TODAY’S DOSE OF HONESTY

Nutritional Gynecology: Why I coined this term—and how it can help you.

Never heard of it? You’re not alone. The concept is relatively new and fairly unheard of, and the term is mine. I began using it approximately eight (yes, EIGHT) years ago, right after I got my master’s degree in nutrition from Columbia University. At that time, I truly had a professional lightbulb moment: I realized that numerous gynecologic issues and conditions have a direct relationship to nutrition, metabolism, food, and weight gain, and that there was likely a significant opportunity in this space to help women by “connecting the dots” between our hormones and the food we eat. Let me explain.

First, the hormones: Hormonal changes occur during puberty, pregnancy, perimenopause/menopause, and in women who have polycystic ovarian syndrome (PCOS). While reputable research into the connection between these hormonal conditions and food has been quite limited up to this point, it’s exciting to me, as a nutritionist and as a gynecologist, that there is finally interest and activity, within the medical community, in this area of women’s health. It’s not the entire picture, but rather an important lens through which to view these key stages in a woman’s life.

In fact, science is now providing solid evidence that food and gynecologic health are cohorts: One large review of studies, published in the journal Nutrients in June 2021, found that nutritional factors and dietary habits play a significant role in the development of gynecological diseases, including uterine fibroids, endometriosis, PCOS, and gynecological cancers. That same investigation found that diets rich in fruits and vegetables, Mediterranean diets, green tea, vitamin D, and plant-derived natural compounds may offer long-term protection against gynecological diseases, while fats, red meat, alcohol, and coffee may actually stimulate their development.

But let’s focus on menopausal weight gain for a moment. It’s about food intake and activity level, of course, but hormones come into play in a big way too. We know that adipose tissue (aka fat) is responsible for up to 100% of the estrogen produced in menopausal women’s bodies. In pre-menopausal women, the ovaries are the primary driver of estrogen production, but excess fat and the weight gain factor produce estrogen in this age group too. The interaction between fat and estrogen production is complex, but think of it this way: During perimenopause, when the ovaries start to produce less estrogen, our brains say, “Hmmm, there seems to be a shortage coming. Let’s start storing fat in the midsection to help generate some estrogen.” Hence, the universal midsection weight gain that comes with perimenopause/menopause! 

So, to combat this hormone/weight gain alliance, what’s the best nutrition plan? This is more nuanced. There is no shortage of experts who claim there’s only ONE way to eat, or ONE hack to solve the menopausal weight problem, but the reality is that it’s not that simple. I am always skeptical of anyone who presents only one way to do something. In medicine and health, there are usually numerous approaches, and—as always—the therapeutic or clinical sweet spot lives in finding what works best for you!

That said, there ARE some basic guidelines I believe women should follow to maximize their gynecologic nutrition. This includes committing to:

• Consuming 25 grams of fiber daily. (I get most of mine in my smoothie, so I know I definitely am meeting these numbers.)

• Getting approximately 1.5 grams of protein per kilogram of body weight daily, from lean meat, dairy, and plant-based protein sources. For me, this comes out to 80 grams of protein a day, but you should calculate how much you need based on your weight and activity level.

• Minimizing processed and ultra-processed foods. This means anything with a long shelf life or that comes out of a bag or a manufacturing assembly line.

• Strive to eat REAL food—that is, food that resembles a form actually found in nature! 😊

In general, if we eat like this, we will support our hormones through all the key stages in a woman’s life, in a way that minimizes major weight gain and allows our metabolism to keep up with our hormonal changes. That’s why I call it Nutritional Gynecology! For more information, you can read this article, which is free and accessible to the public.

MY FITNESS & WELLNESS CHALLENGE UPDATE

Why you should do unilateral training.

