October is Menopause Awareness Month. But there is already a menopause movement gaining momentum. Whether it’s the explosion of menopause awareness in the UK, online menopause clinics like Midi Health popping up, or the expected rise in the global menopause market to a whopping 24.4 billion by 2030, the evidence is undeniable.

As a registered dietitian who specializes in developmental stages, I believe the menopause movement is missing the mark. And it has to do with something that occurs more than a decade prior when the midlife developmental stage begins. Although no official definition exists, midlife extends from about age 40 to 65. The average age of natural menopause – defined as a year without a period –is right around 50. This means women are almost halfway through midlife when menopause occurs.

What shows up in our 40s is due to a physiologic shift after age 30. By the third decade, relative muscle mass and power start to decline. And according to a 2019 study in the Journal of Osteopathic Medicine, 26% of premenopausal women (35-50) already have osteopenia, weakening of the bones. Changes to the brain start early too. After 35, we steadily lose 0.2% brain volume per year, which increases to 0.5% after 60. Nitric oxide, a vital signaling molecule that keeps arteries flexible – and plaque from forming on the arterial wall – is roughly half of what it was in our 40s compared to our early 20s.

In short, before a woman’s sex hormones decline, the effects of aging are already in place. Yet we are not addressing it because midlife is not a defined developmental stage. For instance, the 2020 Dietary Guidelines for Americans took a life stage approach for the first time, making recommendations based on life stage. They hit all the childhood stages – infancy, toddlerhood, adolescence — and then lumped together the entire adult stage from 18 to 65, before acknowledging older adults (>65). There was nothing about midlife.

“It’s fair to say that of all the periods in the life course, the middle years, roughly ages 40 to 59, are the most overlooked,” wrote Margie Lachman, psychologist and lifespan development expert, in the 2015 journal Research in Human Development. “There are no journals or professional societies specifically devoted to midlife, yet all other age periods, infancy, childhood, adolescence, young adulthood and old age, have dedicated publications and organizations.”.

Leaving midlife unexamined is full of pitfalls. For instance, the mainstream help for midlife women focuses on relieving vasomotor symptoms with hormone therapy or medications like antidepressants. While this has a place, it’s a limited long-term health strategy because it doesn’t address the changing needs of midlife women.

What if we approached midlife the same way we do other developmental stages? For example, a 6-month-old infant has a high need for iron due to rapid growth and declining iron stores. We don’t aim to manage symptoms of iron deficiency. No, we increase iron requirements. Why is it so foreign to think that an aging woman moving from being fertile to infertile wouldn’t also have changing needs?

There is evidence to support this theory. When sex hormones like estrogen decline, the risk of several micronutrient deficiencies rise including choline, vitamin D, magnesium, and the long chain omega-3 fatty acid DHA. For instance, women capable of becoming pregnant are more efficient at making DHA from dietary sources. In the Framingham Offspring Cohort, those in the highest quintile of red blood cell DHA had a 49% reduced risk of Alzheimer’s disease, when compared to the lowest quintile. Because most Alzheimer patients are women, isn’t it feasible that women over 50 who have declining estrogen, also have higher DHA needs?

Read: A Roundup of at-risk Menopause Micronutrients

And many of the “symptoms” that occur during perimenopause and menopause—hot flashes and sleep issues especially – are not benign but signs of diminishing vascular health. Because both estrogen and progesterone stimulate nitric oxide synthesis, which is already declining with age, menopausal women are hit hard. In fact, nitric oxide has been implicated in hot flashes, although it’s not a mainstream theory yet.

Nitric oxide expert Nathan Bryan has been sounding the alarm for making nitrates found in vegetables (inorganic nitrates), essential nutrients. That’s because the diet provides roughly half of the nitric oxide we need via nitrates in leafy green vegetables, root vegetables like beets, and celery. In fact, post-menopausal women who ate two salads a day for 10 days had higher flow mediated dilation, which is a test for nitric oxide vasodilation. So, tell me, where are the studies examining the relationship between dietary nitrates, vascular health, and hot flashes in women?

And strength training can protect women from bone and muscle loss that occurs early and through midlife. According to a 2007 study, resistance training prevents bone loss in early post-menopause just as much as menopausal hormone therapy. A recent meta-analysis shows exercise as a promising strategy to combat osteoporosis, but the quality of evidence is low. Let’s do high-quality studies! And why do most insurance companies only cover bone density screening after 65, when midlife is essentially over?

This Menopause Awareness Month let’s stop ignoring the changing needs of midlife women. It’s time researchers, policy makers, and health professionals recognize midlife as a vital development stage and support the research needed to define the changing needs of women. A bigger and broader “midlife movement” has the power to change the face of health for future generations of women, while focusing solely on menopause will keep us stuck.

The post Why the Menopause Movement Misses the Mark appeared first on Maryann Jacobsen.

This year I joined my husband in a dry January. Only thing was, after a week, I didn’t feel any better.

I mean, I didn’t have sleep issues before or anything, but I guess I expected a boost.

After all, I kept hearing about how alcohol disrupts sleep and makes perimenopause and menopause symptoms worse.

Although I didn’t make it the entire month, the experience pushed me to research this controversial and complicated topic finally. And boy, did I find some surprises.

But before I get into that, let’s go back to the 1970s, when the complicated relationship between alcohol and health first began.

Could moderate alcohol really be heart-healthy?

In 1974 a group of researchers discovered something odd. Alcohol abstainers had the highest number of heart attacks in their cohort.

This led to research showing that light to moderate alcohol had cardioprotective effects, while excessive consumption showed the opposite. Although abstainer bias was an issue–ex-drinkers being less healthy overall -researchers began controlling for this.

By 2000, data from two national health interview surveys in the US population supported the following consensus:

 In large populations, excess alcohol intake had been found to be associated with excess death, liver cirrhosis, some cancers, hemorrhagic stroke, cardiomyopathy, and hypertension. On the other hand, clear evidence exists for a protective effect of moderate alcohol intake against coronary artery disease.

A change of mind and a trial that wasn’t

Early in the 2000s, the data was examined under a new lens, claiming that the healthy drinker bias – people who drink moderately tend to participate in health behaviors – cancelled out any benefits.

The years to follow were a constant back and forth between the opposing camps. The only way to get answers was to do a large, long-term randomized control study which had been talked about for years

And in 2018, it was finally going to happen. The National Institute of Alcohol Abuse and Alcoholism’s Moderate Alcohol and Cardiovascular Health trial (MACH) began in February 2018.

This study was unfortunately cut off in May due to criticism of its funding from the alcohol industry.

Where we are now: The Precautionary Principle

Due to the doubts placed on old data, alcohol’s link to cancer, and new studies casting further doubt on the heart health connection, updated drinking recommendations reflect the precautionary principle.

For example, the World Health Organization says there is no safe level of alcohol. As of 2023, Canadian guidelines recommend no more than two drinks per week.

The 2020 Dietary Guidelines for Americans still recommend drinkers keep it to one drink a day for women and two for men as you can see below. But this didn’t come without criticism.

It’s worth noting another issue found with epidemiological studies: the under report bias. In one Canadian study, drinkers under reported their alcohol intake by about half.

“Systematic under reporting of alcohol use could result in overestimating the association between a low amount of alcohol consumption and the risk of adverse health outcomes,” wrote Vance and colleagues in this 2020 piece in JAMA Internal Medicine. “especially given evidence that heavy drinkers under report their true levels of alcohol consumption by up to 40% to 65%.”

My head was spinning at this point in my research, which is why I dug deeper to include controlled studies. Once I had the chance to review it all, I came up with these 7 surprising findings.

1. Nitric oxide is at the heart of it

I kept thinking: what is the mechanism that could make alcohol cardioprotective?

Researchers that isolate animal and human tissues from endothelial cells that line blood vessels find that low doses of alcohol increase nitric oxide, a vascular dilator, while larger alcohol doses decrease it.

I’ve written about the importance of nitric oxide and endothelial health here and here. It matters because endothelial dysfunction, which results in reduced nitric oxide, is the initiating event of heart disease.

“It is evident that low concentrations of ethanol are beneficial to endothelial cells,” wrote Toda and Ayajiki in the 2010 Alcohol and Alcoholism Journal. “whereas high concentrations impair endothelial functions and cell viability.”

Excessive alcohol increases substances that lower nitric oxide, like homocysteine and oxidative stress. But why do low doses increase nitric oxide?

While we don’t know for sure, a randomized crossover trail gives us clues. Thirty-six postmenopausal women were given either white wine (25g of alcohol) or a cup of grape juice to have with dinner over six weeks.

The moderate drinking group had higher levels of adiponectin and an improved insulin sensitivity and lipid profile. Adiponectin is an adipokine produced from fat tissue known to increase nitric oxide and decrease inflammation.

