Category: Uncategorized

Uncategorized, Women's Health

Staying Strong and Healthy as You Age

drrupe

 Statistically as women age, they tend to gain weight.  This is caused by multiple factors, not just menopause. Life is busier and more stressful. Overall activity levels decline, and muscle mass can begin to decrease. However, the hormonal changes of menopause and perimenopause, with their tendency to make us gain weight around our midsection, do not help either.

There is no “ideal” body weight. Your goal is to be the healthiest version of yourself as you age. You want to be strong and not frail. You want to avoid osteoporosis, hypertension, diabetes and heart disease. Yes, we all want to look and feel good, but lets focus on our health and not a number on a scale.

Some patients are truly in a unhealthy place. If your BMI is greater than 30 and you have medical conditions affected by your weight, then there is no time like present to accept that you need to find a way to embrace healthy lifestyle changes. The choices you make today will greatly affect your quality of like in the coming decades.

For other patients the extra 10 pounds of perimenopause may be more of a vanity issue. If you have a healthy BMI and no medical concerns, then you have to decide if you are willing to go to the workout and diet extremes it takes to maintain your perceived goal weight or if you can accept your new normal. Most of us in our forties don’t have the time or energy to exercise 2 hours a day and count every calorie that passes through our lips.  

Below are the best evidence based strategies to maintain a healthy weight as you mature in life.

1. Mediterranean Diet

The best eating plan for perimenopause has been debated, but the latest research supports Mediterranean style eating.  This including lots of vegetables and lean proteins.

Daily Goal-

  • 5-7 servings of fruits and vegetables
  • Protein 1- 1.5 g/ day (i.e. If you weigh 100kg then you should eat between 100-150 grams of protein each day)
  • Limit sugar and simple carbs

2. Increase Fiber to 25-30 g / day

Fiber does many things including encouraging healthy intestinal bacteria, helping you feel full longer and reducing constipation.

Some high fiber foods include:

  • High fiber cereal (the most fiber is in Kelloogs Bran Buds)
  • Oatmeal, chia seeds
  • Raspberries, dates
  • Almonds
  • Beans, lentils,chickpeas

3. Good Quality Sleep

Poor sleep adds to elevated stress hormones (cortisol) which can cause you to store fat around your abdomen. Poor sleep also makes you hungrier the next day

Strategies to help with sleep:

  • Reducing alcohol
  • No caffeine after noon
  • No screens for 30 min before bed
  • Taking a magnesium supplement (magnesium glycinate 400mg with evening meal)
  • Taking a warm bath before bed
  • Keeping your bedroom cool or using a cooling bed pad
  • Apps – Headspace. iRest.
  • Menopausal hormone therapy

4. Exercise

We should all be moving our body at least body 30 minutes a day. Walking, Zumba, biking, spin, aerobics, running or whatever works for you. Exercise helps your heart, mood, and sex drive, and prevents osteoporosis.

However, if you are only doing cardio, you will likely begin to lose muscle as you approach menopause, so you need to add some type of weight training to your routine to build muscle and improve your metabolism. If the thought of lifting traditional weights seems boring, intimidating, or not feasible in your schedule there are many other options available. I personally recommend a crossfit style workout because it combines your cardio and weight training, and while it might seem intimidating at first, it can be scalable to all ages and fitness levels. Yoga may be more your style. Types of yoga that really engage your muscles and core (like power yoga or vinyasa) can also help with your strength and metabolism. Yoga has also been shown to reduce other menopausal symptoms like brain fog, hot flashes, and insomnia.

5. Limit alcohol to 1 serving/ day

Your body has less tolerance for alcohol as you age. It can affect sleep, increase risk of osteoporosis and dementia. Much like our food serving size,  alcohol serving sizes have increased over the years. One “serving” of alcohol is 6 oz of wine, 12 oz beer or 1.5  oz of liquor. 

6. Supplements

There is a lot of misinformation about supplements, especially in menopause. Currently the only recommended supplement is Vit D 800 IU/ d.