Today marks the 8th week of my 6-month experiment with trainer Korey Rowe. If you missed its beginnings, the point was to see what it would feel like to commit to the best fitness, eating, sleep, and meditation practices I could. At baseline, I logged my recent cholesterol, weight, body measurements, heart rate during exercise, and body fat percentage values. I also took pre-start photos of myself. So far, it’s been extremely interesting! I feel stronger and more fit than I have in the last five years, and my daily back pain is completely gone. I’ve also gained 5 pounds, 3.5 of which are muscle, as detected by body composition analysis. And I have learned A LOT. One of the most valuable things Korey has taught me is the wisdom of unilateral training.

With unilateral training, you work one leg at a time, and one arm at a time, for most (though not ALL) exercises. Why is this important? For one thing, we all have asymmetry in strength between one side of our bodies and the other. If we train only with exercises like squats or lat pulldowns, for example, where the movement engages both sides of the body at the same time, we are letting the strong side take over for the weak side without even realizing it. This worsens asymmetry—and for me, was the leading cause of my daily back (muscle) pain!

The MAIN reason for focusing our training on one side of our body at a time is to prevent injury. When we fall, we are rarely solidly planted on BOTH feet. (If we were, we likely wouldn’t fall in the first place!) So, the benefit of regularly training one limb at a time is not about aesthetics, vanity, or even long-term fitness but, rather, an acute avoidance of major trauma. I now swear by this principle and spend probably 80% of my leg workout time doing everything with one leg, and then the other. This includes pistol squats (which I featured on my Instagram feed a month ago), single-leg RDL (deadlifts), walking lunges, side lunges, and single-leg bridges (done on my Instagram LIVE with Korey Rowe last month). 

You can start this TODAY the next time you brush your teeth! Balance on one leg while you brush in the evening, and the other when you brush in the morning, or switch between one side and the other in the same brushing session!

SYMPTOM SOLUTIONS

Why you might need a sleep study.

I’ve said it before, and probably in this newsletter: I absolutely love to sleep. I also have been (truly) blessed with the ability to fall asleep and remain in slumber until morning. I also know that, for many, many people, sleep does not come easily. And sometimes it presents a dark threat: sleep apnea. Here are some grim facts:

• Approximately 39 million U.S. adults have obstructive sleep apnea (OSA).

• Untreated sleep apnea can lead to heart, kidney, and metabolic health complications.

• Snoring is a common symptom of OSA in up to 94% of sleep patients.

• Just a 10% increase in body weight may make you 6 times more likely to have OSA.

The best way to determine whether you have sleep apnea is through a sleep study. I asked our Core Expert, sleep specialist Dr. Thanuja Hamilton, a few questions about sleep studies.

How do you know if you need a sleep study?

The most common reason for a sleep study is to check for sleep apnea.

Several symptoms might suggest you have sleep apnea. They include snoring, waking up gasping, apneic episodes witnessed by a partner, morning headaches, unexplained awakenings, daytime fatigue despite getting sufficient sleep, and a dry and sore throat in the morning. Less obvious signs that suggest sleep apnea include irritability or mood changes, difficult-to-control hypertension, arrhythmias, frequent overnight urination, poor concentration, and memory issues.

Besides apnea, sleep studies can look for other issues that may cause awakenings and poor sleep, such as periodic limb movements, both subtle and overt; REM behavior disorder (RBD), a vigorous acting-out of dreams that can become dangerous; and other movement disorders or parasomnias (like sleepwalking and night terrors). There are also drowsy disorders such as narcolepsy that require more extensive testing in a sleep lab, for which the patient may stay overnight and into the following day. 

Can a sleep study be done at home?

Yes, but home sleep tests are generally only to rule sleep apnea in or out. They don’t have all the electrodes that an in-lab sleep study might have, which can measure brain waves, heart rhythm, and muscle activity, as well as oxygen and airflow.

So, for people who are diagnosed with sleep apnea: What type of CPAP masks are there now?

