May 2009 Archives

With serious food allergies on the rise, it's hard to know if your child is at risk. Here's how to keep her safe, even when you're not around.

Copyright Jessica Snyder Sachs, as first published in Parenting

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Ann Wood's* son Daniel almost died when he was 2 - from a snack. At first, Wood hadn't been worried when she'd called home from work and her babysitter mentioned that Daniel had just thrown up after eating an almond butter sandwich. "These things happen," she'd reassured her babysitter. "Just keep an eye on him." When Wood called back 15 minutes later, though, Daniel had developed diarrhea. When she called a third time, as she rushed home to their New Jersey suburb, he was struggling for breath. "Call 911 right now!" she instructed.

As Daniel emerged from an ambulance at the hospital, his face was covered with large red welts. The paramedics had found him in anaphylactic shock, which meant that his throat was swelling shut and his blood pressure was plummeting toward zero. They brought him back with injections of the stimulant pinephrine and an inflammation-squelching steroid. The next day, Wood and her husband learned that Daniel's reaction was from a life-threatening food allergy to peanuts, a trace amount of which had likely cross-contaminated the almond butter.

Now in second grade, Daniel isn't the only one of his friends with food allergies. Five kids in his grade carry EpiPens, the prefilled syringes that contain enough epinephrine to reverse a severe allergic reaction. And his grade is hardly unique. In the U.S., about 1 in 12 children under 3 have food allergies, and around 150 die each year because of them. Outside the U.S., the problem is no less serious; the incidence of food allergies in kids around the world has at least doubled over the last decade.

"The increase seems to be part of a general rise in allergies of all kinds," says Scott Sicherer, M.D., a pediatric allergist at New York's Mount Sinai School of Medicine and author of Understanding and Managing Your Child's Food Allergies. 

While it's not clear what's behind this disturbing trend, many experts think it may have to do with the so-called Hygiene Hypothesis: that modern life - with its lack of exposure to the "germiness" of infiltered water, dirt, and animals - can leave people's immune systems prone to overreact to harmless substances. The result: Even something as innocent-seeming as a peanut can cause the body's defenses to go into overdrive. As overactive immune cells release histamine and other inflammatory chemicals, they produce symptoms such as hives, itching, diarrhea, and in severe cases, life-threatening anaphylaxis. 

While regular exposure to relatively harmless bacteria might help make us less allergy-prone, no medical expert would advocate going back to the days of rampant cholera and intestinal parasites. So where does that leave us? Fortunately, there are steps you can take to reduce your child's risk of developing food allergies, and ways to handle them if they arise.

A Family Affair

The first thing you'll want to figure out is your family's allergy history. "The more people in your family who have allergies, the greater the risk your child will have one," says Dr. Sicherer.

Kathleen Murray-Lyons, of Townsend, Delaware, has allergies and asthma, so her pediatrician suggested special measures to decrease her 1-year-old son James's chances of food allergies. He recommended she delay introducing James to certain foods that are common allergens, such as nuts and eggs, and offer even low-allergenic foods, like carrots and rice, only gradually and one at a time. (See What to Introduce When). "So far, so good," says Murray-Lyons.

Another tactic doctors recommend: Wait to introduce any solids to your baby until after 6 months (as opposed to 4 months), since studies have found that this significantly decreases the risk of your child developing food allergies. As for what you should eat if you're breastfeeding, studies are mixed as to whether it's helpful to eliminate allergenic foods from your diet. Talk to your doctor about your particular case.

How to Recognize and Respond

Figuring out that your child has a food allergy can be half the battle. Leslie Norman-Harris of Woolwich Township, New Jersey, recalls the night her daughter, Camryn, 4, ate a mouthful of rice with shrimp.

"When she told us her mouth felt itchy, my husband and I looked at 
each other and said, 'Uh-oh.'" Fortunately the symptoms subsided, but they knew not to give Camryn any more shrimp.

