TODAY'S AJENDA #65

Last week, I was fortunate to visit Switzerland for the 4th time, this time on a business trip. What I’ve realized is that there’s something about Switzerland that really has an impact, and it’s not just the Alps, pristine trains, or their incredible chocolate. It’s their un-obsessed approach to wellness. 

Because while us Americans hit 5 AM bootcamps and do celery juice “cleanses,” the Swiss’ fitness routines are baked into daily life, and this integration has made them one of the world’s healthiest countries. 

As a physician (and someone personally curious on how this Alpine country stays healthy!), I’ve done several deep dives into their wellness culture. Here’s what I’ve observed, what the research supports, and what we should borrow from the Swiss: 

1) Fitness Is Woven Into Everyday Life

The Swiss move. All. The. Time. 

They walk to work, bike to the store, take the stairs, and hike mountains. Not because they’re “fitness fanatics,” but because their environment of accessible nature, reliable public transit, and pedestrian-friendly cities encourages movement. 

That kind of low-intensity but consistent movement does wonders for cardiovascular health, blood sugar, mood, and longevity: 

• Science Says: One study found that if England and Wales increased their daily walking from 11 to 25 minutes and cycling from 1 to 4 minutes (to match Swiss patterns) it could prevent up to 17,000 deaths a year (Götschi et al., 2015). 

In short? In Switzerland, movement happens by default. In the US, where most cities are car-centric, it’s a choice. The result is the average Swiss person takes 9,165 steps a day, while Americans get only 5,117 steps. 

2) Building Resilience > Burning Calories 

In my conversations with Swiss trainers, doctors, and physiotherapists, I kept hearing the same thing: fitness isn’t just about “burning calories.” It’s about building resilience. 

That’s why Swiss fitness programs are built on three pillars: 

1. Strength

2. Endurance

3. Coordination 

Together, these pillars keep both your body and nervous system sharp today and for years to come. The programs include single-leg exercises, mobility drills, balance boards, and proprioceptive training (your body’s ability to sense its position in space). 

• Science Says: One study found that older adults who engage in regular balance and coordination exercises can reduce fall risk, maintain independence, and improve cognitive function (Dunsky, 2019). 

The Swiss have recently developed more cutting-edge ways to test this kind of fitness, and I was so impressed that I’m now helping bring the technology to the US (more on that soon!). You will be the first to know! 

3) They Don’t Rush Recovery

Americans often see exercise as a punishment (a way to “earn your calories”...*cringe*) and rest days as laziness. But in Switzerland, that mindset couldn’t be more different. 

The Swiss respect the recovery process. A full day off after a tough session, time in sauna, massage, and cold exposure are all seen as normal, even necessary, parts of fitness training. It’s far from indulgent! 

What We Can Learn

No, you don’t have to move to Bern or Zurich to benefit from the Swiss fitness mindset. But you can bring some of their habits home:

• Respect recovery as part of the training process. 

• Integrate exercise into real life, not just the gym! 

• Prioritize daily movement over occasional intense workouts. 

• Train balance and coordination (especially as you age). One of my favorite ways to do this is to stand on one leg as you brush your teeth. 

The Swiss aren’t chasing aesthetics, they’re chasing function and longevity. And in my opinion? That’s a wellness goal worth pursuing. And THIS is why I love the Swiss! 

As someone who flies once a week (often more!), I’m no stranger to the toll air travel takes on the body. Think bloating, dry skin, and the “I just licked a salt shaker” feeling (the worst). 

But why does flying have this effect on the body? And more importantly, what can we do about it? 

Cabin Pressure: The Unseen Force

The main culprit is cabin pressure. Airplanes are pressurized to 6,000 to 8,000 feet above sea level, which is way higher than what most people experience (unless you live in a high-altitude city). 

At this altitude, oxygen levels drop, triggering mild hypoxia, a state where your body isn’t getting as much oxygen as it needs. To compensate, your blood vessels widen (a process called vasodilation) which can cause fluid to leak into surrounding tissues. 