Another intervention study with 40 men showed that 30g of daily alcohol of wine or gin had anti-inflammatory effects. But the wine had the additional effect of decreasing hs-CRP, an acute inflammatory marker.

Red wine provides additional benefits mostly due to its polyphenol content, including resveratrol, anthocyanins, and catechins working as powerful antioxidants. The wines with the highest resveratrol according to one study is Pinot noir and St. Laurent red wines.

Of course, these studies are not the last word on alcohol and cardioprotective benefits. But they are in agreement with epidemiological studies revealing that in small doses, alcohol–especially red wine–may have heart health benefits.

2. Low to moderate drinking supports glycemic control

Did you know alcohol plays a role in blood sugar control? According to a meta-analysis of 14 trials, moderate alcohol significantly reduced fasting insulin and glycated hemoglobin, and insulin sensitivity in women only.

“Although these trials were generally short-term,” wrote Mukamal and Beulens in a 2022 editorial in the American Journal of Clinical Nutrition. “every existing trial among adults with diabetes that has spanned months to years has also demonstrated significant improvements in insulin resistance and/or glycemia.”

In a two-year trial, 224 people 41-74 with type 2 diabetes, were given either 150ml mineral water, white wine, or red wine to drink with meals.

Between the three groups, there were no differences in blood pressure, weight, liver function, symptoms, or quality of life, except the wine groups reported better sleep quality. The wine drinkers had increases in HDL, with red wine showing the most increase, and improvements in fasting blood sugar and insulin.

This adds to the observational research suggesting that moderate drinking helps reduce the risk of type 2 diabetes.

One theory is that increases in adiponectin,  helps to increase insulin sensitivity and aid glycemic control.

3. An unknown (but not so new) twist on breast cancer risk 

According to the National Cancer Institute, alcohol causes 4% of cancers worldwide. Although heavy drinking increases this risk, light to moderate drinking is not benign.

The type of cancers linked to alcohol include cancers of the esophagus, head and neck, colon, and rectum and breast cancer for women. In fact, half of alcohol-related cancers are breast cancer. 

How does alcohol increase cancer risk? It could be the breakdown of alcohol to acetaldehyde (a known carcinogen), drinking-induced oxidative stress, or lower absorption of B vitamins such as folate.

But for breast cancer, experts believe estrogen plays a role. In fact, drinking has been found to increase estrogen at intakes of 15-30g per day, mostly through parent estrogens (which are precursors to making estrogen), lowering of sex hormone binding globulin (SBHG), and decreasing estrogen’s clearance from the body.

These estrogen levels may raise the odds of estrogen receptor positive (ER-Positive) breast cancer.

Here’s the kicker: menopausal hormone therapy (MHT) boosts this risk.

A 2015 study pooled two cohorts of 30,789 women aged 50 and older. Weekly alcohol consumption of >7 drinks per week resulted in 72 additional breast cancer cases per 100,000 compared to abstainers.

But for those on MHT, this number more than doubled to 180 additional cases.

Then there’s the Copenhagen City Heart Study revealing MHT users who reported more than two drinks a day had five times the risk of breast cancer compared to those who did not drink or use hormones.

This isn’t new either as studies as early as the 90s showed this.

For instance, MHT users drinking alcohol increased their estrogen three-fold for about five hours with no increases seen in women not taking hormones. And a review back in 1999 concluded: “Alcohol and hormone exposure together may act synergistically to create increased breast cancer risk.”

Every paper I could get my hands on showed an increased risk of combining alcohol and MHT than either one alone.

Why isn’t this talked about more? And why was the most current study on the subject done nearly a decade ago?

4. Alcohol’s effect on menopausal symptoms is a mixed bag (but not beer)

I kept hearing about how no amount of alcohol was good for common menopause symptoms like hot flashes. But that’s not what I found.

In 2005 women ages 45-54 were separated into those who experienced hot flashes and those who didn’t. The results showed that current alcohol intake of at least once per month, was associated with less frequent and severe hot flashes.

In a 2015 study with 732 women aged 45 to 54 years revealed moderate, daily drinking was significantly associated with lower odds of experiencing hot flashes.

But another study with 293 women of the same age showed daily alcohol consumption significantly increased the risk of hot flashes. From all the I found, the research on hot flashes and alcohol were mixed.

Beer is another story because it contains isoxanthohumol (IX), which, during the brewing process, is turned into xanthohumol (XN). In the body this is activated into 8-prenylnaringenin (8-PN), a strong phytoestrogen.

Thirty-seven postmenopausal were assigned to drinking alcoholic beer, non-alcoholic beer, and a control group. Both beer groups had reductions in hot flashes by over 40% while in the control group it was 10%.

A 2017 review of the literature states: “There is evidence that regular and moderate intake of the polyphenols commonly found in hop and beer may help to relieve many common symptoms presented by women undergoing menopause.”

Who knew?

5. Alcohol can disrupt sleep

Alcohol has been used as a sleep aid for centuries but official research behind it didn’t start until the 1930s.

Initially, alcohol depresses the nervous system, which helps people relax and fall asleep. Yet alcohol can negatively affect sleep quality, particularly decreasing rapid eye movement (REM) and causing wakefulness the second half of the night.

“Evidence now suggests the deeper sleep of alcohol is also associated with an increase in frontal alpha waves, markers of wakefulness, and sleep disruption,” said Dan Ford, sleep psychologist and founder of the Better Sleep Clinic in this article on CNET. “Thus the deep sleep of alcohol is likely not to be restorative.”

Dose and timing are important. For instance, alcohol given close to sleep allows people to fall asleep but compromises sleep quality. One experiment measured the effect of moderate doses of alcohol on sleep at four different circadian phases, making the following conclusion:

Our data indicate that alcohol consumption near one’s circadian trough and when one has been awake for at least 13.33 hours (i.e., relatively high homeostatic load) is the worst time to consume alcohol in regards to disrupting sleep.

The higher the dose, the more sleep disruption, although even moderate drinking can increase sympathetic nervous system activity, potentially disrupting sleep. One review found circadian alterations following intake of higher than .5g/kg. For a 150-pound woman, that would be 34g of alcohol.

6. The pattern of drinking matters

We’ve talked about dose and timing of alcohol, but there’s also the pattern of drinking. Do we drink with dinner? On an empty stomach? Right before bed?

A 2016 review in Food and Function, shares evidence that drinking wine with meals provides additional benefits than drinking alone.

For starters, when alcohol is taken with food, its metabolism starts in the stomach with the enzyme alcohol dehydrogenase (ADH). This puts less of a burden on the liver, allowing a gradual rise in blood alcohol levels.

Drinking wine with meals may lower the risk of food borne illness as it helps kill pathogenic bacteria.

Other benefits may be maximized too. A study with 312,388 adults from the UK Biobank without type 2 diabetes were followed for over 10 years. Consuming alcohol with meals was associated with 12% lower risk of developing diabetes, but drinking outside meals wasn’t.

And last is the Mediterranean diet which includes red wine with meals. Research from the PREDIMED trial shows the Mediterranean diet with nuts or olive oil decreased risk of cardiovascular disease and breast cancer, compared to a low-fat diet.

So, enjoying wine, or another alcoholic beverage, with a meal may be a superior pattern of drinking. Of course, we need more research to say for sure.

7. Alcohol affects everyone differently

The last thing to remember is that we all react differently to alcohol, with some people unable to control their intake. According to the National Institute on Alcohol Abuse and Alcoholism, the misuse of alcohol is linked to increased chronic disease, sleep problems, certain cancers and accidents.

For instance, consuming 200g of alcohol over one to two days — binge drinking — increases the risk of a coronary event 3-6 times compared to distributing the alcohol over the week.

A 2022 study in the Health Promotion International interviewed 50 women from South Australia (ages 45-64). They found women’s relationship with alcohol varied depending on social class.

Identifying the reason women drink is important, as many drink to numb or avoid feelings. One woman said:

Loneliness is definitely a factor for me, and I think it is for a lot of women. And I think once you start having a drink, it becomes a habitual. I’d like to see more done in terms of the loneliness because I think it is a real thing.

Of course, using alcohol in this way can be unhealthy both by drinking too much and not finding a long-term solution for the loneliness.

Another factor is that we all metabolize alcohol differently depending on our genes. Although not the scope of this post, differences in metabolism may be at least partially responsible for how we feel in response to alcohol, risk of cancer, menopausal symptoms, and alcohol use disorder, and its ultimate effect on health.

In short, we can look at our family health history, lifestyle, preferences, and how we respond to alcohol when making decisions about drinking.

