garden is irrigated by an old bike hooked up to a generator run by patients with diabetes. They get exercise and grow healthy food!

This model has been replicated across the world – including Peers for Progress that created pilot programs to treat diabetes in Cameroon, Uganda, Thailand and South Africa based on peer support. The peer support group models were more effective than conventional care intervention for improving the health of diabetics and health care costs decreased 10 fold.

This experiment that continues today at Saddleback may catalyze decentralized, community-based, systems approaches to health for corporations, cities, states and nations throughout the world.

An old African proverb says that if you want to travel swiftly travel alone but if you want to travel far, travel together.

In my next blog I will explore further ways in which we can collectively take back our health in our communities, how we can get healthy together.

My new book The Blood Sugar Solution, which comes out at the end of February is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society.  Obesity and diabetes is a social disease and we need a social cure.

My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.

To learn more and to get a free sneak preview of the book go to www.drhyman.com.

Now I’d like to hear from you …

What do you think about using community as a cure for chronic illness?

Have you joined with friends or family to take back your health? What has your experience been like?

What ideas do you have for us to take back our health in our homes, schools, workplaces, and places of worship?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, MD

Have you noticed how so many of us know what to eat, know about good nutrition, and have a clear idea of what we should and shouldn’t eat – but we just don’t do it?

It’s crystal clear that understanding what to eat or how much to exercise doesn’t’ guarantee that we’ll translate that knowledge into action especially when we look at weight loss.

That’s why I’m excited to introduce you to the work of nutritional psychologist Marc David and The Institute for the Psychology of Eating – www.psychologyofeating.com. Marc has been a close friend and colleague of mine for many years, and his books and trainings have been life changing for so many people. His work provides the missing ingredient that many have been searching for – a profound and practical understanding of the mind of the eater. Marc’s two best-selling books – The Slow Down Diet and Nourishing Wisdom will teach you how thoughts, feelings, beliefs, stress relaxation, pleasure, and more – powerfully impact nutritional metabolism and weight. His work is a great combination of science, psychology, heart and soul. He has originated two new cutting edge fields – Dynamic Eating Psychology and Mind Body Nutrition – that will powerfully change the way you see your relationship with food and nutrition.

I highly encourage you to learn more about Marc David’s work — just go to www.psychologyofeating.com. There’s a free audio gift for you to download, and you can discover more about the unique professional trainings that the Institute for the Psychology of Eating offers. A few more brief words: Marc’s Institute trains people to work with weight loss, body image, overeating, and a host of nutrition related health concerns like digestion, fatigue, mood and immunity. His programs are for professionals, those looking for a new career, and anyone looking to use this great new approach for their own personal benefit. It’s some very inspiring and cutting edge work that can take your interest in nutrition to a whole new level. I know that they have a new Distance Learning Program and some great early enrollment incentives if you contact them by March 1st.

Today I wanted to share an article Marc wrote that outlines a few of the “secrets” of eating psychology.

To your good health,

Mark Hyman, MD

Secrets of Eating Psychology

By Marc David

Most of us have been taught to believe that good nutrition is simply a function of eating the right food and taking the right supplements. Of course, this is true, but there’s more to the equation. What we eat is only half the story of good nutrition. The other half of the story is who we are as eaters. That is, what we think, feel, believe our levels of stress, relaxation, pleasure, awareness, and the inner stories that we live out all have a real, powerful, and scientific effect on nutritional metabolism.

Recent advances in the mind-body sciences have been proving what ancient wisdom traditions have been saying for eons – that the mind and body exist on an exquisite continuum, and profoundly impact one another.

