TODAY'S AJENDA #67

What if I told you that you could lower your blood pressure, reduce inflammation, stabilize your blood sugar, and decrease your cardiovascular risk, all by simply sitting in a hot room and doing absolutely nothing? 

Do I have your attention? I thought so!

Today, we’re talking saunas. And before you shoo this off as some bougie spa indulgence, let me assure you: There’s real science that says saunas can protect your heart, brain, lungs, and more. 

Curious? Let’s step inside. 

Finland: Ground Zero For Sauna Science 

In Finland, saunas aren’t just a trend, but a way of life. With three million saunas and a population of 5.5 million, nearly every Finnish household has one. Most Finnish babies experience their first sauna before they’re five months old.  

That’s why Finland is Ground Zero for most sauna research. One of their most popular studies followed 2,300 middle-aged men for 20 years and discovered: 

• Those who used saunas 4-7 times per week had a 63% lower risk of sudden cardiac death and 40% lower risk of all-cause mortality compared to those who used them once a week.  

• Men who stayed in for more than 19 minutes had half the risk of sudden cardiac death compared to those who stayed under 11 minutes (Laukkanen et al., 2015). 

I know what you’re thinking: “Jen, I’m not a Finnish man.” (Fair.) But the biological mechanisms and benefits should theoretically extend to women. 

What Saunas Can Do For Your Brain, Body, and Bedtime

Heart health is just the beginning. Here’s what else regular sauna use has been associated with: 

• Improved mood and mental health: In a 2016 study, participants who did whole-body hyperthermia saw their depression symptoms drop. Researchers believe it’s because heat activates pleasure-sensing brain circuits that are under-active in depression (Janssen et al., 2016). 

• Muscle recovery: Heat helps increase blood flow to tissue and reduces delayed-onset muscle soreness. A study with basketball players found that 20 minutes in an infrared sauna after training significantly reduced muscle soreness (Ahokas et al., 2022). 

• Pain relief: A Korean study of mostly older women found that 90°C dry sauna sessions twice daily for five days reduced chronic lower back pain by 40%. (Cho et al., 2019). 

• Better sleep: The post-sauna cooldown mimics your body’s natural evening temperature drop, which may reset your circadian rhythm and improve sleep quality. 

The Sauna Longevity Link 

We’ve covered how saunas can help your muscles, mood, and sleep. But that’s only the tip of the (steamy) iceberg. 

A comprehensive 2018 review of all Finnish sauna research found that regular users (4-7 times per week) had a 47% lower risk of developing high blood pressure, a 65-66% reduced risk of dementia and Alzheimer's, and lower rates of lung disease. Most remarkably? They had a 40-60% reduction in overall mortality compared to once-weekly sauna users. 

As if that weren’t enough, another 15-year follow-up study found that those using a sauna 4-7 times a week were 61% less likely to suffer a stroke than those using a sauna once a week. 

How Does Sitting in a Hot Box Lead to Health Benefits? 

Well, when you step into a sauna (whether it’s traditional, dry, infrared, or steam), it puts the body into a mild, temporary state of heat stress, similar to a moderately intense workout. This does more than just make you sweat. It: 

• Increases your heart rate…which strengthens cardiovascular endurance. 

• Dilates the blood vessels…improving your blood flow and delivering oxygen more efficiently throughout your body.  

• Raises your core temperature…releasing heat shock proteins, which help repair damaged cells. (This is probably where most of the benefits arise.)

Is There an Age Limit For Saunas? 

No! Go to Finland and you’ll see 90-year-olds hitting the sauna (are we surprised?). Age doesn’t disqualify you, but it does mean you’ll want to approach it with a bit more intention. 

For women over 50, saunas are a great choice. As estrogen declines and cardiovascular risk increases, the sauna’s heart-health and circulation-boosting benefits become especially valuable. And for women over 60 (and beyond), it’s still beneficial. Just start low and slow, since as we age, our body’s ability to sweat and cool off decreases.  

How to Sauna Safely 

A few sauna safety tips: 

1. Start with 10–15 minutes, 2–3 times a week. Work up gradually as your body acclimates.

2. Hydrate before and after. Even mild dehydration can mess with blood pressure and cause fatigue or dizziness.

3. Listen to your body. Lightheadedness, palpitations, or nausea? Get out. There’s no medal for pushing through.

4. Avoid alcohol before or after. It’s a recipe for vasodilation overload (and not in a good way). 

5. Cool down slowly. Allow your heart rate to normalize before jumping in a cold shower or plunge. 

The Future of Sauna-ing 

It might sound far-fetched now, but experts predict that one day, doctors will prescribe sauna sessions for things like high blood pressure and depression. 