My drinking decision

This research helped me understand why stopping drinking didn’t make a difference to me. First, I drink beer and wine moderately (1/2 drink–1 drink).

Most of the time, I drink early, right before dinner and during the meal. I don’t have a family history of cancer. Although alcohol abuse runs in my family; I do not have that problem.

Alcohol does not affect my sleep unless I stay out late and drink more than usual, which is becoming a rarity.

And I’ve had minimal hormone-related symptoms, and no hot flashes.

Could it be the beer? Maybe!

If I go on hormone therapy, I will look more closely at drinking and perhaps cut back. This area definitely needs more research and focus.

The SMART way to drink

Drinking has a mix of benefits and risks that each individual needs to weigh.

As for any of the potential health benefits, drinking is not the only way to gain them, thankfully. So, it’s never advised to start drinking if you don’t drink.

But if you choose to drink, there’s a way to do it that helps stack the benefits in your favor. So based on this research, I used the smart acronym to help you drinker smarter.

Stop drinking more than 3 hours before bed to ensure good sleep. Drink earlier in the afternoon/evening and try a favorite herbal tea later in the night.

And if drinking is not working for you, stop for a period (or for good) and see how it makes you feel.

Make it low to moderate and skip days. Pick a favorite cup that meets the moderate guidelines. For help with skipping days, try the Mindful Drinking app which has strategies for reducing drinking during the week.

If you are on hormone therapy, talk with your health care provider about how much alcohol to drink. 

Always have alcohol with food or enjoy a drink socially. Drinking with meals helps maximize the benefits and slow the absorption of alcohol. Drinking moderately with friends can increase social bonding, another benefit to health.

Remember your B vitamins, including folate which, as research shows, may help decrease the risk of breast cancer. Sources of folate include asparagus, Brussels sprouts, bread, lentils, leafy greens, broccoli, and citrus fruits.

READ: Yes, Every Midlife Women Needs a Multivitamin (And Here’s Why) 

Try the “Mediterranean way of drinking” which includes red wine alongside a Mediterranean-style diet which have shown benefits in PREMED study. A Mediterranean diet is rich in fruits, vegetables, whole grains, olive oil, nuts, legumes, with moderate fish, dairy and poultry, and less often red meat.

To drink or not to drink—you decide!

The next time you hear you must cut out alcohol, remember there’s another side to it.

Every woman needs to decide for herself what is best. That may be to quit, take a break, or keep enjoying it with some tweaks.

All are perfectly acceptable.

The post Should Midlife Women Avoid Alcohol? 7 Surprise Findings That Will Help You Decide appeared first on Maryann Jacobsen.

Every day countless midlife women are blindsided by seemingly overnight changes to their heart health.

“I knew women’s heart disease risk rose after menopause, but honestly, as an athlete I allowed myself to be blissfully ignorant…until I hit late perimenopause myself,” writes Selene Yeager, creator of Fiesty Menopause. “It was jarring to see my LDL cholesterol skyrocket into the red on my InsideTracker graph over the transition.”

How could this be? We’ve all been sold this idea that if we have a “healthy lifestyle,” we’re guaranteed rockstar metabolic health forever. But this just isn’t the case, and it’s time women understand what is really going on.

As I’ve done my research for my book for midlife women, I’ve made some important discoveries. And I’m revealing a missing piece to the heart-health puzzle I don’t think midlife women know about.

But before we get into all the details, you need to understand the why behind our protective sex hormones.

Why Estrogen and Progesterone are heart protective

You’ve probably heard that declining levels of estrogen increase the risk of heart disease. It’s true that estrogen has both an antioxidant and anti-inflammatory effect, and women’s risk for heart disease rises after menopause.

After learning this, I was determined to find out what exactly our sex hormones do to help our heart and vascular system.

One of the key functions of both estrogen and progesterone, and their receptors, is they help stimulate nitric oxide (NO) production in the vascular endothelium. This is the layer of cells that line blood vessels, which are critical to vascular health and function.

This is summarized in this 2018 review in Heart and Circulatory Physiology:

Generally, E₂ [estradiol] exposure in women increases vascular relaxation and endothelial-dependent vasodilation, increasing blood flow in numerous vascular beds. NO bioavailability can also be impacted by oxidative stress, and it is well known that estrogens have antioxidant capabilities.

In short, having a healthy endothelium plays a central role in vascular tone, blood flow, and blood pressure regulation. This is important because you need a healthy endothelium to keep plaque from forming on the vessel wall.

The importance of Nitric Oxide

Starting as early as 1876, nitroglycerin has been used to treat heart patients, which is basically nitric oxide at work. But it wasn’t until a century later that scientists discovered nitric oxide.

Nitric oxide is a gas in the body that has a multitude of functions. For this post, we’ll focus on its important function of dilating blood vessels and increasing blood flow to and from the heart. Nitric oxide has a very short half-life, so your body is constantly making it.

I detail more about nitric oxide before in this post.

Studies show that as we get older, the enzyme that helps make nitric oxide, nitric oxide synthase (NOS) released from endothelial cells, stops working as well. When menopause hits, nitric oxide levels decline even further, making matters worse.

Endothelial Dysfunction: a silent pre-disease state

Without as much nitric oxide, the endothelium suffers, also called “endothelial dysfunction,” and arteries slowly narrow.

Endothelial dysfunction is the silent, initial step in the development of atherosclerosis. It goes unnoticed because clinical signs aren’t apparent yet.

According to a 2021 review in International Journal of Molecular Sciences:

Endothelial dysfunction is generated when there is an imbalance in the production or bioavailability of endothelium-derived nitric oxide (NO), generating a decreased vasodilator response and a prothrombotic and proinflammatory endothelium

This is where things get complicated. There is no agreed upon screening tool for endothelial dysfunction, even though identifying it early is crucial. There is also no test to measure a person’s nitric oxide levels.

Studies most often use a measure called flow-mediated dilation (FMD) of the brachial or femoral artery, an NO dependent process. You can see from the bar chart, how FMD decreases with menopause stage.

So, if midlife women are going to prevent or stop endothelial dysfunction in its tracks, they need to do some investigative work.

Check these underlying conditions first

An optimal functioning thyroid supports heart health, and after 40, thyroid dysfunction in women peaks.

But it’s not just overt hyper or hypothyroidism that can cause problems, but more subtle changes. In one study, women in the lower most quartile for Thyroid Stimulating Hormone (TSH, 0.3–1.44 mIU/L), were less likely to have metabolic syndrome than those in the upper quartile (TSH, 2.48–4.00 mIU/L).

(FYI – most consider subclinical hypothyroidism >4 and overt hypothyroidism >10)

In another study with postmenopausal women, higher TSH was linked to a higher risk of cardiovascular disease than in women with TSH in the normal range.

Estrogen also affects the thyroid’s ability to produce T3 and T4, so during the menopause transition, the pituitary gland releases more TSH to stimulate the thyroid. And a higher TSH, reduces the endothelium’s ability to make nitric oxide.

Another condition is high homocycteine, referred to as hyperhomocysteinemia. After menopause homocysteine increases, which has been linked to impaired nitric oxide availability and endothelial dysfunction. This is why I recommend a multivitamin with B vitamins as outlined in this post.

Another biomarker to check is uric acid, which also can increase post menopause. High uric acid is linked to gout and joint pain, and you guessed it, decreased availability of nitric oxide.

Work with the appropriate healthcare provider to resolve these issues if they come up.

More subtle signs of Endothelial Dysfunction

Indirect measures of endothelial function include current cardiovascular screening tools such as blood pressure, LDL cholesterol, triglycerides and ApoB.

Insulin resistance and endothelial dysfunction are often related so you could see higher fasting blood glucose and insulin. A quick ratio of HDL/triglycerides can help you determine risk for insulin resistance. In one study, >3 increased increased the risk of insulin resistance in women 40-60 years old.

In my FREE biomarker guide, I mention a test called ADMA which is also an indicator but rarely done. CRP, a marker of inflammation, is also associated with endothelial function.

But there are physical symptoms as well. In a 2017 study in Menopause, 272 women aged 40-60 free of cardiovascular disease had their hot flashes monitored and had FMD done. Women age 40-53 with more frequent hot flashes had lower FMD, indicating poorer endothelial health.

In these women, hot flashes were a stronger indicator than other risk factors and even estrogen levels. We already know that severe hot flashes are linked to higher cardiovascular disease risk and women should not just brush them off.

From Endothelial Dysfunction to Coronary Microvascular Disease

In her late fifties, for two years Barbara Fleeman tried to get answers to her symptoms of chronic cough, exhaustion and shortness of breath. After running “typical” tests, doctors told her there was nothing wrong with her heart.

