Middle age and menopause don’t have to mean your sex life is impaired or worse, over. Heck, there are even solutions and treatments for sex after menopause.
But there can be additional challenges such as trying to find vaginal dryness relief, loss of libido or sexless marriage, crashing fatigue in menopause, even embarrassment over body changes that make us feel less than sexy.
Our menopause health clinic’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, spends a lot of time at her practice helping women regain their vibrant sex lives, and one thing she does is recommend books by Dr. Laurie Mintz, particularly A Tired Woman’s Guide to Passionate Sex.
In this podcast, Dr. Dunsmoor-Su got to chat directly with Dr. Mintz about all the things that can dampen the spark and how to reignite it.
LISTEN NOW
If you need help reigniting your sex life, a menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.
Dr. Laurie Mintz is a licensed psychologist in private practice and a tenured Professor at the University of Florida, where she teaches the Psychology of Human Sexuality to hundreds of undergraduate students each year.
Dr. Mintz has published over 50 research studies in academic journals and six chapters in academic books. She has received numerous professional and teaching awards. She is a Fellow of the American Psychological Association, indicating that her work has had a positive national influence on the field of psychology.
Dr. Mintz is also the author of two popular press books”both written with the aim of empowering women sexually: Becoming Cliterate: Why Orgasm Equality Matters and How to Get It and A Tired Woman’s Guide to Passionate Sex: Reclaim Your Desire and Reignite Your Relationship.
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With the “stay home” orders and recommendations flying around, most of us have had our normal lives pretty thoroughly disrupted.
And that means our patterns and habits are disrupted as well. We can’t hit the gym or the spin class or the pool. We’re making lunches at home rather than grabbing a bite out. Even our sacred coffee routines are different!
But some things you can continue to do or even do better, and hydration is one of those. It’s your own bathroom, and it’s likely closer to your work area than in the building you normally work in. And if you don’t have ice or a clean glass, well, that’s no one’s fault but your own!
Hydration is incredibly important, especially during the menopause transition and after. It feeds your brain,lubes your joint pains, helps hydrate skin and other tissue “ all things that are harder to do after estrogen declines.
We talked with Registered Dietitian Nutritionist and owner of Champagne Nutrition Ginger Hultin about why proper hydration is necessary and how to stay hydrated (and not drink too much alcohol) in this time of online Happy Hours.
To see the webinar of this conversation, check out the Gennev channel on YouTube. Prefer to listen while doing other things? Listen to the podcast version on Stitcher or wherever you listen to podcasts. Transcript below.
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Do you find yourself drinking too little water or too much alcohol or both during these strange times? Come share your hydration strategies (and how you keep liquor consumption under control when everyone suddenly wants to have an online Happy Hour) with us in the Gennev Community Forums!
TRANSCRIPT
Coach Stasi Kasianchuk
Hello and welcome to our webinar on hydration and alcohol consumption. So I am Stasi Kasianchuk, a registered dietitian, nutritionist, exercise physiologist, and the director of Gennev’s health coaching program. Today I’m here with Ginger Hultin. She’s going to give us some background information on herself. And she is an amazing dietitian, wonderful person and has lots of experience. So I’ll let Ginger give her introduction on what she’s, what she’s doing right now.
Ginger Hultin
It’s really nice to meet you. Thank you for the introductions. Stasi. I’m Ginger Hultin. I own a company called Champagne Nutrition. It’s based here in Seattle. It is a nutrition company and I see private clients virtually and I’ve actually been virtual even before everything that has happened this spring. So I just love the flexibility. My company’s name is Champagne Nutrition because I do love champagne. I’m just going to throw that out there. But also I really believe in the joy that food and drink that we love what that brings to us. And so with my clients, I really try to be more about balance and getting people off that diet roller coaster. And instead of include the foods that they like in their lives in a more balanced way. So that really is how I work with my clients.
Stasi
So I’d love to start off with talking about the connection between hydration and immune function, especially in light of the COVID 19 pandemic. Ginger, what types of questions have you been getting from your clients? How have you been helping them around hydration? Specifically related to immune function.
Ginger
Yeah. I’m having some really interesting conversations with people right now because everyone’s lives have changed so much and I think there are some struggles with like, do I meet my hydration needs at home? You know, like what does that look like versus what I used to do at work. Also just like healthy eating, focus on health versus some stress eating and you know, really this joy of baking, which is so fun.
But how does, how does all this fit together? So those are the things I’m talking to my clients about. As far as the immune function, it’s really interesting because the most important thing is that our bodies are as optimized as possible. And so part of that is really protecting the fluid balance in your body and making sure that the cells that are so important for the immune system, like those spider cells and natural killers, the white blood cells, those are able to circulate to the best of their ability. So part of getting enough fluid is really providing that volume and the blood and the healthy circulation so that we’re energized and we’ve got that volume moving around. And secondarily, fluid’s really important for detoxifying our body. So we’re making a little toxins all the time just by breathing, eating. It’s part of our body’s natural, natural process. And we have really amazing ways to flush that out through urine, through bowel movements, through sweat.And so fluid is really important to be keeping things moving along. So it’s important in a number of ways.
Stasi
Ah, that’s such a good point. And I like what you mentioned around optimization. It’s really how to make yourself optimal, and what is optimal for you may be different for me, may be different for our panelists that are watching. We know that hydration is important though because it is going to play a role in a lot of the things that that you mentioned from, from the standpoint of that cell production and the detoxification, getting things out. We know when we drink more we have to typically go to the bathroom more. There’s a great example of how that excretion process is helping the body to work optimally. Yeah. So when we’re thinking about hydration, Ginger, you know, I get a lot of questions from clients, well what about, you know, does juice count? Does coffee count? Does tea count? Bubbly water? Is that bad? Is that good? And how do you navigate those? Or what are some of the recommendations you have on like what counts as hydration?
Ginger
Yeah, that’s an awesome question. I actually get the bubbly water question all the time. So I’ve dug into that research. I’ve given several interviews on that specifically. And the bottom line with that actually is that bubbly, sparkling water counts as much as regular water. And the thing is, it’s kind of filling cause it’s got that gas bubbles in it. So you often can’t drink as much quantity. So it is important to have plain regular water be the base of your day. But I’m drinking some bubbly water right here. It absolutely counts. And there’s also this kind of old myth that coffee and tea, soda, anything that’s caffeinated is a diuretic and so it doesn’t count towards hydration, but actually it does.
So let’s say you drink a coffee, you know, like a 16 ounce coffee, you’re drinking 16 ounces of fluid. It’s not like one per one, like all of that doesn’t magically go out through the urine all at once. So you definitely retain some though caffeine is a mild diarrhetic. So anything without caffeine like herbal tea or juice definitely counts. I do want to remind listeners to pay attention to added sugars. So that’s another part of this conversation. Juice with added sweeteners can be not dehydrating, but just a challenge for balancing our needs during the day.
Stasi
Yeah, that’s a good point of looking at what is in the hydration choices that you have. And I think it’s always a good reminder that coffee and tea are made with water. You can’t make them without water. And so you are getting the hydration benefits from that.
And then just paying attention to how that, how it makes you feel. I know some women that I work with, they noticed that coffee does make them go to the bathroom more because of the stimulus, the stimulus to the bladder. So you may need to balance that with additional water, whether it be bubbly water or regular water on that.
The other thing that I have found has been helpful is adding things to water. I had a client yesterday telling me that just by adding chia seeds to her water, she enjoys it more. She thinks about drinking it more. That gives her the benefit of the fiber and the healthy fats. But it’s something that creates a little bit more excitement around that drink, the water that they’re, they’re having. Do you have any other suggestions on things that can be great to add to water or things that have worked for you or your clients around that?
Ginger
Yeah, I actually have a passion around this. So as much as I talk about alcohol, there’s actually this big trend right now, especially among younger people. Like gen Z, even younger than millennials, they’re actually a population that’s not statistically drinking as much as people maybe in our age category or older. So I’m doing more mocktail recipes and I’m doing infused water recipes on my blog. I recently did a big pitcher of water infused with mint leaves and pineapple and it was so delicious and I ended up like keeping like going and grabbing for it because it was just delicious and so hydrating. So I really suggest that. It’s a very smart idea.
Stasi
And that’s another way, speaking of the immune function, if you’re adding things like herbs or flavor additives, you’re going to get the anti-inflammatory properties around that. That can certainly, again look at that”¦how can you support being optimal as much as possible. So you’re getting another dose of nutrients with those additions.
Ginger
A hundred percent.
Stasi
Awesome. well you mentioned like speaking of different types of drinks and the alcohol, let’s jump over to that. Cause I think that’s really what our panelists probably want to hear about. When it comes down to it, I am getting a lot of questions now on, you know, is it okay if I drink during this time? Is that gonna suppress my immune system? Or I’m drinking more during this time. I’m home, I don’t need to drive. What else am I going to do? We’re having Zoom happy hours. So it’s a big topic right now and I consider you an expert in the like creativity around drinking. And we’d love just your insight and your thoughts too, again, on that balance piece as well. Cause that’s always important. So a lot there, but we can unpack it together.
Ginger
Yeah, I mean I am literally talking about this with every one of my clients. And it’s funny, even clients that didn’t drink much or hardly at all before, they’re drinking way more now and it’s just like you said, we’re home. There’s all these Zoom happy hours and it’s very easy to sort of slip into this daily drinking. I think this is also a very stressful time for so many people. It’s not maybe the most ideal coping mechanism, but it, it does have that relaxation effect. And so we can talk maybe later about other ways to get the relaxation effect. But I think a lot of people use use wine and alcohol for that. So the most important thing, and people get mad at me when I say this, but I have to say it, is understanding the guidelines for alcohol. They’re actually very clear.
They’re well researched and many large organizations state these guidelines. So for women specifically, the guideline is one alcoholic beverage a day. And so more than that they do see an increase in health risk. And I think very important for this population is an increase in cancer risk, specifically breast cancer. And so I know that a lot of people are really keeping that top of mind and we just can’t deny that there’s a link between alcohol and cancer.
However, there’s also some really interesting research that shows with moderate drinking, again, that one a day or less, there might be some cardiovascular benefits. There might be some blood sugar regulation or lower diabetes risk development. So there’s definitely like a little seems to be okay, maybe even beneficial; too much definitely is harmful to some systems of the body, but it really is the guidelines. One drink a day. We can talk about the portions if you’d like. That’s a common question. And just so you know, you can’t not drink for two days and then have like four drinks on one day. It doesn’t quite work that way.
Stasi
Yeah. This the stockpiling effect, I want to save those for Saturday. Yeah, no, that’s a good point. And it also talks, it really speaks to how the body works in balance that way. You know, our bodies work day to day. It’s not working one way on Friday and one way on this on a Saturday, which again goes back to the immune function. If we want, we want our immune function to show up for us to be that armor every day. So it does require consistency in those habits.
Ginger
I’m glad that you mentioned that. I did want to talk about the way that alcohol affects the immune system and unfortunately there is a lot of evidence that it suppresses the immune system. It’s very hard to give you guys specific guidelines on exactly how much affects your immune system how much. I wouldn’t say that like a glass of wine is going to tank your immune system. Like it certainly doesn’t work like that, but it will lower some aspects of some of those fighter cells for you. I think anybody with alcohol abuse disorder or somebody that’s binge drinking or drinking much higher than the guidelines, there’s always going to be more natural risk there. I’m not familiar with the specific research on exactly how much alcohol could hurt the immune system, but if you are immune compromised where you’re very concerned, it might be worth the consideration to really cut down or out alcohol.
Stasi
No, I think it’s important that you mentioned that. And, and also you know, working with women who are going through menopause and perimenopause or post-menopause, they all report that they notice a distinct difference in how their body processes it. They will say, you know, this time last year or two or three years ago, I could have two or three glasses of wine and maybe feel a little buzz, but I didn’t wake up the next morning with a killer headache and fatigue. And now I have one glass of wine and the next morning I’m like, what just happened? And then it can also vary as their hormones are fluctuating. So I think you know, your point too of what is your own individual situation and that can you know, so that’s why there isn’t this distinct, here’s the amount of alcohol that you can drink and it doesn’t affect your immune system. Everybody’s different. So knowing what works best for you is more important than just being able to say like, what is the blanket recommendation, which really may not exist.
Ginger
I know that it’s frustrating to hear, like, you know, it is individualized and you know, I don’t have the specific answer for you. And that’s why it’s so important for individuals with these questions to work one on one with dietitians like us because we can look at the whole picture and the risk factors and how you are as a person, your tolerance can change to alcohol through your life. It’s really interesting the way we metabolize alcohol. It has to do with the stomach specifically. And I know that that can change in menopause. A lot of people are like, Oh, it doesn’t sit right with me as much as it used to. And then absorption straight to the liver and the liver has to do the heavy lifting, but the liver does a lot for us and there’s all these enzymes there that can either make you a faster or slower metabolizer. And so that’s where a lot of the individualization comes in that we have to talk about as clinicians because not everyone’s the same.
Stasi
Yeah, that’s such a good point. And those enzymes and those pathways are those ones that are influenced by our genetic makeup too and how we might process the alcohol?
Ginger
That’s exactly right. So there are a lot of people in this world that actually don’t have a enzyme that works very well and they are the people that naturally get that alcohol flush. A lot of people will turn bright red and they feel very sick and they don’t process alcohol well at all. If you’re a person listening that’s had that, you probably know I’m one of those. And that’s actually an example of the liver, just not quite having an enzyme that’s working as well as it might be in other folks. And I got asked the question recently, does that mean some people naturally have a higher tolerance, and said, I would say yes, but we, it’s hard to know who is who. And so it’s very hard to, to know without maybe some very in depth genetic testing.
Stasi
Yeah, absolutely. And, and listening to your own body you know, we’re all masters of our own our own understanding of how our body responds to things. So taking those things and then figuring out what’s gonna work best for you. And like you said, working with the dietitian to help you with that could guide the process. Awesome. Well we have a couple of questions or a few questions that have come in. So one says is hard alcohol such as vodka, better for you than wine because there’s no sugar?
Ginger
Yeah, that’s such an interesting question. So I chat a lot about alcohol and sugar and I think that it’s very confusing because you have to actually talk about the way that alcohol is made. And so there’s this spectrum of wine that can either have more residual sugars “ it’s often called RS “ or less. And actually dry wines are very much the trend right now. They can have very little sugar, hardly any carbs, so a lot of them actually aren’t innately sugary. They do have more carbs, as does beer, than spirits, but they also generally have less antioxidants. And there is some interesting research that the antioxidants in red and white wine could be beneficial.
I think the most important thing here is to understand the portions. So a serving of wine is five ounces. A lot of times when you pour a glass, it’s much more than five ounces. Beer is 12 ounces and again, people often drink several beers and that’s several servings. And for liquor it’s 1.5 ounces. And so you can sip on, on spirits for sure. But a lot of people will do some sort of mixer and that’s important too cause if you’re mixing it with juice or Coke, then you’re adding a lot of sugar. If you’re doing water, sparkling water, or a non-nutritive sweetener, that changes it too. So it’s very complex.
Stasi
Yeah. Again, no, there’s not one to answer to these things, but thinking about the whole process. And I like what you pointed out about the portions that is going to be a key thing. Enjoying one glass of wine, two glasses of wine, is different than five and six. And how the body processes that, whether it’s sugar or the alcohol component. Yeah. The next question is, ah, this person says they love water so much and I’m so thirsty all the time that I wake up thirsty. Is there anything wrong with me?
Ginger
Well, that’s a really interesting question. I hear so many different things from my clients as you do to Stasi, I’m sure. I hear people that say I never get thirsty. There’s something wrong with me. And I have people that say I always get thirsty, is there’s something wrong with me. It’s always important to make sure that you’re getting medical care, you’re getting your blood sugar levels tested, you’re making sure that your blood pressure is normalized. So I would definitely make sure you’re, you’re checking off those boxes and talking to your provider if there’s any testing you need. But short of that, I think it is important to know that different humans have different needs and you should drink to thirst. So if you’re waking up thirsty, grab a big glass of water and start off that day. Like what a nice way to to get your body going.
Stasi
Yeah, that’s a good point of the basics. And then definitely that making sure that there’s nothing else that, that thirst isn’t indicating another underlying condition. By you mentioned having your blood blood sugars checked, extreme thirst may be indicative of diabetes. So that blood sugar piece is important. And then obviously the cardiovascular function because hydration plays a role in our circulation. So if something’s up in terms of that regulation, there could be something there. So always a good reminder of just getting those checks, those checks and balances and that those things checked off. One thing that I noticed with menopause, so the thirst sensation can change during this time. So I do have a lot of women that don’t feel like they’re as thirsty. And one thing that I’ll sometimes talk about too is just making sure they’re regularly drinking throughout the day.
So if they get to two o’clock in the afternoon and they’re thinking, I have not had anything to drink except my first cup of coffee, then all right, we probably need to work on increasing that. But another tool that I found to be helpful is looking at urine color. When you’re going to the bathroom. So if you when you go to the bathroom, it should be lemonade ish color does it need to be clear? But if we’re looking at school bus orange and you’re not taking a lot of multivitamins, which could influence your urine color but consistently that color that’s maybe an indicator too that you need, need a little bit more hydration.
Ginger
Yeah. I’d also get that that’s really important. And I also get, you know, a lot of people that say, Oh, I just had a headache all of a sudden, or I felt really fatigued. And so one of the first things I’ll do is to suggest a glass or two of water and see if it makes you feel better. Often it really does.
Stasi
Yes. Yeah. And I another thing around that, when people are starting to exercise more I’ll notice that sometimes that increases their thirst and so they’ll, they’ll be prompted to drink more. But the other piece, they start to notice when they aren’t optimally hydrated. That exercise is a lot harder. And exercise is hard as it is, we don’t need to make it harder. So that could be another indicator.
Ginger
That’s such a good point. There are some days if I’m doing a workout, I’m like, ah, why is this so challenging? And I’ll think, and I honestly believe that fuel with food and hydration, it really affects your body’s energy.
