Micronutrient Deficiencies | Night Sweat Tips | The Biggest Fitness Myth | Recipe

If you're currently taking a GLP-1 medication, or seriously considering one, this is a direct conversation to you about something that almost never comes up in the prescribing process. Not because it's obscure, not because the evidence is thin, but simply because the protocols for managing these medications have not kept pace with how widely and quickly they're being prescribed. That gap concerns me, and it's why I want to address it here.

We talk a lot about macronutrients when GLP-1s come up, and that conversation matters. Adequate protein intake to protect lean muscle mass is genuinely important, particularly for women over 50 who are already navigating the muscle and bone changes that come with perimenopause and beyond. But there is an equally important conversation that's barely happening at all: micronutrient deficiencies.

Here's the basic physiology: 

GLP-1 medications work in part by slowing the emptying of your stomach, which is precisely why they reduce hunger and extend feelings of fullness. The downstream effect is that you eat less. And when you eat less, you are by definition consuming fewer vitamins and minerals, including essential ones like vitamin B12, magnesium, zinc, calcium, and vitamin D. Reduced food intake also means reduced gastric acid production, which in turn affects your body's ability to break down and absorb certain nutrients, B12 being a primary example. This is not theoretical. We have meaningful data from the bariatric surgery literature showing significant micronutrient deficiencies following procedures that produce a similar physiological effect, and emerging evidence now points to the same concern in long-term GLP-1 users.

What makes this particularly worth paying attention to is how slowly some of these deficiencies reveal themselves. Vitamin B12 depletion, for instance, can take months to years before it surfaces clinically, and by the time you feel it, fatigue, cognitive changes, peripheral nerve issues, or, in some cases, anemia, you have likely been running low for a long time. Magnesium deficiency tends to show up more quickly, often as muscle cramps, disrupted sleep, or what I'd describe as a low-grade increase in anxiety that doesn't have an obvious explanation. Hair thinning, which so many women on GLP-1s report, is frequently attributed to rapid weight loss, but inadequate zinc and protein intake are important contributors that deserve equal attention. (More on hair loss in another issue.) 

None of this is meant to alarm you or discourage you from a medication that may be genuinely helping you. GLP-1s have real and meaningful value, and I say that as someone who takes the full picture of evidence seriously. What I am saying is that these medications require monitoring, follow-up, and attention to your nutritional status that goes well beyond what most people are currently receiving. Ask your provider about baseline and follow-up bloodwork that includes B12, Iron, Folate, Vitamin D3, and magnesium. Think about whether a prenatal vitamin, ANY prenatal vitamin, which tends to contain slightly higher amounts of key micronutrients than a standard multivitamin, might be appropriate for you, regardless of whether you're pregnant or even female. And recognize that a multivitamin alone may not be sufficient if a true deficiency is already developing.

The most important thing I can offer you here is not a supplement protocol but a framework: these medications affect your whole body, and caring for yourself on them means thinking in terms of total body health, not just the number on the scale. You deserve providers who are having this conversation with you, and if they aren't yet, I hope this gives you the language to start it yourself.

I just launched a new deep dive video on micronutrients and GLP-1s on YouTube. If you’re taking a GLP-1, it’s worth a watch. 

Most sleep problems have a straightforward explanation. Night sweats during menopause are one of them. Too many women spend months assuming they're just stressed, or running warm, or coming down with something, before anyone connects the dots to what's actually driving it. By the time the pattern becomes undeniable, the sleep debt has already accumulated, the irritability has set in, and the frustration of feeling like your own body has become unpredictable is very real.

Here's what's actually happening: as estrogen levels decline during perimenopause and menopause, the hypothalamus, which is your brain's internal thermostat, becomes significantly more sensitive to even small changes in core body temperature. The result is a vasomotor response, meaning your blood vessels dilate rapidly, your heart rate increases, and your body essentially tries to cool itself down by producing sweat, often intensely, without warning, and in some embarrassing situations. This isn't a minor inconvenience for many women. Research suggests that up to 80% of women experience vasomotor symptoms during the menopause transition, and for a meaningful percentage, those symptoms are severe enough to fragment sleep night after night, contributing to fatigue, mood changes, cognitive fog, and more. So let's talk about what you can actually do.