“No one would listen to me or think the problem was my heart,” she said in this article on Cedars-Sinai.org. “I needed someone to believe me when I would tell them my heart hurts.”

She went to the Barbra Streisand Women’s Heart Center where, after ordering a cardiac magnetic resonance imaging scan (MRI), she was diagnosed with coronary microvascular disease (CMD). Further testing revealed she had endothelial dysfunction.

Coronary microvascular dysfunction (CMD) also referred to as “small vessel disease,” is dysfunction of the small arteries, arterioles, venules, and capillaries. And the majority of people with CMD- 60-75%- are women.

That’s why heart attack symptoms different for women than men. In fact, half of women with chest pain, like Barbara, have no blockages in the main arteries and are told they are fine.

Women, may or may not have chest pain, but also experience extreme fatigue and tiredness, dizziness, indigestion, shortness of breath, chronic cough, and pain or pressure in the lower chest or upper abdomen. It can be mistaken for the flu.

Men tend to have squeezing chest pressure or pain, jaw, neck or back pain and nausea or vomiting.

What makes matters worse, is that CMD may be a breeding ground for other diseases found more frequently in women such as heart failure with preserved ejection fraction, Takotsubo cardiomyopathy, cerebral small-vessel disease, preeclampsia, pulmonary arterial hypertension (PAH), endothelial dysfunction in diabetes, diabetic cardiomyopathy, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis.

And, as stated in this 2020 review in the Journal of Women’s Health, “…an imbalance between the endothelium-derived vasodilator nitric oxide (NO) and the vasoconstrictor endothelin-1 (ET-1) is a proposed mechanism for CMD.

The good news is we can boost nitric oxide levels

In my research I’ve found many ways women over 40 can boost nitric oxide to help prevent endothelial dysfunction. Of course, menopausal hormone therapy, especially when taken close to menopause, can help increase nitric oxide. But there are plenty of other ways too.

Half of the nitric oxide we get actually comes from our diet and the other half from our endothelial cells.

Women benefit from adding nitrate-rich foods, including leafy greens, beets, and celery. Supplements are also available, like HumanN Superbeets. Bacteria in our mouth reduces nitrates to nitrites, which get turned into nitric oxide with help from stomach acid.

But we need to ditch mouthwash and antacids that block the body’s ability to make nitric oxide from food. See this post for more details.

Lowering LDL cholesterol and Apo-B can help increase the bioavailability of nitric oxide. I am a big fan of the portfolio diet, which includes adding foods proven to lower cholesterol as much as statins including nuts, sticky fiber like oats and beans, soy foods, and plant-sterol margarine.

Anything that decreases oxidative stress in the body will help increase nitric oxide, including a diet rich in antioxidants, not smoking, good sleep, lower stress, exercise, and moderate to no alcohol.

Another exciting way to increase nitric oxide is breathing through your nose, deep breathing, and strengthening breathing muscles. Our sinuses are lined with nitric oxide so when we take in air this way, we also take in nitric oxide.

The menopause transition also negatively affects lung function. And this can cause intermittent hypoxia, or periodic low levels of oxygen, which decreases nitric oxide. Luckily, women can strengthen their breathing muscles using inspiratory muscle strength training that I dish about in this Instagram Reel.

Of course, in my book and newsletter, I will include many more ways to boost nitric oxide as I continually make discoveries about the unique needs of midlife women.

Heart disease research for women is lacking

I didn’t complete this article in one day, but rather, spent four plus years accumulating these golden nuggets of information. I have to do this because, unfortunately, the research is not as far along as it should be.

According to the American Heart Association’s Go Red for Women,  1 in 3 women die of heart disease or stroke compared to 1 in 31 dying of breast cancer. Yet the research in women’s heart disease is much less. And less research means poor awareness in our medical system.

Although it’s unlikely younger midlife women have heart disease, it’s very possible the silent form of endothelial dysfunction has taken root. And menopause undoubtedly accelerates this risk.

I suspect that of many of the symptoms of menopause are at least partly due to this decline in nitric oxide. Studies hint at this as a key mechanism and one randomized control trial found that women who wore nitroglycerin patches had a large reduction in hot flashes.

Are you getting riled up yet that women’s health is so behind the times?

Midlife women need to be proactive

Wherever you are in your journey, just know that heart health after 40 comes down to this: we midlife women need to be pro-active in taking care of our endothelial function, so we don’t move onto the next stage of heart disease.

And if you or a loved one have symptoms mentioned in this post, you need to push for more testing by printing this handout and giving it your doctor.

Send this post to family or a friend or share it on social media. We can’t wait around. Too many of women’s lives depend on it.

Want to learn more? Follow Midlife Strong on Instagram or Maryann’s private Facebook group

The post Heart Health for Women Over 40 Comes Down to This appeared first on Maryann Jacobsen.

There’s never been a more important time to help support our daughters, both emotionally and physically. Today’s guest is full of strategies to help keep our girls out of dieting and body image pitfalls that go hand in hand with emotional health issues.

Amelia Sherry is a New York-based dietitian with a master’s in public health who counsels women and families. She is founder of the NourshHer, a site dedicated to help parents raise children to have a healthy relationship with food and body. Sherry compiles her best tips and advice in her new book, Diet-Proof Your Daughter.

We have a candid talk about her book, ways to help girls, and what drives her to help families raise girls to have a healthy relationship with food.

Highlights from the Show

• Why Amelia chose dietetics as a second career, focusing on pediatrics and how her desire to write a book came after counseling families for five years
• Why she focuses on habits instead of body weight.
• The biggest dilemma parents of girls face, and what they can do to get over it.
• What to say (and not say) at the dinner table.
• How the pandemic affected girls’ eating and risk of eating disorders.
• How Sherry uses her Intentional Feeding Mindset framework in her book, which includes the 5 pillars that help families.
• The importance of “influence” in how our children eat and teaching them how to be a conscious consumer with social media.
• How to find out what’s underneath a girl’s drive to change her body.
• How to teach nutrition in a positive, non-threatening way by including simple nutrition concepts.
• How to communicate why skipping meals, dieting, and disordered eating behaviors is not the way to go.
• How to respond when your daughter says she’s unhappy with her body and the importance of conveying family values.
• When to seek professional help for eating and body image challenges.

It’s an opportunity to put your daughter on a positive path, but it’s also an opportunity to help you heal some of the things you may have been struggling with for decades. – Amelia Sherry

Links

NourishHer.com

Book: Diet-Proof Your Daughter: A Mother’s Guide to Raising Girls Who Have Healthy, Happy, Relationships with F0od & Body 

Follow Amelia Sherry on Instagram

Book: Parenting the New Teen in the Age of Anxiety

Duration: 1 hour

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Podcast Music: Corporate Uplifting by Scott Holmes

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The post How to Diet-Proof Your Daughter with Amelia Sherry [Podcast] appeared first on Maryann Jacobsen.

In another post, I detail foods that help us meet needs for certain vitamins and minerals. But supplementation is important too, but there’s so much confusion out there.

Multivitamins have been around for a long time. And I used to be unsure whether taking them was right for me.

But in midlife, I no longer feel that way and I’m going to explain why. But first, it’s important to understand what the multivitamins provide and don’t provide.

What you get with a multivitamin

First, a multivitamin with minerals is usually one (or two) pills with a majority of vitamins and minerals at 100% or more Daily Value (DV).

Yet it’s impossible to get every vitamin and mineral in a single pill. What it can provide at higher than DV levels are important B vitamins like B12, B6, and folic acid.

This is important because the absorption of B vitamins like B12 and B6 declines with age. In fact, government guidelines recommend people over 50 consume supplements or fortified food with vitamin B12.

That’s because we need strong stomach acid to cleave B12 from food, a process that becomes less efficient with age. As people age, they are also more likely be taking medications like metformin and proton pump inhibitors, which interfere with vitamin B12 absorption.

To see if multivitamins help people over 51, researchers analyzed National Health and Nutrition Examination Survey data.

Those who took multivitamins at least every other day had better nutrient biomarker status of folate, iodine, selenium, and vitamins B6, B12, and D compared to non-users.

The one vitamin that exceeded the tolerable upper limit was folic acid. Vitamin B6 deficiency was common in the non-users, and this increased at older ages.

In short: a multivitamin helps close the gap on certain nutrients and is a smart way to get B vitamins.

What you don’t get with a multivitamin

It’d be nice to take one pill and be done. But multivitamins typically don’t contain more than 1000 IU vitamin D and contain very little calcium and magnesium.

Some (like Ritual vitamins for >50) contain omega-3 fatty acids like DHA but the amounts are low.

It simply is not possible to design a multivitamin to meet every woman’s need. There are times we need to take more than the recommended amount of certain nutrients, and this will be different for everyone.