Stasi
Yeah. And that’s, and that’s one way to feel it too. When you’re asking more of your body, then you start to feel that way. And that comes back to that optimization. How can we support our bodies being optimal? Because when it’s in an optimal state, that immune function is going to be more optimal. All right, another question here that says how, how many calories are in about one glass of wine? This is a concern of hers. Okay.
Ginger
Yeah. This is a really interesting subject and guess what? It’s complicated. Let me break it down. I love talking about alcohol because it’s just, there’s a lot to talk about. At a baseline alcohol itself is kind of high in calories. So just to put it in perspective carbohydrates and protein are four calories per gram. Fat is nine calories per gram. Alcohol is seven calories per gram. So if you think about the spectrum, it just is kind of a high calorie liquid. There’s so much more to think about though, because the amount of alcohol that’s in a beverage and the quantity that you’re drinking really makes a difference. So a glass of wine, like a light white wine or a lower alcohol red could be around a hundred to 120 calories. If you bump up towards that 16%, like a big heavy red, that could have, you know, pushing 200 calories.
So there’s a big range and it depends on the alcohol by volume, which you’ll see ABV. So if you want the lower calories go towards like more like an 11, 12% wine. Beer is exactly the same. So the light beers, you know how you see the commercials and they’re like 90 calories. How do they do that? Well, it’s a little bit lower alcohol. And so if you have like a big IPA, like IPAs and porters are heavier, but they’re notoriously much higher in calories, they have way more alcohol by volume. So that, you know, alcohol itself, like there’s a range. So lighter in general, lower alcohol content is just going to slash the calories.
And then with mixed drinks it’s not so much the spirits like, like I think, you know 1.5 is, is around a hundred, 120 calories, 1.5 ounces across the board, unless it’s more sugary like port or something. But it’s the mixer “ if you have any sort of cream, coconut, sugary juice, things like that, you’re going to really boost the calories. Margarita, pina coladas, those are classically very, very high. So it really depends on what you’re drinking.
Stasi
Yeah. And that gives some perspectives to just some guidelines around, you know, what you should look for if you’re looking for that lower calorie option. This next question here is why after drinking, do my breasts feel more lumpy? Are you familiar with this at all?
Ginger
That is very interesting. You know, the only thing that comes to mind and I need to dive into the research is I wonder if there’s some dehydration going on there and maybe some changes in body fluid. Yeah, I, I wonder about that. What do you think, Stasi?
Stasi
Yeah, I’m not familiar with that either. Just, you know, one thing that comes, that I would think of is perhaps if there’s any hormonal shifts that are happening and again, alcohol is going to be a stress on the body. So is there some level of stress response or some type of, it’s a toxin. The body’s trying to detoxify, so something going on there, but that would also be, I think a great question for a medical practitioner, OB GYN, primary care, just again, rule out anything else that might be creating that, that lump sensation.
Ginger
Yeah, I’m glad that you brought up that alcohol’s a toxin. I mean, it really is. The body is very excited to get rid of it. So so the body’s working hard to do that. It is kind of inflammatory. So especially if you’re drinking higher higher levels, it can be inflammatory to the body. So yeah, that would be a good one to get checked out. That’s an interesting question.
Stasi
Okay. Another one here, going back to the infused water recipes, this person would like to know where you post your recipes for the fusion. And you mentioned on your blog if you want to share the, the address or something, feel free to do that.
Ginger
Yeah, definitely. It’s at champagnenutrition.com and my infused water recipe’s pretty far up in the blog category. I’ve got some really great stuff up there right now. Lots of mocktails, cocktails. And another thing that I really focus on is lighter alcohol options. So I have spritzers up there, which is like white wine with some soda water or you know, that sort of thing that is lighter in alcohol, uses very minimal added sugar, uses natural ingredients so that maybe you could have two and you’re kind of at a party and you’re enjoying it, but it really is very light and fits into your health goals.
Stasi
Awesome. Great options there. And we’ll make sure to link these resources as well in the followup email that everybody gets with the link to this presentation. So we’ll make sure to put the link to Ginger’s blog there. Well thinking about that socialization and alcohol do you have any recommendations, things to make to help make this social isolation fun and still be able to enjoy and find that balance with alcohol? Anything that you’ve tried? I love seeing all of the things on Instagram that you’ve posted with your creativity, but things that you’re excited about right now.
Ginger
Yeah. You know, I really am trying to make the best of this and I’ll tell you some things that have worked for me and for some of my clients. One is I learned pretty quickly that I can’t be on like a two hour Zoom happy hour drinking wine. Like that doesn’t fit with my health goals. And so I go to a lot of happy hours now with no alcohol. I’ll bring like some soda water. So really mixing that up and just making sure to take breaks throughout the week and then have nights that I’m not drinking. Like that’s been really, really helpful. One of my clients texted me today and said, you know, I’m going to take a break for the rest of this week, no alcohol til Friday. I was like, okay, great. That sounds like a good plan. She’s kind of just testing the waters.
Another thing that I’ve really been focused on is being active in new ways. So I’m like you, Stasi, I’m deeply committed to exercise and I was really into weightlifting and going to the gym every day and that I can’t do anymore. So I started implementing this thing that I’m in love with, which is every morning I’d get up and I start my day with a walk. So that really helps me stick to a schedule, get up early and just really get outside. I want to keep this forever like it has been so really, really positive for me. So that’s been just very grounding and a really nice part of, of this experience, I must say.
Stasi
Yeah, that’s a good point of having that routine something you know, that you’re going to do and then starting your day with that. And that’s something if you’re looking forward to that, if you have that set aside time in the morning that’s maybe perhaps a little bit on the earlier side than drinking late into the evening may not be as much of an option. Cause you know, how, how, how you might feel and that walk is, is more important.
Ginger
Yeah. A hundred percent. You think about it the night before.
Stasi
And I like what you mentioned too around like having nights where there isn’t any alcohol or it’s okay to go to a Zoom happy hour without an alcoholic beverage. And really if you’re concerned about what other people think, I mean, what better way to pretend? There’s no, you know, no one has to see it. You can be creative. And that’s another option there to know that just because there might be Zoom happy hours all the time doesn’t mean that your beverage has to contain alcohol. Great points. We had another question come in on how warm versus cold water. I perform prefer warm water all day. It helps me stay warm. Any concerns with that?
Ginger
You know, from my point of view, not at all. I actually, I know there’s some cultural differences too. I think that around the world, different cultures prefer cold versus warm water, which is always interesting. I’d say cold, hot or warm, do what’s best for you and your body. Especially up here in this chilly weather makes a lot of sense to me. There shouldn’t be a difference in hydrati
When most of us think of grief, we think of losing a loved one or the end of a relationship. Does it make sense to have a sense of grief in the coronavirus crisis, even if you haven’t lost anyone?
On Isolation and Grief With Psychiatrist Swapna Vaidya
According to psychiatrist Dr. Swapna Vaidya, yes. Grief is caused by loss, and many of us have lost at the very least a sense of security and our predictable routines. Others may have lost jobs, opportunities, and of course, loved ones.
But we’re all in this together, and the potential for unity and for providing one another with support, globally, has never been greater.
In this podcast, Dr. Swapna Vaidya speaks with Gennev Director of Health Coaching Stasi Kasianchuk about the nature and course of grief and how to be kinder to everyone going through grief and isolation “ including yourself.
To watch the video of this webinar, visit the Gennev YouTube channel. And subscribe to be sure you get notified of every new webinar.
Prefer podcasts? Follow Gennev on Apple Podcasts or Stitcher to get every episode.
Dr. Swapna Vaidya is a psychiatrist and Executive Medical Director in the MultiCare Health System.
Stasi Kasianchuk is a Sports Dietitian, Exercise Physiologist and Gennev Director of Health Coaching.
Practical, medical, and encouraging support with a menopause expert: Gennev is telemedicine for women. Learn more.
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TRANSCRIPT
Coach Stasi Kasianchuk
So welcome everyone to our wellness webinar. This is a really great one today on a great topic that’s pretty relevant right now”the topic of grief. So I am Stasi Kasianchuk. I am a registered dietitian, nutritionist and the director of health coaching here at Gennev. So, Swapna, I’d love for you to give your background, introduce yourself to our audience. And yeah, let us know who you are.
Dr. Swapna Vaidya
Oh, okay. I’m Swapna Vaidya. I’m a psychiatrist. I currently work at Multi-Care Hospital. But I have had an extensive background in consultation psychiatry. So what that means is that I have had a background dealing with psychiatric issues with patients, who are going through medical problems or are going through trauma. And I was in New York actually during the 911 time and so I have personal experience working on the ground for disaster psychiatry. So this is where my background is and here I am today trying to sort of connect with all of you to share some of the experiences that helped us back then and to talk a little bit about grief.
Coach Stasi Kasianchuk
Yeah, absolutely. Yeah. Thank you so much for joining us. And I’m interested too because we do hear a lot about some comparisons from what we’re experiencing now with the COVID 19 pandemic to 911. So your experience, your insights from that experience to now will be really great and during this this webinar. You mentioned that topic of grief and we’ve seen more some more publications on grief right now and there’s some, you know, just this feeling that even when I’m talking with my clients through Gennev of, of just there’s something different, there’s something in almost in the air, but individuals are trying to work through this. Can you give us a brief description of what is grief from your from your background and what do you see or how is it maybe playing out for people right now in this situation?
Dr. Swapna Vaidya
Yeah, thank you. You know, Stasi, because this is really an important issue to discuss right now and you nailed it. Like a lot of people are trying to draw comparisons between what happened in 911. And you know, I’ve a lot of friends back in New York who are psychiatrists and they are all just saying that this sense of loss, this sense of grief is even much more than what they experienced when 911 happened because of the fatalities, you know, which are being just immense. So that being said, you know, what is grief? Grief is a sense of loss and that’s actually the best way I can describe it. And you know, normally when we look at grief, we say, okay, this is connected to bereavement, that you lost somebody. But right now what everyone is experiencing is a big sense of loss, missing the way life was.
Missing what was the normal. Missing the fact that you could just pop up and go to a restaurant and have dinner. That’s grief. So grief is a normal human response. To any kind of loss. So I’m going to get a little technical and I’ll talk about the stages of grief and how it’s pertaining to this pandemic, if I may.
So, yeah, so you know, Dr Elizabeth Kubler Ross, she was the pioneer who did a lot of research on grief and she talked about stages of grief. So the first stage is denial. And then we connect this to the pandemic right now that are personal levels of grief, local levels, and then on a national level of denial. So on a personal level, you know, I mean, I’m sure a lot of people who are this, Oh, I’m never going to get this virus or that I’m young, this is not going to happen to me or not to my family.
So that’s a personal level. On a local level, the denial is that, Oh, well you’re not gonna follow social distancing, that doesn’t really apply to me. And then on a national level, we’ve seen various forms of denial as to how we first denied it and then we accepted it and now we know what it is. Then we look at anger. So the next day just anger. Now, once we deny it and we know, okay, this is really happening, then we get mad. You’re really angry. And how do we express the anger? Towards the people who we are living with. And that is why I’m really concerned a little bit about on the other side is the rise of domestic violence and anger towards children. So this is a huge important issue. How we need to deviate from anger and go towards acceptance. And the other issue of anger is the social media. I mean I’m sure you’ve seen the rantings and the ravings and you’re right and I’m wrong.
So this is a way people are trying to clutch onto any sense of control. Then the third stage is bargaining. Then we are trying to bargain with each other. They’re saying, okay, maybe if I do social distancing for a week or maybe if I just stop it, you know, perhaps for I wouldn’t go to this place or that place and then this would be, this would be done. Or I can see X, Y, Z friends because guess what? I’ve been seeing them so they will not be infected. So this is bargaining and then sadness. Finally we are sad, we are demoralized, we are depressed. And then acceptance. Then we say, and that is the stage we have to arrive at. But you know what? Everybody takes time to arrive at that stage. So in a way, what I’m trying to say is that it’s okay, these are the feelings you’re feeling, but the ultimate stage that you want to come to is acceptance. You know, there’s that serenity prayer. We can change things, but some things we got to accept, you know, and this is one of those hard life lessons. So this is a what I would suggest in terms of grief as well as how it’s pertaining personally and locally with us.
Coach Stasi Kasianchuk
Yeah, you brought up a lot of good points there, Swapna. Several things come to mind. The first one that I had, you mentioned these layers, the personal layer, the local layer, the national layer. We might even, I don’t know if we can add a global layer on to that. From your perspective, do those layers “¦ Does that add add more grief or does that make it heavier for the individual knowing that it’s not just in their personal bubble? There’s layers upon that. Do you see that effect with people?
Dr. Swapna Vaidya
Yeah, it actually can be dual, you know, in a way how human being how we are social creatures. So when we know that we are not alone in this, then knowing that it’s a global pandemic somehow helps. But then on the other hand it can become a very worrisome thing. So this is how we have to set our acceptance and set what we can do and how we can control things that are in our control. So for instance, ruminating about it and worrying about it to a certain extent is just going to be destructive, but understanding that we are not in this together, we are not in this alone and there is all this rush of vaccines being studied and antibodies being studied and all that, gives us hope. So I would tend to go on the side of hope to say that we are all in this together and hence we are all connected on a personal level, local level, national level. And then as you explained, Stasi, even the whole world, pandemic.
Coach Stasi Kasianchuk
Yeah, no, that’s such a good point of finding ways to, to shift the thought process to shift from a maybe a more pessimistic thought to a more to a more optimistic thoughts to be supportive of what we’re going through. The, another question that I thought of too when going, you talked about this process being normal, so is it, is it normal to go through these stages in order, or do people tend to go to one stage, skip, come back? Is there a what, what do you usually see or what is considered normal?
Dr. Swapna Vaidya
You said such a good point. Yes. There are no ways that, you know, one person reacts well situation. It’s not such a sort of like a single mold will fit everybody. So there are some people who would probably go towards acceptance, you know, maybe because they’ve been traumatized before. A lot of the folks that I’ve seen, you know, the psychiatrist or my friends or colleagues that I’ve talked to in New York have said that, that they reach the stage of acceptance pretty quickly because they had gone through it before. So they had already experienced it before. And when they knew that what happened then they couldn’t control what happened. And what’s happening now is not something they can control. But on the other hand, perhaps people who have never experienced this in lifetime, like, you know, the young kids, teenagers, maybe the millennials, they have never seen this.
And this might be a very, very difficult time. And that’s why I talked about the local level. I talked about the denial there. A lot of young people were saying, Oh, this can’t affect me. But we are now seeing like a huge demographic of young people with no preexisting health issues also getting sick by this virus. So that’s something that the mind frame had to shift to understand that this is actually happening to everybody. Maybe our older and our elderly population are more susceptible and they may have a very devastating course of the illness, but that doesn’t spare even the younger, the middle aged folks that we have. And hence I think that it depends on where at the stage. If you been if you’ve had experience before, if you had some amount of training in trauma and acceptance or understanding that can actually help how you can switch. So something to see.
Coach Stasi Kasianchuk
Yeah. You know, silver lining, I guess to having have gone through something similar to this that perhaps you’re more resilient, resiliency or experienced is built. Would you agree with that?
Dr. Swapna Vaidya
I agree. And actually, you know, I was going to talk about resilience. I came across a very good article about resilience and you know, I was reading about Sheryl Sandberg and her Option B and I think she’s going to come up with much more material about it. But there was some things which really stuck with me from that article. She talks about resilience, but she talks about three Ps, the three Ps, the letter P that are bad for you. So may I? So number one, she says, number one is personalizing it. Number two, saying this is a permanent thing, you know, and number three saying it’s pervasive, meaning it’s affecting everything that I do. So these three Ps are destructive. So how would you personalize this? You personalize this by saying, Hey, you know what? I did something wrong. Oh, I got this virus and I gave it to my mom or I gave it to my, you know, things are not in your control.
So self-compassion is something you should practice. You shouldn’t blame yourself. Second thing is permanence. The thing that, Oh, this is uncertain, I am never going to go back to normal. This is forever. But we know things are not forever. We know this too shall end. The thought and the last important thing that she talked about was pervasiveness. It doesn’t mean that every aspect of our life is affected. We still have some silver linings, as you said, you have a time to call your friends, your childhood friends. I mean, I hadn’t connected with them for God knows 25 years and now we have like this WhatsApp group when people are sharing things and it’s really nice to listen to, you know, your childhood friends and what they are going through and how connected the world has become. You know, so we cannot say that everything about this is horrific and horrible. Try to find some silver lining, whatever that may be.
Coach Stasi Kasianchuk
Yeah, I like that. I had not been familiar with those three Ps, but I think that gives, to add another one, gives perspective on just how, where you’re and allows that reflection, that mindfulness to piece to reflect on how am I internalizing this and what am I doing with the information and how can I change the story a little bit or reframe to be able to support to support myself.
Dr. Swapna Vaidya
Right. I think reframing that, that aspect. You talked about cognition, you know I’m so sorry. I just got caught up cause I was on my phone so that one was fine to call me. Another thing, I’m, I’m still on call in the hospitals, so I’m sorry if there are like, you know”¦
Coach Stasi Kasianchuk
Oh, thank you for doing, for being on the front lines right now.
Dr. Swapna Vaidya
Exactly. And I really thank my doctors and my healthcare workers. And that’s such an important thing too, you know, sort of like connect with right now, this is where I say that when you talk about how can you help in the stand and make like people feel helpless, but there is a way “ you can work as a community, you can work in your home, you can take care of your elders, your children, and at the same time you can actually try to do something good for the community such as health care workers. Our essential workers were going and putting their lives at stake. You know like some doctors are getting meals for the patients, for their staff, for their nurses, for their healthcare workers. And, and that way some doctors are actually cleaning the rooms in the ICU so that the cleaning lady doesn’t have to go in. I mean, I thought that was tremendous. I mean, I’ve reading been reading about these things on a Facebook and I think that’s such a, humanity is in, in its best best way. So resilience doesn’t really mean that you have to reject your unpleasant emotions. You absolutely accept them. You accept them, you feel them, you go through them, but you don’t let them control you. That’s the key. And that’s the hard, hard part. You know,
Coach Stasi Kasianchuk
I think, I like that you, you made that distinction of being able to experience your feelings but also not letting them then sweep you away. I’ve been talking a lot with clients about giving permission, having them give themselves permission to most of it’s around more on self care, giving permission to take a nap if you’re feeling tired, giving permission to giving permission to, you know, maybe take a little bit more time for yourself. So whether it’s a little separating, finding space in your house where you can have some time alone and being okay with taking that time, it can be a hard thing to, to feel emotions, to give permission. Do you have recommendations for people on how to best, how to best feel emotions if that’s not something they’re comfortable with?