Other symptoms (which almost always appear a few minutes after eating the offending food):




Itching (throat, mouth, eyes, skin, and/or ears)

Lip swelling

Rash (hives or a flare-up of eczema)

Throat tightness (trouble swallowing or breathing)

Tongue swelling that obstructs the mouth

Chest pain


Sudden paleness or blueness, unconsciousness, and/or a faint pulse

For a mild allergic reaction, such as stomach upset or a rash, watch your child carefully in case she gets worse, and call your doctor. To relieve discomfort, you can give her a weight-appropriate dose of an antihistamine such as Benadryl or its generic equivalent (diphenhydramine).

If your child has a severe allergic reaction (like throat tightness, lip swelling, or unconsciousness), call 911. She may need an injection of epinephrine. Later, talk with your doctor about whether you should keep epinephrine on hand. 

Testing and Treatment

If you think your child has a food allergy, see your doctor, who may recommend a pediatric allergist. He'll likely perform one of two tests: the classic skin-prick, which entails scratching a small amount of the allergen into the skin and watching for a reaction, or a blood test that screens for allergy-related antibodies.

But know that allergy tests are far from perfect, says Hugh Sampson, M.D., director of the Jaffee Food Allergy Institute at Mount Sinai School of Medicine. It's possible to have an allergy that doesn't show up on a test, or for a test to show that your child is mildly allergic to a certain food even though he can eat it without a problem. Bottom line: Diagnostic tests are best used to help confirm a suspected allergy, rather than to go fishing for possible ones.

Another alternative for determining food allergies is simply to talk about your child's symptoms with your doctor. Dr. Sampson, for example, says he looks for common patterns. Does the child always develop symptoms within minutes of having a particular food? Is it a food known to provoke allergies? If the answers are yes, then you may be dealing with a food allergy.

Once you know your child is allergic to a food, the best thing to do is avoid it entirely. (Allergy shots, while often effective for respiratory allergies, aren't usually used to treat food allergies because there's a greater risk of a dangerous reaction.) If your child does accidentally eat the wrong thing, the best line of defense is to follow your doctor's emergency plan, which will likely include relieving symptoms with an antihistamine or an emergency shot of epinephrine, depending on how severe the symptoms are.

Several promising treatments are now being studied. Most involve "immunizing" a person against the food allergen by injecting a modified version of it together with a substance that tells the immune system to "back off," or treat it as harmless. If these treatments pan out, they may become available as soon as 2010.

Avoiding Allergens

Steering clear of allergenic foods can be one of the toughest jobs a mom can take on. Fortunately, as of January 2006, the Food and Drug Administration requires all food labels to state if ingredients include any protein derived from one of the eight major allergenic foods. But you still need to be vigilant about reading the fine print on labels, which can contain surprises.

"Who would ever have thought that baby-food meats would have dairy in them?" says Jennie Oko of Westmont, Illinois, who has became an ingredient detective ever since her son Matthew, 3, was diagnosed with a dairy allergy as a baby.

Next: Make Your Child Food Smart

Not only do you need to be careful about keeping problem foods out of your house, you also need to teach your child to steer clear of them in other settings. "You don't want to scare him," Dr. Sicherer cautions. Just calmly explain, "Mommy and Daddy don't want you to feel sick, so it's important that you take food only from us and Grandma."

Dr. Sicherer even suggests role-playing together - for instance, by pretending to be a visitor offering him a cookie. If he starts to accept it, say something like "Uh-oh. Remember what we talked about - visitor doesn't know about your allergies."

You'll also need to get used to explaining your child's dietary restrictions when you eat out. A recent survey found that restaurant workers generally don't realize that something as small as a cross-contaminated serving spoon or frying pan could trigger a severe reaction.

"I Want What They're Having!"

For young children, not being allowed to eat what other kids do can be upsetting. When Sabrina Sciarrotta was 18 months, "she was so eager to have everything her big sister, Julia, had," recalls her mom, Monica, of Brea, California. "But while Julia was fine with dairy, Sabrina got headaches and broke out in rashes." To avoid a conflict, Sciarrotta now doles out Julia's yogurt and milk only when Sabrina is napping.

There will inevitably be times, though - at birthday parties, for instance - when your child can't ignore her limitations. Get in the 

habit of sending your child to such events with "safe" food alternatives. At school, be sure to explain her food allergy to her teachers and the nurse. If your child has a severe allergy, see if her school will even send notes home to her classmates' parents, explaining that certain foods shouldn't be sent in for sharing.

