TODAY’S DOSE OF HONESTY

I got a master’s in nutrition, and it’s important you know why.

In 2013, I returned to my alma mater, Columbia University, to begin a 3-year master’s degree program in human nutrition. Back then, I was spending a lot of time—both in my medical office and on national television for “Good Morning America”—talking about food, weight loss, diets, and nutrition, and I felt unqualified to speak about these issues beyond what I could find through a Google search. I felt I needed formal education to discuss these topics appropriately.

So, I explored my options. They ranged from online certification programs to courses that could be completed in a week…even a weekend. This didn’t cut it for me. I'm classically Type A, so I wanted the highest academic degree I could get short of a doctoral degree (Ph.D.). I chose Columbia’s 3-year master’s program, which was designed for health professionals who had day jobs—like me. I could complete it on weekends.

I took a deep breath and embarked on the road of formal nutrition education. And I know I did the right thing: A recent survey of a panel of nutrition experts and medical residency program directors, published in JAMA Network Open, found that 97% of the survey panelists strongly believed that nutrition education for medical practitioners is so important that these competencies should be officially evaluated through licensing or board-certifying exams. In other words, nutrition matters! It needs to be formally taught and tested so that health professionals can communicate this information to the public from a perspective of science and evidence.   

Why is this important? Well, for one thing, there are a lot of opportunistic scams/shams and a veritable explosion of misinformation on social media and even in traditional media about food, eating, diet, and nutrition.

I want to be clear: I have no problem with people or companies in the food and nutrition business. Soon, I will be in the food business too, with the upcoming launch of my home-delivery weight management meals. I want to believe these entities are “do-no-harm,” quality businesses that have people’s best intentions at heart, as I do. What I DO have a problem with are businesses that are gimmicky at best, dangerous at worst, and promote and sell weight loss/nutrition concepts and products without proof that those concepts or products are grounded in and backed by scientific data/evidence. THAT is a big no-no for this woman of science.

Many doctors on social media and elsewhere today talk about nutrition as if they were experts. The reality is that most doctors who graduated a decade ago or more received almost no education in nutrition during their medical training. “Nutrition” in most medical schools consisted of how to feed critically ill patients through a tube. Seriously.

Luckily, that is changing, if a bit slowly. A good start: It’s finally being formally studied. The recent JAMA Network Open article by David Eisenberg (a panel member) determined that “dietary patterns are one of the strongest behavioral influences on disease risk regardless of individual genetics, and 70% of the leading causes of death in the U.S. are DIRECTLY affected by diet.” That’s a strong statement. Other data suggest that when medical students and physician trainees receive education in culinary medicine and nutrition, they’re more likely to discuss food/diet, etc., with their patients, and even more likely to make personal cooking and eating behavioral changes themselves, improving their own health. (Doesn’t surprise me at all!)

Here’s my point: When you hear a message—any message—it’s important to consider the credentials of the messenger. Credentials matter, and formal education matters, as does real-world clinical experience. I also believe online searches, even those that scan the medical or scientific literature, can be misleading; not every study or published paper has a high-caliber methodology or design. We have a saying in medicine: Garbage In = Garbage Out—which is to say, poorly engineered research will produce results that don’t withstand rigorous scrutiny.

We all want to believe we’ve discovered a nutrition hack that will easily and dramatically change our health for the better. Sorry. It’s just not that simple, nor is it easy. Rarely can what we eat or drink be considered or studied in isolation. Humans are complex organisms, and we eat and drink things in combination with other foods and beverages. That’s why my professional and personal approach to nutrition is much more balanced and moderate. My nutrition philosophy is based on formal education, science, and what I call the 4 S’s: An eating plan has to be Safe, Simple, Sustainable, and (low in) Sugar. 

Your dose of honesty for today: There isn’t just ONE way to eat, and there’s no magic food, pill, or supplement. True scientists appreciate how nuanced nutrition is.  

SYMPTOM SOLUTIONS

How stretching can make your life worth living.

Perhaps it’s the word “stretching” that turns us off—that thing you’re supposed to do after a workout or a day of physical exertion, and that you might be inclined to skip. You feel a bit sore maybe one or two days afterward, but life goes on. Sure does.

Now, fast-forward 20, 30, 40 years, and the condition of your body might have you regretting you skipped those 5-10 minutes of stretching. The quiet moments spent coaxing your body to become more flexible are more important than you might think. For women in the menopause transition and beyond, good flexibility can mean the difference between enjoying an active life or feeling trapped in a body that doesn’t work properly.

How does stretching work?

Stretching is a powerful tool that is key to optimal flexibility. When you stretch, your muscles lengthen and relax, which helps your joints move through their full range of motion. Stretching increases blood flow, delivering vital nutrients more efficiently and supporting muscle recovery. By improving joint mobility and coordination, stretching can also help alleviate pain. Here’s what else it might do for you:

• Decrease your risk of injuries.