Dr. Swapna Vaidya
You know? Exactly. And again, everybody’s going to be different, right? Everybody’s emotions and reactions are going to be different. But what I would recommend, I like what you said about how you give yourself permission. So I will give you my example, I have a five year old, right? And I want to kind of sometimes get away. I tell my husband, you know, like, listen, I’m going to be in the terrace or something, you know, just doing, I need 20 minutes. I just need some time to focus on myself because there is so much going on work-wise, so much going on community wise, you know? And then with his needs, I want to be the best version of myself, the best way I can. But you know what, there are times that I am the thing that my emotions are somewhat on the show. You know, like being very shocked and bored sometimes and I have to collect that, not be accepting own it, you know, but I, I don’t need to be pervasive and permanent about it.
You know, I don’t need to think that this is the way I am always going to be. So what if I falter? I have another chance, you know, and my boy is going to grow with me and he’s growing up also understanding this, he himself is adapting. So we have to kind of carve out a new normal, I think the best advice I can give you or give anybody is to be kind to yourself. Self criticism. I mean, to certain extent is good, but try to forgive yourself. Forgiveness is the key. But then you’re forgiving your spouse or your you know, friends or you know, your son. That sensitivity factor has become such a huge issue. And I feel like, especially now since we were all confined and we are becoming, you know, kind of like, what is this? When can we get out? And that’s the time to recognize, let’s try to be compassionate and kind first.
Coach Stasi Kasianchuk
Yeah. That and that comes with perhaps try to when we have those feelings of anger or frustration, you have to turn those down a little bit and try to make that kindness and compassion forefront, which can isn’t always instinctual when we’re in these situations dealing with grief.
Dr. Swapna Vaidya
You know, I mean, when I was sort of like preparing for this talk, I think a lot of the things that I read resonated with me. So it’s, it’s just important to realize that even though maybe I’m a psychiatrist and I can, I’ve studied this, but to adapt to this as a person, as a human who’s going through this, it’s equally hard. So this is this. I think I would tell everybody that once you get this knowledge or you’d read about it, you know, it’s okay to go back and then sort of ruminate and say, Oh, maybe this didn’t work for me. Maybe I’ll try something different. You know, for instance, when I say to people, “meditation,” they’re like, Oh, come on, I’m so anxious. I’m not going to meditate. But even anxiety can be meditation. Why? Because you’re actually feeling that anxiety, processing it and understanding it.
One good thing about that would be to maintain a journal. Write down, write down those anxious thoughts. Why are they coming? Are they rational, you feel? Are they irrational? Can you do something about it? And even then, let’s say you acted in a certain way, you’re not proud of yourself, then write down about that and say, okay, what could I have done different? If I have another opportunity, can I do something different? Apologize. You know, forgiveness, as I said, is, you know, I think it’s going to be a much needed, much needed gift that we all can give each other because we all have to say, I’m sorry. You know, I may have acted out of anger and I, you will see the other person absolutely identifies and says, you know what, even me, I’m also going through this. And then you move on and that’s the best you know sort of like advice that I can think of for people.
Coach Stasi Kasianchuk
Yeah, taking that step and having the courage to call those feelings out I think is so important. Can be hard. But like you said, oftentimes when you are saying you realize that the other person’s also feeling the same. So then there’s, there’s a moment of bonding and that over anger.
Dr. Swapna Vaidya
That’s the thing, you know, when you resonate and when you say, we’re in this together, you know, this is affecting me in XYZ way, this is affecting you in another way. But guess what? It’s affecting all of us. Not a single person that we can talk to today would say, Oh, this is all great and you know, I have found my way out of it, not a single person. And so then knowing that gives you hope because you know that, you know, you’re not the only one struggling. Yes, you are struggling, but there are others many more. And then it gives you that appreciation of how, what can I do to be productive and help them.
Coach Stasi Kasianchuk
Yeah. And that’s the doing things a lot of times when we feel this place of grief or helplessness, doing something can help maybe move us through the stages. You recommended helping healthcare workers or contributing to your community in certain ways. Anything else that you can think of? You know, even what about for that the individual themselves? What can they do themselves?
Dr. Swapna Vaidya
Absolutely simple things, you know, try to sort of find out that recipe that, let’s say you miss going to the restaurant sites. So try to Google the recipe that you actually actually miss and see if you can make it. It may not turn out great, but at least you tried. That would be one thing. Find out what your interests are, you know, like, do you like to garden or do you like to paint maybe or play games? Maybe, you know, like you could have people are doing Facebook games, you know, sort of like FaceTime or, you know having interactive games with each other. What can you do? You can have a virtual happy hour with somebody. Just be careful with how much you’re drinking because that’s a rather slippery slope. So, you know, things such as that. And you will find that you have developed these hobbies or that you had neglected these hobbies because you didn’t have time.
Reach out to that old friend of yours that you always meant to call, but never had the time. You know, and if you have kids, I mean, try to kind of, you know, be at their level and try to learn at their level and help them out and, you know sort of try to see yourself in a different light than just that you’re in this pandemic. But there are many ways to self-soothe, heal oneself you know, like give yourself a mini spa at home, you know, put a face mask on, watch your favorite movie, right? I mean there are many perks of working from home also in that sense, cause you don’t have to travel. So you at least have the time that you can save yourself and say, okay, let me do something to make my spirit lift up.
Whether it’s for 20 minutes or something, go for a stroll. You know the weather’s getting better. Go for a walk, maintain social distancing and soak in the sun. And then always have this attitude, that this too shall pass. They will be sometime there is going to be time. This is not an easy fix. I think you mentioned at one state, it’s like running a marathon, not a sprint. So you did like, so I am using that exactly what you said. And I would say that that’s what you can do one step at a time, one moment at a time, one breath at a time and knowing that this too shall pass and you’re going to appreciate how we’re spending our present because our present is important. You know, we don’t have to wait in the past and we don’t have to project the future.
We can still enjoy things right now. Maybe a limited wat, but there are ways to appreciate what’s right and good for us. You know, I was reading about this and I, I found out like in London, some people actually having parties of their driveways, dance parties. So they’re maintaining social distancing, they’re blaring music and they’re all dancing. And then in New York, my friend when I had connected with her, said she was having, these healthcare workers were, you know, walking and there was applause from people. So you know, I was on the phone with her and she actually made me hear it and it was amazing. So some of those things.
Coach Stasi Kasianchuk
That gives me chills just thinking about that. And I’ve, I’ve seen in some other countries too where at certain times of day everyone comes out and applauds or plays music for their healthcare workers. And it’s just, I mean, that type of unification is something we wouldn’t experience otherwise. So there’s definitely power in that.
Dr. Swapna Vaidya
Well, yeah, I heard it. I mean, even though like, you know, she had the phone close to a window and it was just amazing. Even though I wasn’t there, I felt like, wow, this is such a great appreciation and the whole world, the city is coming together.
Coach Stasi Kasianchuk
Yup. Exactly. Yeah. That unification piece. Well we have a question that came in from one of our viewers and it says what if you need to be the cheerleader or positive force for others? Can you be honest about how worried or down you feel? This person feels fear of pulling them down when they’re, when I feel fear pulling them down when they’re leaning on me for leadership or security. So how do people balance that?
Dr. Swapna Vaidya
You know, that’s such a great question. You know, how do you balance when you are supposedly this leader, but even leaders can experience insecurity and fear. You know what’s worked for me, transparency, always be transparent about your emotions. You know, say that, you know, I’m having a hard time right now. What can I do? You know, like lean on others. Sometimes it’s okay to lean on others, even for the leader or even for this most optimistic person because you want to do that. If that makes any sense.
Coach Stasi Kasianchuk
Yeah. No it does. And, and I think again, it comes back to we’re all in this together and we need to support each other. So, and that give and take where we all may be going through these ebbs and flows or flowing through the stages of grief. When I am feeling like I need support, I need to be able to lean on someone to say I need support right now. And then when you need support, come to me, there’s strength in that.
Dr. Swapna Vaidya
It’s going to be reciprocal. So leadership can be at local level, family level and community level. Again, national level. And I go back to these levels because it’s important to know that none of us are going to find the right answers. There will be times we fall, totally stumble, we are doing our best. Recognizing that and having self compassion. You know, often cheerleaders, they kind of have this whole burden on their shoulders thinking that this is really my thing and I have to own it. No, this is a collective thing. Let’s all own it together.
Coach Stasi Kasianchuk
Yeah. And then here’s another question that’s something else that I see is and I’ve actually been reading about, and I’d love to get your take, is this comparative grief where people might say, I feel they feel guilty complaining about their situation when others have it so much worse. What are your thoughts on that when we say, well, you know, your, you have a family member in the hospital, I’m, I shouldn’t feel bad for not being able to leave my house. What are your thoughts on that?
Dr. Swapna Vaidya
So remember when I went back to resilience and I talked about those three bad Ps, the first P was personalization. This is falling exactly there because you are not allowed to, you know, feel guilty. Everybody’s circumstances are different. Granted that, you know, on a level, you might see that this is much more catastrophic than what you’re going through. But that doesn’t diminish your grief. That doesn’t diminish your feelings of loss in any which way. And I think it’s important to own that, to say that you can’t feel guilty about the way you’re feeling because then you will not practice self-compassion. And if you don’t practice self-compassion, you’re not going to be helpful to others. Because again, I think I have mentioned it before, but it’s like going in that aircraft and you don’t put that oxygen mask on yourself. You’re not going to be good to anybody. So please I think that is a fine line. I think between being selfish, it’s not being selfish, it’s actually being compassionate towards yourself. And that’s okay. Right? So then when people compare and say, Hey, you got it better than me, or I go to see this happens everywhere. But that doesn’t mean you need to personalize it and express it as like, this is my problem or this is my guilt. So that, that we personalize. Let’s take that away.
Coach Stasi Kasianchuk
That’s such a good point. And you’re right, that it gets in, gets in the way of that compassion and, and even, you know, the feeling of guilt. You know, working with clients even before this, guilt, oftentimes it would come up, especially with working moms, you know, balancing work and family and guilt would sometimes come up and it can be a feeling that’s, that weighs people down. And it’s almost like it, it creates a knot or it creates this rock in people. So having them really turn that guilt into compassion or eliminating the guilt and transitioning more to that compassion can open up possibilities.
Dr. Swapna Vaidya
Oh, absolutely. Because you know, the more you’re self destructive and thinking you have done so many wrongs in your life, you’re not going to be able to come up to a level that you can be useful, let alone to yourself, to others. So that’s a very important thing to talk about.
Coach Stasi Kasianchuk
Great. Yeah, no, thanks for sharing that and say, we have another question here that said I have started to enjoy the slowness of sheltering in place. In some ways we’re developing good and new habits. I worry about losing things when things do get back to normal. How do we hang onto the good changes that are happening right now?
Dr. Swapna Vaidya
You know, such a good point because you know, I myself am experiencing that and I feel like what do I do now that I recognize that slowing down a bit was so good for me? So I think that registering that and making sure that once we step back to this new other
Nutrition plays a critical role in supporting our immune system. Now more than ever it’s time to prioritize your nutrition to keep you healthy and well. This doesn’t need to take excessive amounts of time or advanced culinary skills. Give a listen to our podcast to learn easy ways to prepare and eat meals that support your immune health.
In this podcast, you’ll hear Gennev’s Director of Coaching Stasi Kasianchuk, RND, talking with another Registered Dietitian Nutritionist, Monika Jacobson, about the importance of good food during stressful times.
Healthy food is always important, but in this time of global pandemic, the more we can do to take care of ourselves, the more we slow the spread and ease the burden on overloaded health care facilities.
And if the way we take care of ourselves makes us and our families feel good, happens to be delicious as well as nutritious, and can even be a fun activity to do together, well, even better!
Click here for more information on Gennev’s Integrated Care that provides access to Registered Dietitians trained in menpoause. And learn more about Monika and her organization, Eat Move Thrive-Spokane.
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About our speakers:
Coach Stasi Kasianchuk RDN is a Sports Dietitian, Exercise Physiologist, and menopause specialist. Check out her movement videos on the Gennev channel of YouTube.
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Monika Jacobson is a Registered Dietitian Nutritionist (RDN) with over 10 years of experience coaching people through their health and wellness journeys.
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TRANSCRIPT:
Stasi Kasianchuk:
I am Stasi Kasianchuk. I am a Registered Dietitian Nutritionist, Exercise Physiologist, and the Director of Gennev Health Coaching. Today I’m here with Monika Jacobson, and we’re going to be talking about how to prepare nutritious meals during this COVID-19 crisis. So Monika, I’d love if you could just give our audience a little bit of background for you, on your business, Eat Move Thrive – Spokane, and what you do on a day-to-day basis there.
Monika Jacobson RND:
Thanks Stasi. I’m also a Registered Dietitian Nutritionist and I own a business called Eat Move Thrive – Spokane. And I’m located in Spokane, Washington… Eastern Washington, for those of you who may not know and in my business I do one-on-one virtual coaching and most of that is centered around nutrition, but I’m always talking about exercise and stress management and sleep and the psychological pieces that play into all of that because it definitely works very much together. But nutrition is definitely my expertise. So, I work with clients one-on-one and video meetings like this, or over the phone. And when we’re not in the middle of a global pandemic, I’m out in the community a lot doing cooking classes, teaching various nutrition topics or wellness topics to groups of people in studios, gyms, and corporate settings. I do a lot of corporate wellness with local companies in town. A little bit of everything, but lots on the coaching side of things these days as most of us are at home.
Stasi Kasianchuk:
That’s such a great thing that we have the telehealth platform to work from right now. It’s certainly working to our advantage.
Well, you know, you bring up the pandemic that we’re in and certainly it is a unique situation. I think I can speak for both of us and that we have never lived through anything like this and it’s certainly a unique time. One thing that excites me is that the importance of nutrition for immune health, which you and I both know from our studying, our training and our backgrounds, but now I have clients that are a lot more interested in this. So I’d love if we could just talk maybe through some basics, have a good conversation about why nutrition is important for the immune system, and different foods that can help with that.
And then we’ll get into the nitty gritty on how to help people to do that. Does that sound okay for you?
Monika Jacobson RND:
Sounds great.
Stasi Kasianchuk:
All right, awesome. Well, you know, I love food in general and the power of food to support the immune system. And I see the opportunities here for people to expand and try new things, but also to understand the importance of how food supports our health in a variety of different ways, especially immune support. Most recently, I’ve been talking to my clients about food being kind of the building blocks of the immune system. And if we’re going outside into our world right now, we want to have an armor on. And food can definitely do that. What types of conversations have you been having with your clients around this, and what has helped them to understand the importance that food plays with immune health?
Monika Jacobson RND:
That’s a great question. I have been talking more about immunity. In general, I would say even at the start of cold and flu season, but now more than ever, it’s front of mind. So, I do think of food as medicine, but also as preventative medicine. And I think of it as fuel in our gas tanks. And if you put high-quality fuel into your gas tank, you’re going to perform better. And I don’t mean from an athletic standpoint or performance (standpoint). What I mean is, that the natural metabolic processes in your body, including those around immunity, can function at their best. Food has really powerful properties and especially very specific foods to support that immunity.
I’m talking with my clients about how to make the most nutritious choices right now, so they’re keeping their immunity in tip-top shape for whatever bugs and viruses they may encounter right now. Because not only do we want to avoid COVID-19, but we also want to avoid having to go to the hospital for just anything at this point. So I’m keeping our immunity strong for all those reasons just feels extra important right now.
Stasi Kasianchuk:
That’s such a good point. Obviously COVID-19 is getting a lot of attention, but that doesn’t mean other colds, flus, bugs are disappeared. They still exist too. That’s the great thing about food that I like because it’s not like a drug that’s just targeting one thing, and you can get so many benefits from foods, especially fruits and vegetables. I think sometimes my clients might get tired of me saying, “You need to eat more fruits and vegetables”. But really at the basics, these whole foods do provide such a benefit that we don’t have to worry about overdosing. I have not yet had anyone overdose on vegetables. I suppose there could be some digestive challenges, but you know, I think we have some benefits there that they’re powerhouses.
And like you said, food in general, contains these phytochemicals when we’re thinking about plants that go in and really support the immune system and doing the job of filling that tank. So the quality that you’re putting in can really support the quality of your health.
When it comes to other foods… Obviously fruits and vegetables are important. They are going to support our immune system. They have lots of vitamins, minerals to do that. Other foods that you see as important to help your clients… Do you have other things that you’re recommending to them when it comes to immune function?
Monika Jacobson RND:
Yeah, that’s a good question. So, you’re right. Certainly fruits and vegetables. Absolutely, ginger, garlic, turmeric. I’m thinking more about herbs and spices and not fruits and veggies that you would just eat whole.
I mean, you can eat a whole knob of ginger or a head of garlic cloves, but incorporating those natural herbs and spices into cooking can be really powerful. I think we think about like, “Oh, maybe taking those in supplemental form”, which also has its place. But I encourage my clients to use those types of foods, ginger, garlic, turmeric, those are the ones that always come in front of mind to me because they’re so easy to incorporate in lots of different types of recipes. And even together, like those three together, working a lot of like Thai dishes and Indian dishes. So keeping those in the refrigerator”¦ those are foods that I would always encourage. Tell me what you think Stasi, but I know there’s some research around Omega 3s… So, aside from fruits and vegetables, getting fatty, cold-water fish, like salmon, or sardines. Smaller fish that are white flesh, like a Black Cod, is a little harder fish to find.
Stasi Kasianchuk:
I think you’re right on the Omega 3s too. Again, going back to those building blocks”¦ you know, Vitamin C and Zinc get a lot of credit, but Vitamin C and Zinc alone are not going to support your immune system. It really is multifactorial and we got to have all the pieces. And certainly, if you do eat animal protein, fish is a great option. And if you can get a hold of high quality, say, a wild-caught salmon, that’s great. The anchovies and sardines like you mentioned are great ones, sometimes a tough sell for people. But those are obviously canned products too, so they’re really shelf stable right now, and you can stock up on those and have those as easy Omega 3 sources available to you.