Picture public saunas in neighborhoods and nursing homes, not just for relaxation, but as community hubs. (Honestly, it’s long overdue!)

The science is starting to support that vision. Countries like Norway are already weaving saunas into public health programs, and places like the U.S., UK, Canada, and Australia are exploring similar models. But until we all have access to a community sauna down the block? Here’s a more accessible option: The HigherDose Infrared Sauna Blanket.* I bought this sauna blanket "for my husband" last year, but I was really buying it for myself too. And today, we both use it and love it!

The HigherDose Infrared Sauna Blanket is an investment cost wise, but the science is there to suggest heat therapy helps with muscle recovery, circulation, burning calories, and relaxation. And having one at home gives me all the benefits with zero excuses (it's harder to skip recovery when it's sitting right there in my living room!).

What I love about it is it brings a spa-element of wellness to my home and lets me multi-task while using it (talking to my husband, watching sports on tv, or just [gasp] relaxing). I also like the hygiene aspect of the fact that no other people use it, and feel it’s a great resource to complement my workouts.  

If you’re interested in healing and longevity, I’d put this on the top of your list.

Despite doing everything right—eating well, staying active—your limbs still feel heavy, swollen, and nothing seems to help. But when you went to your doctor, they said it was just “aging” and to “lose weight.” You wonder: Am I losing my mind? 

You’re not. 

What you might have is lipedema or lymphedema, two very real conditions that affect millions of women yet remain wildly misunderstood and often undiagnosed.

After several of you reached out to inquire about these conditions (thank you for the suggestion!) I knew it was time to address this head-on. Here’s what you need to know: 

First: What’s The Difference? 

These are two separate medical conditions, but both cause swelling in the body. (That’s where the “-edema” comes in: It’s the medical term for fluid-related swelling.). 

Lipedema is a chronic fat disorder that almost exclusively affects women. It causes painful, symmetric fat buildup, usually in the hips, thighs, and legs. The fat doesn't respond to diet or exercise and is often inflammatory and hereditary. 

• Science Says: Despite up to 11% of women having some form of lipedema, it’s not uncommon for healthcare providers to misdiagnose it as obesity.

• Lymphedema, on the other hand, is caused by a malfunction in the lymphatic system, leading to fluid buildup usually in the arms or legs. It can be primary (from a congenital issue) or secondary, often following surgery, injury, or cancer treatments like lymph node removal or radiation. 

And yes, women can have both.

How Lipedema and Lymphedema Impact Women Over 50 

The cruel irony is just as you’re hitting your stride—kids in college, career peaked, finally some time for yourself—lipedema and lymphedema can hit your body. Hard.  

While lipedema typically occurs earlier (often around puberty, pregnancy, or perimenopause), symptoms worsen once you hit menopause and estrogen levels decline. 

• Here’s Why: Estrogen regulates fat storage and supports blood vessels. When estrogen levels drop, fat is more likely to accumulate, and the small blood vessels that support tissue health become more fragile. This can lead to more pain, swelling, and the progression of lipedema. 

Lymphedema is typically triggered by damage to the lymphatic system, often from surgery, radiation, or infection. And as you reach your 50s, those medical interventions become more common, which means the risk of developing lymphedema rises too.

The worst part? This is the age when medical dismissal peaks, and symptoms get brushed off as “just getting older.” I’ll be the first to call that BS. 

The Science: What We Now Understand 

Thankfully, researchers are starting to understand what’s happening in the body, which means real hope for treatment. Recently, scientists have uncovered that: 

• Lipedema fat isn’t regular fat. It’s starved of oxygen and inflamed, which explains why it hurts so much (and why dieting never worked). A 2021 study confirmed that this tissue is loaded with inflammatory markers and hypersensitive to estrogen fluctuations, so hormonal changes during menopause likely contribute to the problem (Katzer et al., 2021). 

• The lymphatic system could be protected. Scientists have found VEGF-C, a protein that helps grow new lymphatic vessels. This could open doors to treatments that protect your drainage system instead of just managing symptoms.

How to Treat Lipedema and Lymphedema in 2025 

Gone are the days when compression garments and elevation were all we had to offer. Today, management is multidimensional:

1. Manual Lymphatic Drainage (MLD): This gentle massage remains the gold standard, but only when done by trained lymphedema therapists.  

2. Liposuction for lipedema: Liposuction done by surgeons trained in lipedema care can reduce pain and restore mobility, especially if caught early. 

3. Low-level laser therapy and pneumatic compression: These FDA-approved devices can improve lymphatic flow and reduce swelling (and it’s often covered by insurance!). 

4. Diet: While it won’t cure lipedema, omega-3s, low-glycemic foods, and quality protein can calm inflammation and support your lymphatic system. Some women are also finding relief with ketogenic diets, but more data is needed. 