Outgrowing Food Allergies

The good news is that many children's food allergies go away by age 5. In fact, milk, egg, wheat, and soy allergies disappear nearly 85 percent of the time. So if your child has sworn off, say, soy for several years, ask the doctor if it's a good idea to reintroduce it to him again. She may suggest repeat allergy tests under medical supervision.

While you're still dealing with food allergies, however, remember that "life should not be viewed as a mine field," says Dr. Sicherer. Wood agrees: "We try to protect Daniel while letting him live a normal life."

Allergy - or intolerance?

Many people use the terms "food allergy" and "food intolerance" interchangeably, but they're very different things. An allergic reaction involves a misguided immune response to an otherwise harmless substance. The result is runaway inflammation, which produces the rashes, itchiness, and swelling typical of allergies.

An intolerance results when a child (or adult) lacks one or more digestive enzymes needed to break down a food ingredient. Gas, bloating, and an achy stomach are the hallmark symptoms. (Lactose, or milk sugar, is by far the most common offender.) An intolerance can cause serious stomach pain but, fortunately, isn't life threatening.

* Name has been changed for privacy, at the request of the family.

Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill & Wang/FSG).

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Unlikely Partners in the Sea

Copyright Jessica Snyder Sachs, as first appeared in National Wildlife 

Narwhals, among the Arctic mammals most threatened by global warming, may help scientists track temperature changes in otherwise inaccessible ocean depths

BIOLOGIST Kristin Laidre sits in her University of Washington office overlooking Puget Sound's busy Portage Bay. With little prompting she lets her mind drift to a much larger, colder bay some 2,500 miles to the northeast. "What stands out about Baffin Bay," Laidre says, "is how you can fly for hours over the dense ice, a landscape where you wouldn't expect a single living thing, and then you look down and see a small lead, a tiny crack in the ice, and there will be a narwhal."

On the most memorable occasions, Laidre and her colleagues have watched what they call the classic narwhal ménage à trois--two males crossing and rubbing their 6- to 9-foot-long tusks above the head of a bobbing female. "It's quite remarkable," Laidre says. Laidre has spent the past 10 years tagging, tracking and studying the narwhal--the Arctic's most specialized, range-restricted and northernmost whale. The narwhals of Baffin Bay account for 80 to 90 percent of a world population of 50,000 to perhaps 80,000. A second group, of around 5,000, inhabits the northern part of Canada's Hudson Bay. An even smaller population of unknown number lives east of Greenland.

The narwhals that winter in the deep water of central Baffin Bay get there by migrating thousands of miles from summering areas in the shallow bays and fjords of the High Arctic. Despite the extreme cold and ice cover, winter is a period of intense activity for this small, highly social whale. Winter is mating as well as feeding season, a time when narwhals consume the vast majority of their yearly diet.

On a typical winter day, narwhals dive almost continually to graze on the pitch-dark seafloor and there gorge on fatty, energy-rich Greenland halibut, or "turbot." Many dives reach down to 5,000 feet and last some 30 minutes. At such depths, narwhals are sustained solely by their highly oxygenated blood and muscles, the deep-sea pressures having collapsed their lungs. When they surface to breathe, as all whales must, narwhals zero in on small--sometimes fleeting--cracks in the thick winter ice pack. Open water can suddenly freeze during windless conditions and temperatures below minus 30 degrees F.

Come April, the ice pack begins to loosen, signaling the narwhals to begin their two-month-long northward migration. It's during this early spring window--when the ice has loosened but has not yet turned to slush--that Laidre flies east from Seattle to rendezvous with her longtime colleague, Mads Peter Heide-Jorgensen of Greenland's Institute of Natural Resources. "Our work has focused on gaining a fundamental understanding of how this animal uses its ecosystem," Laidre says. "Only then can we begin to suggest ways that it can be protected."

That the narwhal remains so little studied stems directly from the difficulty and expense of mounting research expeditions across Arctic seas, Heide-Jorgensen says. "I'm sure a similar effort on almost any other creature would yield a lot more data, but it's also gratifying to study an animal where every piece of information you learn is worth its weight in gold."