Monika Jacobson RND:
Yeah, absolutely. One of my favorite recipes is a canned salmon, sweet potato cake that I bought from actually another fellow dietitian. And these are a tasty, easy recipe that you can even batch cook and have that ready to go, on hand for a week, or freeze some and cook them as needed. Canned salmon, which I think a lot of people would go, “Ooh, I don’t know about that,” but there’s a lot you can do with those shelf-stable, seafood products, actually.
Stasi Kasianchuk:
Right now, shelf stable is just really important. They can be convenient: you can stock up on them, keep you out of the grocery store a little bit longer, and be able to use those as nutrient-rich sources.
That reminds me of another nutrient that I don’t know always gets the attention it deserves for the important role it plays in our immune function, but protein. I think, for protein, we always think “muscle building”. You know, it’s going to repair our muscles after a workout, but really, (also) recognizing that adequate protein intake is needed when to support the immune system, to support antibodies, to support the enzymes and the processes that go into immune function. So, that’s another gray area where something like the canned salmon is also going to provide those Omega 3s and the protein.
Again, food for the win, because you’re getting more, more than one thing out of there.
Monika Jacobson RND:
I’m always a fan of trying to get nutrition through food first and then supplements. I will say one of the supplements, and I’m not really a big supplement person at all, but one supplement that I think is pretty warranted is Vitamin D
We’ve all heard that a lot of us are deficient, especially in parts of the country with less sunlight or not as warm weather. Where our skin isn’t as exposed to daily sunlight. I know, certainly at this latitude in Washington, and it’s cold and dark more often than we’d like, so many of us are deficient. But Vitamin D is also really supportive of immunity amongst a million other things. So if you have that supplement at home, it’s not a bad one…just make sure you’re being consistent with it right now. For lots of reasons, but certainly immunity during this time.
Stasi Kasianchuk:
Yeah. And that’s a great reminder, especially with vitamin like that, that you can’t really get from food. Well, it’s in some sources, but the amount that you would have to take… the amount of salmon you would have to eat or the amount of fortified milk you’d have to drink to get what you, (what most people) need, it’s going to be way over what’s maybe tolerable for you.
So, yeah. Good point. That is a relatively inexpensive supplement. You know, buying just the generic brand, 2000 IUs per day, to start with. And then keeping that in your consistency point is really important.
Monika Jacobson RND:
Yeah, exactly. Thanks for putting out the dosage. I agree with that.
Stasi Kasianchuk:
Yeah. Awesome. The other thing that I’ve been working with a lot of my clients on too is hydration and that can also support immune function. And what with being at home more often, I’ve noticed that some people, including myself, I would say my hydration has probably decreased because I’m in a different routine.
So typically if I would go out, I’d bring a water bottle… and if I’m at a meeting, I’m sipping on my sipping on water throughout the meeting. But now, with the shift in routine, things are getting juggled. And so, I’ve had to remind clients too, that hydration plays a role in your immune function. So that’s another area of, of support there.
Monika Jacobson RND:
That’s a great point. It’s making me thirsty and I’m reaching for my water.
Stasi Kasianchuk:
There you go. Everyone take a water break right now. Sip of water if it’s near you. So we got one question: Can I buy any vitamin C or D brand because there are vegan and common ones? To the best of my knowledge, when it comes to vitamin C or Vitamin D, even a generic brand is typically going to be okay.
The one caution I would put with the vitamin C is that I would limit it to a thousand milligrams or less. Right now I have heard of people thinking, “Oh, vitamin C is good for the common cold, so COVID is worse than the common cold, so I’m going to take more vitamin C.”
And more is not always better. It is an antioxidant and sometimes antioxidants in high amounts can become pro-oxidative. So you want to be careful with that on the vitamin C”¦ that would be my recommendation. I don’t know if you have any insight on that, Monika, or any additional things to add?
Monika Jacobson RND:
I think that’s a good answer. I think that it doesn’t really matter from what I know: vegan versus non-vegan ones. Sometimes that has to do with the capsule of the supplement, if that’s made from like gelatin from an animal versus not, that’s often what the vegan differentiation is. So that itself I don’t think would really matter unless, unless it’s personal preference. But for the actual C or D itself, I don’t think that would matter. And I will also say, when you take a supplement, it’s often not as bio-available and as readily absorbed in the body. So, if you can take the supplement but eat an orange that day, or put some lemon juice into your salad… I’m sure Stasi and I have helped lots of clients with figuring out how to do practical things with food. So you’re getting those nutrients through food first. But that’s just another way to ensure instead of taking double the supplement, we’ll take your normal supplement and then just eat it through the food as well.
Stasi Kasianchuk:
Yeah, exactly. No, I like that point too. Especially with things with vitamin C, you’re going to get that fiber which is also important to fuel your gut health, which plays a role in the immune system. So again, you’re always going to get more bang for your buck when you’re getting food to provide those nutrients.
Well, we got another question that says, “I have family members in my home that are exhibiting symptoms. Are there menu tips I should be following to help them improve?”
We’ve got one more question on the supplements… So let’s finish up with supplements and then let’s dive into some practical strategies. I think that’s really where the rubber hits the road and we can talk about some of that menu planning. So, the other question on the supplements was, “Is it wise to take vitamin C and D together, or are there combinations that make them more effective?”
So based off of my understanding with these, is that their supplements are good to take with food to help increase their bio-availability. Vitamin D can be better absorbed if consumed with fat. So that might help with that absorption.
As far as vitamin C, I don’t know of anything specific to help with the absorption of vitamin C… although vitamin C can help with the absorption of iron. So there is that connection there. Monika, anything that you would recommend around how to take these supplements?
Monika Jacobson RND:
I don’t think it matters if Vitamin D and C are taken together. I don’t think they compete for absorption, if that makes sense. But I agree with you, Stasi, that they should take those supplements with food. Pretty much, almost always, supplements should be taken with food… unless there’s a medication interaction that would differentiate or, take them separately for some reason. I don’t think it would matter if you did like vitamin C with breakfast and Vitamin D at bedtime or with dinner.
I don’t think it’s, it’s a huge issue either way.
Stasi Kasianchuk:
That’s my understanding as well. We have several supplement questions coming in right now. So maybe we’ll tackle some of these and then transition to the food, which may also help, from a supplement standpoint… letting you know different nutrients that could come from the food.
So are there good food sources of zinc?
Seafood is a good source of zinc. That’s definitely one area where you can get a really high amount of zinc. Things like oysters and shellfish especially. As far as other food sources with zinc”¦ A lot of things that may depend on the soil, but a lot of things that are grown in soil, there’s going to be zinc in there. So you’re thinking, again, plants are going to be high sources of zinc, or contain zinc, that can be available to support your immune system. And the other additional zinc sources come to mind for you. Monika?
Monika Jacobson RND:
Mm beans. I think beans are another source. We can beans, but no, I agree. Like anything that’s grown in the soil, because zinc is a mineral that food naturally occurs. It does pull the zinc out of the soil into the food. So yeah, I don’t think so. Aside from seafood, that’s, that’s the big one actually.
Stasi Kasianchuk:
In animal products, there is going to be zinc”¦ thinking of turkey, chicken, there’s going to be zinc in those, but certainly seafood is going to pack pack a bigger punch on that.
And then another question, how about… is it okay to eat canned sardines to get Omega 3s ?
Absolutely. That’s a great source. Sardines, anchovies… they’re bottom feeders. So, the bigger the fish, the more contaminants that can be in that fish because of the other things they eat.
So those bottom feeders are actually the better ones to consume.
And then, can you comment on B vitamins? B2 as a stress vitamin and a, B complex? Also, getting Bs through the diet, especially in non-meat eaters.
So, for B vitamins, they are involved in a lot of metabolic processes in the body.
So they’re definitely important to include. Again, going back to food first, you’re going to get a lot of benefits from foods that are high in B vitamins.
So even things like whole greens, beans, these are going to be B sources that are in non-animal products. B12, depending on if you eat any animal products, if you don’t… B12 maybe what you’re missing. So, if you are vegan for example, that’s where a B12 supplement may be appropriate because that is going to be much more of a challenge for you to get. Any additional recommendations from you or what you recommend working with vegan clients?
Monika Jacobson RND:
No, I think you’re right. B12 is the big concern for people that don’t eat meats, or eat very little of it. That’s often a supplement that I think can be pretty warranted for people with vegan or vegetarian diets, especially long term.
I would say otherwise, if you’re eating a diet rich in fruits and vegetables and beans and whole grains, you probably don’t need to supplement with extra B’s.
Aside from the B12.
Stasi Kasianchuk:
We see a lot of products too that are super, super high in B vitamins and while they are water soluble, again, going back to we may not know what this super supplementation longterm does, we don’t know that we actually need that supplementation.
And these high amounts may have unintended consequences down the line. So always be careful that when you see a label where the amount is hundreds of thousands times what you actually need.
One other question on drinking vitamin C versus taking it as a pill. So this person says that they love Emergen-C. And again, I would go back to perhaps by drinking in the liquid, maybe it is more bio-available because it’s broken down, it’s spread out versus in one capsule.
However I would still recommend sticking to one packet of Emergen-C per day. There tends to be high amounts of other, more synthetic, vitamins, and then getting your other sources of vitamin C from those whole foods.
All right, let’s jump into the fun stuff. Let’s talk about cooking meal planning… Rubber hits the road… eating. All of those things. I’m putting this stuff together, when it comes to meal planning right now, which for many people looks different than when they were meal planning a month ago… or maybe even last week. Things change very quickly, day to day.
I have to say, I have several clients that have been wanting to meal plan for awhile, and a silver lining to this coronavirus is, they have more time and they really almost have to right now.
There is some strategy to going to the grocery store. So it’s helping them to implement those habits on a more need-to basis.
Monika Jacobson RND:
Absolutely.
Stasi Kasianchuk:
Well, with the meal planning, what have you found for yourself, or for your clients, that has been the first step? Especially if you’re thinking about never having meal-planned before? Maybe you always wanted to, but where, where do you start with your clients or, or even what you do for yourself?
Monika Jacobson RND:
Sure. I think we have this idea that meal planning is maybe bigger than it needs to be. I know I’ve talked with lots of clients who feel like, “Oh, but then I don’t have a whole Sunday afternoon to just make all my meals for the week. “ Or, “Our lives are so busy. Like we have lots of stuff in the evenings just it doesn’t work for me.” Or, “I don’t want to eat the same thing like many days in a row.”
But it doesn’t need to be any of that.
I think the biggest thing about meal planning is what’s in that word itself, which is “plan”. I think we have to plan, and that doesn’t mean 7 days in advance. I think it can even be, “What’s for dinner tonight?”
Or, “What am I going to feed my family or myself tomorrow?” Because the simple act of taking chicken out of the freezer to thaw-out so you can cook it at night means you’ve planned ahead.
So, the more I’m thinking in advance, the better prepared we can be as meal planners. When I’m working with my clients, I’m, I’m talking about, “Okay, let’s figure out a system that’s gonna work well for you.”
There’s lots of ways to meal plan. There’s apps, and there’s ways you can write foods down on paper, or put a cute little chalkboard in your kitchen, or whatever you want to do.
I’ll show you what I give all my clients when I’m working with them, one-on-one… it’s this little meal planner and basically it’s all days of the week with a shopping list next to it.
So as you’re planning out, okay, Monday we’re doing spaghetti and salad. Tuesday we’re doing taco Tuesday, or maybe we’re doing meatless Monday on Monday. Wednesdays we’re doing I don’t know, bean burgers or something like that. So then as you’re mapping out, I’m just talking about dinners here, but I think dinners are the hardest for a lot of us, especially if you’re cooking for multiple people or a whole family.
So then you can make your grocery list side-by-side to the menu. And so when you’re shopping, you know you’re buying for exactly what you need. Versus impulse buys are just buying a bunch of random stuff that sounds good and then trying to figure out what you’re going to make with that. I think the biggest thing about meal planning is that itself; planning and writing it down in some way.
Stasi Kasianchuk:
Yeah, that’s such a good point to have that. And I like how it’s visually laid out. So that it’s all right there. You see what matches up to what you’re buying, and what day that’s going for can be really helpful. That strategy and taking that time to write it down. And what I find too is sometimes it’s that initial planning. If it’s new, if I haven’t done it before, it feels uncomfortable”¦
So even plan out one day… start with one day, if you’re new to meal planning or this routine of being home is new to you”¦ just start with one day. And maybe you play, you practice with choosing a recipe for the evening, for one meal, and then what would that writing it down be as well to just kind of go through those motions and start, start feeling that and understanding that.
Yeah, just get started. Just jump in and start playing.. And, and I like too, how you mentioned there’s no right or wrong way. And I think you’ve told me before too, you know, meal planning doesn’t have to look like Instagram-perfect. It can be messy. It should be messy, have fun with it, make the kitchen a mess. And it may be looking like that and it doesn’t have to all fit into, you know, glass containers that fit perfectly in your refrigerator. It can look in a lot of different ways on how you do that. So give yourself permission to make mistakes. Have fun, but just start that initial planning process.
One question that came through, any great options for feeding a family of five? I sit at my desk working from 10 to 3 every day, so I don’t have time. And then, any tips for creating meals that my kids and husband can grab and go, because we’re all doing our own thing throughout the day.
So a lot of, you know, if you’re now working from home, it may not necessarily mean, “Oh, you’re working from home. You can also meal prep all day.”
If you’re working from home, you’re working all day. So having those convenient meals can be helpful. Do you have any recommendations for more of that batch cooking, or things that can feed larger families but still be relatively simple to make?
Monika Jacobson RND:
Yeah, definitely. So I think there’s some things that you can do at the start of the week. Maybe it is on a Sunday, where you do a little bit of work, but then it sets you up for success for the rest of the week. Right now, we’ve got a family of 4, so my husband and I are both working from home, and we’ve got 2 kids that are young… they’re 3 and 5, so they’re not quite making their own meals just yet, but soon enough.
But I like to have stuff ready to go, so when we’re busy, we can just get in there and grab things, which I think is what you’re looking for. So like maybe it’s boiling off a dozen hard boiled eggs at the start of the week or chopping up some vegetables that will keep well in the fridge for several days. Like some celery and carrots, cucumbers, snap peas, radishes, and just have those chopped up.
So you kind of have this veggie tray, maybe you have a dip or two that the whole family likes where people can just come grab their little plate or bowl of veggies with a scoop at the dip and then mosey on.
I also like to have some cooked, whole grain on hand. So maybe I do a pot of brown rice or quinoa.
And also have some cooked protein on hand, like some shredded-up chicken or open up a can of chickpeas or garbanzo beans. So you’ve got protein and grains and veggies kind of already to go, can even put that all together and make rainbows for lunches.
But I think having some of those whole foods prepped and ready to go will be just as easy for someone to come and grab any of that stuff. Then, open a bag of chips… or raid the pantry for the other more snacky foods, which aren’t necessarily bad at all, but it’s just having some of that stuff ready to go.
I like what you said, Stasi, about batch cooking too. Maybe at the start of the week you make a big pot of chili or soup, or a one-pot meal, that just everyone kind of takes their scoop of this, warm it up for themselves when they’re hungry and ready to go. And it’s already done in advance.
I think those kinds of meals work well on those busy weeknights when kids are in sports, or everyone’s kinda here and there and everywhere, or in times like now where people kind of fend for themselves for that like midday meal.
Stasi Kasianchuk:
Having your food environment to set you up for success.
I think there’s a great opportunity to stock it with healthy options, first. Obviously, you can have flexibility around some of those treats, things that you enjoy, maybe some of those comfort foods right now, but really having the majority being from those whole foods.
And I love what you mentioned around vegetables that can be eaten raw or with, you know, your hummus dip, your bean dip… something that’s easy to grab. Right now buying things in prepared and plas
Wearing a face mask (except the N95s, please leave those for medical professionals) helps protect other people from you. Even if you have no symptoms, you could be carrying and spreading the COVID 19 virus, so it’s important to keep the moisture from coughs, sneezes “ perhaps even breaths “ contained. So please, do wear a mask if you’re out and about among people.
Protecting others is awesome. Protecting yourself and those you love? Priceless.
One of the most unknown and underrated ways to strengthen your immune response is gut health. Science is only beginning to understand the importance of a healthy gut, including what all the gut does (a lot) and how best to protect and feed it.
We took these questions to a gut health expert: Dr. Erika La Vella of lavellayourguts.com. She is a board-certified metabolic surgeon and describes herself as a “wife, and mother who is passionate about health in the most preventative and holistic of ways.” She talked with Gennev Director of Health Coaching Stasi Kasianchuk about what the gut biome is, how it works, and some of the many ways we’re finding that a balanced gut biome makes us healthier “ and an unbalanced one can disrupt our health.
So. especially in a time when we all REALLY want and need the most robust immune response we can have, how do we feed our gut and protect it?
Listen up and find out!
Prefer to watch AND listen? Check out the video of our Gut Health webinar on YouTube. Be sure to subscribe to our channel for more great content about COVID 19, menopause, and women’s health in midlife.
More webinars are planned, so if you like this, take a look at what’s coming up. Register to attend the live webinar and/or to receive links to the webinar on-demand as a podcast or video.
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TRANSCRIPT:
Coach Stasi Kasianchuk
Thank you so much for joining on this webinar for on gut gut health related to immune function. So I am Stasi Kasianchuk and I’m the director of health coaching here at Gennev, and we have the pleasure of introducing or talking with Dr. Erika La Vella today, but I’m really excited to have her here today to talk on this. She has an extensive background and expertise in this area. She’s and lots of great practical tips as well to bring to you today. So welcome, Erika, and thank you for joining.
