TODAY’S DOSE OF HONESTY

What your resting heart rate reveals, and why you should monitor it.

This past week, I needed to get an EKG as part of an outpatient surgery pre-op protocol; I had to have a D&C hysteroscopy to remove a tiny endometrial polyp. I was SHOCKED by the results.

If you know me, you know I loathe the word “shock.” I find it melodramatic (even for me, and I love me some melodramatic moments!) and rarely appropriate or accurate. But in this instance, SHOCK was the letter-perfect word to describe my reaction to seeing my resting heart rate was just 52 beats per minute! This was a direct result of the past 5 months of my 6-month experiment with trainer Korey Rowe, and it was all I needed to realize just how effective this training and wellness program has been. 

From a cardiology perspective, resting heart rate is a direct reflection of our level of fitness/conditioning—and lower is better. I’ll explain this in more detail in a bit, but for comparison: A resting heart rate of 60-100 bpm is considered normal; mine was 67 bpm BEFORE I started the 6-month experiment. That latest EKG result was a full 15 points lower. Never in my adult life have I been so fit and conditioned—including when I was 42 years old and competing in sprint-distance triathlons—that my resting heart rate was this low!

There have been many other surprises and outcomes during the past 5+ months of this experiment, which I will detail in future newsletters as I compile and review them all. But I felt compelled to share this immediately because it’s so significant. So, conditioning-related heart rate improvement is on the Ajenda today; here’s a mini-med school on resting heart rate and cardiac function.

For the most part, a lower resting heart rate is a common indicator of improved cardiovascular fitness. Here’s what that means:

1. Improved heart efficiency

When you do regular aerobic exercise, your heart becomes stronger and pumps more blood with each beat. This is called stroke volume increase. The equation from basic cardiology is “Cardiac Output = Heart Rate x Stroke Volume.” In other words, with improved aerobic fitness, your heart doesn’t need to beat as often to maintain adequate blood flow. That’s a good thing.

2. Increased vagal tone

Exercise boosts the activity of the parasympathetic nervous system (responsible for the “rest-and-digest” response). This boosts vagal tone, which slows the heart rate during rest by promoting relaxation.

3. Decreased sympathetic activity

Regular exercise reduces sympathetic nervous system activity at rest. This system is responsible for the “fight-or-flight” response and higher resting heart rates, so less activation leads to a calmer, slower heart rate.

4. Improved oxygen delivery

Exercise enhances the efficiency of your body’s oxygen delivery system. Better oxygen utilization in muscles reduces the heart’s workload, meaning fewer beats are needed to meet the body’s needs at rest because it pumps more oxygen-filled blood with each beat.

5. Heart remodeling

Over time, the heart adapts to regular exercise by growing slightly larger (the left ventricle specifically), which allows it to pump more blood per beat (this is the stroke volume part). This is particularly common in endurance athletes.

6. Hormonal adaptations

Fitness training leads to changes in hormone levels, such as reduced resting levels of adrenaline and cortisol. These hormones can elevate heart rate, so lower levels contribute to a slower resting heart rate and better cardiac health.

All of this emphasizes how much increasing overall fitness optimizes the cardiovascular system. It becomes more efficient and less strained, which is reflected in a lower resting heart rate. But here are the qualifiers, and many of my followers raised these questions after my Instagram post about this last week. Sometimes a low (lower than 60) resting heart rate signals something abnormal; it can be:

• a sign of arrhythmia (such as heart block)

• a side effect of certain medications (like beta-blockers)

• a symptom of sleep apnea, autonomic central nervous system dysfunction, hypothyroidism, electrolyte abnormalities, or certain genetic or congenital conditions

• a consequence of advanced age

Most of the time, these conditions produce other symptoms as well, and are generally not common in someone with a resting heart rate in the 50s or low 60s who works out almost daily. Also, just because your heart rate is not in the 50s does not mean you’re UNFIT if you do a lot of aerobic activity. Remember, every individual’s body will respond differently to exercise.  

Here’s the bottom line: When I started my 6-month experiment, I was already in good shape, but I knew I was far from fit and maximally healthy. The beauty of a program like this is that everyone’s path will be different, and so will the change—as it should be. But it WILL be a change for the better. I never expected to see such a profound improvement in my cardiac function, but that’s even more proof of the miraculous, positive response of the human body to change and committed work. 

So, your dose of honesty for today: It’s never too late to make progress…whether you’re in your 20s, your 70s, or anywhere in between and beyond!

