TODAY’S DOSE OF HONESTY

A discovery from my personal Fitness & Wellness Challenge: SLEEP WORKS!

You may know that I LOVE sleep. In fact, I’ve spoken about it extensively on TV and in my books, my magazines, and my medical practice. I firmly believe that sleep is AS IMPORTANT as good nutrition and good fitness for our overall health and well-being.

It is SO important, in fact, that whenever I discuss a physical or psychological issue with a patient, I ask FIRST about their sleep patterns. Inevitably, I hear the following: "I don't sleep well. I don't sleep enough. I can't sleep." Then I dive in to help. Usually, I start by assessing the physical or medical conditions that can interfere with sleep quality or quantity; top of that list are often hormonal issues like pregnancy, perimenopause, or menopause. Next, I have to exclude other medical problems that can disrupt sleep, such as coughing, restless leg syndrome, frequent urination, or various types of pain. 

Behaviors are critical in the evaluation of sleep. Some help it, others negatively affect it. Unfortunately, most of us are guilty of engaging in behaviors that hinder sleep (either by doing them or NOT doing them), and in a big way—like consuming caffeine after 12 noon, drinking alcohol, looking at our phones or computer screens in the middle of the night, and not getting daily exercise. Then there’s the sleeping environment. For optimal rest, the bedroom needs to be cold (66-67 degrees is ideal), dark (no blue lights, streetlights, or night lights if possible), and quiet. Quiet, or the interruption of it, really, might be sound coming from outside the room (the street or another part of your home) OR within (from pets or your spouse!). Things like eyepatches, ear plugs, or white noise machines can definitely help in this respect! 

And here's the thing: Sleep behavior needs to be fairly consistent, day in and day out. You cannot—I repeat, cannot—”make up” lost sleep on weekends, even though it may feel good to try. This means you should strive for lights out around the same time every night and wake up at roughly the same time every day, give or take an hour or so.

The majority of adults require 7-9 hours every night. NOT getting this amount can and will affect everything over time—your skin, metabolism, hormones, immune system, brain/cognitive function, GI tract, and mood. People who don’t get enough sleep have trouble losing weight and face a higher risk of cardiovascular disease and numerous types of cancer. Despite overwhelming evidence of the importance of sleep, however, it’s still often considered a luxury when, in fact, it’s a medical necessity.  

I learned this firsthand during my career as an OB-GYN, when I had to work or be on call 24 hours and/or be up all night delivering a baby. I did NOT feel good the next day! I'm sure you know, too, how horrible being sleep-deprived makes you feel. But do you know/remember what it feels like to be well-rested? I am learning that powerful sleep lesson just 3 weeks into my 6-month experiment in wellness and fitness. 

Since I stepped away from my role as ABC News Chief Medical Correspondent on June 26th and started my experiment with trainer Korey Rowe, I have consistently gotten 8+ hours of sleep a night (sometimes even 9!) because I no longer have to wake up at 4 or 5 a.m. every day. And guess what? I feel a really big difference! Before, I was getting 6-7 hours a night and felt tired at the end of the day, but I was used to it. I was never, ever able to get 8-9 hours of sleep, so I never knew what that felt like. Now I do. It's amazing. And so many of YOU have asked about sleep that I wanted to share my sleep prescription.

My best advice for better sleep.

• Make sleep non-negotiable. It needs to be a priority, not an afterthought. Set a time in your schedule that allows you to get 8 hours and commit to being IN BED by that time. Period. No excuses. No one will die if there are dirty dishes in the sink or an email hasn't been sent by day’s end. Trust me, it can wait until tomorrow.

• Stop all caffeine after 12 noon (the half-life of caffeine is 8 hours, which means that 50% is still in your bloodstream at 8 p.m.), and cut out alcohol—for a while or permanently—to see how it negatively affects your sleep. (Trust me, it does.) Taper off any other liquids 2-3 hours before bedtime, to minimize nighttime bathroom trips.

• Assess your sleep environment. Do you need a new mattress? Is it cool enough? If your spouse or partner snores: Either encourage them to get tested for sleep apnea, get yourself a white noise machine, or sleep in another room. Yes, your sleep is THAT important.

• Get daily exercise and meditate. BOTH have been massively helpful for me and millions of others with sleep problems.

• Try magnesium—250-500 mg in any form. Whenever I take magnesium, I sleep VERY soundly!

• Take a bath. I've recently gotten into this ritual, and I love it. It soothes, relaxes, and eases the transition to bedtime. If you don't have a bathtub, a warm shower will do as well.