So the good news is simply this: you can powerfully change your health and your nutritional status without changing anything you eat, but by changing you the eater. In my 30 years as a nutritional psychologist, I’ve seen so many profound breakthroughs in clients and students around weight, overeating, and a long list of health conditions when they began to practice some of the simple principles of eating psychology. Consider some of these key “secrets” that I think everyone should know:

1.  Stress can put weight on – relaxation can take it off.

It’s fascinating how stress, fear, anxiety, anger, judgment and even negative self-talk can literally create a  physiologic stress response in the body. This means that we generate more cortisol and insulin, two hormones that have the unwanted effect of signaling the body to store weight, store fat, and stop building muscle. Strange as it may sound, we quite literally change our calorie burning capacity when we’re stressed. What’s more incredible though, is that as we learn to smile more, ease into life and breathe more deeply, the body enters a physiologic relaxation response. In this state, we actually create our optimal day-in, day-out calorie-burning metabolism. So, you could be following the best weight loss diet in the world, but if you’re an anxious mess, the power of your mind is limiting the weight loss of your body. Far too many people adopt stressful weight loss strategies – impossible to follow diets, overly intense exercise programs, tasteless food, extremely low calorie meal plans – all of which can create the kind of stress chemistry that ensures our weight will stay put. It’s time to relax into weight loss.

2.  Happiness is the best digestive aid.

Can you recall what happens when you eat during anxiety or stress? Many people report such symptoms as heartburn, cramping, gas, and digestive upset. During stress, the body automatically shifts into the classic fight-or-flight response. This feature of the nervous system evolved over millions of years as a brilliant safety mechanism to support us during life-threatening events. In the moment the stress response is activated, something very interesting happens – the digestive system shuts down. It makes perfect sense that when you’re fending off an angry gorilla, you don’t need to waste energy digesting your breakfast. All the body’s metabolic energy is directed towards survival. So, you could be eating the healthiest food in the universe, but if you aren’t eating under the optimum state of digestion and assimilation – which happens to be relaxation – you literally and metabolically are not receiving the full nutritional value of your meal.

3.  Overeating – it’s simpler than you think.

Most people think they overeat because they have a willpower problem. “If only I could control my appetite, then I would stop being such a willpower weakling and start losing weight.” Well, here’s the good news – you don’t have a willpower problem. The problem for a majority of overeaters is that they don’t actually “eat” when they eat. What I’m suggesting is that we aren’t always fully present to the meal, aware of its taste, eating it slowly, or simply feeling nourished by the food. When this happens, the brain, which requires taste and satisfaction, misses out on a key phase of the nutritional experience. The brain literally thinks it didn’t eat, or didn’t eat enough. And it simply screams back at us – “Hungry!” So, you can dramatically decrease your overeating by increasing your awareness and presence at every meal.

4.  Slower eating means faster metabolism.

One of my favorite nutritional questions to ask a client or student is “Are you a fast eater, moderate eater, or slow eater?” If the answer is “fast”, then it’s time for an overhaul. That’s because the act of eating fast is considered a stressor by the body. Humans are simply not biologically wired for high speed eating. So when we do eat fast, the body once again enters the physiologic stress response, which results in decreased digestion, decreased nutrient assimilation, increased nutrient excretion, lowered calorie burning rate, and a bigger appetite. The bottom line is that you can literally empower your nutritional metabolism simply by slowing down. What’s fascinating is that for many fast eaters, slowing down is quite a challenge. But try this – don’t just eat slow – eat sensuously, feel nourished by your food, and take in all the sensations of your meal.

5.  Make sure you have enough Vitamin P – Pleasure!

Far too many people are taught to believe that pleasure is something frivolous. Well, it’s actually required by our biology. All organisms on planet earth, be they lion, lizard, amoeba, or human are programmed at the most primitive level of the nervous system to seek pleasure and avoid pain. Well, if you’re eating and not paying attention, the brain will drive you to seek more pleasure via overeating. What’s worse, if you’re stressed while eating, the excess cortisol in your system actually de-sensitizes us to pleasure – so you’ll need to eat more food in order to get the pleasure we are seeking. The bottom line is this: If you want more pleasure from food, you don’t need to eat more of the ice cream. Simply breathe, relax, de-stress, enjoy, pay attention, and the body will naturally experience the pleasure it seeks. And the great news is, since pleasure catalyzes a relaxation response, it actually fuels digestion and assimilation