For starters, their team has documented the narwhals' faithfulness to their narrow migratory routes. They've also reported the Baffin population's need to consume some 880 tons of Greenland halibut daily each winter. Field observations and autopsies on hunter-harvested whales have likewise confirmed that narwhals eat surprisingly little during the milder summer months. "We don't know why, but narwhals depend on their wintering grounds to supply the bulk of their diet," Laidre says.

Global Warming Threat
In 2008, Laidre and Heide-Jorgensen's research flashed briefly into public view with the publication of an international consensus report that ranked narwhals as edging out even polar bears as the Arctic mammal most vulnerable to climate-induced habitat change. According to the report, this extreme sensitivity to global warming stems directly from the whale's small range, narrow migration routes, limited world population and restricted diet. Combine these traits with the narwhal's low genetic diversity and, Heide-Jorgensen says, "I think you can understand what makes them so vulnerable."

Just how global warming will affect the narwhal's environment remains unclear. Counterintuitively, one possibility is that warming will further reduce the scant open water that ensures winter survival for narwhals. Such a cooling trend could result from the increased rainfall that global warming can produce in coastal regions. The increased influx of freshwater decreases ocean salinity, which can slow or shut down ocean currents that would normally deliver warmth from the Equator. In line with such predictions, in 2005 Laidre and Heide-Jorgensen reported that Baffin Bay sea ice cover had been steadily increasing since 1978. During this time, the percentage of open water at the end of winter had shrunk to an average of just one half of 1 percent. "Now that seems to have reversed," Laidre says of the last four years. "Instead we're now seeing less and less ice cover."

Unfortunately, increased open water could bring its own problems. One major concern is that rising water temperatures could render the narwhal's ecosystem less productive--particularly in regard to the cold-water turbot that provide the whale its primary food source. Another is the possibility that fishing fleets will begin entering the narwhal's previously ice-locked feeding areas. "Both Canada and Greenland have looked at extending their coastal fisheries offshore," Laidre says. "With reduced ice cover, that interest will only continue." Indeed, the international competition for nearby fisheries has been so fierce at times as to escalate into armed conflict. During the so-called Turbot War of 1995, the Canadian Coast Guard used machine guns and water cannons to disrupt and seize Spanish trawlers plundering Newfoundland's Grand Banks. Whichever direction global warming takes Baffin Bay, environmental shifts are already in motion. "The whole ecosystem is changing, not just with respect to narwhals," Laidre says.

A Promising Role
Baffin Bay's narwhals may play a pivotal role in better understanding these changes. Over the past two years, Laidre and Heide-Jorgensen have used a grant from the National Oceanic and Atmospheric Administration to harness 10 narwhals with satellite transmitters. The transmissions relayed the animals' positions and surrounding water temperatures as the whales made thousands of winter dives to the bottom of Baffin Bay.

Laidre tracked the narwhals' daily movements from her computer monitor at the University of Washington's Polar Science Center. Now that the last of the transmitters has fallen away and sunk, she is beginning the daunting task of analyzing the temperature data with the help of the science center's oceanographers.

Preliminary analysis suggests that the whales are diving at fronts--areas with large and rapid temperature changes that stem from warm, upwelling waters. "On its own, these data aren't going to reveal anything about global warming," Laidre says. "But they can serve as a baseline for future studies, and, when combined and compared with historical data, they may show differences from the past."

Already the data transmitted from the outfitted narwhals are rivaling the meager information collected through far more expensive, manned expeditions that require research vessels to venture into iceberg-strewn waters, winch instruments into the deep on cables and then return months later with the hope of retrieving them.

Meanwhile, the narwhal's short-term prospects look good, with populations appearing stable in the decade since the governments of both Greenland and Canada forged hunting quotas with the region's native Inuit peoples. The Inuit harvest several hundred narwhals each year, both for the male's valuable tusk and for the nutritious meat and vitamin-rich skin that have long helped Arctic peoples survive on a diet largely devoid of fruits and vegetables.

Today, Arctic researchers can still watch thousands of migrating narwhals passing by their coastal camps in a single day--sometimes spaced apart only by the 9-foot-long tusks of the males. Heide-Jorgensen describes being awed by both the view from coastal cliffs and the sounds he hears from his tent under a midnight sun. He describes the noise of a narwhal surfacing to breathe as somehow both prehistoric and resembling the brake release of a diesel truck. "A kind of whistle that ends with an airy sigh," he says. "And that's when you forget how cold it is. It's just you and these ancient creatures with a life so special and isolated from anything else."

Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Farrar, Straus, and Giroux, 2007).

The Tale of the Tusks

Though technically considered "toothed" whales (as opposed to filter-feeding whales that have mouths lined with baleen), adult narwhals have no functioning teeth inside their mouths. The male's tusk, which grows as long as 9 feet, begins as one of six pairs of teeth inside the mouth of a fetus. Four pairs of those teeth disappear before birth, leaving two pairs. One of these develops into the cuspids, or "fangs," and the others into vestigial teeth. In males the left cuspid continues to grow outward in a counterclockwise spiral, emerging through the upper jaw and lip to form a spearlike tusk. Typically the right cuspid remains imbedded in the upper jaw, but about one in 100 males sports double tusks. Similarly, about one in six females will bear a single, shortened tusk.

Cetacean Senior Citizen

Although they live in a dangerous winter environment where the vagaries of sea ice can lead to sealed breathing holes and death from suffocation, narwhals, according to a recent study by Mads Peter Heide-Jorgensen of Greenland's Institute of Natural Resources and his colleagues, has determined that the animals nevertheless are among the longest-lived mammals.

To determine the age of narwhals, the researchers studied changes in eye chemistry that occur predictably as the animals age, using specimens from 75 dead narwhals collected in West Greenland in 1993 and 2004. The oldest of the whales, a female, was between 105 and 125 years old. The oldest male was between 75 and 93 years old. However, the animals in the study came from a heavily hunted population. "The maximum age in other narwhal populations with less disturbed age structure might be considerably higher," the biologists concluded in a paper published in the Journal of Mammalogy. "Maximum age also is likely to increase when more specimens are examined."

Biologists have estimated the life span for a number of whale species, and some of them, too, are long-lived. The oldest recorded orca, or killer whale, and the oldest blue whale were both 90; the oldest fin whale reached 100. The real Methuselah in the cetacean world is the bowhead, another species of Arctic seas; the oldest on record lived 211 years.

Two of the most familiar whales did not win the whale life span sweepstakes. Sperm whales, the species of titular interest in the novel Moby Dick, live about 70 years and humpbacks about 48.

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By Jessica Snyder Sachs

If you're religious about what really matters, you can take shortcuts with the rest. Check out our guide to being a sensible slacker.

1. Work Out 5 Days a Week?

It's not your imagination: Our bodies simply become higher maintenance after 40. Indulgences of food or drink are quicker to take revenge. Muscles require more maintenance. Screening tests become more important. So there's a lot to remember -- and yet the wellness precautions keep coming, with new dos and don'ts every passing year. Can anyone do it all?

Actually, no. And if you try, say experts, you may end up throwing in the towel on some of the essentials, as well as what's helpful but optional. So find out where you can settle for good enough and still enjoy great health.

Rule 1: Work out 30 to 60 minutes a day, five days a week. 
The Midlife Shortcut:
 Catch up when you miss workouts.

To reduce the risk of heart disease, cancer, and osteoporosis -- all big concerns for women over 40 -- experts urge us to exercise at least 30 minutes a day, five days a week (and for maximum health benefits, make that an hour rather than half an hour). But daily workouts can be difficult to fit into a life crammed with work and family responsibilities. Then there's the knee and joint pain that many women experience after years of pounding their way through "healthful" exercise.

Why there's wiggle room: The cumulative hours -- the total time you clock each week -- is what really counts. In fact, the weekend warrior has gotten a bad rap, says exercise physiologist Jane Roy, PhD, of the University of Alabama at Birmingham. If you're too busy Monday through Friday, weekends are a great time for getting in two or more hours of enjoyable exercise a day. You can catch up by spending a weekend morning or afternoon playing tennis with girlfriends, taking back-to-back aerobic and Pilates classes, or going for a long walk or run.

Then, during the week, concentrate on interspersing sedentary activities such as computer work with small but frequent movement breaks, Roy adds.