Also, there’s poor absorption of iron in multivitamins. Because nutrients like calcium interfere with absorption, it’s always better to take iron separately along with some vitamin C if your iron is low or you need a maintenance dose. Read more about why it’s so important to get your iron tested.

In short: if you only take a multivitamin, you may fall short on key nutrients like omega-3 fatty acids, magnesium, vitamin D, calcium, and iron (especially with heavy periods).

Are there health outcomes?

As for health outcomes associated with taking multivitamins, the evidence is mixed. Yet this can be a tough thing to measure, as most RCTs are not very long.

What I think matters most is making sure you are meeting your nutrient needs, using lab testing to make decisions as much as you can.

The most intriguing aspect of the research on multivitamins (especially B vitamins) is cognitive function. According to a 2020 meta-analysis in Nutrients:

Our meta-analyses indicated that B vitamin supplementation for 3 months or longer may be beneficial to the cognitive function of middle-aged or older people even when they do not have an apparent B vitamin-deficiency

There’s also new data from the Cocoa Supplement and Multivitamin Outcomes Study (Cosmos) Mind RCT trial including 2,262 adults 65 and older without dementia. It showed taking a multivitamin (Centrum Silver) for three years was associated with a 60% decline in cognitive aging.

This gets to one of the main reasons I recommend multivitamins with minerals to midlife women.

Multivitamins address the homocysteine problem

Although the age group of the aforementioned study is older, the thinking is the higher B vitamins (vitamin B12, B6 and folic acid) in a vitamin like Centrum Silver helps to reduce homocysteine, which is linked to cognitive decline.

Homocysteine is a sulfur-containing amino acid and its blood levels can be raised due to lower intake and/or absorption of B vitamins, which are cofactors in its metabolism.

And get this: researchers have known for years that homocysteine inches up as women go through the menopause transition.

According to a study out of China, homocysteine (>10) increased as women moved across the menopause transition.

In the study, 43% had high homocysteine (hcy) pre-menopause, 26% in perimenopause and 45% post menopause. Those are high numbers!

This is a problem because high homocysteine has been linked to endothelial (cells that line blood vessels) dysfunction, the precursor to cardiovascular disease, the number one killer in women. According to a 2019 review:

These data suggest that declines in estradiol across stages of the menopause transition may lead to elevations in Hcy and cysteine that may contribute to endothelial dysfunction in postmenopausal women

And as I’ve already alluded to, homocysteine plays a key role in brain health. An international consensus statement on the subject came out in 2020 (see below).

Why aren’t doctors doing anything about homocysteine

Homocysteine was a hot topic over two decades ago.

Yet randomized control studies were disappointing. Giving folic acid with or without vitamin B12 and B6, which reduced homocysteine, didn’t decrease cardiac events in those with active disease or at risk.

My problem with this is not only did most of the participants already have chronic disease, most were older than 60.

And that could very well mean that they have been living with high homocysteine for 20 or more years. Quite frankly, the damage could be done.

In fact, the ability of the body to regenerate the endothelium decreases with age. So, it would make sense to me to work on preventing or catching a high homocysteine in midlife, when it’s first likely to jump.

Additionally, as pointed out in this review, researchers only gave one or a few vitamins known to lower homocysteine and not the entire range known to be involved.

That’s another reason I like a multivitamin. It has the range of B vitamins involved, and not just super-high levels of a few.

So, what is the answer?

All midlife women should consider taking multivitamins that supply higher levels of B vitamins, including B12 and B6. For instance, a multi like Centrum Silver or One a Day 50. I think those brands need a makeover because you don’t have to be 50 or silver. And if you have any health conditions, check with your doctor.

I eventually switched to this one that fit the bill perfectly. It’s also good for people with the C677T polymorphism of the MTHFR gene who have trouble metabolizing folic acid.

But I opt to take mine every other day because of my nutrient-rich diet and good lab numbers. I’ve had my homocysteine tested once and plan to get it again at my physical and will see how my numbers are trending.

I’m not a big fan of high-dose b-vitamin complex because the research isn’t clear on the benefits/risks of such high levels for non-deficient people. Yet, even if we don’t know the exact amount of B vitamins needed, research suggests we need higher levels than the RDA as we age.

Of course, I take other micronutrients in addition to the multivitamin, but that’s a topic for another post.

Any questions related to multivitamins??

The post Yes, Every Midlife Women Should Take a Multivitamin (And Here’s Why) appeared first on Maryann Jacobsen.

Cellular repair. Improved insulin sensitivity. A longer life with reduced risk of chronic disease. Increased metabolism and fat burning. 

Because of these strong claims, I’ve been wanting to do a deep dive on intermittent fasting for years now. So, in preparation for my latest book for midlife women, I finally did it.

And it revealed that the benefits of intermittent fasting are anything but a slam dunk.

But before we get into all the details, let’s do a quick review of the ins and outs of intermittent fasting.

What exactly is intermittent fasting?

Intermittent fasting is having periods during the 24-hour cycle when you don’t eat (fast).

There are two types of intermittent fasting, including time restricted eating (TRE) and alternate day fasting (ADF).

TRE includes an eating window between 4 to 12 hours. For instance, a 4-hour window would allow eating during that time followed by 20 hours of fasting while an 8-hour eating window allows 8 hours of eating and 16-hour of fasting.

ADF is eating as you normally would one day and fasting or nearly fasting (0-25%) the following day. Or a person chooses two days to fast like 5:2, which is five days of normal eating and two days fasting.

To give you an idea, data suggests most people eat within a 14–15-hour window, meaning they eat more hours of the day than they fast.

What happens when you fast (and “theory benefits”)

Once the human body goes more than 12 hours without food, there’s a decrease in blood sugar, insulin, and leptin as the body uses glycogen stores to make glucose (energy) along with amino acids and fatty acids.

When liver stores of glycogen run out, the body breaks down fat to make ketones as an alternate fuel source. Metabolic flexibility is one of the key theory benefits. I call them “theory benefits” because they are still theories needed to be proven in human studies.

The thinking goes that because fasting requires the body to switch between glucose and fat/ketones as fuel sources; it becomes more efficient at moving between these two states, boosting metabolic health.

A second thing that happens is a decline in nutrient sensing pathways, such as insulin and insulin growth factor. This “turning off” and deprivation of nutrients increases cellular repair and maintenance, referred to as autophagy.

It’s like being forced to leave your house to have it remodeled. When it’s done, you have a new and improved living space.

And of course, fasting is thought to enhance weight loss, especially fat loss. We touch on these theory benefits throughout this post.

1. The ancestor argument carries little weight

One of the most familiar arguments for intermittent fasting revolves around our ancestors. You hear about how they went days without eating, leading to helpful metabolic adaptions that helped them survive.

An article in Inverse interviewed historians to fact-check these claims. Paul Freedman, Ph.D., a food historian from Yale University, argues that our ancestors had more opportunities to eat than we have led us to believe:

We exaggerate the poverty of hunter gatherers. There were good days and bad days but for the most part, people had more choice and security than we think.

Much of this comes from animal research showing improved longevity with dietary restriction (DR). The “evolutionary theory of DR” posits that during food scarcity, organisms invest in themselves and are better prepared (and fit) when food is plentiful again.

But a 2020 study threw a wrench in this evolution theory. The researchers found that fruit flies who switch between fasting and feeding had increased mortality and laid fewer eggs compared to those who stayed on a rich diet. The researchers conclude:

Our results question the current explanation of DR’s evolutionary origins and, thereby, its relevance in interpreting DR’s mechanistic origins.

2. Most of the health claims rely on animal studies

In a 2021 review, Halpern and Mendes assert that most of the health benefits associated with intermittent fasting comes from animal models. This is a problem because rodents react differently to fasting than humans do.

For instance, in most of the studies, rodents eat during the active phase of their day for a few hours, then fast the rest of the time. And they go into ketosis sooner than humans do.

In humans, after 8-12 hours of fasting, ketones reach detectable levels of .2-.5 mM but this jumps to 1 and 2 mM by 48 hours. But rodents have detectable levels after 4-8 hours and are in ketosis by 16-24 hours. In their review, Halpern and Mendes write:

Many animal models demonstrate increased longevity and reduction in chronic diseases with caloric restriction and IF, but data in humans are lacking. Many benefits are alleged to be associated with ketogenesis, but it is unclear whether the level of ketone bodies achieved in popular IF patterns would be enough to elicit the same responses observed in rodents.

Autophagy likely happens earlier in mice too, as some studies suggest. Very few studies even look at autophagy in humans, but the ones that have suggested it can take anywhere from 18 hours to four days to kick in.

3. Intermittent fasting is not superior to calorie restriction for weight loss

When compared to people eating their regular diet, those who intermittently fast lose an average of six and half pounds, which varies depending on the type of fasting.

