TODAY’S DOSE OF HONESTY

One health issue that is on your mind…

I get asked about incontinence a lot. Besides the fact that I am a medical specialist in women’s health, it’s probably because a) it’s such a common complaint for women in their 40s and up, and b) NO ONE wants to bring up the subject. Leaking a little urine might be rare or frequent, but either way, you should know something about it. So, it’s on the Ajenda today.

Setting aside the type caused by neurologic issues or nerve communication problems with the bladder, the main categories of incontinence include stress, urge, and overflow. You can think of them in this way:

• Stress incontinence is the loss of urine that can occur with laughing, coughing, sneezing, or jumping. 

• Urge incontinence is classically described as needing to urinate before the bathroom door is locked—in other words, as soon as the urge hits.

• Overflow incontinence is caused by not being able to fully empty the bladder, which can lead to dribbling of urine or frequent urination. 

In women who are perimenopausal and in menopause, stress incontinence is by far the most common and is largely caused by a decrease in estrogen in the urogenital tissues. This leads to a “weak” bladder—thus, the occasional drops of urine escaping during exercise or a coughing/sneezing fit.  

According to the American Urologic Association, risk factors for incontinence in women include aging, obesity, chronic coughing, pregnancy, delivery, and menopause. The risk of incontinence increases with the number of children and can occur with both C-section and vaginal deliveries.

Although it’s generally not caused by anything serious, urinary incontinence can be embarrassing and downright annoying. So, what should you do if this is happening to you?

• First, be sure to discuss this at your next GYN checkup. OB-GYNs have training in managing incontinence, as do urologists and urogynecologists. 

• They’ll ask you to pay attention to your body: When did urine leakage occur? How often? What were you doing when it happened? Where were you when you experienced it?

• Next, it's important to exclude a urinary tract infection (UTI) or other infection as a cause. 

• Then, they’ll usually recommend keeping a “voiding” diary. This involves recording the times you pee and the amounts of urine you pass in a 3-day period. In addition, you’ll record what, when, and how much you drink. 

Treatment options include medications, vaginal and/or systemic estrogen to strengthen the pelvic floor muscles, or in some cases, surgery. However, the first approach is generally behavior modification—i.e., more frequent voluntary trips to the bathroom to avoid or minimize the risk of any incontinence episodes. If this doesn't work, consultation with a urologist or urogynecologist may be recommended for more sophisticated testing of bladder pressure and pelvic floor muscle function. 

Bottom line: Don't suffer in silence. It's common. And there’s help.

My 6-Month Experiment Update

It happened. In my 7th or 8th week of training with Korey Rowe. I hit a wall.

I expected this but was still caught off guard slightly when it happened because I felt it so suddenly. I woke up one morning, and as I picked up my Facetime call from Korey for my workout, I thought, "I am not about this today." My body felt tired and bloated, an empty tank devoid of energy, and it made me feel frustrated, discouraged, and lazy. There was no way I could entertain even 1 minute or 1 set of “giving it my max,” let alone an hour of it. UGH!!!!

Like so much of my 6-month experiment, though, this quickly evolved into a massive learning opportunity. As I explained to Korey how I felt and thought and questioned what was causing it, he talked me through what was happening. Here’s what I learned:

Are there times/intervals in which we should expect a plateau?

Yes, plateaus can often occur every 4-6 weeks, depending on the intensity and variability of the program. It's natural for the body to adapt to a certain level of training over time, which can lead to periods where progress slows down.

Which is better—take a full day or two off, or do something “light” instead?

This depends on how you’re feeling. Generally, it's beneficial to incorporate active recovery (like light cardio, mobility work/stretching, walking, etc.) rather than complete rest, as this helps keep the body moving without adding stress. However, if you feel particularly fatigued, a full rest day may be more beneficial.

How did you know she was hitting a plateau?