Start with your sleep environment, because it matters more than most people realize, and it can be one of the easiest variables to correct/modify.

One of the most evidence-informed adjustments you can make is reducing the thermal load in your immediate sleep environment, and that means being thoughtful about what you're sleeping on and under. The thermal environment in which you sleep is directly relevant to the physiology driving your symptoms. This is where temperature-regulating bedding* earns its place in the conversation:

What it's made from: Responsibly made and sourced viscose derived from bamboo, a material specifically designed to respond to body heat rather than trap it.

Why that matters physiologically: When your hypothalamus triggers a heat-release response at 3 am, sheets and a duvet that wick moisture and allow airflow can be the difference between a brief wake-up and a full hour of lying in damp, uncomfortable misery.

Where to start:  Bamboo sheets and temperature-regulating duvets are both worth looking at as genuine first-line environmental interventions, not an indulgence.

How to get it: I’ve collaborated with Cozy Earth to bring you their great products for 20% off, this month only! I tested them myself, they meet my (very high) standards, and I use them.

Layer your approach, because no single solution does everything.

Beyond your bedding, there are several strategies worth building into your routine. Keeping your room cool, ideally between 65 and 68 degrees Fahrenheit, supports your body's natural overnight temperature drop and gives the hypothalamus less to react to. (I sleep at 67 degrees exactly!) Wearing lightweight, moisture-wicking sleepwear, staying well-hydrated through the day, and limiting alcohol and spicy foods in the evening can all reduce the frequency and intensity of night sweats for many women. None of these is a cure, but together they form a genuine support system for your body during a real transition.

For women whose night sweats are severe, persistent, and meaningfully affecting quality of life, I want to be clear that hormone therapy remains the most clinically effective treatment we have for vasomotor symptoms, and it's worth a thoughtful, individualized conversation with your physician about whether it's appropriate for you. Other options, including certain non-hormonal prescription medications, such as fezolinetant, have also shown real efficacy in clinical trials. The goal isn't to push through or simply manage; it's to understand what's available and make informed decisions in partnership with someone who knows your full medical picture.

What I want you to take away from this is that night sweats are not something you simply have to endure in silence, and they are not a sign that something is catastrophically wrong. They are a physiological response to a hormonal shift that your body is navigating, and with the right environmental setup, lifestyle adjustments, and medical support when needed, most women find meaningful relief. Start with what you can control tonight, including your sleep environment, and build from there. And I really don’t care if your husband, boyfriend or partner gets cold as a result. That’s what blankets are for!

There is a fitness myth I keep seeing everywhere, and it makes me nuts because it sounds so believable. It’s the idea that there is one perfect workout. One class, one machine, one method, one “secret” that is going to solve everything after 50.

And to be fair, I understand why we want that to be true. We are all busy. We are tired of being told we need to do more and just want a clear answer. We want someone credible to say, “This is the thing. Do this, and you’re good.” Walking. Pilates. Strength training. Yoga. Zone 2 cardio. HIIT. Barre. Pickleball. Whatever the current favorite fad happens to be…

But here’s the problem: almost every one of those things is good for you, BUT actually none of them is enough by itself.

That’s the part the fitness industry does not love to say out loud, because “do this one thing” is much easier to package and sell than “your body is complex and needs different types of stress, challenge, and recovery.” But over 50, this really matters. Variety is not just nice to have, it is physiological.

Your body is not one system; it is many systems working together. Your muscles need resistance. Your heart needs endurance and intensity. Your joints need mobility. Your tendons and ligaments need gradual loading. Your bones need impact or force. Your nervous system needs balance and coordination. Your brain needs novelty and challenge. And your body needs recovery, which, somehow, still feels like the least glamorous wellness advice ever, even though it may be one of the most important.

This is where I think a lot of very disciplined, very health-conscious women get frustrated. They are active, consistent, and they are doing “the right thing.” But often, the right thing they’re doing is actually one thing done over and over again.