The weight loss is comparable to calorie restricted diets, but some people prefer to fast because they don’t have to count calories.

There isn’t much long-term data to see if people maintain their weight. One of the longest studies to date compared people on a calorie-restricted diet or ADF for a year. The first six months was the weight loss phase and the second six months maintenance.

There were 100 participants (86 women and 14 men; mean age 44). Weight loss and metabolic biomarkers were similar between the groups.

ADF participants had higher HDL at six months, but not 12 months. And at 12 months, ADF participants had increases in LDL cholesterol. A 2022 review in the Journal of the Academy of Nutrition and Dietetics examined 13 studies comparing fasting and continuous calorie-restricted groups with identical calories. The weight loss and metabolic biomarkers were similar between groups.

READ: Trying to lose weight at midlife. Don’t. Do THIS Instead.

4. Health benefits derived from intermittent fasting alone are inconclusive in humans

To help sort out the benefits of fasting alone, I found a handful of studies that controlled for calorie intake (isocaloric) but did not induce a calorie deficit for weight loss.

In one study, middle-aged men and women were assigned to eating three meals a day or one meal (consumed between 5 and 9pm) of isocaloric meals.

Even though the one-meal-a-day group fasted for longer, the subjects had higher fasting glucose levels, and impaired morning glucose during the 2-month diet period compared to those consuming three meals spread throughout the day.

In another study in Cell Metabolism, eight pre-diabetic men consumed meals of identical calories. Yet one group ate between 6:30-8:30 am and 12-2 pm (6-hour window) while the other had a longer window, starting at the same time but ending at 8pm.

There was no weight loss in either group, yet the early feeding group had large reductions in blood pressure and insulin levels and improved insulin sensitivity.

What these isocaloric studies suggest is eating windows that start earlier and end earlier improve metabolic health more than later eating windows. But it has more to do with the timing of eating.

5. The time you eat may be more important than hours fasted

In just three days of eating and sleeping 12 hours out of a regular pattern, people experience decreased leptin, increased glucose and insulin, increased blood pressure, and reduced sleep quality.

It’s like a retail store that has fewer workers later in the day and at night. If they get an unexpected surge of customers, people will have to wait, and the process is inefficient.

Well, with eating, our bodies are more “ready” to utilize glucose earlier and throughout the day than at night. Needing less inulin to get the job done.

Seventeen people with closely controlled calories had their energy measured in a respiration chamber. While eating the same calorie load, they had days of skipping breakfast or dinner.

On the breakfast-skipping day, glucose was 46% higher after lunch than on the dinner skipping day. Additionally, breakfast skipping increased “the inflammatory potential of peripheral blood cells” after lunch by 45%.

Another respiratory chamber study found that eating 700 calorie meal at 10pm instead of 8am reduced fat burning significantly. The researchers conclude:

We found that the daily timing of nutrient availability coupled with daily/circadian control of metabolism drives a switch in substrate preference such that the late-evening Snack Session resulted in significantly lower lipid oxidation (LO) compared to the Breakfast Session.

6. Having a later eating window may have null or negative effects

Many people push off the morning meal to extend their fast. Plus, it allows them to have dinner with their family or to go out with friends.

To test this later eating window, in 2020 researchers assigned 116 men and women to eat between 12-8pm or as they normally did (control group). At 12 weeks, there was no difference in weight and metabolic parameters between the groups.

But the fasting group also showed a decrease in lean mass.

“I went into this hoping to demonstrate that this thing I’ve been doing for years works,” lead author and UCSF cardiologist Dr. Ethan Weiss told CNBC. “But as soon as I saw the data, I stopped.”

Another study compared an early TRE (6-2pm) to a later window (11-7pm), and a control with 82 people for 5 weeks.

The early group had greater improvements in insulin sensitivity. And the early group, but not the late group, showed improved fasting glucose, reduced body fat and inflammation, and increased gut microbial diversity.

7. Not everyone responds to fasting in the same way

In every study, there are people who respond better than others. So, if you have a later eating window and your metabolic health is good, then that may simply work for you.

And how we respond to any fasting regimen may have more to do with our gut, according to a review in the Journal of Diabetes:.

Because the gut microbiome is involved in the personal response to food, it would be reasonable to assume that the personal response to IF can also be linked to the gut microbiome.

Also, study populations vary based on age, metabolic health, etc. For instance, the results for a population like the prediabetic men above may not apply to women who are not prediabetic.

And any restrictive eating plan is not beneficial for people with a history of disordered eating or eating disorders.

In a 2022 study in Eating Disorders, researchers assessed 44 women and 20 men who were currently intermittently fasted for 16 hours daily for eating disorder symptoms. Compared to controls, the fasting men and women not only had more eating disorder symptoms, but 31% were at or above eating disorder cut-offs.

“While I started to tune in more to my body and develop a more healthful relationship with food, I started to find the restriction in intermittent fasting more and more problematic,” writes Erin, The Incremental Mama, who shared her two-year experience with intermittent fasting and how it triggered disordered eating

8. Men and women react differently to intermittent fasting

A 2013 study on rodents showed that fasting can disrupt female reproduction. The rats did water fasts every other day for 12 weeks, resulting in changes in estrogen, LH, and the menstrual cycle.

Yet according to a review on intermittent fasting and hormones in humans, estrogen was not affected, but there were lower levels of testosterone. Studies also show decreases in insulin, T3, DHEA, and higher levels of cortisol.

What does this mean? No one really knows. Fasting stresses the body, so cortisol spikes are to be expected. Over the long haul, this may or may not be helpful depending on the population.

We know menstruating women who don’t consume adequate energy, experience stress, or have too low body fat may not ovulate. In one study, women with BMIs lower than 25 had increases in blood sugar with ADF, but the men did not.

Women over 40 need to be aware of a few things. First, they experience increases in cortisol during the menopause transition. And second, they are more likely to experience thyroid dysfunction. Could the hormonal fluctuations from fasting negatively affect them?

Again, we are far from decided on this, but it’d be nice to get some answers.

READ: The Telltale Signs You’re in Perimenopause

9. It may not be kind to muscle mass

People who lose weight without resistance training and high protein consumption typically lose about a quarter of lean body mass, yet some research shows fasting can induce even more of a loss.

One review in the International Journal of Obesity comparing fixed regimens of eating found that those with an intermittent approach lost significantly more lean body mass than those on calorie restriction. The researchers conclude:

Since it is ultimately fat mass loss that improves health indices and not the loss of muscle, the significantly greater loss of lean mass in the regular intermittent dieting group versus the continuous dieting group is concerning and needs to be further assessed.

Is this last word on fasting and muscle mass? No. But since it has been argued that fasting protects muscle, this is something people need to be aware of.

10. There is a high cost to benefit ratio

My biggest takeaway from this deep dive is the high cost to benefit ratio. Intermittent fasting in the modern world is challenging and the benefits are not as straightforward as we’ve been led to believe, as you can see the outstanding research questions below.

But there are other things we can do that there have clear benefits and less cost.

For one, exercise helps improve metabolic flexibility, autophagy, and insulin sensitivity.

And building muscle mass through resistance training helps improve insulin sensitivity due to its role in glucose disposal.

So is eating in line with your circadian rhythm by moving eating earlier in the day and less at night. In fact, closing the eating window to a doable 11-12 hours from 14 hours positively affects health.

A 2021 study in the Journal of the American Heart Association found crazy benefits to blood pressure, inflammation and endothelial health when middle-aged adults did just five minutes a day of high-intensity inspiratory muscle strength training (breathing with resistance).

Five minutes!

I could go on, but it probably makes more sense to check out my Midlife Strong Newsletter for more easy, sustainable tips.

Summary

The research to date shows that intermittent fasting is an alternative to a calorie-restricted diet for weight loss, but is not superior.

Whether it boosts metabolic flexibility, insulin sensitivity, cellular repair, and fat loss beyond its role in calorie reduction and weight loss has yet to be shown in humans.

If intermittent fasting has worked for you, great! But if it hasn’t, there’s no need to feel guilty about it. There is a smorgasbord of tools available to improve your health.

What have your experiences been with intermittent fasting?

Listen to my review of this post on the podcast!

Subscribe via Apple Podcasts, Stitcher, Spotify, or RSS<

Want to learn more? Follow Midlife Strong on Instagram or join Maryann’s private Facebook group.

The post 10 Signs Intermittent Fasting Doesn’t Live Up to the Hype appeared first on Maryann Jacobsen.

During my physical my doctor mentioned a recent study which cast doubt on vitamin D. She wasn’t willing to give up on recommending vitamin D supplements, but wanted to make me aware.