6.  Emotional eating – it’s not the enemy.

At our core, we are emotional beings – rich, complex, juicy, unpredictable feeling-filled creatures. We love, we celebrate, we laugh, cry, we break down, we rise up… So how could we NOT be emotional eaters? We love food. We love our favorite restaurant. We love how food makes us feel good. Some of us love cooking for others. Some of us are passionate about nutrition. It’s time to get over it – if you’re human, you will bring emotionality to the table. Once we embrace the reality that we’re genetically hard-wired for emotional expression, we can relax a little more.  Underneath the quest to eradicate emotional eating from one’s life is often found a hidden desire to eliminate uncomfortable feelings. We strive for an impossible to attain goal that constantly leaves us frustrated and in failure. Yes, this thing called emotional eating can be very painful. But it’s not the actual problem – it’s a symptom that’s pointing to something deeper. It’s an alert mechanism from body wisdom that’s calling us to check in, and follow the flow of emotions within us to see where our soul is calling for more awareness and insight.

7.  Get rid of toxic nutritional beliefs.

Finally, many of us have absorbed toxic nutritional beliefs that are as harmful and debilitating as any of the toxins in our food. Here’s what I mean: it’s surprisingly common for people to believe that “food is the enemy”, or “food makes me fat”, or “fat in food will become fat on my body” or “my appetite is the enemy” or “as soon as I have the perfect body, then I’ll finally be happy.” Such beliefs may seem harmless, yet they can create a relationship with food and self that’s filled with tremendous suffering and pain. Think about it – if “food is the enemy”, then we are constantly in a fight or flight stress response whenever we eat, or even think about food. Such a powerful stressor can cause all the problems of stress-induced digestive shutdown, decreased calorie burning capacity, and an inner life that’s seldom at peace. The question is: Is your relationship with food nourishing, or punishing?

Hopefully, you’ve noticed that there’s way more to good nutrition than simply the food itself. We bring all of ourselves to the table – our hopes, fears, thoughts, feelings, dramas, and dreams. And the more we include a well rounded nutritional profile – Vitamin R – relaxation, Vitamin P – pleasure, Vitamin S – slow, and Vitamin L – Love – the more we can literally nourish ourselves on every level.

Deen would also have us believe that she really didn’t expect us to eat her signature hamburger sandwiched in the middle of a donut. But whether unwittingly or not, Deen and her brand of junk food have been preying on a very human vulnerability: our innate tendency to become profoundly addicted to sugar, fat, and salt.

Bolstered by “experts” such as Dr. Linda Siminerio, director of the Diabetes Institute at the University of Pittsburgh Medical Center, who said, “To my knowledge no particular food has been linked to an increase in the risk of diabetes,” Deen refuses to acknowledge that her sugary, fatty foods led to her diabetes.  No food has been linked to diabetes?  Dr. Siminerio stands alone with Paula Deen in that belief.

Deen said she would not change her own lifestyle or cooking style drastically, other than to reduce portion sizes of unhealthful foods. “I’ve always preached moderation,” she said. So just have half the hamburger on an open-faced donut sandwich?  If all calories were created equal, that might fly. But nutrition research over the last 30 years has demonstrated overwhelmingly that all calories are not created equal.

Food is information. Any sixth grader will tell you that 1,000 calories of broccoli is different from 1,000 calories of soda.  Even the American Diabetes Association and Weight Watchers have changed how they categorize foods based on the fact that while chocolate chip cookies and spinach are both carbohydrates, they do not have the same effect on your hormones, appetite, metabolism, or weight.  Sorry Paula, you can’t just eat less of the same junk foods and reverse or even stabilize your diabetes.

Paula Deen’s celebration of excess and indulgence is irresponsible if not outright dangerous in the face of our obesity epidemic. Nearly three out of four Americans are overweight or obese, one in two Americans has pre-diabetes or diabetes (or what I call “diabesity”), and, shockingly, 25% of diabetics and 90% of pre-diabetics are not even diagnosed.