• On my AJENDA for sleep: Try Nightcap from Alice Mushrooms. These are Reishi functional mushrooms (not the psychedelic kind) blended into a delicious dark chocolate (a small square, so not too much caffeine) with other ingredients known to help improve sleep. I swear by Alice Mushrooms and look forward to one square before bed almost every night! Buy or learn more about them at alicemushrooms.com.

• Don’t let hot flashes disturb your sleep! For perimenopause- or menopause-related sleep troubles, treat the underlying cause. If hot flashes are waking you at night, treatment is indicated. This could be hormonal (HRT), non-hormonal (ex. Veozah), or a complementary product like Relizen, which is cytosolic bee pollen extract.

Do your own sleep experiment: Try getting 1 extra hour of sleep a night for the next 2 weeks and see if you feel a significant difference—I bet you will! 

My Fitness & Wellness Challenge update.

Speaking of my experiment, I am 3 full weeks into this with trainer Korey Rowe. Overall, I feel GREAT! But there have definitely been a couple surprises and interesting findings so far.

For one thing, the lower-back pain I was living with, that I chalked up to age, is literally gone! Remember a few issues back when my entire left side went into severe muscle spasm, starting with my back? Well, after being evaluated by a chiropractor who told me that he thought that muscular asymmetry was to blame, I vowed I would never go through that again. Then, during my Day 1 assessment, Korey discovered that asymmetry was, indeed, to blame and that my ENTIRE right side (except my arm) was weaker than my left. So, my left side has had to do a boatload of extra work—constantly. Hence the dreaded spasm. Since starting my 6-month experiment, I’ve been working each side separately, and have noticed that the tightness and pain in my lower back is literally gone! 

The other surprise of the first 3 weeks is the change in numbers. In checking my body composition via In Body analysis, I have already lost almost 2% body fat, while my total weight has actually increased by 4 lbs. I admit that the number on the scale going in the “wrong” direction was something Korey had to help me with. He explained the increase: Heavy weight training causes microscopic “injuries” to the muscles. It's how and why they grow, during the stress-and-repair process. The injury to the muscle creates a temporary inflammation (not always a bad thing) that leads to some retention of water and, consequently, weight gain. Also, I've been eating more, to fuel muscle growth, and that’s responsible for some weight gain too. But I have faith in the process and know I’m getting stronger, fitter, and healthier. So, I’m trying to focus more on shedding body fat than pounds. 

The big lesson: When you’re on a plan toward a fitter, healthier body, track the number on the scale, but remember that fat-free muscle mass and body-fat percentage are often changing too. Just stay the course!

Follow my progress with my Fitness & Wellness Challenge on Instagram (@drjashton) and every week in this newsletter!

SYMPTOM SOLUTIONS

Dr. Jen’s Rx for healthy bones.

Most of us think of osteoporosis as an old ladies’ disease, something we shouldn’t worry about until we’re 65+. On the contrary: Doing what you can at any age to treat your bones well can help ward off the disease and keep your body healthy, strong, and youthful for the long haul.

Osteoporosis is, in fact, a SERIOUS disease that can cause painful fractures, disable you, and even shorten your life. More than 50 million people in the U.S. are living with it. Nearly 50% of women aged 50 and over will suffer an osteoporosis-related fracture during their lifetimes. It’s sneaky too: It doesn’t come with symptoms like other health conditions. You probably won’t feel or notice any signs you have it. What you might notice are body changes that can signal your bones are losing strength or density, which can include:

• Losing an inch or more in height

• Changes in your natural posture (stooping or bending forward more)

• Shortness of breath

• Lower back pain

The most common “symptom,” of osteoporosis, unfortunately, is suddenly breaking a bone, especially while doing something that normally wouldn’t pose an issue. The GOOD news: The sooner a healthcare provider diagnoses it, the less likely you are to experience bone fractures. And there ARE steps you can take to lower your risk of bone loss.

What puts us at risk for osteoporosis

As with all diseases, some risk factors are under your control, and some aren’t. So, it’s important to know the difference and control what you can. What you can’t really control: This disease is most common among older people, although you don’t have to be old to have weak bones. Women are more likely to develop osteoporosis than men, perhaps because women have smaller, weaker, thinner bones to begin with. And certain conditions—and the medications that treat them—can also increase your risk. If you have cancer, chronic lung disease, liver or kidney disease, irritable bowel syndrome, rheumatoid arthritis, or low thyroid, talk to your doctor about whether your bones might be at risk.

That said, certain lifestyle issues can increase your chances of bone loss too, but the good news is that they mostly are ones YOU can change for the better.

• Smoking.Smoking generates substances known as free radicals, which kill bone-building osteoblasts, harm the blood vessels that supply nourishment to your bones, and damage cells throughout the body.