Ideally you should try to get 1000mg/d (premenopause) or 1200mg/d (postmenopause) of calcium from your diet. If you are not able to get adequate calcium from your food intake, then a calcium supplement is recommended as well.

Tip: Low fat Greek yogurt and cheese are great sources of calcium and protein.

Perimenopause is awesome opportunity to set a healthy tone for the second half of your life. It’s not a time for yo-yo diets and self loathing, but a time to objectively look at your health and make the best choices you can. Increase your veggies, put down that second glass of wine, add in some weight training and see your PCP for a check up; because you only live once and you want that once to be an awesome healthy fulfilling life.

Resources:

“MyFitnessPal”  is a free app that will allow you to track your fiber/ protein/ calories.

Weight Loss for the Last Time by Dr. Katrina Ubell has good strategies for making healthy habits and dealing with stress eating. (I don’t agree with her recommendation for intermittent fasting.)

Menopause Manifesto by Dr. Jen Gunter. Good overall menopause information.

OB/GYN, Uncategorized, Women's Health

Do I have PCOS?

drrupe

September is PCOS Awareness Month and with 5 % of  reproductive age women affected, I plan to bring you several posts this month on this often confusing diagnosis.

Polycystic Ovarian Syndrome is a misnomer. It is not an ‘ovarian syndrome’ at all. The root cause of PCOS is a combined genetic and metabolic issue. The majority of women with PCOS are insulin resistant. When sugars hit their blood stream, their body requires extra insulin to process the sugar. The higher levels of insulin have several effects in different areas of their body, including disrupting the hormonal balance of the ovaries and the communication between the ovaries and the brain that trigger ovulation.  This hormonal mix up causes the ovaries to release too much male hormone, leading to lovely features like acne, abnormal hair growth and even male pattern baldness in extreme cases. The extra male hormone gets converted to excess estrogen in the fat cells, which further prevents the normal hormonal fluctuations.

It is much harder for women with PCOS to lose weight and keep it off, due to their body’s resistance to insulin. As they get heavier, the fat cells themselves secrete additional hormones that worsen the insulin resistance.  Essentially, the more weight a woman with PCOS gains, the harder it is to loose the weight. This helps explain why 80% of women with PCOS are obese.

PCOS tends to run in the family.  In studies of identical twins, if one twin has it, there is a 70% chance the other twin will have it as well. This leads us to think that the abnormal insulin metabolism is caused by an inherited genetic defect.

Despite the hormonal imbalances going on in the body with PCOS, the ovary tries its best to ovulate. Much like the “Little Engine That Could” the ovary desperately attempts to make its eggs grow each month, but rarely will it mange to get an egg mature enough to fully ovulate. This leads to a swollen ovary with multiple tiny cysts of immature eggs (follicles). The PCOS ovary stays enlarged and swollen, but the ‘cysts’ associated with PCOS are multiple tiny cysts; not the large painful kind that women often need to be surgically removed.

PCOS is syndrome based on a series of symptoms. There is not a single test you get that gives you a definitive “positive or negative” therefore the diagnosis can be subjective. There are varied criteria used for PCOS by different medical organizations and in the past the European definition differed from the US version.

The most common definition of PCOS in the US is a patient who meets 2 of the following 3 criteria:

1. Anovulation (Women who have irregular periods and do not ovulate regularly)

2. Evidence of elevated male hormone (either lab work or symptoms)

3. Enlarged ovaries on ultrasound with multiple tiny cyst.

The classic patient with PCOS is overweight, with most of their obesity in their abdomen. Weight loss is extremely challenging due to their body’s insulin resistance. Their cycles are sporadic, every 2 to 3 months. They struggle with fertility due to their ovary’s inability to ovulate despite its best efforts. They get the added bonus of often needing to wax their chin way more than their friends. PCOS is a challenging condition but the good news is, it’s manageable. In my next post I will look at the different ways to manage your symptoms and therapies to help fertility.