Caring for these people will cost us $3.4 trillion over the next ten years.  Today, one in three Medicare dollars is spent on diabetes.  Our country is becoming the United States of Diabetes. And since 1983, there has been an increase of over 1,000% in incidence of diabetes worldwide.  Globally we are becoming the United Nations of Diabetes.

Deen’s endorsement of Victoza, a diabetes drug, lulls us into the belief that the false god of medication will save us from our excess.  Don’t worry. Just keep eating 55 pounds of flour and 150 pounds of sugar a year, the American average.  If you have bad genes, big Pharma will be there to save you.  But remember, the last blockbuster diabetes drug, Avandia, has led to 47,000 heart attack deaths since it was introduced on the market in 1999.  Sorry to break the news, but if you are standing on a tack, it takes a lot of aspirin to make your foot feel better.

While some may have a genetic predisposition, those genes only get turned on when doused in mountains of white flour, white sugar, and fat.  Type 2 diabetes is almost 100% preventable and curable with dietary intervention.  When Deen says she doesn’t blame herself, then whom does she blame?

This week in Indian Wells, California, President Clinton convened the best and brightest minds in health care, business, and fitness to put a stake in the ground that “Health Matters.”  President and Chelsea Clinton, Dr. David Satcher, Richard Gephart, Jillian Michaels, and others including myself painted a picture of the tsunami of cost and suffering brought on by the obesity epidemic and the need for innovative solutions in healthcare, our communities, schools, and the workplace, none of which included smaller portions of bad food.   Everything from “instant recess” to community-based programs for people to get healthy together, to banning sodas from schools, to better access to real foods for the poor was on the menu at the Clinton Foundation event.

Deen said her diagnosis was not a death sentence. But diabetics have four times the risk of heart attack and dementia as well as an increased risk of a spate of cancers, not to mention nerve damage, liver failure, kidney failure, and blindness.  Sorry Paula, but if you don’t make serious lifestyle changes, diabetes is a death sentence.

On the Today show she told Al Roker, “Honey, I am your cook, not your doctor.”  Sorry again Paula, but dinner is a date with the doctor. Food is medicine, and what you put on your fork is more powerful than anything you will ever find in a pill bottle.

But perhaps there is a silver lining here. Because Paula Deen can turn this around. And if she can do it, so can you.

At Saddleback Church this past year I partnered with Rick Warren, Dr. Mehmet Oz, and Dr. Daniel Amen in a social experiment. We put the church on a wellness program based on rigorous nutritional science and lifestyle medicine. Members ate real, whole, fresh food; broke their addiction to sugar and processed fats from industrial food; and learned how to shop, cook, eat, move, and celebrate life together. We had dozens of diabetics who not only lost weight but also got off their medications and even insulin and reversed their disease.  If a church that started its day with ribs and donuts can do it, so can you, Paula Deen.

Paula, be a cheerleader for America and create new recipes and a new show to teach us that food can be both fun and good for you.  Please help us Paula. We need you.

Statins have been proven to prevent second heart attacks, but not first heart attacks.

Take it if you already have had one, but beware if your doctor recommends it for you if have never had a heart attack.

This current study adds to an increasing body of literature questioning the benefits of statins, while highlighting their potential risks.

New Study Shows 48 Percent Risk of Diabetes in Women Who Take Statins

This study examined the data from the large government sponsored study called the Women’s Health Initiative, the same study that disabused us of the idea that Premarin prevented heart attacks in postmenopausal women.

In fact, based on this randomized controlled trial, estrogen replacement therapy, once considered the gold standard of medical care for the prevention of heart disease, was relegated to the trash bin of history joining medicine’s many other fallen heroes including DES, Thalidomide, Vioxx, Avandia, and more.