Once again, the public gets a dose of confusion about vitamin D with the latest study headlines. This time, the message is that we may not need D supplements after all; as a registered dietitian, I cringed.

For me, this study did nothing but get me riled up enough to write this post. And here’s why.

Vitamin D: a Look Back

It has been over two decades since researchers began searching for answers about the benefits of vitamin D. That is, following a growing number of observational studies revealing that vitamin D levels are inversely related to several chronic diseases and conditions, beyond its well-accepted role in bone health.

Mostly, results from randomized control studies (RCTs), thought to be the gold standard for establishing cause and effect, have been unclear.

This led to a waning of vitamin D enthusiasm and some health professionals and organizations dismissing screening (blood testing) and recommended supplementation.

But then the pandemic hit.

Vitamin D and The Pandemic

The pandemic brought vitamin D back under the spotlight when a relationship was established between vitamin D levels and the severity of COVID-19.

After all, vitamin D plays an essential role in the immune system, including a known link to respiratory diseases. And so, the RCTs got underway. In typical fashion, the enormous interest in vitamin D waned after not all studies showed benefits.

READ: Can Vitamin D Protect Us From Covid-19?

That brings us to the study making headlines: the Vitamin D and Omega-3 Trial (VITAL). This ongoing trial with 25,871 U.S. men and women is testing if supplementation with 2000 IU vitamin D and 1g omega-3s reduces the risk of chronic disease.

This latest study examined the relationship between vitamin D supplementation and fracture rates in midlife and older adults, showing no significant difference in those taking vitamin D over five years.

The Key Issue with Vitamin D Intervention Studies

A 2018 review led by Mark Bolland from the Department of Medicine, Bone and Joint Research Group, University of Auckland, found that 70% of large, randomized control trials on vitamin D choose individuals who are not deficient.

And the VITAL study was no different. Only 40% of subjects were even tested for vitamin D at the onset, which dwindled to 8% by the end of the study.

“The basic problem with the VITAL study was that it had very few participants with low vitamin D concentrations [25OHD],” said William B. Grant, PhD, Director of the Sunlight, Nutrition, and Health Research Center and author of 304 publications on vitamin D. “For bone health, there seems to be little benefit above 20 ng/mL; the mean 25OHD for those who provided values was 31 ng/mL.”

Not only that, but the control group was allowed over-the-counter supplements, including vitamin D, which made the comparative effectiveness of the active group less. Last, the researchers gave everyone the same vitamin D dose (2000 IU) even when we know people in larger bodies need 2-3 times that amount to raise their blood levels.

In fact, one secondary analysis of the VITAL trial found that people with BMIs under 25 who took vitamin D had a 38% reduced risk of advanced cancers. Could that be because 2000 IU was enough to raise their vitamin D levels but not for those with higher BMIs?

Nutrition RCTs need careful design

These issues have prompted researchers to promote careful design in nutrition studies. In 2014, Robert Heaney put forth guidelines specifically stating that nutrient status must be measured which are shown below.

“The change in nutrient status produced in those enrolled in the trials must be measured and recorded in the report of the trial,” he wrote. “The hypothesis to be tested must be that a change in nutrient status (not just a change in diet) produces the sought-for effect.”

This idea of nutrient measurement that Robert Heaney emphasized eight years ago is something many health professionals and researchers believe is the missing key in the vitamin D clinical research literature.

It begs the question: Why are we focusing more on vitamin D supplementation than the actual vitamin D status achieved in individuals?

It’s Vitamin D status not Supplements that Matter Most

An NIH funded Vitamin D to Type 2 Diabetes (D2d) trial, which gave twice the vitamin D as the VITAL study (4000 IU) demonstrates how results differ when they were based on supplementation alone versus vitamin D status.

Although fewer people in the vitamin D group developed diabetes over two years, the results were not statistically significant. However, in their secondary analysis, researchers found that those who maintained blood levels between 40-50 ng/mL had a 52% reduced risk of developing diabetes, while those with levels greater than 50 ng/mL had 71%, compared to current recommended levels of 20-30 ng/mL.

Endocrinologist Sunil J Wimalawansa provides evidence that vitamin D levels >50 ng/mL are needed for a robust immune system and for reducing COVID-19 complications and mortality.

Research on breast cancer hints at higher levels being beneficial, with one study that pooled two randomized clinical trials and a prospective cohort found women with vitamin D levels >60 ng/ml had 82% reduced risk compared to those with vitamin D levels of <20 ng/mL.

A recent review details how protection may vary per condition with >30 ng/mL found for heart disease and overall mortality, >40 ng/mL for hypertension and preterm delivery, and >50 ng/mL for diabetes and the immune system.

READ: Vitamin D for Kids: What Parents Need to Know 

It’s Time to Get Answers!

This latest study on vitamin D doesn’t tell us to forget about supplements. It tells us we need a nutrition study overhaul.

Bolland and colleagues estimated there to be 69% waste in vitamin D studies in bone health alone, with 36% lacking novelty and another 33% adding no new clinical knowledge. We can do better than this.

In 2022, perhaps more than ever, it’s vitally important that we get vitamin D public health recommendations right. We need studies that are better designed and equipped to find answers.

Any researchers up for the challenge?

The post What do the Latest Vitamin D Studies Really Tell Us? appeared first on Maryann Jacobsen.

Yep, the way we breathe can have a tremendous impact on our health in either direction–especially the duration and quality of sleep. This is vital as we age, making midlife the perfect time to invest in your breathing.

My latest podcast guest is sharing his experience and all that he has learned about the benefits of breathing.

Nick Heath is a PhD, type 1 diabetic, and certified instructor of the Oxygen Advantage. He was astounded to discover how targeted breathing exercises not only enhanced his energy levels but his diabetes management.

This led to the development of his site The Breathing Diabetic, which showcases his three key breathing principles along with supportive research.

In episode 38 of the Healthy Family Podcast, I sit down with Nick to find all that he has learned and get the details on his principles to maximize breathing.

Show Highlights

• How taping his mouth at night change everything and made him take notice of the benefits of nasal breathing.
• The mechanism behind how nasal breathing affects blood sugars and the nervous system.
• Why more people don’t know about the benefits of breath training and how that will change.
• If you have THIS symptom, you are likely breathing through your mouth at night.
• How to tape your mouth safely at night and other benefits of nasal breathing.
• How to breathe during exercise to lower heart rate and promote recovery.
• The benefits and timing around a slow breathing practice.
• How proper breathing improves Heart Rate Variability and balances your nervous system.
• The multiple roles of nitric oxide on health and how breathing influences it.
• What intermittent hypoxia is and how it can boost health (and nitric oxide!).
• The importance of resistance training for your breathing muscles, which includes your diaphragm and intercostal muscles.

Your paranasal sinuses are always producing nitric oxide, so when you breathe in through your nose you carry this gas down into your lungs and this relaxes the blood vessels which increases blood flow and helps to redistribute blood flow and ultimately gets more oxygen in. – Nick Heath

Links

The Breathing Diabetic website

411 Newseltter

Oliver Jenkin Insight Timer

Wim hof method

Oxygen Advantage

James Nestor’s book Breath

Mouth taping products: Myotape and SomiFix

Breathing Apps: the breathing app and breathwrk

IMST: POWERBreathe and Expand-a-lung

Study on IMST benefits 5 minutes a day

Sign up for the Midlife Strong Newsletter

Duration: 44:03

Download episode
Subscribe via Apple Podcasts, Stitcher, Spotify, or RSS

Podcast Music: Corporate Uplifting by Scott Holmes

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Follow Midlife Strong on Instagram or join the private facebook group

The post 3 Breathing Exercises That Will Change Your Life with Nick Heath [Podcast] appeared first on Maryann Jacobsen.

It’s a tricky time. But the truth is it’s an important time for them to get key nutrients they need.

Teenagers brains are still developing until 25 and bones grow until 30. Boys are still growing until 18 or 19, while girls tend to stop growing around 16.

Plenty of evidence points to teenagers needing to supplement their diet with one if not all of the following 6 supplements.

Let’s take a look to sort it all out.

1. Multivitamin with minerals

When kids are young, their nutrients needs are much less (expect for iron with infants). It’s not as difficult to meet their nutrition needs though food.

But after age 14, teens need the same if not more nutrients than adults do. Yet this is also a time eating habits take a turn for the worse.

Funny thing is younger kids are more likely to take a multivitamin with minerals than teens.

Studies show adolescents who consume multivitamins with minerals are more likely to meet their nutrient needs than those who don’t.

This is true for the population over 9 according to a 2017 study in Nutrients. Even in a group with diets with high odds of meeting their needs, 16% of dietary supplement (DS) non-users, 6.0% of DS users, and 0.9% of full spectrum multivitamin vitamin users (FSMV) were at risk for one or more nutrient deficiency.