• Alcohol. Drinking more than a moderate amount (moderate = 1 drink a day) may affect calcium and vitamin D metabolism, both important to maintaining healthy bones.

• Your body shape. Although being too thin can be a risk factor for weak bones, research suggests that belly fat may also put bones at risk.

• Low estrogen levels.Some women with irregular periods suffer from low estrogen, which can weaken bones. If you have irregular periods due to low estrogen levels, talk to your doctor about how this may impact your bones.

How to protect your bones.

Fortunately for your skeleton, there are several things you can (and should!) do to keep your bones healthy and strong and decrease your risk of bone loss.

Work those muscles.Not just any exercise will do; you actually need a certain kind of activity that stresses your bones into tolerating more force. When you do exercise that puts weight on your bones, they get stronger and are able to build more bone. Specifically, walking, running, yoga, hiking, and lifting weights all force your muscles and tendons to pull on your bones. As a result, your bones get stronger and you’re less likely to suffer fractures as you age.

Eat foods with calcium & vitamin D.To slow bone loss, you need to eat enough calcium- and vitamin D-rich foods. If your body isn’t getting adequate calcium, it breaks down bone to obtain it, accelerating bone loss. More than 70% of Americans are calcium-deficient, and most women underestimate their calcium needs by at least 50%. Some of my favorite sources of calcium and vitamin D include dairy products; almonds and seeds; leafy green veggies like spinach; sardines and canned salmon; beans, lentils, and soy foods; and fortified OJ and cereals.

Consider supplements. It’s best to get calcium and vitamin D from food, but supplements in the right dose can’t hurt, and can help if you’re not getting enough. For healthy women, I recommend 500 mg twice daily for a total of 1,000 mg (the body can’t absorb more than 500-600 mg of calcium at a time). For vitamin D, I suggest 1,000 IU per day, best taken with a meal.

Get tested.The best way to check your bone strength and health is to get a bone density screening. This test, sometimes called a DEXA test, utilizes X-rays to measure how much calcium and other bone minerals are packed into a segment of bone. Bone density tests are easy, fast, and painless—no needles! Virtually no preparation is needed. If you haven’t had this screening yet, schedule one with your healthcare provider soon.

For more information on the prevention and treatment of osteoporosis, visit the Bone Health & Osteoporosis Foundation’s website at bonehealthandosteoporosis.org.

COMMUNITY

“Since I started perimenopause, I am bleeding so much more—what the heck?”

Did you know that your period should really be considered a vital sign? Well, it should! That's because the regularity or pattern in which your period shows up and how long it lasts is an important barometer of your overall health.  But what if you are in perimenopause? Which, by the way, can start as early as mid-30s for some women.  

Being in perimenopause can and often does absolutely derail even the most regular menstrual cycles. While it would be nice and convenient for your period to simply disappear into the sunset, bleeding, unfortunately, often becomes WORSE during perimenopause—meaning (potentially)longer periods, heavier periods, missed or skipped periods, or shorter cycles (when there is less time between bleeds). This is very common. In fact, according to the American College of Obstetricians and Gynecologists (ACOG), one-third of outpatient visits to the gynecologist are for abnormal uterine bleeding, and it accounts for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years. Bottom line: UGH!!!

Based partially on age, irregular bleeding patterns normally have hormonal causes—because, yep, you’re in perimenopause. However, and this is very important, it is ALWAYS important to exclude the potentially serious causes, even the rare or uncommon ones. This means pregnancy and precancer, or hyperplasia of the endometrium (uterine lining). In fact, the standard of care for any woman over age 35 who has irregular bleeding advises a medical workup to exclude these rare but serious possible causes; it usually includes a pregnancy test, some blood tests, a pelvic ultrasound, and possibly an endometrial biopsy. 

In particular: Women with PCOS or who have overweight or obesity are at higher risk for endometrial hyperplasia (precancerous changes of the lining of the uterus). If this is you, be sure to have an ultrasound and biopsy if the irregular bleeding pattern persists. After this has been excluded, then—and only then—can we chalk up irregular bleeding to perimenopause. Then, we wait.

To help your doctor provide a more accurate diagnosis of your condition, keep track of the dates and patterns of your bleeding. And if it becomes annoying or interferes with your quality of life, seek help; there are options for treating and managing this bleeding. These include low-dose birth control pills, a progesterone-releasing IUD, or even surgery—from an endometrial ablation to a D&C, removal of a polyp or fibroid, or possibly hysterectomy. Bottom line: Perimenopausal irregular bleeding is incredibly common, can be annoying, but could signal something that needs further attention. Knowing how it should be evaluated—and that there are options for treating it—is key.

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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 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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