That’s why your hands, ankles, and face may look puffier after a flight, especially if you’ve been immobile for hours. In my case, minutes after takeoff, my rings get tight and my ankles swell. Not pretty! 

The Dehydration Factor

Then there’s the air. Airplane cabins typically have humidity levels between 10% to 20%, which is drier than the Sahara Desert. (I’m not exaggerating: the Sahara averages 25%!) 

• Here’s Why: The air outside the plane at cruising altitude is extremely cold and holds almost no moisture. Even after it's filtered and conditioned for the cabin, it remains bone dry. 

That dry air causes moisture to evaporate from your skin and respiratory tract without you even noticing. The result? Tight skin, chapped lips, and more importantly, dehydration. When you’re dehydrated, your blood thickens slightly, which can lead to: 

• Contact lenses feeling like sandpaper. 

• One glass of wine feeling like two (or three). 

• That sluggish, heavy-legged feeling mid-flight. 

• An increased risk of deep vein thrombosis (DVT) especially on flights over 8 hours. 

Sodium, Circulation, and Salt Retention

There’s (unfortunately) more. When you’re dehydrated, your body clings to sodium in an effort to preserve water. That sodium retention makes you more prone to fluid buildup in your tissues. 

Now toss in salty in-flight snacks, poor circulation from hours of sitting, the inflammatory effects of travel stress and poor sleep, and you’ve got the perfect recipe for a puffy, parched version of yourself. 

What You Can Do About It

This doesn’t mean you’re doomed to land looking like the Michelin (Wo)Man. Here’s what I do: 

1. Limit Alcohol and Caffeine

Both are diuretics, which means they promote fluid loss. Personally, I completely avoid alcohol and coffee when flying (and pretty much on the ground too).

2. Move Your Body

Get up every 90 minutes to walk the aisle, do ankle circles in your seat, or flex your calves. Movement keeps your blood flowing and helps prevent swelling. Compression socks (they’re not just for your grandmother) can also help. I often wear a pair! 

• Science Says: A 2016 review analyzed 11 studies on 2,637 passengers and found that wearing graduated compression stockings during flights reduced the risk of DVT by 90%! 

3. Avoid Salty Snacks

Airport food is generally a salt bomb. Go for potassium rich foods (bananas, nuts, dried apricots) as potassium helps balance out sodium and promotes healthy fluid levels. 

4. De-Puff Topically

If you’re landing and heading straight to an event (or just want to look alive), try caffeinated eye creams and cool compresses to calm under-eye swelling. 

Or, give yourself a gentle lymphatic massage to move fluid and boost circulation with jade rollers and gua sha tools. 

5. Don’t Skip Sleep

Try adjusting your sleep schedule a few days before your trip and bring an eye mask or noise cancelling headphones. Melatonin can help, but talk to your doctor (especially if you’re over 50). 

Personally, the only time I use prescription sleeping pills is for major time zone shifts, like when I go to Europe or crossing more than 6 from NYC. Here’s how I use it: 

On my first night in Europe, I’ll take a sleeping pill at around 10pm Europe time. This way I get 8 full hours of sleep and start my day at 6am the next day, roughly on track to be “normal.” 

I also take a sleeping pill for the first few nights back in the US to minimize the chances of waking up at 3am. I find this practice of assuring 8 hours of sleep to be very helpful in dealing with jet lag. 

Talk to your doctor about using prescription sleeping pills specifically in this manner. They are NOT for nightly use!

6. Hydrate Strategically

Aim for 8 ounces of water for every hour in the air. But remember, it’s not just how much water you drink, but how well your body absorbs it. That’s why I’m a big fan of electrolyte-enhanced water or low-sugar hydration powders, which help your body actually retain what you’re sipping.