Dr. Erika La Vella
Thank you Stasi. And thank you, Gennev for inviting me. Yeah, so I am a current practicing metabolic and weight loss surgeon and I didn’t always think I wanted to be a surgeon. I was motivated and excited to go to medical school. I love to work with my hands. I love practicality. I love learning about physiology, the kind of physiology that overwhelms a person’s immune system and turns on sepsis and you know, emergency surgeries and things like that. And so ultimately I ended up finding surgery and then found this glorious niche of health coaching meets nutrition meets surgery. And now I do weight loss surgery. And my love for, for gut health has really blossomed out of my own personal journey. So in the midst of my medical school career, I was having a lot of GI issues and that was gosh, almost 10 years over 10 years ago now.
And I discovered that I had a GI parasite. And that process of learning about the parasite, learning about my body, learning about the biochemistry, learning how stress was impacting my ability to to respond to my body’s needs has really shaped my love and desire for talking to everybody I know about gut health. And I’m a total nerd. I read research papers like they are novels. So I I just, I love, love, love the information and I’ve developed quite the network of colleagues in this field. And yeah, thank you so much for having me.
Stasi Kasianchuk
So let’s start off Erika, by giving our audience just an understanding of what the gut microbiome is. We hear this term gut microbiome, I think we’re all learning a little bit more about that as it becomes more known and more researched, but love to get you to just give your overview. So we all at the same starting place.
Dr. Erika La Vella
Yeah. So we have in our bodies and on our bodies, trillions of bacteria organisms, and it’s believed that these organisms are absolutely essential for health. So that’s been part of the big paradigm shift, so to speak, in our language around health is that no longer are all these bacteria deemed to be problematic. So urinary tract infections, yeast infections on the skin, all of this is a sign and symptom that you don’t have a healthy microbiome balance in your body. So while we have these tons and tons and tons of different cells, there’s also a very time sequence in which we are naturally exposed to them. And so we can talk a little bit about that later. But the microbiome in, in just the broadest sense is this very intricate, interdependent relationship. It’s like a rain forest, you know, it’s like, it’s like your backyard. If you remove flowers that pollinate bees, then you see this downstream, sequelae effect.
And so it really is an ecosystem and we have to think about health in terms of how do we nourish this entire ecosystem. And while there are bacteria themselves and you know, probiotic, which what we’re talking about with supplements, the types of bacteria that are present in our bodies, they have the ability to take nutrients from our diet. So what we eat feeds them. And then the chemicals that they make then act as a sort of language that then communicates not only to our cells and to our DNA, but also communicate to each other. And so this is a thing that I find just, it’s so beautiful. They really are sentient creatures that have evolved on this planet well before humans even walked the earth. Literally every living organism on earth has a microbiome. Their ability to then communicate with each other by releasing these chemicals. And it’s all based off of the basic biology of eating and, and, and pooping. Because what the bacteria poop out is this chemical soup that then confers. Are we then going to be healthy inside or are we going to turn on genes that spawn inflammation? And yeah, so I hope that answers everyone’s question because again, you have to think about it very broadly. It really is an ecosystem.
Stasi Kasianchuk
I love your comparison to the rainforest and the downward effect cause I think that illustrates the symbiosis that we see with the different microbiome micro organisms in terms of how it all works together. So that’s a good analogy there. What would you say, so, I mean, thinking about the development of our microbiome, how does that occur in terms of how do we, how do you mentioned eating and pooping, which are certainly really natural things. We don’t talk, we talk about eating a lot. Pooping doesn’t always get the attention, but I tell clients all the time, if you’re not pooping, we have bigger problems than if you are. So, you know, it’s a, it’s a natural thing that we all do. And and certainly related to the gut microbiome, but how does that what’s the role of just how the microbiome gets developed?
Dr. Erika La Vella
Yeah. and just a little side note, I am very comfortable talking about pooping. It’s like a tabletop conversation at my house. And I think as a, as a surgeon, any general surgeon out there can agree, it’s like the first sign that your patient can go home is when they’re pooping. So I, we, we celebrate poop. So the gut microbiome is, used to be belief. So right now our technology and our science is changing so rapidly. I mean the fact that we can all sit remotely and have this conversation is pretty magical. And even our science and our ability to test not only what types of bacteria are growing in somebody’s stool, but then also what are those chemical messengers that are now in somebody’s bloodstream. So that’s kind of where this whole microbiome thing is now going is a blood test that tests for those chemical messages and what’s healthy and what’s not healthy.
The gut microbiome or the vaginal microbiome, the mouth microbiome, the biomes on your skin, “biome” just means the collection of organisms that is there. It used to be believed that your placenta or a placenta, whichever one you were born into, was sterile. And what is currently being debated is, is it really sterile or is it not? And what we have discovered, we being scientists is that it’s not always sterile. And then, okay, when is it not always sterile? Well, sometimes if the mother has a cavity or if the mother has a bacterial vaginosis or if the mother has the word is dysbiosis. And dysbiosis just means that your microbiome is causing inflammation or some sort of imbalance in your body. And it again, it’s not very prescriptive. Different bacteria are really healthy in some people. And then in other people they aren’t necessarily doing helpful things.
So it really starts in utero. And I even like to talk to people, it really starts preconception. So as a woman, if you can, if you are blessed with the opportunity to anticipate and plan your pregnancy, we need to start working on gut health and dental health and getting your body as dialed in as possible so that you have a really healthy pregnancy. There are some data out there suggesting that if the woman has dental disease or cavity or caries, they are actually at seven times increased risk of having premature delivery. Same thing with vaginal yeast infection, not yeast infections, but dysbiosis. So we don’t always have the mechanisms mapped out yet, but we know that sometimes bacteria from a mother’s gut, from their vagina, from their oral cavity can get into the placenta. And right now it’s estimated that half do and half don’t.
But then the birth route becomes really important because when a baby is pushed out of the vagina naturally, it actually bathes in the the bacteria and the yeast and the microbiome of the woman’s vagina. But also usually during that process, the woman’s pushing, and again, we’re going to talk about poop and it’s not sexy to talk about pooping during delivery, but it often happens and that baby’s coming in really close contact with that perineum. This is now believed to be a Keystone event and Keystone species from mom get transferred to baby. They get on their eyes and their nose and in their mouth. And currently most gynecology or obstetric practices have actually modified C-section deliveries to start doing vaginal swabs with Q-tips, put a Q-tip in the vagina while you’re in labor and then let it soak and then they swab the baby’s nose and mouth with it and they’re studying their microbiome for the next several months after delivery.
And they’re finding that the Q-tip swapped babies tend to be on a similar health trajectory as those that are born by C-section. What happens when you get born by C-section as you don’t make contact with that flora and so your gut and your as a baby, it kind of goes into this rapid development of of what what looks like to be like more like an adult microbiome. And so these stages seem to be very necessary for the stage of development that we’re in when we’re born, when we’re born, we really are only designed to digest breast milk, digest colostrum. And actually that’s the next piece to that is when we do start breastfeeding, which is right away colostrum, we, we’d get a lot of our immune benefit from our mom. So the breast milk actually puts that into it. And then that feeds the baby.
Not only that, but the different layers of the gut. And I would love to tell people about the anatomy of the gut and how the different different layers and different functions both on the microbiome side, but also on the human side, the different layers that are really important to help protect you, not only from bad bacteria that you accidentally eat but even just from food and undigested food particles. So your largest immune system’s in your gut. And it’s believed that these key sequences prime your immune system for healthy functioning. And it’s all related to, again, as a fetus, they call it the fourth trimester, right? You’re just, you’re born without any real ability to fend for yourself and survive in the environment as if you do when you’re a fully developed adult or adolescent. So all of these functions between mammals, nursing mammals and their young, are very important for this kind of sequential development of the immune system. So there’s, you know, immunoglobulins and you know, all lots of big medical and scientific immune speak, which I could blurt out. But I think for, for your listeners, just acknowledging this relationship and this in this time sequence contact with these things at these very specific times.
Stasi Kasianchuk
Excellent. Well that’s a great foundation. I think you know, the start of our immune system and really right now as we are in this pandemic and all of us wanting our immune systems to be as strong as possible. I’d love to just hear now you, you alluded to the role of the gut and the immune function. So if we can dive a little bit deeper, maybe that comes into some of the layers. But really what does the gut, how does the gut play a role in our immune system in general and then maybe perhaps what it may be doing right now. I know we’re learning a lot, so there’s nothing out there that’s definitive, but if you’ve come across anything in terms of what might be happening as our guts are supporting us and hopefully supporting our immune system during this pandemic.
Dr. Erika La Vella
Yeah. So I’ve been, you know, scouring the literature to date. There’s not a microbiome, COVID 19 study. But there is a lot of good literature out there documenting what happens in HIV and HIV is, you know, it’s, it’s, it’s a totally different virus, but what HIV has the ability or what it does is it really damages the host immune function to the point sometimes where the immune cell count, the CD4 count, which is a type of immune cell, gets so low that patients with this type of disease can’t, can’t fight off any infection on their own. And you know, that’s kind of the definition of immunocompromised. And the literature regarding the microbiome: simple, simple, simple “ kefir. Kefir actually helped reverse the evidence of HIV and actually helped rebound the CD4 counts. And so it’s, it’s this connection again, the largest immune cell collection is really under the gut lining and your gut is only one cell layer thick and it’s brand new.
The turnover, the cellular turnover turnover is about three days. So every three days you can think, just like we shed the layers of our skin, we shed the inner layer of our gut, but it really is only one cell layer thick. And under that Oh, somebody asks what is kefir. I can see that I should define kefir. Kefir is a fermented yogurt, like a fermented milk drink. And it’s, it’s, it’s awesome because it has over, well some of my favorite brands, if I can speak brands, my favorite brand is Nancy’s because Nancy is right here in Oregon. But also they make it with organic grass fed dairy from whole milk cows. And then they also add a fiber to it called inulin, which I would love to tell people what inulin is. And then it has 13 different beneficial strains of bacteria in it.
And again, it’s an ecosystem. So when you’re thinking about probiotics and how do you support your natural immune system in this way, when we have been evolved to eat probiotic foods before refrigerators, we were, everything’s fermenting. In fact, the magic of fermentation is really how long something sits out on your counter. And so if you really want to you, you can make kefir at home. The little it’s called kerfir pearl and the you put it in, in, in milk and you just leave it on your counter for a few days and it will, it will start to grow and culture. That’s what a culture is. But yeah, so again, there are many different ways I keep, I’m getting a little distracted. I see the chat box pop up every once in a while. There are vegan options. If you’re a non dairy person, of course you can put this stuff in coconut water.
There’s, there’s coconut kefir or water kefir. But in general, bacteria needs some sort of sugar substrate. And so lactose, bacteria just love lactose and cultures all over the world for a very long time have been eating dairy in this way. In fact, buttermilk is a cultured product. Buttermilk is a fermented food. And you know, back in the days when people just used to have their own dairy cow on their own property, they’d milk a cow. They wouldn’t pasteurize it, they’d bring it home. It’d be what they would drink would be fresh, scoop off the butter and then leave it on your counter for three days. And now you have buttermilk. So fermentation is in the air. These bacteria, these wild yeast, they again, they grow in our bodies, they grow in our soil. And the farming practices that exist today have been shown and rumored to be depleting the soil of those probiotics that naturally grow in the food.
And as a personal experience I do grow a garden. I do care for my own soil and I love fermenting things. I make my own sauerkraut. I make my own kvaas and make my own sourdough bread. And there is a big difference between picking something fresh, like a cabbage out of my garden, barely rinsing it off. Maybe if even I just dust off the dirt. And then chopping it up and watching it ferment in my, in my kitchen versus during the wintertime having to go to the grocery store even if it’s organic or not, you know, that stuff’s just pressure wash sprayed with antifungals. It just, it doesn’t ferment the same. That’s all I have to say. It doesn’t ferment the same. So again, this idea behind immunity, it, it really is as simple as you just, you have a lot of immune cells right underneath the, the barrier. And so the gut barrier, I’m just like, we have a blood brain barrier trying to protect our brain, which by the way, the brain is not sterile.
Exactly. There’s just more layers. These bacteria are literally all over our body. The, the problem is, is in the past we haven’t been able to culture them, you know, and it’s not like we’re going around doing brain biopsies to culture them. But now we have different DNA sequencing techniques and we have different ways to extract the those little chemical communicative language to identify what, what some of these, these things are. So the gut barrier it consists of the bacteria that are present but also on your body, what the mucus layer is like. And this is where I just have to do my plug about ibuprofen, Aleve, Neproxin, all the nonsteroidal antiinflammatory medications, which are so commonly prescribed, they are ruining your mucus layer. They just poke holes in it. And there have been tons of studies documenting that. Not only can it cause an ulcer in your stomach, absolutely it can, but on an endoscopy, when they look with the camera and they take biopsies, people can have ulcerations and be losing iron and bleeding just from taking ibuprofen.
And again, it’s the whole class of medicines. So that is usually rule number one to anybody who wants to heal their gut. Stop taking those medicines. And if you have pain and you think pain is inflammatory, well then that’s another opportunity to really think about your body, what you’re feeding your gut, and how can you optimize the state of ecosystem balance within your body. Because when our gut layer in the mucus, layer is, it has holes in it. What happens is the bacteria on the top, they’re not all good, but again, they work in in a ecosystem type way to keep each other in balance. I don’t know if your listeners have heard of Clostridium difficile, but that’s abbreviated C diff. And that is often a bacterial infection that happens when we take antibiotics. So when we take antibiotics, we are effectively reducing that ecosystem balance.
Not all the population dies, but some of them, because the antibiotics have different mechanism of function, some of them do. And so when the pH changes and when that balance, that diversity, you want tons of different, you want that rain forest of ecosystems. You don’t want like just, you know, three or four, you want tons. So when that balance gets disturbed, then this other type of bacteria that is always present within you starts to over flourish. If we have States of inflammation in a weakened mucus layer, then the cells underneath start to also become effected. They can get leaky so they aren’t as tight, they can leak. And then that allows not only on digested food particles, so inflammatory things from our diet, but also bacteria and bacterial toxins to leak across that membrane as well. And then underneath that layer is where the immune system is. And so anything that your immune system scans, it’s like, it’s like going through security scans and determines is not safe, is not human and is not recognizable as having an intended function in biology like making cholesterol, making skeletal muscle, you know, doing different functions of biology. Then your immune system gets over-reactive. It treats it like it’s a virus. It treats it like it’s an invasive bacteria.
Stasi Kasianchuk
So then that that action of the immune system tack tackling something that it’s perceived as foreign is when we feel symptoms of being sick, would that be a correct?
Dr. Erika La Vella
That would be a correct statement, yes.
Stasi Kasianchuk
Okay. All right, well that’s a great, really good insight. In terms of the connection there, I’m certainly, especially that one cell layer that you mentioned within our gut being being the barrier between foreign foreign particles that we digest and take in and the the actual our inside and that immune system, that’s a pretty small barrier there.
Dr. Erika La Vella
It’s fragile and it just deserves some intention.
Stasi Kasianchuk
Yes. Well, let’s transition here and we have a couple of questions coming in. So I’m going to take a break to go back to there are some questions on the kefir, so I’m going to take a break to go back to those and then let’s jump into things that our audience can do right now to nourish their guts and, and support their immune system. But we’ll start with these questions first. So where can you buy the kefir pearl if you wanted to do do you have any recommendations, whether it’s online or where you found, where you found them.
Dr. Erika La Vella
Locally? I go to my co op. But yes, you can also do it online.
Stasi Kasianchuk
Okay. and then we have another question about that. Someone that says they drink Nancy’s kefir, but a GI doctor mentioned to them that most bottled probiotics get destroyed by stomach acid. What is your thought on that?
Dr. Erika La Vella
I think a lot of doctors under-appreciate the complexity and also the millennia of time that humans have been living with probiotic foods and the benefit. So yes, your stomach acid might be killing the bacteria, but it’s not the bacteria that are giving you the benefit. It’s the chemicals, the poop remember, they’re active, they’re very active. They’re alive. So I love Nancy’s because it adds inulin, which is a food for them, a prebiotic. They’re eating it, they’re digesting it. In the fridgerator, fermentation slows down, but it doesn’t stop completely. Whereas on the counter, because of the temperature, fermentation kind of speeds up. And so anyway, even though it’s in the refrigerator, it’s still alive. Maybe it’s just a little sleepy, but it’s still alive. When you eat it again, it’s bound to food. It’s bound to that lactose.
It’s not like your stomach acid destroys everything that you ever eat and then you never get any nutritional value from it. That’s not how digestion works. Our stomach acid breaks down protein, but it’s not really designed to kill things. Again, pH is important. But also it’s those chemicals of fermentation, those chemical messengers and those are called postbiotics. And postbiotics, there’s not a lot of literature on it right now. At least not commercially and, but I think you’re going to see that change. In fact, Dr Axe, I just started searching this yesterday, tried to see how many practical tips I could find for, for your listeners. But Dr Axe’s website actually does a pretty good job detailing out what a postbiotic is and how you get the benefits from them.
Stasi Kasianchuk
Excellent. Yeah. So the, based on what you said, it sounds like the purpose of our stomach acid in addition to breaking down proteins is really to maintain a pH environment within our stomach, which can protect us in some ways, kill some things, but perhaps the the, the beneficial probiotics that are, we’re consuming from different foods, especially the pH may actually not have the same impact on, on those beneficial organisms.
Dr Erika La Vella
Yeah, it’s, it’s, it’s a little more, it’s just, it’s, it’s more nuanced because it’s not that you’re, it’s not that your, your stomach, your body isn’t designed to host of probiotics. So if you were to do a stool sample, you would very rarely find that the probiotics that you’ve been taking are actually living in your gut. I look at it more like a fertilizer, and again, it’s a fertilizer because it’s not necessarily that the lactobacillus itself being alive is going to burrow its way in, take root within you. It’s literally communicating to the rest of your native microbiome and it can do that through stomach acid. Does that make sense? Yeah.
Stasi Kasianchuk
Yeah. There’s again, back to that relationship. Everything. There’s not existing in a bubble and it’s not good and bad, it’s really about the relationship.
Dr Erika La Vella
Yeah. That the bacteria don’t have to be alive when you eat them. They have to have been actively fermenting. And so you have to have those post fermenting, I call it bacteria poop cause it’s what they make. But you have to have that to get the benefit. And when you eat a fermented food, an active live food, if it’s alive, when you eat it, then you know you’re getting the postbiotics.