In this new study researchers reviewed the effect of statin prescriptions in a group of 153,840 women without diabetes and with an average age of 63.2 years. About 7 percent of women reported taking statin medication between 1993 and 1996. Today there are many, many more women taking statin medications, thus many more are at risk from harm from statins.

During the 3-year period of the study, 10,242 new cases were reported – a whopping 71 percent increase in risk from women who didn’t take statins. This association stayed strong at a 48 percent increased risk of getting diabetes, even after taking into account age, race/ethnicity, and weight or body mass index. These increases in disease risk were consistent for all statins on the market.

This effect also occurred in those with and without heart disease. Surprisingly disease risk was worse in thin women. Minority women were also disproportionately affected. The risk of diabetes was 49 percent for white women, 57 percent for Hispanic women, and 78 percent for Asian women.

But in a typical “my mind’s made up, don’t confuse me with the facts” statement by the medical establishment, the researchers said we should not change our guidelines for statin use for the primary prevention of heart disease.

In a large meta-analysis published in the Lancet last year, scientists found that statins increased the risk of diabetes by 9 percent. If current guidelines were followed for those who should take statins, and people actually took them (thank God only 50 percent of prescriptions are ever filled by patients), there would be 3 million more diabetics in America. Oops.

Other studies have recently called into question the belief that high cholesterol levels increase your risk of heart disease as you get older. For those over 85 it turns out having high cholesterol will protect you from dying from a heart attack, and, in fact, from death from any cause.

Low Cholesterol May Kill You

A recent study showed that in healthy older persons, high cholesterol levels were associated with lower non-cardiovascular-related mortality. This is extremely concerning because millions of prescriptions are written every day to lower cholesterol in the older population, yet no association has been found between higher cholesterol and heart disease deaths for those aged 55 to 84; and for those over 85, the association seems to be inverse — higher cholesterol predicts lower risk of death from heart disease.

The pharmaceutical industry, medical associations, and academic researchers whose budgets are provided by grants from the pharmaceutical industry continue to preach the wonders of statins, but studies like these should have us look good and hard at our current practices. Are we doing more harm than good?

Cardiologists recommend putting statins in the water and giving them out at fast food restaurants and having them available over the counter. They believe in driving cholesterol as low as possible. Statin prescriptions are handed out with religious fervor, but do they work to prevent heart attacks and death if you haven’t had a heart attack already?

Bottom line: NO! If you want to learn why this is true, read on.

Statins Don’t Work to Prevent First Heart Attacks

Recently, the Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death. In addition, many other studies support this and point out the frequent and significant side effects that come with taking these drugs. ^[i] If scientists found that drinking two glasses of water in the morning prevented heart attacks, even if the evidence was weak, we would jump on board. Big up side, no down side.

But this is not the case with statins. These drugs frequently cause muscle damage, muscle cramps, muscle weakness, muscle aches, exercise intolerance^[ii] (even in the absence of pain and elevated CPK – a muscle enzyme), sexual dysfunction, liver and nerve damage and other problems in 10-15 percent of patients who take them.^[iii] They can also cause significant cellular, muscle, and nerve injury as well as cell death in the ABSENCE of symptoms.^[iv]

There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn’t get the benefit of billions of dollars of marketing and advertising that statins do. One big trial was touted as proving statins work to prevent heart attacks, but the devil is in the details.

It was the JUPITER^[v] trial that showed that lowering LDL (or bad cholesterol) without a reduction in inflammation (measured by C-reactive protein) didn’t prevent heart attacks or death.^[vi] Statins happen to reduce inflammation so the study has been touted as proof of the effectiveness of these medications. Mind you it wasn’t lowering the cholesterol that helped (which is the intended purpose of statins), but the fact that they lower inflammation. What is ignored by people who use this study to “prove” that statins work is the fact that there are so many better ways to lower inflammation than taking these drugs.