Currently, there are four main styles:

• A full-face mask covers both the nose and mouth. It’s best for mouth breathers or people who have frequent nasal congestion. It’s also a good option for people who move around in their sleep, as it’s less likely to come off during the night. Some people, however, may find full-face masks uncomfortable or claustrophobic.

• A nasal mask covers your nose or sits just beneath the nostrils and is held in place by straps that go around your head. Nasal masks are a good option for people who breathe through their nose, as they provide a secure fit and are generally more comfortable than other types of masks.

• A nasal pillow mask is a newer type of CPAP mask designed to be less invasive. These have small pillows that fit inside your nostrils and are held in place by a headgear strap. These masks are good options for people who find traditional masks uncomfortable or who need something less obtrusive.

• An oral mask is designed to cover only your mouth and is held in place by a headgear strap. It’s a good option for people unable to breathe through their noses due to congestion or other nasal issues.

Manufacturers are always working to make these apnea interventions more comfortable, including tubing that is out of the way, materials with memory foam, or substances with the ability to conform to the face better.

Talk to your doctor about whether you should be tested in a sleep study environment and, if sleep apnea is diagnosed, what all your options are for the most effective treatment.

OUR CORE EXPERT

Thanuja Hamilton, M.D., is a double board-certified sleep medicine specialist with a practice in New Jersey, Advocare Sleep Physicians of South Jersey (advocaresp.com). She is corporate medical director of Persante Health Care, a national provider of sleep center management services, and serves as medical director of Jefferson University Health Systems and Virtua Health Sleep Labs. @drthanujahamilton

COMMUNITY

“Is there a way to minimize pain during IUD insertion?”

First, this is an excellent question! Next, some IUD facts:

An IUD (short for intra-uterine device) is a type of birth control that’s inserted into your uterus by your gynecologist. IUDs are the most common type of long-acting reversible contraception; and once it’s in place, you don’t have to worry about birth control until it’s time to replace it (3 to 10 years, depending on the brand). Only a healthcare provider can insert, adjust, or remove an IUD.

IUDs are one of the most effective forms of birth control that don’t require surgery (a 99% effectiveness rate). They’re also the 2nd most popular form of reversible birth control after birth control pills. Globally, approximately 23% of women and people assigned female at birth who use contraception choose IUDs. But they are becoming more popular in the U.S. since the Dobbs decision overturned Roe v. Wade and placed contraception in jeopardy for millions of women throughout the country.

More recent studies have supported the use of IUDs in perimenopause and beyond. And IUDs are approved even for use in teens. Those containing progestin also have FDA approval as a treatment for managing heavy bleeding, so I’ve recommended IUDs for many of my gay patients, for reasons having nothing to do with preventing pregnancy.

Despite its benefits, and the fact that it’s a simple and quick office procedure, IUD insertion can cause pain, and sometimes that pain is considerable. But you know what? It’s 2024, and suffering is OUT. If your gynecologist does not offer you pre-procedure medication before the insertion, you should probably find another provider. There's no reason for the pain and stress that might occur, particularly in women who haven’t given birth.

Since Day 1 of my clinical practice back in 2004, I would routinely pre-medicate my patients with not one, not two, but three different medications. The first was an over-the-counter NSAID for pain (ibuprofen). The second was a prescription benzodiazepine, which is a low dose of the Valium class of medications (I prescribed Klonopin or Xanax). With this, they might perceive the pain but not react as strongly to it. It’s also a good muscle relaxant, and the uterus and cervix are types of muscle. These two were taken before the procedure. Finally, the night before the procedure, I prescribed an intravaginal medication (called Cytotec) that softens the cervix and makes the necessary dilation less painful. This is not only humane—it’s safer: It lessens the chance of uterine perforation that could occur if the cervix is not easily dilated and/or the patient is moving around due to pain.

If you’re considering an IUD, talk to your gynecologist about its benefits and risks specific to your age group, as well as every step in the insertion process. And don’t forget to ask for pre- and post-pain-relief options!

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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