Stasi Kasianchuk
Well, let’s jump into some of those. Because I think it sounds like those are what they might be. Steps that can help keep our gut healthy and then also support our immune system. In return. We had a question. Someone asked what is kvaas and if you wouldn’t mind sharing.
Dr Erika La Vella
Yeah. So I, I’ve done a little bit of research and I’m not a huge food historian, but I believe it comes from Eastern Europe, maybe even Russia. And this is how I make it because these are all just variations of the same, same practice of fermenting food. I take filtered water and from my garden, I can’t make kvaas from things from the grocery store, so from my garden. I take fennel, beet, carrot, celery, and dill. And I put it in a Mason jar with a little bit of sea salt, just a pinch. And then I put a I usually do coffee filter paper and a rubber band over the top. And because of the beets, the water turns this gorgeous fuchsia pink. And it has this almost, I, it’s, it’s kinda like the savoryness of a bloody Mary, but it’s like very refreshing because it’s, again, carrots, beets, celery, fennel, and dill.
And any way you can make your own kvass recipe in any way you want, but it’s the fermentation drink that comes from these vegetables that you grow on, on your kitchen counter. I think in grocery stores now you can find products called gut shots. And basically it’s the juice off of sauerkraut. You know, it’s all it is, is the, the byproducts of fermentation. And again, I think all of this stuff, you can make your own recipe. It’s just fermentation’s a very intimate process. You’re constantly looking at it, you’re smelling it, you fail more than you succeed when you’re in the beginning stages. But it’s just can you foster this relationship in your environment with more living organisms? Because again, it’s what they make, it’s those byproducts of fermentation. That is like the fertilizer, the compost for your guts.
Stasi Kasianchuk
Excellent. Great comparison there. We also did have someone share related to the C diff that you mentioned the C difficile unfortunately sorry to our listener that had to experience this, but their mother did die from C diff after being overdosed on antibiotics. So it is something that’s unfortunately not uncommon.
Dr Erika La Vella
No. And our hospital has published a few papers on this, but we use kefir in the hospital and you can also use miso. So, so we, miso is also a very potent, very, very potent probiotic food. And again, a little bit of miso, warm water, right? You can even use boiling water in your miso and still get the benefit of the probiotic. And this is on the same parallel as the stomach acid killing the bacteria. The boiling water isn’t going to have the bacteria survive, but it’s already been actively fermenting, sometimes for five years buried underground in a soy fermenting crock. So it’s the byproducts of the fermentation that are really overlaying all the health to the host. Yeah.
Stasi Kasianchuk
Yeah. No, that’s a good reminder of someone just shared that they tried to get gut shot, they love gut shot and it was sold out at the grocery store in Poulsbo yesterday. So probably a lot of the immune boosting things are, well what are some recommendations, Erika, that you see as being simple, accessible, potentially not sold out right now that our listeners could start doing if they aren’t already to support their gut health?
Dr Erika La Vella
Yeah. so I like to think about the pre pro post idea, but also number one, take care of you. And what I mean by that is get some good sleep and practice mindfulness. There was a study in 2002 and I just discovered this in the last year and a half, and it resonates so deeply with my own experience because all of my gut problems, I probably had an intestinal parasite for many years, but it didn’t show itself until the stress of medical school. And so right now a lot of us are feeling intermittent anxiety, grief, uncertainty. Some people have been laid off jobs, aren’t gonna be able to pay their mortgage. There’s just a lot of fear about our own health right now. And the media, I find myself checking the statistics on the COVID 19 crisis a little too frequently. So I, I’m, I’m speaking from my own heart, my own experience right now. When we take time to practice mindfulness and actually get our nervous system in resonance with our parasympathetic state, which controls the vagus nerve, the vagus nerve “¦
Oh, I have to, I have to,
How do sleep (or a lack of it) and stress (an abundance of it) affect your immune system?
A lot, it turns out, and while that’s always important, it’s particularly important during this time of COVID 19.
What are the risk factors for contracting COVID 19, and what are the best ways to protect yourself, where sleep and stress are concerned?
To help people be well during this pandemic, Gennev is offering a series of weekly webinars on issues of women’s health and how they’re impacted by the isolation. If you weren’t able to attend, or you wish to hear the information again, below is the podcast of the webinar. Hear Gennev Director of Health Coaching Stasi Kasianchuk’s tips for maximizing sleep, minimizing stress, and making sure your immunity “armor” is as strong and resilient as it can be.
Be sure to learn about and register for upcoming webinars on gut health, mental health, nutrition, movement, weight management, and more, and find links to previous webinars.
Access the video of this webinar on sleep, stress, immunity and COVID 19 on YouTube.
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Want more from Coach Stasi? Check out her video playlist on YouTube and find ways to keep moving safely, and at home.
Complete transcript:
Coach Stasi Kasianchuk
Well thank you all for joining. My name is Stasi Kasianchuk, and I am the director of health coaching at Gennev. I’m a registered dietitian, nutritionist and exercise physiologist and I do work, Im one of the coaches that works with our clients here at Gennev. So today I am hosting this webinar on sleep, stress and coronavirus or COVID 19. Right now we’re offering weekly webinars that are going to be topics related to women’s health, supporting you at this time and during this coronavirus pandemic. So hopefully you can take the, the information here, apply it to your life, and then the other piece that you have the opportunity if you’re participating live, please feel free to put questions in the chat whether it’s on Facebook or on the zoom recording. And we will, I’ll make sure to answer those throughout the presentation. So thank you all very much for joining.We’ll give people a few more minutes just to log in and get set up before I dive into the information. I’ll give you a little bit of information on Gennev in case you’re new to Gennev. We are a women’s health platform that’s done remotely. We offer the health coaching like I mentioned. And all of our coaches are registered dietitian nutritionists. I specifically have a background in exercise physiology. So our coaches are also able to provide exercise information in addition to nutrition. We also provide lifestyle strategies to help you manage things right now during menopause and even pre-menopause, it’s really important that we’re taking care of our health all throughout our lives and we’ve seen that women haven’t always gotten the support they need. And so we’re setting out to change that. So a lot of things I can support women with are sleep and stress, which we’re gonna talk about today.Even managing menopause symptoms with different lifestyle tactics that can be really helpful. And looking at how to best fit these strategies into your current life. We also have a telemedicine platform where we have OB GYNs who can support you and gynecological needs. And we also just recently launched primary care accessibility in some states where we can also help you with primary care needs, especially at this time where you don’t want to be going to a doctor’s office but you still need to take care of your health. We can offer that over over the phone and through video with our telemedicine providers. So keep that in mind, more information on our websites and feel free if you have any questions on that throughout the, the webinar today, I’m happy to take those as well. Want to really make sure that we’re supporting you.All right, so our topic today, stress, sleep and COVID 19 and, and really immune function. So I want to just start off with some basics around stress, sleep and immune function and how they connect. You may have a basic idea of this but wanted to give you little bit more of the connection. I think we all know the importance of sleep. Sleep is one of those things that I hear commonly with the clients, I wish I could get more sleep. Oftentimes the women that I’m working with during menopause sleep is disrupted. It’s hard to get good sleep during this time. But we know the importance of sleep. We all feel better when we’re rested and our bodies actually tell us when we’re tired and when we need to get more sleep. The challenge is we don’t always listen to that in our society today.Perhaps a silver lining to what we’re experiencing right now is that we are being told to slow down and that may provide opportunities for more sleep, which is really important to immune function. Now stress can come in all different forms. It can, there can be good stress. Having a deadline that you’re excited about, a project to work on, whether it be work related or otherwise: These are forms of good stress. When stress becomes more chronic or starts to give that feeling of suppression and anxiety or sometimes it feels like a knot in your stomach or a decrease in appetite or youre emotional or perhaps you’re more moody or quick to respond to things in ways that you don’t feel as normal for you. That’s when that chronic stress can take more of a toll on our body. Now, our immune system is very complex.We’re not going to go into all the details of that today. That could be several webinars on its own, but it’s a very intricate system that is set out to protect us. And really we are on a daily basis, even before coronavirus, we face pathogens and invaders that enter our body in all sorts of ways: through our mouth, through our nose, through our eyes. Those are the common ways but even things on our skin and our immune system is able to fight those things that may be foreign to it and making sure that it’s helping to keep us healthy. So whenever there’s an invader, the immune system sends out a message that says it’s an alarm system for the body. Something’s not right. We need to take care of this. We need to remove it. We need to break it down, get it outta here, let’s go.So all of the, the immune antibodies, they go and they attack that foreign invader. Oftentimes there’s, this is happening all the time and we don’t even know it. So we don’t get a cold or flu every day, thankfully. But when the immune system just isn’t quite able to fight that invader, that’s when we notice symptoms. And that’s a sign that the immune system is stressed. The immune system is taxed, wasn’t quite able to beat that invader before the symptoms started. And the symptoms are really part of an inflammation cascade. So the invader starts to create inflammation in the body, and that’s when we may notice those symptoms related. Maybe it’s a cough or sneezing. Itchy eyes can be common ones, or in the case, like we’re noticing with coronavirus, it’s that dry upper respiratory cough. And unfortunately people that might already be immune compromised so their immune system’s already stressed are having difficulty breathing and that’s where the complications are coming in.So we want our immune system to be as strong as possible all the time, but especially now and when we aren’t getting enough sleep because sleep is the time that our body is repairing and it’s really the time that the body can fully rest. And if when we’re not getting enough sleep and the recommendations are about seven to nine hours of restful sleep, then that can be an additional stress on the body, can start to feel like I just didn’t have a quite enough, the immune system starts to feel like I just didn’t have quite enough time to recover last night. And then you go into the next day under-recovered from the day to day stress that happened before. And if you have something that’s invading you, whether it be a virus or a pathogen of some sort, bacteria, the immune system may not be as strong to fight that.Now, if you have a poor night’s sleep every now and then, chances are the body can compensate. Body has mechanisms to be able to work through times when there isnt, you know, when there might be some things that are off. So if it’s one day here or there . probably going to be okay. We get concerned is when sleep is poor, whether it’s poor quality or less than that, seven to nine hours on a consistent basis, maybe over months. I work with some clients, unfortunately over years they’ve had poor sleep. And they do notice the impacts on, they’re often sick more often. They don’t have the energy, they don’t have the stamina to do the things they used to and to really show up to the day like they’d like to. So we know that sleep could impact that. And part of that can place additional stress on the immune system and when you want your immune system showing up for you right now, getting that optimal sleep is really important.We’re going to talk about some strategies down the line, but I wanted to just go next into stress. So I mentioned that stress can be good and bad. Eustress or distress, so eustress is that positive stress, maybe that excitement, that anticipation of doing something new or you know, celebrating with friends, these getting to see someone you haven’t seen in awhile. These are all forms of good stress, stress that’s good for us. Exercise is actually a form of good stress as well. It places a stress on the body, but how the body responds actually helps to strengthen the basically the, the stress response and the resiliency of the body. Now on the other hand, this negative stress is going to be things that are more chronic longterm. Whether it’s work stress that’s really negative or if it’s interactions with coworkers or colleagues or family, friends that aren’t, aren’t feeling good for you.And again, you typically, we notice that we have a pit in our stomach. There’s something in our demeanor. Maybe our response tends to be more short than we typically would be. These are all signs of distress or stress that’s not helpful for our health and our wellness. And again, if this type of stress, this type of stress is normal to happen on occasion. What we want is to have mechanisms and strategies to manage our response to the stress so that the stress load doesn’t become chronic. It’s that chronic load that again adds additional stress to our body and can compromise our immune system because the immune system’s connected to all the things we’re working on. So if we’re constantly stressed or anxious about things, it could impact our sleep. So keep us up at night and then we’re missing out on the sleep to support the immune system.And that additional stress just gives, takes away from the immune system. So the immune system is not ready to fight like we want it to. We want it to be a full shield of armor as we walk into our day, even if we’re just staying in our house. But certainly right now if we’re walking around outside those are the types of things that we want to make sure our immune system is showing up for us 100%.So that’s a little bit of background on the connection of sleep, stress, immune function, and really we want that immune system to be as strong as possible right now where we know that COVID 19 is out there. And we can’t see it. So we want that armor to protect us. I’m going to take a little pause to see if there’s any questions related to some of those basics in terms of the connections between sleep stress and immune function.Anything out there from our viewers that you’d like more information on? Next, we’ll be going into some strategies to help you. So those are coming. Okay. So question from one of our viewers, what do you think about OTC sleep aides? So over the counter sleep aides? Great question. So there are those out there. You know, things like Tylenol PM or Aleve. There are some that have that, that can have that drowsiness effect and these especially if you’re taking them because your sleep is being disrupted due to pain, then using these as a temporary option maybe OK to help decrease some of that inflammation temporarily to allow you to get some sleep until that inflammation heals. Now that it should not be a longterm approach. I this is, this is more of a bandaid and what they approach the I like to use with my clients and that we do with all of the support we provided at Gennev is a more holistic approach.So we want to get to the cause and provide you with lifestyle strategies or supportive supplements if necessary that treat the cause versus just the symptoms. And so over the counter sleep aides are really just treating the symptoms and they actually in a lot of cases aren’t providing the quality of sleep. You may feel like you’re getting more sleep because your, you may feel more drowsy. They can help you to go to sleep faster. But oftentimes and I have clients that report that when they’ve taken these before, they wake up and they’re more tired or they don’t feel like they’re getting restful sleep. The quality of sleep is also important. So I wouldn’t recommend using these longterm if you’re working with a physician and they’ve recommended them to you for a short term basis, that may be appropriate, especially if you’re dealing with inflammation and pain.But really incorporating more lifestyle strategies like we’re going to talk about can get you further and support your health in a better way.All right, so next question. What if I’m not sleeping because of stress? And this is so common right now. I would say, and interestingly, the clients I’ve talked to this week, it’s been a theme. People are just feeling more tired. And I think it’s important to recognize that even if you are confined to your house, maybe are not moving as much as you used to. Maybe your routine seems seems in theory to have slowed down. The information that we’re getting from all of the sources can still stress the nervous system. We may not even realizeit, it doesn’t feel like our heart rate is racing. It doesnt feel and we might be getting some things passively, but know that that can stress your central nervous system and can require energy for your body to process that and you may feel more fatigued. At the same time if that stress is keeping you up at night and youre staying awake, that can certainly be a problem.What I recommend for my clients when it comes to that is starting off with deep breathing. That can be a very simple exercise where you’re breathing in heavily through your nose, big, deep breaths, typically holding to about the count of four and then exhaling through, out your mouth and repeating this several times and really trying to focus on your breath. So very simple, doesn’t require any devices, it doesn’t require any equipment. And the power of our breath is really important to supporting our immune function as well as with stress management. Now I do have some clients that say I can’t focus on my breath, I have too many things going in my head; that’s just not realistic. So in those cases, guide a guided meditation whether it be through an app. Headspace right now is offering free Headspace subscriptions to health care workers.So if you’re a healthcare worker, especially if you’re on the front lines, but even if you’re not and you’re taking care of the health of other people right now, take advantage of that offer. And they do offer, if you’re not a health care worker, Headspace does offer free initial trial and there’s a lot of different guided meditations around sleep specifically that can be helpful. Calm is another app as well as Insight Timer. These are great ones that I’ve tried and my clients have tried with success in terms of helping to turn off the brain, provide some more calming meditation based music and being able to shift and to support your sleep at night. The other thing that you can also do is simply just meditation music channels on Pandora or Spotify. You can put in spa meditation, music. They usually have some soothing nature songs or some great options as well.Just keep in mind if you have the free version, you will have advertisements. So those may wake you up. But yes, those are some options that have been successful for my clients and really just helps to calm the brain and the body with that way. And the advantage of just putting the earbuds in limiting the screen time you want to not use you want to avoid as much blue light as possible during the night because that can also disrupt your sleep. Great question.So another question. My stress levels are up because I’m busy cooking meals, educating my kids, trying to work at home. Any suggestions for quick ways to relieve my stress amid the chaos? There is chaos out there. It’s been interesting to see both with my clients in my own life. I’m trying, hearing from my coworkers and all of us are making our way, and this is certainly unprecedented times.There isn’t a rule book for this. Perhaps we’re creating the rule book. Hopefully we don’t have this happen again. But you know, history has a funny way of, of repeating itself in different forms. But we are all essentially on the front lines in terms of navigating these new routines for us. And that’s really what I recommend starting with how can you develop a routine, make it realistic and give yourself credit for all that you’re doing right now because there isn’t a rule book. We know that everyone is trying to do their best and giving yourself credit that you are doing the best you can is a great first step in recognizing that you’re not giving up on this, but it is hard and you’re trying to manage as best as possible. Now that being said, when it comes to things like cooking, being okay with easy meals and perhaps that’s ordering takeout from a local restaurant that needs your support, that can be a great way to alleviate the cooking, have that meal, go pick it up, or if they’re doing delivery bring that home and then take that off your plate of having to deliver a meal.If you can do it once a week, twice a week, that could be a great way to relieve some of that stress around meal preparation. The other thing is looking at meal delivery services. There’s a lot of them out there that really offer meals that are healthy, a variety of different nutrients. Whole foods. The ones that come to mind that I recommend to clients are Sun Basket and Thistle. And then, and even Hello Fresh. Those ones tend to have a good variety of fruits, vegetables, whole grains and lean proteins that can be really supportive of adequate nutrition during this stressful time. And nutrition’s also something that can support your immune system. So where when the stress hits I do you encourage you, what is something that you can make simpler, do simpler and take something off your plate. So those are some ways that my clients have been finding some success in that.Even delivery options for groceries or a lot of the major grocery stores are delivering, if you have Amazon Fresh near you, that’s an option. I know in some areas wher
I can make you believe there’s nothing wrong with me by the way I look and act, but in reality, there’s a raging battle inside my body that I’m constantly fighting. – Richelle
Menopause can be challenging all by itself. Pair it with a chronic condition like multiple sclerosis (MS), and the challenges can seem overwhelming.