Yet other studies have shown no proven benefit for statins in healthy women^[vii] with high cholesterol or in anyone over 69 years old. ^[viii] Some studies even show that aggressive lowering of cholesterol can cause MORE heart disease. The ENHANCE trial showed that aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more arterial plaque and no fewer heart attacks.^[ix]

Other research calls into question our focus on LDL or the bad cholesterol. We focus on it because we have good drugs to lower it, but it may not be the real problem. The real problem is low HDL that is caused by insulin resistance (diabesity).

In fact studies show that if you lower the bad (LDL) cholesterol in people with low HDL (good cholesterol) that is a marker of diabesity – the continuum of obesity, prediabetes and diabetes — there’s no benefit.^[x]

Most people simply ignore the fact that 50-75 percent of people who have heart attacks have normal cholesterol.^[xi] The Honolulu Heart Study showed older patients with lower cholesterol have higher risks of death than those with higher cholesterol.^[xii]

Some patients with multiple risk factors, or who have had previous heart attacks do benefit, but when you look closely the results are underwhelming. It’s all in how you spin the numbers. For high-risk males (those who are overweight and have high blood pressure, diabetes, and/or a family history of heart attacks) and are younger than 69 there is some evidence of benefit, but one hundred men would need to be treated to prevent just one heart attack.

That means that 99/100 men who take the drug receive no benefit. Drug ads say the risk is reduced by 33 percent. Sounds good, but that just means the risk of getting a heart attack goes down from 3 percent to 2 percent.

Despite the extensive data showing that statins are a questionable therapy at best, they are still the number one selling drug in the US. What isn’t so well known is that 75 percent of statin prescriptions are written for people who will receive no proven benefit. The cost of these prescriptions? Over $20 billion a year.

Yet somehow the 2004 National Cholesterol Education Program guidelines expanded the previous guidelines to recommend that even more people without heart disease take statins (from 13 million to 40 million)^[xiii] What are we thinking?

Why would respected scientists go against the overwhelming research that statins don’t prevent heart disease in people who haven’t already had a heart attack?

You can find the answer if you follow the money. Eight of the nine experts on the panel who developed these guidelines had financial ties to the drug industry. Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutes of Health saying the evidence was weak.

What Should Women Do?

It is time to push the sacred cow of statins overboard.

But first let me say this. If you have had a heart attack, or have heart disease, the evidence shows they do in fact help protect against a second heart attack, so keep taking them.

However, you should be aware that most prescriptions for statins are given to healthy people whose cholesterol is a little high. For these folks the risk clearly outweighs the benefit.

The editorial that accompanies the recent study on women taking cholesterol-lowering medication that I opened this article with was quite clear. Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has “important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality.”

In plain English, she said that we shouldn’t be using statin drugs for women without heart disease because:

1. The evidence shows they don’t work to prevent heart attacks if you never had one.
2. They significantly increase the risk of diabetes.

Treating risk factors like high cholesterol is misguided. We must treat causes – what we eat, how much we exercise, how we handle stress, our social connections and environmental toxins are all more powerfully linked to creating health and preventing disease than any drug on the market.

Remember what you put at the end of your fork is more powerful than anything you will ever find at the bottom of a pill bottle.

My new book The Blood Sugar Solution, which comes out at the end of February, gives exact details on what you should put at the end of your fork to prevent and reverse diabesity. It provides a comprehensive solution to the health problems facing our nation today.

Now I’d like to hear from you …

What do you think of statins?

Have you taken statins? What has your experience been?

Why do you think the medical establishment prescribes drugs that research shows don’t work?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, MD

Other studies have shown that you are more likely to be overweight (and suffer from all of the resulting health consequences) if your friends are overweight than if your parents are overweight. And we are now learning that when you join together in community to lose weight and heal you are far more likely to succeed. The Look Ahead Study, a 13-year study of 5,000 people funded by the National Institutes of Health, compared an intensive group lifestyle change program for diabetes prevention to regular medical care with individual visits to the diabetic educator, nutritionist, and doctor. To date, the group lifestyle program has proven remarkably more effective in lowering weight, cholesterol, blood sugar, and blood pressure than conventional medical care.[ii] Once this study is completed, it will completely change our way of thinking about how to treat disease.