2. Get a Pap Smear Yearly?

Rule 2: Get a Pap smear every year.
The Midlife Shortcut:
 Get tested every two to three years.

Sexually active women under 40 should be tested every year, but women over 40 can stretch it out to once every two to three years once they've had three or more normal results in a row, as long as they're in a long-term, mutually monogamous relationship or are not sexually active, and they're still getting annual pelvic exams.

Why there's wiggle room: When a woman is either not having sex or always has it with the same person (and that person is not having it with anyone else), she's not being exposed to new strains of the human papillomavirus, explains gynecologist Stacy Tessler Lindau, MD, of the University of Chicago Medical Center.

The majority of people who have ever been sexually active have been exposed to one or more strains of HPV. Most women clear the symptoms of the virus within a few months. But in a small minority, the infection causes cells to become precancerous over the course of several years. These are the abnormalities that show up on Pap tests.

What that means is the risk of precancerous changes (and ultimately cervical cancer) becomes very low once women pass through this latency period without being exposed anew by having sex with someone different. Even if you don't have a new partner, says Lindau, "You can be exposed to new sexual partners through your own sexual partner." That's why your relationship has to be mutually monogamous; if you're not sure it is, continue to be tested every year.

3. Eat 5 Servings of Veggies a Day?

Rule 3: Eat your veggies: five servings a day.
The Midlife Shortcut:
 Aim to include veggies in most meals.

Five servings a day add up to a heck of a lot of vegetables. Using USDA food guide serving sizes, you'd need to swallow up to 17 cups of salad or solid veggies a week to meet that goal -- that on top of the four daily servings of fruit you're supposed to get.

Admittedly, as the over-40 metabolism slows, substituting produce for higher-calorie foods and snacks can help with weight control. But as our lives grow exponentially busier, getting down all those veggies can become overwhelming.

"Five servings a day remains an admirable goal," says registered dietitian Christine Gerbstadt, MD, of the American Dietetic Association. And she argues that meeting it can be a lot easier than you think. "Potatoes count," she notes. "Just don't make it french fries every day." You can also add salsa, tomato sauce, or any kind of bean to the list.

But she's also willing to compromise. "A decent daily plan is to include some vegetables in most meals, then concentrate on rounding out the rest of your diet by pumping up the fibrous whole grains and healthy fats."

Why there's wiggle room: If you look at the big nutrition picture and aim for moderate goals, success may encourage you to surpass your quota. But if you don't hit the mark every single day, Gerbstadt says, you can get by with a daily multivitamin -- that will ensure you get the vitamins and minerals that are naturally abundant in fresh vegetables.

4. Brush After Every Meal?

Rule 4: Brush after every meal. 
The Midlife Shortcut:
 Put down the toothbrush and grab some gum.

Or a toothpick. Or gum. Or a glass of water. It's not necessary to brush your teeth after every meal if you do something else to remove the food debris.

Why there's wiggle room: Brushing when you get up and before you go to bed is just fine, according to Edmond Hewlett, DDS, of the UCLA School of Dentistry. In fact, Hewlett says it's a bad idea to brush right after consuming acidic foods or beverages such as wine, orange juice, and most soft drinks. "The acidity slightly softens tooth enamel," he explains. So habitually brushing right after eating these foods can contribute to tooth sensitivity and cavities.

Chewing sugarless gum has other benefits besides removing food residue. It also increases saliva, which contains minerals that help replace the enamel lost to acidic food and acid-producing mouth bacteria. That's particularly important after age 40, when your natural saliva production starts to decrease. And if the gum contains xylitol, you'll get an added bonus: This sugar substitute inhibits the growth of cavity-causing tooth bacteria.

5. Sleep for 8 Hours?

Rule 5: Eight hours of sleep every night -- no sleeping in. 
The Midlife Shortcut:
 Sleep late on weekends.

Yes, the human body does need eight hours of sound sleep each night, says Joanne Getsy, MD, of Drexel University College of Medicine, in Philadelphia. "It's a fallacy that you need less sleep as you get older," she says. "You don't need less; you simply get less." Anyone dealing with hot flashes and sleep disturbances knows this too well. But whereas many experts insist that "catch-up sleep" isn't as good as the real thing, Getsy says there's room for deviating from your normal wakeup and going-to-bed times.