• Enable your muscles to work most effectively.

• Enhance your performance in physical activities.

• Improve your posture.

• Ease tension headaches.

• Help with back pain.

• Improve your ability to do daily activities.

Stretching helps both body AND mind.

When you DO stretch, you usually feel good afterward, right? This is because static stretching (when you hold a position without moving for a period of time) triggers your parasympathetic nervous system, a network of nerves that relaxes your body following stress or danger. Activating this branch of your nervous system can help alleviate the psychological effects of stress, which helps calm and relax you. It’s also thought that stretching may release endorphins, hormones that help relieve pain and improve mood and focus.

And it might even help with menopausal symptoms: A 2016 study of middle-aged Japanese women found that those who stretched 10 minutes at bedtime experienced fewer mood swings and hot flashes than those who didn’t. If you need a change in outlook, try yoga—which is basically slow stretching while focusing on your breath; sometimes a quiet room or some calming music enhances the relaxation. After just 10-15 minutes of yoga, you may feel like a new person.

When you DON’T stretch, you get none of the benefits, at best—and at worst, you put yourself at greater risk for joint and muscle pain, injury, and frailty later in life. The great thing about stretching? You can do it just about anywhere. You don’t need to go to a gym or purchase any expensive equipment. You already have everything you need—your body, comfortable clothes, and the floor (although a yoga mat or rug does help you avoid slippage). There are plenty of online images and videos to get you started.

How to stretch properly.

First and foremost—and especially if you are older: You must make it part of your weekly routine. Better yet, daily. Like so many other improvements to our bodies, flexibility is not a once-and-done thing. For stretching to accomplish its work, you need to do it regularly. Some fitness experts recommend stretching at least two to three times per week, but I encourage you to do a bit of stretching daily. Even 5 minutes is helpful. Here are more tips to make stretching safer and more effective:

• Avoid stretching cold. To avoid injury, it’s best to get your blood flowing before you start stretching. Doing a low-intensity activity like walking or easy jogging for 5 minutes can help warm up your muscles.

• Do it gently. Don’t force any position that causes pain. If a stretch hurts, it means you’re stretching too far.

• Stretch both sides equally. This will help prevent flexibility imbalances.

• Don’t bounce. Bouncing while you’re stretching can injure your muscles or tendons. It can also tighten your muscles.

• Enjoy your progress. If you make stretching a habit, don’t be surprised at how much better your body feels!

COMMUNITY

“Do GLP-1 supplements work as well as Ozempic?”

Just as winter always follows fall, we are predictably seeing products marketed as “GLP-1 support supplements” all over the place, since semaglutide-like medications are all the rage in the weight loss space. But before you spend your money, here’s my take on these nutritional weight loss supplements—from the standpoint of a nutritionist and doctor who is board-certified in obesity medicine.

First, the physiology that accompanies weight loss: When anyone loses weight, the loss is a combo of fat mass and muscle mass. Typically, as much as 25% of the weight lost can come from muscle mass. But body composition testing performed on people who lost weight on GLP-1 agonist drugs—like Ozempic, Wegovy, or Mounjaro—indicated that as much as 40% of pounds lost can be due to muscle loss. (Rapid weight loss can also produce a greater percentage lost from muscle mass vs. slower weight loss). This medical headline was both misconstrued and improperly leveraged to suggest that the GLP-1 class of medication was not beneficial. Let me explain.

• FIRST: It’s important to know that with age comes a uniform loss of muscle mass in both women and men, called sarcopenia, meaning this is not restricted only to people on these medications. 

• SECOND: What you likely did NOT read or hear, which is critical to understanding the whole picture, is that muscle tissue in the body of someone who is overweight or living with obesity is known to be dysfunctional muscle. So, losing some proportion of muscle that isn’t healthy or functioning optimally, along with losing fat, is a net positive to one’s overall health, and much better than living with the risks of added pounds. 

• FINALLY: There are two low-risk, tried-and-true ways to boost muscle health and minimize overall loss of muscle mass—they’re called “Eat enough protein” and “Lift weights”! 

Bottom line as of now: There is absolutely no science to support that supplements marketed as a “GLP-1 supplement” contain anything special or have been shown to result in anything special. The only supplements I recommend for anyone trying to lose weight (whether on a GLP-1 agonist or not) are creatine (3-5 g per day) and the essential amino acid leucine (25 mg per pound of body weight). Both of these have been studied extensively for their beneficial effects on body composition and strength, for women in midlife and beyond.  

So…Caveat emptor: Buyer beware! Sometimes the basics are all you need.

ABOUT DR. JEN

In her 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 written several books, including the best-selling book, 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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