Dr. Jen began to experience increased fatigue, a dip in motivation, and reduced endurance capacity and strength output, despite consistent effort, proper nutrition, and sleep.

How did you coach her through this training roadblock?

I explained to her that hitting a plateau is a normal part of any long-term training journey. It was an opportunity to reassess and tweak the program, introducing new challenges and varying the training to help her body break through the plateau. To support continued progress, we incorporated active recovery and did a “de-load” for a few days to get her ready for the new phase of her training plan.

Plateaus can be frustrating, and it was important to have open communication with Dr. Jen, offering empathy and understanding for any frustration she might feel while reinforcing her past successes and the progress she’s made.

COMMUNITY

“There are so many kinds of yogurt now! How do I choose?”

Boy, you are not kidding! There are markets with what seems like entire aisles devoted to yogurt and yogurt-like products. The variety is incredible too—dairy (milk- and cream-based), veggie-based (soy, coconut, cashew), drinkable (kefir, kombucha), Icelandic, Australian French-style, frozen, and even pickled! And they all offer superior nutritional benefits, so deciding which one to buy can be overwhelming. As a nutritionist, I’m here to help! For this discussion, I’ll stick with the (not frozen) dairy offerings: regular and Greek.

Why dairy yogurt’s good for your body.

Let’s start here. Both of these fermented products are good dairy options in your diet. I choose Greek over regular yogurt; you’ll see why in a minute. Where they’re on the same page:

• Both support gut health. The probiotics, or good bacteria, in most yogurt help maintain vital balance in your gut microbiome.

• Both are rich sources of protein. Enough said—I’ve talked about protein often in this newsletter.

• Both support bone health. Greek has less calcium than regular, but both have excellent numbers.

• Both may be more suitable for the lactose-intolerant. In addition to yogurt’s lower natural lactose content, its probiotics aid in lactose digestion.

• Both may improve high blood pressure and cholesterol. Consuming fermented dairy products is associated with a lower risk of plaque buildup and artery stiffness, risk factors for high blood pressure, while yogurt’s probiotics may help lower cholesterol levels by inhibiting the production of certain enzymes.

• Both can help with weight loss efforts. Consuming protein keeps you feeling satisfied longer, which helps reduce overeating. Yogurt consumption is also linked to a lower body mass index (BMI) and body weight and a reduced risk of an increased waist circumference.

Greek v. regular: What’s the difference?

The difference between regular yogurt and Greek yogurt lies in their texture, taste, and nutrient content.

Regular yogurt has a light and smooth consistency and can vary in thickness. Also known as concentrated or strained yogurt, the Greek style is created by eliminating whey (the fluid part of milk) and other liquids before it’s packaged. This gives it a thicker, creamier mouthfeel and a subtly tangier taste than regular.

Where Greek yogurt really shines is in the nutrition department: It contains about half the carbs and sugar as regular yogurt while packing almost twice as much protein. It might have a bit more fat and a bit less calcium, but that hefty protein shot is why the Greek style is my choice. By the numbers:

My best advice: Read labels!

This practice is critical for optimal nutrition anyway, and it will help narrow down your yogurt selection process. Specifically:

• Check ingredient lists. Any that are not milk, live active cultures, or (sometimes) cream are mostly likely added for sweetness or flavor. Add your own natural sweetness to plain yogurt with fresh or frozen fruit, honey, or cinnamon.

• Know the fat content. Whether you choose full-, low-, or no-fat yogurt depends on your personal health goals. If you’re looking for a substantial healthy snack, the full-fat versions are more satisfying; for weight loss, select a nonfat version.

• Hunt down added sugar. Even fat-free versions can hide lots of it. Opt for brands that have less than 10 g of sugar and just 4 g of added sugar) and no more than 15 g of carbs.

• Look for the gut health seal. The Live & Active Cultures (LAC) seal indicates that a product was made with at least 100 million healthy bacteria cultures per gram of yogurt. And that’s a good thing.

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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