Why there's wiggle room: "The aim should be to pay back your sleep debt as soon as you can," Getsy says. Specifically, she recommends scheduling twice-a-week catch-up nights. "Pick one weeknight and one weekend night, and don't plan anything on those evenings," she advises. "Let them be your nights to recover." Daytime napping is okay too, she adds: "Just keep it under an hour so it doesn't interfere with a solid night's sleep."

As for sleep-bingeing on weekends, Getsy advises staying in bed as late as you like on Saturday. Then on Sunday, split the difference between when you'd like to get up and when you have to get up on Monday. That will help ease you back into your weekday schedule.

Even better news: Getsy says that when it comes to sleep debt, it's okay to pay back less than you borrowed. Usually one full night's sleep is enough to make up for a couple of shortchanged ones, she says. "If you feel better in the morning, you've slept enough."

6. Lift Weights 3 Times a Week?

Rule 6: Lift weights three times a week.
The Midlife Shortcut:
 Try for one or two sessions a week.

On top of encouraging us to meet aerobic exercise quotas, the health gurus tell us to get to the gym and pump iron at least three days a week. Strength training is especially important after menopause, at which point a woman's body tends to lose both muscle mass and bone strength.

"When you make the muscle grow, you strengthen the bone that's attached to it," explains Felicia Cosman, MD, of the National Osteoporosis Foundation. Aerobic exercise such as jogging works only about 20 percent of muscle fibers, she says, while strength training with weights engages up to 90 percent.

Why there's wiggle room: There's no magic number as to how often you need to strength train. Aim for regularity, Cosman says, even if it's just twice a week. Nor do you have to schlep to a gym. "Weight machines and free weights are good," Cosman says, "but so are equipment-free Pilates and yoga moves, and push-ups."

7. Do a Breast Self-Exam?

Rule 7: Do a breast self-exam every month.
The Midlife Shortcut:
 Do it often enough to notice changes.

We came of age being trained to search for lumps every month. The mandate feels even more compelling now, given how greatly the incidence of breast cancer increases after 40.

As it turns out, however, there's little evidence that obsessively examining yourself really helps women catch more life-threatening lumps.

Why there's wiggle room: After years of urging women to perform monthly self-exams, the American Cancer Society recently deemed them optional. But what's still important, says ACS spokesperson Debbie Saslow, PhD, is that women become familiar with how their breasts feel and what's normal for them. "For a lot of women, that's still a monthly exam. For others, it's the occasional self-exam or simply paying attention when getting dressed or showering."

Where Not to Cheat

Here's where our health gurus draw the line. Follow these three rules, they say, as scrupulously as you can.

Keep Moving 
Yes, you get brownie points for working out on weekends, but you lose out on lots of benefits if you just sit in a chair the rest of the week, says Jane Roy, PhD, of the University of Alabama at Birmingham. So get up for a stretch break at least once an hour at work (you could walk down the hall to talk to a colleague instead of sending an e-mail), and a few times a day, catch some fresh air with a quick five-minute stroll outside.

If you need extra motivation, consider this: Five one-minute stretch breaks over the course of a day burn just 15 to 20 calories. But over the course of a year, that adds up to over two pounds of fat.

Get a Mammogram Every Year 
When cancer strikes women in their 40s, the tumors tend to be aggressive, which means fast-growing -- so the early detection offered by mammograms is crucial, says the American Cancer Society's Debbie Saslow. After menopause, women tend to have slower-growing cancers, she adds, but the incidence increases. "So going longer than a year just isn't worth the risk," she says.

Maintain a Healthy Weight 
Overweight women are more likely to develop heart disease, diabetes, and many types of cancer than normal-weight women are.

In fact, a recent analysis estimates that 20 percent of all cancer deaths in American women are linked to excess weight. In general, cancer rates increase when a woman's body mass index exceeds 25, says Colleen Doyle of the American Cancer Society. The risk rises more dramatically when the BMI passes 30. Abdominal fat appears to be closely associated with postmenopausal breast cancer and cancers of the colon and pancreas. And some experts say that the risk increases when a woman's waistline exceeds 32 inches.

Originally published in MORE magazine, February 2009.

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