How to check your resting heart rate

Your resting heart rate should be taken first thing in the morning before you get out of bed. Your pulse will increase with any activity—including getting up, eating, drinking, or smoking. So to get an accurate resting heart rate, you should be completely still and calm. If something like an alarm startles you awake, take a moment to lie quietly for a few minutes before checking your pulse. If you can’t take your pulse when you wake: Wait 1-2 hours after consuming caffeine, exercising, or dealing with emotional stress. Then lie down or sit quietly for at least 10 minutes before taking your pulse.

To take your pulse manually: Place your index and middle fingers on your wrist below the base of the thumb or just below your jaw on the side of your neck (over the carotid artery). Apply gentle pressure until you detect a pulse. Count each heartbeat for 15 seconds then multiply by 4. Or use an app on your smartphone or wearable device like a smartwatch.

SYMPTOM SOLUTIONS

Swollen legs: What that means, and what you can do about it.

I’ve been asked this question by my patients, my followers on social media, and many of you: “Why are my legs and feet swelling suddenly?” My answer will almost always be “See your doctor.” Because you may need to share your recent medical history and have some tests to diagnose exactly why you’re experiencing this.

Caused when tiny blood vessels (capillaries) leak fluid, swelling—known as edema in medicine—can affect several parts of the body, including the brain, lungs, lymph nodes, and eyes. But it’s most likely to show up in the legs and feet, so that’s the focus for today. Not only does this type of swelling, called peripheral edema, produce discomfort and, well, frustratingly puffy legs, ankles, and feet, but it can also be a sign of more serious problems. The extent and severity of edema depend upon the underlying cause or medical condition.

Edema can affect anyone, but the condition most often affects people who are pregnant and adults who are aged 65 and older. For the record, here are the most common symptoms of edema:

• Swelling or puffiness of the tissue right under the skin

• Stretched or shiny skin

• Skin that holds a dimple, also known as pitting, after it’s been pressed for a few seconds

• A feeling of leg heaviness

• Difficulty walking if your legs, ankles, or feet are swollen

There are many potential causes and risk factors for edema, some of which can be prevented and others not; the most common include:

• Sedentary lifestyle. When you don’t move enough, your body retains fluid, which tends to collect in the extremities including the lower legs, ankles, and feet.

• Pregnancy. To maintain optimal health for the fetus and placenta, the body tends to retain more sodium and water than normal, which can cause swelling.

• The menopause transition. Yes, add edema to the potential havoc wreaked by fluctuating levels of estrogen and progesterone. The adrenal glands are crucial for maintaining the body’s water balance; during perimenopause and postmenopause, low levels of these hormones affect the adrenal glands and sodium levels, resulting in swelling.

• Nutritional issues. Excess sodium intake can increase the amount of fluid retained by the kidneys, increasing pressure in the capillaries and promoting fluid leakage. Many processed foods contain overwhelming amounts of it.

• Certain medications. High blood pressure meds and pain medications such as NSAIDS (nonsteroidal anti-inflammatory drugs) are common culprits.

• Injuries. Whether the injury is acute like a broken bone or chronic, such as repetitive stress or recurring pain from past physical trauma, it starts the same way: with pain, then swelling.

• Overweight/obesity. Carrying excess weight can lead to a condition called lipedema, a hallmark symptom of which is swelling.

• Dehydration. As I mentioned in last week’s newsletter, this happened to me; Korey recommended I drink more water. If you don’t consume enough H₂0, your body compensates by retaining the fluid it needs.

So, how do you treat edema—and can you prevent it?

First and foremost: If the swelling is severe, new, or persistent, seeing your doctor for a proper evaluation is important. They might prescribe a diuretic (sometimes called a “water pill”), which helps flush excess fluid from your body, or other drugs that will help treat the underlying cause of your edema. If you are in peri- or postmenopause, ask about whether hormone replacement therapy may help you. Finally, contact your doctor immediately if the swelling is accompanied by shortness of breath, irregular heartbeat, and/or chest pain.

That said, there are a few steps YOU can take to prevent fluid retention in your body:

• Put a pillow under your legs when you’re sitting or lying down, to keep them elevated above the level of your heart.

• Do not sit or stand for long periods without moving around.

• Wear support socks or stockings, which put pressure on the legs, ankles, and feet to keep fluids from accumulating. Edema shoes are available for people who experience chronic edema and need adjustable footwear to accommodate swelling.