So when Pique* launched their new hydration electrolyte powder, R•E Fountain, the timing couldn’t have been better. I’ve been dying to share this new product from Pique with you all since I got their first samples last month, and now, R•E Fountain is finally live! As you know, I’m a big fan of all Pique beverage products, and this one arrived just in time for my trip to Switzerland.

R•E Fountain is a clean, calming electrolyte mix formulated with Triple Biomaxed Magnesium (glycinate, taurate, and L-threonate) which promotes deep calm, quality sleep and relaxation, and cognitive recovery.

It has zero artificial flavorings, sugar, or maltodextrin, which is crucial especially on flights since sugary mixes make dehydration worse. (It gets its beautiful blue color from organic spirulina!)  

I’ll drink R•E Fountain on a red eye flight to wind down, and when we land in the morning, I feel more well-hydrated, focused (no brain fog!) and ready for the day. The Pique team was kind enough to offer a 10% off for life for Ajenda members when you subscribe. Lock in your discount right here! 

This is a question I hear a lot from women who are navigating the hormonal rollercoaster of midlife. The short answer is that yes, estradiol cream can rub off on your partner. But before we panic and picture our partner growing breasts, let’s go through the science. 

Wait, What’s Vaginal Estradiol? 

Vaginal estradiol is a treatment for genitourinary syndrome of menopause (GSM), which is a collection of very uncomfortable symptoms including vaginal dryness, burning, painful sex (dyspareunia), and urinary urgency that affects up to 84% of people in menopause. 

0.1% estradiol cream delivers a low dose of estrogen directly to the vaginal area. Unlike hormone pills or patches, it doesn’t deliver a lot of estrogen into your bloodstream, making it a great option for women who want symptom relief without whole-body hormone effects.

“Is it safe?” Standard doses of vaginal estrogen doesn’t significantly raise blood estrogen levels and is considered safe, even for women with a history of breast cancer (but as always chat with your doctor first).  

Transference: Fact or Fiction?

Here’s the concern: If you’re using vaginal estradiol, can it transfer to your partner during sex, specifically from vagina-to-penis contact? 

There is evidence that transfer is possible, especially with higher-concentration creams or if sex happens right after applications: 

• Science Says: A 2008 study found that small amounts of estradiol were detected in male partners after skin-to-skin contact with women using topical estradiol. However, these levels stayed well below the normal range for men and didn’t pose any health risks. 

Transference is actually more likely with transdermal gels or patches. If those aren’t fully dry or placed on high-contact areas (think thighs or arms), it’s more likely to rub off on someone else.  

That said, “theoretical” doesn’t mean “impossible.” There have been rare cases of male partners experiencing mild hormonal symptoms (like breast tenderness) after prolonged exposure. But again, these cases are rare, involve high doses, and the symptoms went away once the exposure stopped. 

Practical Tips

If you're using 0.1% estradiol cream, here are a few ways to minimize any potential exposure to your partner:

1. Time it right: Apply the cream several hours before intimacy, or use it on alternate days from when you expect sexual activity.

2. Use at bedtime: This gives it time to absorb while you're lying down and reduces likelihood of direct transfer.

3. Consider other formulations: Vaginal estrogen tablets or rings may pose even less risk of surface transfer, as they sit further inside the vagina and don’t leave residue externally.

4. Talk about it: If your partner has concerns, bring them into the conversation. This is about shared health and intimacy.

Bottom Line

For most women, the benefits of vaginal estradiol far outweigh the theoretical risks. When used properly and timed thoughtfully, the chance of significant hormone transfer is very low. 

Still, if you or your partner notice anything unexpected (like breast tenderness, mood changes, or skin issues), it’s a good idea to chat with your healthcare provider. They’re there to help you navigate treatment options that don’t just support symptom relief, but increase your quality of life.

Did you enjoy Today’s Ajenda? It would mean the world if you left us a testimonial!

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

Forwarded this email?

Missed the last issue?

Want a copy of Dr. Jen’s best-selling book?

*Note: This newsletter includes affiliate links. Sponsors may earn a commission if you purchase.