A woman who walks 10k steps every day is wonderful, but she never lifts enough weight to truly challenge her muscles. Another woman lifts weights, but avoids cardio because she hates it or because someone convinced her cardio was “bad for cortisol” (which is not true by the way).  Someone else does Pilates three times a week and has a beautiful core, but never trains her heart rate. Another does high-intensity cardio, but never stretches, never works on balance or strength, and wonders why her hips feel like they belong to someone else. And then there is the woman who plays tennis or pickleball and thinks that counts as everything, until her calf, Achilles, shoulder, knee, or lower back files a formal complaint.

I say this with love because I have done versions of this myself. We all have. We find what we like, what we’re good at, what fits into our schedule, what makes us feel competent, and then we cling to it. The problem is that after 50, the body becomes much less tolerant of missing categories.

That is not meant to be depressing. It is meant to be clarifying. 

In our 20s and 30s, many of us could get away with doing random exercise and still feel pretty good. A run here, a yoga class there, a few weeks of being “good,” and our bodies responded. But in midlife and beyond, especially around menopause and after it, the margin changes. 

So the question is not, “What is the best workout for women over 50?” The better question is, “What am I missing?”

That one question can change everything.

A smart fitness routine after 50 needs strength training, ideally three times a week, because muscle is not just about looking toned. Muscle is metabolic tissue. It helps with glucose regulation, joint stability, posture, bone health, and independence. It is what helps you lift your suitcase into the overhead bin without making a noise that scares the person in 12C.

It also needs cardiovascular training, and not just one speed. Easy cardio matters. Walking matters. Zone 2 matters. But if it is safe and appropriate for you, your heart also needs higher-intensity work. You need enough to remind your cardiovascular system that it can work hard and recover. This means the assault bike, treadmill sprints, rower sprints, any sprint interval training, stuff that feels super unpleasant but delivers extraordinary results.

Then there is mobility and flexibility, which I used to think of as the thing you do at the end if there is time, which of course means never. But hips, shoulders, ankles, and the spine all need attention. Strength without range of motion is limited. Mobility without strength is also limited. We need both.

Balance deserves its own category, even though it is probably the least sexy fitness word in the English language. But balance is strength, coordination, brain training, and fall prevention all rolled into one. And it is much better to train it in your living room than to find out you needed it while stepping off a curb in cute shoes.

And finally, recovery has to be part of the plan. Not because we are fragile, but because adaptation happens when the body has a chance to repair. Sleep, protein, hydration, rest days, easier movement days, all of that counts. Recovery is not the opposite of training. It is part of the training.

So no, I am not here to tell you that walking is bad, or Pilates is overrated, or strength training is the only thing that matters, or cardio is the enemy, or yoga is not enough. That is not the point.

The point is that any one of them, alone, leaves gaps and is definitely not enough.

If you love walking, please keep walking. Just add strength. If you love lifting, keep lifting. Just add cardio and mobility. If you love Pilates, keep doing Pilates. Just add heavier resistance and some heart-rate work. If you love yoga, keep doing yoga. Just add load and power. If you love pickleball, I am thrilled for your social life, but stretch your calves and train your balance.

This is not about doing more for the sake of doing more. It is about being more complete and more holistic in how we care for the body we have now.

Over 50, the goal is not just to be thinner, smaller, or “good” at exercise. The goal is to be strong enough, steady enough, mobile enough, and fit enough to live your life with confidence. To carry things, climb the stairs, play on the floor with babies and small children, travel, recover from setbacks, avoid preventable injuries, and feel capable in your own body.

There is no single magic workout. Not Barry’s, not Bar Method, not Hot Yoga, not SLT or PVOLVE, or SoulCycle or Orange Theory… It’s not either/or. It’s EVERYTHING. Which is why I want us all to have the wisdom to stop giving a complex system only one overly simplistic answer.

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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…

^{This material is provided solely for informational purposes and is not providing or undertaking to provide any medical, nutritional, behavioral or other advice or recommendation in or by virtue of this material.  This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.}

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