• When traveling by car or plane: Make sure to take breaks to stand up and exercise your legs to prevent potential clotting in your legs.

• Reduce the amount of salt in your diet. That means reading packaged/processed food labels religiously.

• Get some exercise every day. Even if it’s a walk on a work break or after dinner, moving is an important antidote for edema. Exercise also helps alleviate stress, which—as with so many other health conditions—can amplify the effects of edema.

• Stay hydrated! Aim to drink 2.5 to 3 liters of water daily.

• Try my prevention pick: I bought my mom and dad some leg compression devices from Normatec as a Hanukkah present. They can improve circulation, reduce edema, and are great for post-workout aches and pains or for people who are not very mobile—in other words, for older adults as well as fitness enthusiasts. Click the link below to learn more about these products.

COMMUNITY

“Can you explain intermittent fasting? Will I lose weight?”

Good question. Let me begin by sharing that I’m actually doing it.

A LOT has changed in this 6th month of my training with Korey. At his suggestion, I decided to incorporate 16-hour intermittent fasting (IF) into my daily routine. I’m not alone by a long shot—it’s currently one of the most popular eating/weight loss strategies. According to a 2022 global survey, more than 80% of respondents had heard of intermittent fasting; nearly 42% said they felt significantly less hungry after 1-2 weeks of IF. And IF studies of more than 4 weeks’ duration recorded a 1.18- to 3.15-inch decrease in waist circumference in participants.

So, what does the medical literature say about IF for perimenopausal and postmenopausal women—and why am I doing it, personally?

First, the science. Much of the good data on the cellular and metabolic benefits of IF comes from studies done on, yes, men. And the research with women was mostly among premenopausal subjects. This is important because women are not smaller men, nor are they men with ovaries. Women, by nature, are designed to reproduce, and so our metabolism and hormonal biochemistry are all designed to support that. 

Part of what happens when we don’t have as much glucose to burn as fuel—as is the case with 16-hour IF—comes down to what’s most readily available and poses the least stress and effort to the body. For women, that is muscle glycogen, not fat. This is why when people say IF "isn’t good for women,” they do have a scientific point of merit: Unfortunately, because of our physiology, we tend to burn a smaller percentage of fat with IF than men do.

That’s not the entire picture, though. For many people—women and men alike—eating too many calories is a clock issue: The more hours they are awake, the more often they eat…and, consequently, the more calories they consume. When this consumption is nutrient-deficient or calorie-dense, problems (read: weight gain and resulting poor health) can and will develop. This is part of the reason why many people DO lose a few pounds when they practice time-restricted eating like IF—they are simply eating less. 

In addition, some good data supports the benefits of “resting” the energy of our cells or shifting it from digestion-focused to repair-focused (autophagy). Finally, remember that individual goals are very important whenever you plan to adopt a new behavior. Ask yourself: What am I trying to achieve or change, and will IF help or hinder me in reaching that goal?  

Now, the “why.” For me, this is purely an experiment. And what I’ve learned so far in a little more than a week has been very interesting:

• I eat dinner whenever I want; as soon as I’m finished, I start the timer on my fasting app. This usually means I stop eating by 8 p.m., so my 16-hour fast will get me close to noon the next day.

• Of these 16 hours of fasting, I’m asleep for 8 of them. When I wake up, I have black coffee, then drink a liter of water mixed with leucine (amino acids). This doesn’t “break the fast” but it does help prevent the breakdown of muscle for fuel—I definitely do NOT want to lose the muscle mass I’ve built over the past 6 months!

• My eating feels more mindful and intentional and less rote and automatic. 

• I’m paying close attention to my target of 90 g of protein per day, and sometimes I do find it challenging to hit that number in just 8 hours of eating. When I feel like I might miss my target, I’ll eat a protein bar with 20 g of protein.

So far, I've been doing IF for 10 days, and my weight is down 1 pound. But losing weight was not my primary motivation for trying it (as I have gained weight from increasing muscle mass over the past 5 months). Truthfully, the most significant finding for me is how good I feel by practicing time-restricted eating. I actually feel less hungry and more mindful about the way I eat.

In general, most people begin to lose weight within 2-4 weeks of starting intermittent fasting. However, some people may see results sooner, while it may take longer for others. Fasting for 14 hours is a good place to start. If you are overweight, you may begin to shed pounds more quickly than someone at a healthy weight; this is because your body has more fat to burn. People with diabetes, a history of eating disorders, or who are underweight should not practice IF. Good luck with it!

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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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