And in those with poor diets, the risk of deficiency was 63% in DS non-users, 51% in DS users, and 29% in FSMV users.

Which supplement? Choose multivitamins with minerals that have 100% DV for many of them. Because their needs are so similar to adults, consider adult formulations. For girls, I like the One a Day Petites because they are smaller (you take two). Another option is to take multivitamins every other day, especially teens who eat a fairly balanced diet.

2. Magnesium

Most multivitamins lack enough magnesium to make a real difference, or don’t have any.

Magnesium is a cofactor for over 300 enzymes to help regulate many body functions including protein synthesis, blood glucose control and blood pressure regulation.

Most tweens are getting about half the magnesium they need but this jumps during the teen years. It’s estimated that 75% of boys 14-18 and 87% of girls are falling short on the recommended 410mg and 360mg respectfully.

A lack of magnesium may even affect teens behavior. According to 2015 study teens with the highest magnesium intakes, had the lowest risk of externalizing behavior problems.

Studies also show an inverse relationship between magnesium blood levels and ADHD.

That doesn’t mean adolescents should mega dose but ensuring they are meeting their needs makes sense.

Teens who don’t eat nuts regularly will have a hard time meeting their magnesium needs. Check the food list to be sure.

Which supplements? According to the Office of dietary supplements “magnesium in the asparate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate.” If your teen is taking a MVI every other day, try giving magnesium on the alternate days.

3. Omega-3 fatty acids

What you also won’t find in most multivitamins is omega-3 fatty acids, DHA and EPA.

During adolescence the brain goes through a “brain remodel” between the ages of 12 and 25 of which DHA plays a key role.

In fact, DHA continues to increase in the brain during adolescence to reach about 15% of fatty acids. This increase occurs during an important time.

Emerging research shows a link between DHA status and depression and other psychiatric disorders, behavior/attention and learning.

Minimum recommended amounts are 250mg, DHA and EPA while 14-18 consume 1-3oz/week which is less than half of that: 47-141mg/day.

Which supplement? I like Ultimate Omega-3 Juniors from Nordic Naturals because the pills are smaller. Eventually they can move up to ones used for adults. Consider their diet, cut back when fish intake is high which can change from week to week.

For more details on food sources and benefits, see my mega post on DHA and EPA throughout the lifecycle.

4. Vitamin D

Like everyone else, teens are at risk for vitamin D deficiency. Multivitamins will have some vitamin D – the RDA or up to 1000 IU but check the label.

According to the 2011-2014 National Health and Examination Survey (NHANES), 4.8% of 12-to-19-year-old’s had vitamin D levels <12ng/ml and 22.7% between 12-19ng/ml.

What we know is that non-Hispanic blacks, Asians and Mexican Americans have significantly lower vitamin D levels than Non-Hispanic whites. Those who supplement are also are more likely to have higher vitamin D levels.

The best course of action is you suspect your teen is low in vitamin D is to get them tested. Because the levels recommended for maintenance of vitamin D are different than for getting levels up.

And if your teen is prone to depression, testing can help you identify if vitamin D is playing a role.

Although most will benefit from 1000-2000IU per day, a lot depends on their size, sun exposure and skin color. See my post on vitamin D for more details.

Vitamin D3 is great choice and can be found anywhere.

5. Iron

During growth phases iron is always a watch out because needs increase to support growth. Girls are at higher risk for iron deficiency because they menstruate but that doesn’t mean boys can’t have low iron.

What’s important is to check the Big 4 and symptoms. Diet, blood loss, high needs, and absorption.

Please check my article on ferritin for more details including the long list of symptoms including fatigue/low energy, mood issues, pale, decreased exercise performance, heart flutters, sensitivity to cold, headaches, and dizziness.

For example, a menstruating vegetarian athlete would have three out of four risk factors, making her high risk for low iron.

Any athlete should be careful. At the start of cross-country season teen runners were evaluated checking hemoglobin and ferritin. At the beginning of the season one out of 30 males had low iron (<12ng/ml) and 8 out of 20 females.

By the end of the 11-week season, four additional males had low iron and another female making it 17% and 45% respectfully.

Now that’s with very low iron. In fact, a ferritin above 40mcg/L is recommended for adult endurance athletes to optimize performance in adults. Research is lacking in the teen population.

So talk to your teen, take note of symptoms, and don’t hesitate to ask the doctor to check their iron.

Intermittent iron supplementation found beneficial in a Cochrane review, may be a great choice for your teen. In one study, weekly iron for 16 weeks of 60mg elemental iron (check labels) was enough to raise ferritin from 27.97 to 45.45 in adolescent girls.

Which supplement? Start with ferrous forms like ferrous sulfate with vitamin C. If your teen has trouble tolerating, try iron bisglycinate. Always have ferritin and blood levels checked when taking iron.

6. Calcium

Calcium needs are high in teens, a time when 95% of adult bone mass is reached. Getting adequate calcium allows adolescents to deposit calcium in their bones.

Yet according to The National Osteoporosis Foundation, 0 out of 10 kids in this age range meet the 1300mg.

Taking large calcium supplements Is not recommended.

A good strategy is to first focus on diet. You can use the International Osteoporosis Foundation also has a calcium calculator and downloadable app.

Then fill in gaps with fortified foods like orange juice or calcium chews.

Of course, it’s not just calcium but physical activity and vitamin D that matter which you can read about here.

Read: Why Puberty is the Ideal Time to Invest in Bone Health

What a teen supplement plan looks like

Let’s look what a teens supplementation plan and execution looks like. You have Sarah who eats pretty well but doesn’t eat fish or nuts and also eats out with friends quite a bit. Although her mom has given her supplements before there was no real plan or consistency.

Her mom talks about the importance of her nutrient needs and why she thinks she needs to add consistent supplementation.

She starts her on multivitamin with minerals every other day. She takes magnesium and vitamin D on the alternate days. And fish oil every day as she doesn’t eat fish (though now she says she will try more).

She complains of heavy periods and gets checked and her ferritin is low at 12mcg/L. She takes 65mg elemental iron every other day.

When Sarah gets follow up ferritin levels, they now are just over 40, so she switches to weekly iron. She is eating fish sometimes so adjusts her fish oil depending on her fish intake.

And during the summer, when she gets more sun, she takes vitamin D twice a week only. She also gets some in her multivitamin.

James who is 14 starts on daily multivitamins, magnesium and omega-3s because his diet is pretty limited. As he gets older his diet improves and his parents move him to every other day regimen.

Buy pill containers

To get her daughter independent, Sarah’s mom buys one of those days of the week containers typically used for medication. Simply put the supplements in there and have your teen take them on their own.

Yeah, they’ll miss days but hopefully they’ll get into a routine of taking them. Periodically check in to see if anything needs change.

This also helps teens understand how their diet may be lacking. Sarah never thought much about nuts but knowing they have magnesium has encouraged her to start eating them.

Overall, dietary supplements can play an important role in helping teenagers fill in nutrition gaps.

Do you supplement your teen?

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This pollo asado bowl recipe started out as something for grill night, which works great. But soon I discovered I can cook it in the oven and it turns out nice and juicy. I often double the recipe to have chicken bowls all week.

In my meal plan I call them chicken fiesta bowls with beans and my no-fail Spanish rice. But you can also do tacos or burritos. The sky’s the limit.

Anyone else making something like this?

5.0 from 1 reviews

Pollo Asado Bowl [Recipe]

 

Print

Prep time

10 mins

Cook time

22 mins

Total time

32 mins

 

Serves: 4

Ingredients

• 1 -1.2 pounds chicken breasts
• ¼ cup olive oil
• ¼ cup lime juice
• 3 garlic cloves, minced
• 1.5 tsp taco seasoning mix
• ½ tsp salt
• Taco seasoning
• 2 Tbsp chili powder
• 1 Tbsp cumin
• 1 Tbsp garlic powder
• 2 tsp onion powder
• 1 tsp salt

Instructions

1. Preheat the oven to 400F. If you have big chicken breasts, slice to make more thin.
2. Add the marinade ingredients (all but chicken) in a small bowl and combine with the chicken in a big ziplock bag.
3. Mix until the marinade covers all the chicken. Put in the fridge for an hour or more.
4. Line a sheet pan with foil or parchment paper, and add the chicken.
5. Bake at 400F for 20-22 minutes or until the chicken reaches a temperature of 165F.

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For more easy dinner ideas, check out Maryann’s book The Family Dinner Solution: How to Create a Rotation of Dinner Meals Your Family Will Love

The post Pollo Asado Bowl [Recipe] appeared first on Maryann Jacobsen.