We get better together. The community is the cure.

So what happens when our relationships suffer?

For many people, relationships are a major source of stress. As much as you love and need them, your parents, partner, children, boss, and even your friends can be the cause of a lot of aggravation. The resultant stress can have a tremendous impact on your health.

As my friend and colleague Christaine Northrup, MD points out in the newly revised edition of her book The Wisdom of Menopause, midlife can be an especially difficult time to navigate tough relationship issues. She says:

“It is no secret that relationship crises are a common side effect of menopause. Usually this is attributed to the crazy-making effects of the hormonal shifts occurring in a woman’s body at this time of transition. What is rarely acknowledged or understood is that as these hormone-driven changes affect the brain, they give a woman a sharper eye for inequity and injustice, and a voice that insists on speaking up about them. In other words, they uncover hidden wisdom—and the courage to voice it. As the vision-obscuring veil created by the hormones of reproduction begins to lift, a woman’s youthful fire and spirit are often rekindled, together with long-sublimated desires and creative drives. Midlife fuels those drives with a volcanic energy that demands an outlet.

“If it does not find an outlet—if the woman remains silent for the sake of keeping the peace at home or work, or if she holds herself back from pursuing her creative urges and desires—the result is equivalent to plugging the vent on a pressure cooker: Something has to give. Very often what gives is the woman’s health, and the result will be one or more of the “big three” diseases of postmenopausal women: heart disease, depression, and breast cancer. On the other hand, for those of us who choose to honor the body’s wisdom and to express what lies within us, it’s a good idea to get ready for some boat rocking, which may put long-established relationships in upheaval. Marriage is not immune to this effect.”

And neither are your relationships with other family members.

Relationships change as we evolve. Sometimes changes you are trying to make cause the people around you to feel uncomfortable. This is especially true when you are working on profound dietary and lifestyle changes—changes that are often needed to heal your mind, body, and spirit. Your friends and family may wonder how your newly adopted lifestyle will affect them. They may ask: Are her dietary choices a subtle judgment on me? What if I don’t want to eat the same foods she does? (This one especially comes up in families.) What will we do together now that she has chosen to spend her time doing new activities? Sometimes even changing your hairstyle is enough to stir the pot!

So how do you manage these situations? Here are some ideas from The Wisdom of Menopause:

1. See it for the Petri dish it is. Experiment and expect resistance!
2. Remind yourself that it’s okay not to be the good girl (or boy!) who sees to everyone’s needs except her own. This goes for any pattern you’re trying to break.
3. As you end or update some relationships, you may feel a little sad. That’s okay. Grieve and let go. By doing so, you’ll be protecting your health for years to come.
4. Laugh. Bringing humor into a situation almost always eases tension.
5. Distance yourself—even if it means skipping the traditional family get together—so you don’t become emotional or stressed by others’ behavior.

Midlife and the menopausal transition in particular is a blessing, because it brings to light the things that no longer serve you. That can be your diet, your exercise regimen (or lack thereof), your career, and, of course, some of your relationships.

I know it seems scary. Holding on to the relationships you have—even if they aren’t supportive—may feel like a better choice than giving them up for the promise of new friends, love interests, or colleagues. But, be courageous! Seeking out people who will truly support you on your journey to health is critical if you want to get and stay vibrantly healthy for life. What is waiting on the other side of the grief that can ensue with transition is a life filled with more health and happiness than you can imagine.

Learn more about navigating your own “change” in The Wisdom of Menopause.

Now I’d like to hear from you …

Have your relationships had an impact on your health? How have they impacted it and how have you managed these problems?

Have you had to make difficult relationship transitions? What was this like and how did changing help you heal?

How has menopause or midlife had an impact on your health and relationships and what steps are you taking to manage these changes?

Leave your thought by adding a comment below.

To your good health,

Mark Hyman, MD