Part of the problem is that so few studies have been done on how menopause affects women with MS, so women dont know what to expect. And because many of the symptoms of menopause are so similar to those of MS, it can be difficult to know exactly whats happening.
Women like Richelle already deal with so much uncertainty about their bodies. The menopause clinic team at Gennev wants to help women with MS be better prepared to understand and manage their menopause.
Richelles story of MS and menopause
Diagnosed with MS in 2009, Richelle believes she’s now in perimenopause, but like many women, she’s finding it hard to identify where she is in the journey. “I believe I’m in perimenopause. I don’t know for sure,” Richelle says. “I have night sweats, hot flashes, and cramps occasionally but I have a Mirena IUD, so it’s hard to know. I have had sporadic spotting while using Mirena but no real periods.”
MS only complicates and adds to the confusion so many women feel as they enter perimenopause earlier than they thought, and with symptoms they didn’t know to expect.I had never been someone who sweats very much so suddenly having night sweats was strange to me. “I’ve mentioned to my doctors that I believe I am entering menopause. I asked if they could test my hormone levels but the VA doesn’t provide hormone tests,” she says. But she has noticed an intensifying of the brain fog and fatigue that MS already causes.
Like most of us, she finally self-diagnosed perimenopause, based on what information she could gather. I just realized how hot I would get but still believed it was too early for menopause.At the moment, Richelle hasn’t made lifestyle changes or added prescriptions to help combat menopause symptoms. But her MS does make perimenopause physically harder on her.
Her advice to other women in the same situation?
Rest.
Rest when your body tells you to. If you need to lay down in the middle of the day, give yourself permission; you’re not lazy. Buy a fan…or five.
The more information we can provide women all women the better well be able to make the choices that impact our health and quality of life. So, what do we know? Unsurprisingly, the answer is: not enough.
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Does menopause worsen MS symptoms?
So little research has been done that this is a difficult question to answer. However, MS is more common in women and MS symptoms tend to first appear in the mid-reproductive years. And because both the first period and postpartum period can trigger relapses, it seems likely theres a connection between womens reproductive hormones and MS.
One small study seemed to indicate some reduction in relapse rate but that disability progression didn’t change after menopause.
A small study on MS and menopause from 1992 showed slightly more than half the subjects reported a worsening of MS symptoms, about a third noticed no change, and a small percentage reported an improvement. Of those who noticed improvement, three-quarters had received HRT.
While this may show some promise for HRT in women with MS, the study of 30 women is too small to draw conclusions. Sadly, the alarms raised by the largely erroneous WHI study of HRT means even fewer women have been placed on HRT, and that means fewer women to study.
Other, larger studies have also reported mixed results: in some, women reported that hot flashes caused MS symptoms to flare up. Because those with MS are more sensitive to heat and the neurologic symptoms of MS worsen temporarily when the body is overheated (Uhthoffs phenomenon), controlling vasomotor symptoms such as hot flashes and night sweats may be more urgent for women with MS to retain quality of life. Women who have had surgical menopause in particular notice a worsening of multiple sclerosis symptoms, possibly because the fall off of hormones tends to be much more dramatic and sudden.
In a study published in 2016, researchers found the impact of menopause on MS was statistically significant (meaning there is a likely correlation) but that the effect of menopause on the progression of MS was modest (approximately 1 Expanded Disability Status Scale point over 10 years).
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How to manage menopause and multiple sclerosis
MS and menopause symptoms can overlap, making it difficult to distinguish typical menopause symptoms from a flare up of MS.
Symptoms they have in common include fatigue, bladder issues, depression, waning libido, vaginal dryness, brain fog, and mood swings. If you’re unsure whether what you’re experiencing is a perimenopause or MS, you should consult your doctor. Tracking your periods to note irregularity may help you determine whats happening in your body.
For the most part, according to a study on MS medications and menopause, MS doesn’t change the age of onset of menopause. Women taking the medications methylprednisolone and beta interferons (IFNs) may enter the transition earlier, though the studies aren’t yet large enough to determine correlation.
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HRT
Once you’ve determined you’re experiencing peri/menopausal symptoms, you can begin to take steps to manage those symptoms. Because HRT may have some protective effects when it comes to neurological issues, its worth having an in-depth discussion with your doctor, ob/gyn, and any other medical support on your team.
Additionally, HRT may help with reducing hot flashes and maintaining bone density, both of which are particular concerns for women with MS.
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Lifestyle changes
Managing menopause with MS is much the same as managing without, says the UK-based MS Trust:
– wear removable layers and keep a cold drink nearby for hot flashes.
– Keep your bedroom cool and have a cooling towel by your bed for night sweats.
– Exercise regularly, practice good sleep hygieneto get as much quality sleep as you can.
– Consider yoga and meditation for relaxation and reducing anxiety.
= Take the best possible care of your body and spirit as you can.
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In addition, many women find their symptoms are lessened when they reduce caffeine, alcohol, and sugar. Definitely quit smoking if you possibly can.
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MS taking over your life?
A menopause-certified provider can be helpful. Book 30 minutes for your personal consultation with a menopause speicalist.
As a society, we dont’ really discuss menopause, so many if not most women are caught off guard by perimenopause symptoms. We often dont expect the hormonal fluctuations in our early or mid-40s, nor are we aware of the symptoms that can occur just about anywhere on our bodies and arent just limited to hot flashes and irritability.
Unexpected and unexplained symptoms are a concern for anyone, but it can be much more alarming for those who may experience similar symptoms for another reason such as an MS flare-up. So its even more important for women with MS to understand the symptoms of perimenopause, when they might occur, and how to manage them.
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Are you dealing with MS or another chronic illness? How has it impacted your menopausal transition? How do you manage both? Please share your story with the Gennev community via our Community Forum.
Our recent podcast on COVID 19 was so popular, we decided to do a deeper dive into the particular risks women face and how we can best protect ourselves and those we care about.
Webinar With Lauren Leedy, Stasi Kasianchuk & Dr. Swapna Vaidya and Jill Angelo
In this webinar/podcast, Gennev CEO Jill Angelo talks to Dr. Rebecca Dunsmoor-Su, Chief Medical Officer and director of the Gennev Telemedicine program, Lauren Leedy and Stasi Kasianchuk from the Gennev Dietitian team, and Dr. Swapna Vaidya, psychiatrist, on ways we can stay physically and emotionally healthy in this very unusual, very unpredictable time.
You can also view the webinar video on YouTube. A list of mentioned resources and the full transcript are below.
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Resources mentioned in the video:
- Fitness:
- Barre3
- DownDog
- Peloton
- Class Pass
- Meal Delivery:
- Thistle
- Splendid Spoon
- Sun Basket
- Grocery Delivery:
- Amazon Fresh
- Whole Foods
- General information:
- Centers for Disease Control
- Harvard Health
- Coronavirus tracker
- Mental Health and Coping resource
- Coronavirus Masterlist of resources for psychological health
Transcript:
Gennev CEO Jill Angelo:
All right. Well we’re three minutes past. I’m kind of prompt, we have a lot to cover today, so let’s go ahead and get started. First of all welcome to everybody. This is a special, a special edition of a webinar that we’ve really never done before around coronavirus and the relationship of it as women with menopause stress and the risks that we are experiencing during this kind of unprecedented time in history. I want to welcome you. We have a number of presenters today. We’re going to jump right into it here rather quickly. But just kind of to level set the, the basis and kind of the reason why we’re hosting this webinar today is very much around we as women are having to go through a lot of adjustment right now.
Our kids are home from school for those of you, those of you who have kids at home. Our businesses might be struggling. We’re working from home, we’re trying to balance childcare with, with work. And in some cases our immune systems could be compromised if we’re older or have other conditions that compromise that. And we just wanted to bring together our team of experts to really talk about how we might be compromised from a health perspective but also mental health and then finally what we can actually do to strengthen our immune systems and even some life hacks to try to manage through this part of history. So I’m Jill Angelo. I didn’t introduce myself, but I’m Jill Angelo. I’m the co founder and CEO of Gennev and with me today you can see the faces and we’re going to move live to everybody here in just a moment, but Swapna Vaidya is an MD and psychiatrist focused on behavioral health and women’s health in particular.
Swapna has been an incredible partner with us in working with women in midlife and so we’re really excited to have Swapna with us today. Dr. Rebecca Dunsmoor-Su is an MD. She’s an OB GYN. She’s certified by the North American Menopause Society. She’s also the chief medical officer at Gennev. And is my partner in crime. She’s runs the health practice of this company and it’s just really awesome, always, to have her taking the helm on, on this topic.
Stasi Kasianchuk is a registered dietitian nutritionist. She’s also a physiologist. She’s one of our health coaches at Gennev. In November last year we started a new offering called HealthFix. It’s a membership for women who want to manage more lifestyle approaches to menopause care and to even just strengthening their own immune system in the second half of life. And Stasi is one of our health coaches.
And then Lauren Leedy is our director of health coaching. She leads our health coaching team. She’s also a registered dietitian nutritionist and has just a rich background. Both of them have worked both on the data side of health, but also with women in midlife. So brought them on board. We’re going to talk nutrition, exercise, lifestyle, stress, sleep, all those things.
So without further ado, I will move us on. But before, if, if any of you are new to Gennev, just to give you a quick little overview of who we are, we’re an online clinic for women in menopause. Specifically we offer telemedicine services via doctors specifically OB GYNs. We also have a chat and video access to our health coaches and registered dietitians through our HealthFix membership. And then we also offer over the counter health and wellness products such as dietary supplements, lubricants and hygiene products, all formulated for women’s health and menopause. And finally, we are a platform for free education and community.
This is the place for women to come if you want to really manage your health in the second half of life. And so we’re thrilled that you joined us today. So with that I’m going to stop sharing slides. We’re going to get to actually the people. And so all of our presenters some of you are muted. I’ll remind you if you start talking to unmute. But what we’re going to do is we’re going to start by just, I’m going to plant some questions and we’re going to go over some content a little bit more from an overview perspective, and then I will open it up for live questions in the last 20 minutes or so of our hour together. And so if you do have questions along the way, you can always pop them into chat. Again, chat is on the bottom menu here in your zoom window. So with that, let’s go ahead and kick it off. And I’m going to direct the first question to Rebecca. Just to talk a little bit about COVID 19 and coronavirus and our susceptibility as women in midlife and menopause. Do we have to worry? Do we have any extra worries? Can you just kind of give us a little bit of an overview and what you’ve seen so far?
Dr. Rebecca Dunsmoor-Su:
I’m happy to go and hopefully I remembered to unmute myself to do so. Hi everyone. I’m glad you could all join us either on the Zoom or on Facebook live or any of our other platforms. I think it’s important to talk about this with a special focus on women’s health because the more we learn about this virus, the more we find that it affects different populations, differently. Currently, I’m at last, last I looked to the who and the CDC for their data, it looks like the biggest risk factors with this virus are age and preexisting conditions. So what we’re seeing is that as we get older, the risk of serious illness and even death does increase. The highest risk group obviously being in their eighties and nineties. Some of that is due to preexisting conditions, but some of that is simply just age and immune system as it, as it ages, it’s less effective.
The preexisting conditions that seem to be the most concerning are things that reduce immunity. So obviously cancer treatment medications that you might be taking to reduce your immune system such as steroids or biologics. But the other, the conditions that are, seem to be very concerning are underlying heart disease and lung disease. So people who perhaps feel who perhaps have heart failure at baseline or who have baseline COPD or asthma might be at slightly higher risk if they catch this virus. That being said, it does not necessarily spare anyone. You know, we’re seeing healthy 40 year olds go, go into the ICU. So I tell everybody, you can’t assume because you’re on the younger side and you’re relatively healthy, that it won’t impact you. We all need to be cautious. And in terms of women and women in menopause, women do not seem to be at, at baseline higher risk from this.
It, if anything is equal risk to men and women if not slightly higher risk in men from what we’re seeing. That may also just be who it’s affected so far and who’s been tested. It’s really hard to know. We haven’t tested extensively enough to really know that. But really menopause itself is not necessarily a risk.
Where I see risk coming in is that menopause can have huge impacts on our immune system because of stress and sleep disturbances. And so really addressing those issues of menopause are key in making sure that we keep ourselves healthy and able to combat this virus.
Jill Angelo:
That’s great. Thank you. Rebecca. One thing I just want to come back to you on for one second. You had talked about medications that people might be on that might make you more, is it susceptible or weakened, our systems. What are those, can you just call those out again?
Dr. Rebecca Dunsmoor-Su:
So the ones that we all think of are steroids. So a lot of people need to be on chronic steroids for a variety of reasons. The medications that we tend to call biologics, they typically end with AB or MAB MABs. And those are usually used for things like rheumatoid arthritis or psoriasis or psoriatic arthritis. Any chronic rheumatologic conditions, we tend to suppress the immune system somewhat because the immune system is the thing on the attack in those conditions. And then the other medications we worry about are things like chemotherapy medications that attack the immune system, attack cancer cells. But also the immune system. So those are sort of the big categories. I would think about.
Jill Angelo:
I saw Swapna was nodding her head, Dr. Vaidya. And I want to direct the next question to you. So you’re working right now with, with patients with mental health challenges and, and maybe stress in dealing with, with coronavirus. Can you talk a little bit about what you’re seeing so far?
Dr. Swapna Vaidya:
Yes. thank you, Jill. And thank you for the opportunity to, you know, talk to all of you and to sort of share some of the situations that we’re seeing right now. And one of the things that I’m seeing is a lot of uncertainty and anxiety regarding the situation as it’s evolving. I’m certain that we are all also feeling it because this is a very new novel situation for all of us. At this point in time, what we are trying to focus on is to stay calm the most that we can and to actually make sure that our patients are being informed that there are dynamic things that are happening and changing, but at the same time, it’s so important to take care of yourselves. One of my very good psychiatrist friends actually sort of jotted down a few very simple things.
One of this is that we’re all in this together. There are simple things we can do. Wash hands, you know, maintain social distancing, listen, be patient. This too shall pass. But at this point in time, the wealth of information that’s coming and it’s very overwhelming. I think it’s very important to channelize what you’re trying to learn from the media and elsewhere. I think it’s so important to take care of each other. I think one of the things that we as women have to remember is that we are the pillar of a family, I mean as it is a woman is struggling all the time, she has to multitask. And this situation has even now driven it 10 to 20 times more intense. Now if you’re talking about families being cooped up together, now you’re talking about dynamics. How are we coping with our relationships?
How are the anxieties coming around? Are we taking care of each other? What about the older population that is living with us? So these are the questions that are coming up a lot and a lot of answers that I have to say to them is that, which is as I’m telling myself, is to take care of each other. Facetime is good, really social distancing. A lot of people are coming and asking me, but why can’t I just go and play and have a play date? And I really feel it’s very important at this point in time to understand the situation of flattening the curve. So as much as you know, engage in self care, you know, follow a good diet, exercise, follow daily routine. It’s okay to go for walks. Meditate, take deep breaths and just simple things as I would say.
You know one of my patients was sort of saying, can you just come up with a simple routine? What should I do? How can I make sure this doesn’t happen? It’s, it just jot it down, right? Like, I mean, okay, what, what do you need? Right? So just kind of make a list. How are you coping? You have one coat, use that coat to go out. Use one bag, you know, simplified your life. And collectively, if we all look into this together, I think we can get through this. You know there have been pandemics and there have been natural disasters and you know, the one thing that I’ve learned, I was actually in New York when 911 did happen and what I really saw was the community come together and collectively address this and you know, things were evolving and even then we didn’t know what was going to happen, but it did pass. And I think this shall pass too, this is my advice to myself and to everybody else, you know, meditate daily breaths. We’re all going to be in this together. We’re going to pass this.
Jill Angelo:
Thank you. I think that’s so reassuring, Swapna. Like it’s, it’s a positive message and we need to hear positivity during this time. Just to kind of go in a little bit deeper around I saw one interesting tweet this weekend around, you know, think about others versus yourself. Even if you are out having dinner or something like that, it’s about the others in your home, whether you’re living with elderly parents or people who are more susceptible to this than you are. That kind of notion of being unselfish and, or caring for the others. I think oftentimes women go to the far right or left on that spectrum. I see women locking down their households right and left. We’re in that kind of the hub of it all here in Seattle. Can you share a little bit more about how, you know, in terms of that thinking of others how we as women can encourage, you know, grown kids or others in our family, in our household that do just want to get out and be with their friends or go out to dinner, that they’ve got to think about others beyond just themselves, who they feel even if they feel very healthy.
Dr. Swapna Vaidya:
You know, I’m Jill, I’m glad that you brought this up and this is such an important time and this is what I was talking about, having a collective consciousness because this is not so much about each one of us individually, but it’s about that vulnerable population. It’s about your grandparents. It’s about that you know, those sector of people who are older with comorbid medical conditions that you as a healthy adult, you may go out and you probably might have a milder version, but here you are at the risk of probably perpetuating it and giving it to somebody in your family who might have a very, very drastic reaction. So I think it’s important to sort of like reinforce this behavior and how would you do it? By promoting this yourself, you know, by pulling up facts, by teaching your kids, but involving your kids.
And I think having age-appropriate discussions with the kids. You know, I have a five-year-old, so I think I kind of like having made some rhymes with him about hand washing with Humpty Dumpty or Happy Birthday, he selects one or the other. Involving them and actually educating them because even if he’s five or 10 or 15 or what have you, education and having a clarity about it really helps.
And I know I keep going back to, we are all in this together, but that’s really the mantra that I keep coming back to. We also as a society have to be collectively conscious. I do have patients asking people, why do I need to be quarantined? I”m healthy. I mean I need to go out. I’m anxious, I’m cooped up. And I know it’s a difficult time, but it’s so important for us as a society to understand that we really are in this together so that we can help flatten the curve and we can actually protect the vulnerable people around us.