5. New pharmacologic options: Trials are underway using medications that help the lymph vessels grow (like VEGF-C-based therapies).  

6. Psychological support: Let’s not forget the mental health toll. Being misdiagnosed for decades, watching your body change, and living with chronic pain is a heavy burden. Support groups and therapy should 100% be part of your treatment plan.

Don’t Forget: You Have Options 

If you’ve noticed your legs are always swollen, aching, or you just “look bigger” despite a healthy lifestyle, you’re not losing your mind. It may be lipedema, lymphedema, or both.

Ask your doctor for a referral to a vascular medicine specialist, dermatologist, or lymphedema clinic. And don’t settle for being brushed off. As I always say: We can’t fix what we don’t name. Let’s name it. And then let’s treat it. 

Imagine standing across from two world-renowned plastic surgeons who’ve spent decades perfecting their craft, giving you straight answers about the procedures you’ve been secretly googling. 

That’s what happened during my Instagram live with my brother, Dr. Evan Garfein (Chief of Plastic Surgery at Montefiore Medical Center in NYC) and his partner, Dr. Oren Tepper, both founders of Greenwich Street Aesthetics in NYC. Once we went live, my inbox exploded with your questions, and I realized that having access to surgeons of this caliber is a true gift. 

You’ve asked for more from them, and I am happy to oblige. This week, it’s Dr. Evan Garfein’s turn. (Dr. Tepper will weigh in next week.) 

Here are your latest questions: 

If you’re over 50 and considering a breast reduction, should you get a lift at the same time? 

A breast reduction can be a great operation for women both under and over 50. In fact, in most cases, a breast lift is actually built into the reduction procedure (both for function and aesthetics). 

Why? During a breast reduction, excess tissue and skin are removed to alleviate symptoms like neck and back pain or skin irritation. But simply removing volume without lifting the breast would leave an unshapely or sagging result. That’s why the tissue that remains is almost always reshaped and lifted to sit higher on the chest wall, restoring a more youthful, proportionate contour.

A good candidate for both is someone: 

• With large, heavy breasts that cause physical discomfort, skin rashes under the breasts, postural issues, or limitations in physical activity, especially if sagging or asymmetry is present. 

• Non-smokers in stable health and at a consistent weight. 

Combining the two procedures creates a result that’s both medically relieving and aesthetically natural, which can dramatically improve quality of life. And in nearly all cases, the nipple is raised as part of a reduction (leaving ‘lollipop scars’).  

How likely is it that my insurance will cover a panniculectomy? 

A panniculectomy is a surgical procedure that removes excess skin and fat hanging over the lower abdomen, usually after dramatic weight loss or pregnancy. This overhanging tissue (known as a pannus) can cause skin irritation, hygiene issues, back pain, and even restrict mobility. 

That’s where a panniculectomy comes in. Unlike a tummy tuck, which tightens abdominal muscles and contours the waistline, a panniculectomy is more medically focused and often deemed reconstructive rather than cosmetic.

The best candidates are individuals who are:

• At or near their goal weight and have maintained that weight for at least six months. 

• Are experiencing physical discomfort or health complications from the excess skin. 

As for insurance? While it’s hard to predict what a given insurance company will cover for a given patient, in the majority of cases, removing excess skin and fat of the abdomen is NOT covered.  

Why? Because insurance companies tend not to cover weight loss after pregnancy, by diet and exercise, or even after the use of GLP-1 agonists.  

However, if a patient has had bariatric surgery for obesity (or other weight loss surgeries), body contouring procedures like panniculectomy are often covered.

^{Dr. Evan Garfein is a board-certified plastic surgeon specializing in cosmetic and reconstructive surgery. He is the Chief of the Division of Plastic and Reconstructive Surgery at Montefiore Medical Center and is dedicated to surgical education and training as Professor of Plastic Surgery at Albert Einstein College of Medicine. He is a pioneer in 3D surgical innovation, including virtual reality and the use of patient-specific 3D printed models that have revolutionized patient care in the field.} 

^{Dr. Garfein’s passion for aesthetic and reconstructive surgery has made him an internationally recognized leader in the field. He has authored over fifty peer-reviewed articles and book chapters in both aesthetic and reconstructive plastic surgery. Dr. Garfein completed his plastic surgery residency at the Harvard Combined Plastic Surgery Residency Program, where he served as chief resident at the Massachusetts General Hospital, Children’s Hospital Boston, and the Brigham and Women’s Hospital.}

^{Follow him on instagram at @drevangarfein and reach his private office Greenwich Street Aesthetics, NYC  at 212-245-2499.}

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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…

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