And at the same time, self care is very important. So one thing I would like to add, Jill, is that as women, we tend to not care about ourselves. It’s always about the other person first, whether it’s your husband or your kids or your mother-in-law. But it’s important to look at what your needs are and it’s okay to be anxious and it’s okay to not know and it’s okay to say, Hey, you know, I don’t have the answers. Can we, you know, sort of like I need help sometimes. So self-care, understanding, you know, when to kind of put your own oxygen mask, as I say, I know that analogy, it’s so important. So as much as we can do to promote healthy active behaviors involving our kids in healthy active initiatives. And you know I’m sure everyone is involved in Facebook and WhatsApp and what have you. But to kind of promote it to create a healthy platform to share healthy coping mechanisms. I mean we have great people on our panel right now, you know, for the nutrition as well as the other health coaches. And I’m also excited to hear more about for myself as to what I can do during this time. But I think that those kinds of things and those kinds of tips would help so much as we all go through this together.
Dr. Rebecca Dunsmoor-Su:
I just, before you jump in, Jill, wanted to add Swapna brings up a really, really important point, which is that most of us will do just fine with this virus and we’re going to be fine. We probably won’t even require hospitalization, but some proportion of us will. And really the goal of the social distancing is so that as people get this and do require hospitalization, ICU care, and even ventilators, we do it one at a time rather than all at once. Because we will run out of space, we will run out of supplies, and we will run out of healthcare providers, if all of us get it all at once. So really what you’re doing is protecting others, even though you might come through it OK. We need to make sure that this happens slowly and gently across sort of this whole nation. We’re all going to get this. None of us is immune, but if we can do it slowly and carefully, we might just make it through this.
Jill Angelo:
I think that’s a really important point. Thanks Rebecca. And thank you, Swapna you know, I can hear you’re, you’re you’re, you’re a mom and action right now doing your job as well as managing family at home. So you’re, you’re an example for sure. So thank you.
Let’s let’s then pop to nutrition. I’m Lauren, I’m going to go to you next. Lauren is our director of health coaching at Gennev: registered dietitian, nutritionist, and I know your husband as well is one of those on the front lines in the healthcare system right now. So to Rebecca’s point around everyone’s gotta be thinking about others and their health and able to care for others. You’re, you’re, you’re doing that in your household. Can you talk a little bit about immune response? Because we all want to keep our immune systems really strong and a lot of that comes, it starts with what we put in our bodies. So talk a little bit about how you’re, you’re coaching your clients right now and thinking through that.
Coach Lauren Leedy:
Thanks, Jill. And yes, it’s a really challenging time. And I too am a mom and this is, this is hard, you know, to, to balance everything. And at the same time to Swapna”s point to take care of yourself. Like it’s so hard as women to put yourself first. So I’m hoping that women still at this time continue to nourish their bodies well. To support an immune response, the big thing is to load your body full of nutrients from whole foods. I’m not talking about going and taking certain supplements. There’s going to be a lot of, lot out there, a lot of people capitalizing on the fact that people are trying to boost their immune system right now and promote supplements. The best thing you can do is load your body full of nutritious whole foods and make sure you’re getting adequate fluids.
Coach Lauren Leedy:
So that’s going to do the, the best to prepare your body for actually attacking or getting rid of this virus. And I know what complicates things right now is the fact that our supply is limited and a lot of us are trying to avoid places like the grocery store and getting food or maybe we have kids at home and we just can’t take the time to go out and get that food. So I’m really recommending to my clients that they use this time at home to try out some new techniques they might have always wanted to try. For example, there’s a lot of amazing meal delivery services out there that you can sign up and have cooking kits or fully prepared meals sent to your home. It’s a really great way to involve your kids too if you do have kids at home to prepare some of these different cooking kits.
Another idea too with fluids, a lot of us struggle with getting enough fluids. One simple technique I wanted to share that, you know, women could try to do while they’re at home is the rubber band method. So a lot of people love this technique. Figuring out how many bottles of water you need to drink in a day, and putting that number of rubber bands around the water bottle. Every time you finish it, you take off a rubber band. So the goal is to get them all off by the end of the day. And, and it’s amazing what just nourishing your body and giving yourself enough fluid can do. The other thing I might add just because as women you’re probably got your hands full right now, that this doesn’t have to be elaborate. You don’t have to feel like you”re cooking all the time. Some time saving tips, you know, use the package foods that are out there and dress them up.
This doesn’t have to be perfect eating, you know, add veggies to a frozen pizza that you have. Throw some extra veggies in a soup or a smoothie, make simple modifications or batch cook once and freeze. So you have multiple meals to work off of. So that’s, you know, it really doesn’t have to be more complicated than what we generally promote.
Jill Angelo:
And how about how about in terms of foods that really boost the immune system? Just call those out. I know we kind of read about it all the time, but, but why don’t you just call those out? What are some specific ones.
Coach Lauren Leedy:
So really fresh fruits and vegetables that are going to be rich in antioxidants. Those are going to the best thing. So the brighter in color they are the better, but you really can’t go wrong with fresh fruits and vegetables. Just a whole foods based diet, not singling out one nutrient or one food in particular. Those are going to be your best bets.
Jill Angelo:
I know in Instagram posts, I think last week you posted a number of these food delivery options. So we should go ahead and include those in our followup on notes for this webinar. But also are, is there any overall guide that you’re watching? Because I know every business is vulnerable during this time. Are any of these delivery services like curbing delivery because they also don’t want to put their staff at risk? Or any, have you heard anything there yet? Are they all functioning?
Coach Lauren Leedy:
Yeah. So I did try to do a grocery delivery service this weekend myself and it was definitely delayed. So another tip I have too, if you need something right away, our local businesses right now, like you said, small businesses, they’re really vulnerable and they’re hurting and we we don’t, you know, want them to, to crash and we want to support them, but at the same time, there’s recommendations to not go to restaurants. Many of them are still open for delivery, takeout. So please use those businesses and maybe try out a new restaurant but get a delivery or get a go pick up your order as another quick strategy. The other thing I wanted to highlight that at Gennev I think is health coaches. You know, put us to the test, use your health coach. Let us know what’s in your pantry right now. And we are more than happy to help you put together a healthy, nutritious meal. So this doesn’t have to be starting from scratch. Like you tell one of us exactly what you have. And we love doing this. We’d love to help you come up with a creative easy throw together meal.
Jill Angelo:
That’s awesome. That’s great. It’s kind of like having someone come over and take a look at your closet and put together like outfits for you.
Coach Lauren Leedy:
It”s our own chopped challenge.
Jill Angelo:
Yeah. Yeah. That’s great. That’s awesome. That’s awesome. Well then on that note I’m going to move to Stasi. Stasi, your colleague on the coaching side of Gennev. And Stasi you focus a lot on just managing kind of exercise and activity and how even that can help manage the stress and/or sleep challenges that we might be feeling during this time. Can you talk a little bit about more about you know, immune response measures that women can take and that you’ve been talking to women about? As we’re all cooped up, can’t go to the gym, you know.
Coach Stasi Kasianchuk:
Yeah, absolutely. And exercise definitely is a passion of mine. Something I’m right now, especially I’m navigating how do I continue to move my body to be able to be my best self as well as we look to manage this. And exercise I love to similar to nutrition is that there’s a lot of varieties. There’s not a one size fits all approach. And so that gives you a lot of opportunity to try something that’s going to find to find something that’s gonna work best for you. And during this time I think it’s important to come back to, again, all of the messages we’ve heard here. Swapna had some great points on, you know, routine. How can you keep a routine or maintain a routine?
A lot of the women that I work with around menopause, it’s a different, it’s a new time of their life, so they are trying to establish a new routine and I encourage now you might have an extra challenge in finding that routine, but incorporating your family. If you have kids at home, kids need to move too, it can help them get some energy out. So maintaining or establishing a movement routine throughout your day. Now if you’re someone who has more been used to having your exercise time in the morning, maybe that’s changed up a little bit, especially if you can’t go to your gym. But still designate that time. So if you can keep the morning time, great. Maybe it has to move to the afternoon or you can still get benefits from spreading it out. So if you don’t have that hour but you can spread out 15, 20 minute blocks throughout the day, bring the kids along. You know, maybe you’re, if it’s safe, if you are not a high risk population and it’s safe for you to go outside and remain social distance that is definitely an option.
I think the fresh air and sunshine if it’s available to you is really good for us right now. Just remembering to maintain those public health recommendations around where you are outside. So I think that’s establishing that routine and incorporating the family is a great way to keep moving and really help to manage that stress when we are in that one place for too long and not moving our body. We know that sedentary behavior is not supportive of our health, so how we can fit that in right now is going to be important.
Jill Angelo:
That’s great. I know I noticed this morning on my, my morning run, every time I’d meet someone on the sidewalk, like the other person would either go to the street, like we totally like avoided each other even on the sidewalk, which was interesting. So yeah, it’s very real.
Coach Stasi Kasianchuk
I have that experience too. Yesterday and it was interesting feeling that it was all of a sudden it was a sign of respect to do that. So interesting times right now, but accepting that, OK, that”s your side of the sidewalk. I have no problem going to the other side. No offense. We’re doing it for each other.
Jill Angelo:
Yeah. You know, one thing I hear you talk about, Stasi, a lot is journaling and and again, this notion of routine and maybe it changing or whatever. Is there comfort in journaling too? You know, I might feel like, Oh God, it’s going to like push it in my face, all the things I’m doing wrong, you know, and be another stress. Or is it comforting and healthy? Like talk a little bit about just even documenting what we’re doing on a daily basis.
Coach Stasi Kasianchuk:
Absolutely. Yeah. Journaling is really helpful for women during menopause because so many things are changing and rapidly it can be difficult to remember what happened yesterday, let alone last week or last month. And because we’re trying to see what patterns are happening to then best put together a toolbox to support women during this time. So every, what I, when I’m working with clients, I want them to establish a toolbox so they have the tools to pull out when certain symptoms come up and they feel prepared for that. Doing the journaling can allow you to see what’s happening over time. And so a lot of women will notice patterns. Oh wow, this happened, this did happen last month. I have it documented. Okay, this might start happening every four or five weeks. So what can I do ahead of that curve to best prepare myself for these situations?
And I think this is relative right now too because this is an added stress. How can you reflect on what’s going on, what you really need right now.Aand Swapna you know talked about jotting things down of what do you need in this present moment. I think journaling can be helpful for that as well. I think as women we not to get into the genetics of it, cause I don’t know, I’m not an expert in that area, but I honestly think women tend to hold things in their head more and we let things and Swapna, feel free to jump in, but it feels like it’s a, a, a storm in our head. And so that first step of journaling I find, I talked to a client on Friday where she was actually working more on journaling related to perfectionistic thoughts. And how those perfectionistic thoughts were taking over.
And by journaling those, she was able to identify it. And in reviewing her journaling, she was able to identify areas where she wanted to focus on this week moving forward. So then it, it pulled out a focus point rather than having to focus on everything. So I think journaling can be really helpful as that step. Could also be a step of where do I need to have a conversation about this versus, okay, this is the
If you’re in or around menopause and struggling with issues such as weight management, sleep, stress, nutrition, bone health, appropriate exercise and more, a health coach could be just what you need. In this podcast, Dr. Rebecca Dunsmoor-Su, Gennev Chief Medical Officer, and Lauren Leedy, Registered Dietitian and Director of Health Coaching at Gennev, talk about what Gennev health coaches do, how they work with our physicians, how they’re specially trained to help women in menopause, and why the Gennev model is such a great value for the money. Want to know where you are in your menopause journey?
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First, take our Menopause Assessment.
Then, make an appointment with a Gennev health coach to learn more about the changes your body is going through, and put together a plan to help you relieve symptoms now and stay healthier in the many years ahead. If you had virtually unlimited access to a health coach, what would you ask? If you’ve worked with a Gennev health coach, tell us about your experience in the Gennev community forums!
Its been about 4 years since Ive had a mammogram. Shame on me.
I stopped after I went through the repeated 6-month ultra-sound monitoring required for suspect spots, common with dense breasts.
Yes, I have dense breasts.
If youre like me, I dread a mammogram for so many reasons. It hurts. My boobs dont like to be flattened, and while my pain tolerance is rather high, breast pain hurts so bad!Its also inconvenient. Im not great about booking scheduled appointments that are a necessary in life. Its not that Im fearful. Rather, Im loathe to do something that feels required compared to pumping out a fun new marketing campaign or an email like this one.
Im certainly not practicing what I preach when it comes to women taking control of their health.
So, Im writing this Friday email as a reminder to book a mammogram during this month of Breast Cancer Awareness for me, as much as it is a reminder for you.
Beyond life getting in the way, mammograms have become something to be feared, mostly due to journalistic hype or new schemes for securing a profit.
Gennev’s Chief Medical Officer, Dr Rebecca Dunsmoor-Su, penned a bold and transparent article on the Myths About Breast Cancer Screening.
In it, she debunks the notion that practitioners earn anything from recommending mammograms. She takes on scare tactics about the levels of radiation used in mammograms (which is less than what youre exposed to in two months of living on our planet).
Its a 45-second read that is your best defense during this month of breast cancer awareness. Most of all, I love her call-to-action to donate to breast cancer services for more women. If you have the means, I urge you to do the same, so all women have access to breast cancer screening.
Some options to consider are the American Cancer Association, Susan G. Komen, Planned Parenthood or a similar organization. More than ever, I urge you to do two things:
– Book a screening if you havent had one in the past year
– Reach out to a loved one who has survived to let her know that you care about her
If you care to share how you reflect, engage in, or respond to Breast Cancer Awareness Month, please shoot me an email at jill@gennev.com. Id love to hear from you.
Jill
As Gennev’s Chief Medical Officer, I help write or edit some of the content you see on our site, but you don’t always hear my thoughts in my own voice. In honor of Breast Cancer Awareness, I want to talk seriously about breast health in midlife, cancer, and screening.
Truth: Breast cancer, caught early, is curable
First, I want to emphasize two important points:1 in 8 women in this country will get breast cancer over the course of their lifetimes.
If you catch it early, it is curable (90% of women with breast cancer will be completely cured).If you are worried about breast cancer, a Gennev menopause-certified gynecologist can give you a trusted opinion. Book an appointment with a doctor here.
4 Myths about breast cancer screening
The second point is why I am writing today. I want to dispel myths about breast cancer screening. I am a full-time practicing clinician in Seattle and will often hear these myths and fears in my practice. It worries and upsets me when women get incorrect or even dangerous information.
Myth 1: Screening kickbacks.
This is the idea that your doctor orders screening tests, labs, vaccines, etc. because they get a kickback or make money on it. The fact is, there are specific laws against kickbacks that we are trained on every year. Doctors can lose our licenses or even go to prison for making money through referrals.
Myth 2: Mammograms are radiation and over time will cause breast cancer.
No, for the most part this is not true. While mammograms do use radiation, they use very little equivalent to about 2 months of the background radiation that you get from living in the world. What is true is that the minor risk of this exposure is completely outweighed by the ability to pick up earlier stage breast cancer, so on balance mammograms overwhelmingly save lives.
Myth 3: I dont need a mammogram as I do breast self-exam and will feel a lump early.
No. I would never discourage self-exams, but they cant take the place of a mammogram. This idea is false because the average size of a lump picked up by regular mammogram is about 1 cm, whereas the size picked up by regular breast self-exam is approximately 3 cm. There is a great graphic produced by the Susan B Komen foundation that shows this.
Myth 4: Thermography is as good as mammography at detecting cancer with no risk.
This one makes me the angriest. False, false and more false. Thermography (the idea that breast cancer is hot and can be picked up with a thermal map of the breast) was tested as an alternative to mammography. In the studies done, this screening modality had a 25% false positive rate (claimed to find cancer when there was none) and much more concerning, a 60% false negative rate, meaning 60% of the time when a lump or cancer was present, it was not detected and the study was negative. More modern devices have been tested again and proven to be equally inaccurate.
So why are there thermography centers? Because the device is FDA cleared which means it has been deemed to be safe to use (it wont directly hurt you) but has never been determined to be effective. Any device with FDA clearance can be used in the US. Centers can promote and sell this modality for profit. Some of the providers who promote thermography actually believe it is effective, but they dont have the training to be critical about the source of their information. Some thermography providers believe that mammograms are part of a conspiracy and that they are saving women from this (really). Some just want to make money. Whatever the reason, thermography is not a safe modality to use.
It’s time to dispel the myths of mammography. And in honor of breast cancer awareness, I do not wear pink – but I do I donate to my local Planned Parenthood which is the largest provider of low- and no-cost mammograms in my region. Find out who it is in your region and consider supporting them. And get your mammogram (I do)!
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I’ve never loved the word nipple until now.
In the last week, someone near and dear to me was diagnosed with breast cancer.
How did she know to get her breast health checked? She had a newly inverted nipple.
That’s not common knowledge for most people. And for her who has a history of it in her family, she thought it to be no big deal.
Until her job moved her to research it further”¦and I don’t mean look it up on WebMD, but seriously do some hardcore medical research.
If you are worried about an inverted nipple, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.
Breast Cancer After Showing An Inverted Nipple
Her findings turned up that it was an indication of breast cancer.
She made an appointment right away for a mammogram that turned into an ultrasound which became a biopsy which really set some wheels in motion.
For my friend, her newly inverted nipple was not impacting her daily health”¦and in fact, was commonplace in her family. So typically, someone in her shoes would write that off as normal, or as another “women’s bodies are complicated” notion.
Fortunately for her, her job involves researching health and wellness care for women. And, because she happened to be researching breast cancer indications (and came upon the inverted nipple indicator), she consulted with her doctor, the cancer was caught early, and she virtually saved her own life.
I’m sharing this story with you, because it underscores how responsible we are for our own health.
Being aware of our bodies, researching any big or small change and making it a priority to speak with a practitioner as soon as you see it versus feel the impacts of it is serious stuff.
We’re living longer, more vibrant lives than ever, and my hope is that Gennev is a place for answers as whether that be in a DIY sort of way or a reach out and ask for help way as just get curious and don’t waste time thinking you’re needy or wondering if something is “serious enough” to look into.
Is an inverted nipple a sign of breast cancer?
As a response to this new learning of an inverted nipple, you better believe that we’re adding it as a symptom to track within Gennev’s Menopause Assessment. We are publishing an updated version of the assessment in October 2019, so if you’ve taken it already, I highly encourage you to take it again at that time. Don’t worry, I will remind you.
And if you too have an inverted nipple, especially if this has happened recently, please go to see a doctor or specialist. Information is power and taking these scary changes head-on can save your life.
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