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As a nutrition coach, I frequently field questions from my clients who are concerned about whether or not they are getting adequate amounts of protein in their diets.

While I think the concern is valid, I do believe that the hyper-focus on this food group is a byproduct of a trend that I like to call “Labelmania.” Everyone is talking about what their nutrition label is these days, and many of the labels du jour have a protein-centric approach, from Paleo and Atkins to Ketosis. I feel like I can’t go to a social outing anymore without people asking me what or how I eat!

Pushing protein

Speaking of labels, another culprit fueling the protein phenomenon is food marketers who overpromote our need for protein on their packaging. It’s hard to walk down a grocery and avoid being drawn to these colorful, impactful labels.

Power Bar is a perfect example of this. Their Chocolate Peanut Butter Protein Plus Bar boasts a whopping 20-30 grams of protein. Sounds great, right? What they don’t promote on the label is the 12 grams of sugar in the bar and the nearly 20 ingredients it contains, most of which are impossible to pronounce.

These labels and messages around protein are everywhere, from TV commercials to social media. It’s so much information, and it can be completely confusing.

I’m here to help, because I want you to know that this whole protein thing doesn’t need to be complicated. I’ve created a list of four protein pointers that will help you get the protein you need without the stress. They’re easy to follow and will help you cut through the marketing and Labelmania clutter.

1. Know how much protein you really need

It’s easy to make your protein quota! Did you know that the average woman needs approximately 46 grams of protein each day?

It doesn’t take much effort to get to 46 grams; even if you’re a vegetarian. For example, if you consume a 3.5 oz serving of salmon (25 grams) + 2 eggs (12 grams) + 23 almonds (6 grams) + 1/2 cup quinoa (11 grams), you’re at about 54 grams of protein for the day. That’s pretty easy to attain and you didn’t even have to eat a bar!

2. Get protein power from plants

Put plant-based proteins in your portfolio. Protein doesn’t need to mean meat, meat, meat. There are so many nutrient-dense, plant-based proteins to fill your plate with AND satiate your appetite.

Some of my favorite plant proteins are lentils, chickpeas, quinoa, almonds, kale, tofu and broccoli. Animal-based proteins are an important part of your diet, but it’s important to be cognizant that excessive amounts can be detrimental to your health.

Experts agree that if you eat more protein than your body requires, it will simply convert most of those calories to sugar and then fat. Increased blood sugar levels can also feed pathogenic bacteria and yeast, such as Candida albicans (candidiasis), as well as fueling cancer cell growth.

3. Go protein au naturel

Reduce your intake of man-made proteins. I get it, you’re busy, and it’s way easier to grab a bar than it is a piece of chicken breast when you’re starving and on the go.

If you are truly concerned about your health and what you are putting in your tank, then remember the Power Bar I told you about earlier. Sure, you might be getting protein, but you’re also getting a whole lot of other fake ingredients that detract from any “good” you’re doing.

I’m not asking you to quit bars cold turkey, but reduce your intake of on-the-go wrapped protein options, and find some other smart, on-the-go solutions.

Starbucks is doing a great job with their Mercato products; from their sous vide egg bites to their protein boxes with hard boiled eggs and hummus. If you’re going to do a bar, I’m a fan of Kind and RXBAR bars, as they have minimal ingredients.

4. Time it right

On workout days, timing is everything! If you have an intense workout, time your protein intake correctly pre and post workout to avoid the hangries. This is important at any age, but it is especially crucial now when hormones can play such a key role in our moods.

By timing our protein intake around workouts, we can manage through the hangries and the roller coaster effect of feeling food-deprived. On workout days, eat a 3- or 4-to-1 ratio of carbohydrate to protein one hour before and after exercise to ensure your muscles are fueled and replenished. By pairing proteins and carbs, you can slow sugar absorption and help stave off food cravings.

The bottom line is this: protein is a powerhouse that has many powerful effects on your body and mind, but your focus should be a well-rounded diet that also includes lots of vegetables, fruits and healthy carbohydrates.

Try to follow my pointers and try not to get too caught up in Labelmania. It really doesn’t matter what label you’re wearing, it’s how you go about wearing it.

Cheers to your health!
Michelle

More from Michelle:

The holidays are coming round again (canyoubelieveit?). Be ready for the stress “” and the stress eating. Looking for a better way to feed yourself and your family? Be sure to check out how to shop your Farmers’ Market and buy from the bulk aisle!

How are you feeding yourself for optimal health? We’d love to know. Share with the community in the comments below, or hit us up on Gennev’s Facebook page or Midlife & Menopause Solutions, Gennev’s closed Facebook group.

 

“Every woman that reaches middle age will experience some level of menopause symptoms. Left untreated, these symptoms can lead to a significant reduction in quality of life,” says Gennev Chief Medical Officer, OB/GYN Dr. Rebecca Dunsmoor-Su.

And because none of the 1.3 million American women who enter menopause each year will have exactly the same experience as another “” and because two women can have vastly different experiences “” there’s never been a real attempt to chart the journey through the transition.

Until now.

Recently we crossed a major milestone here at Gennev: 50,000 women have taken our Menopause Assessment! Created in 2017 by Dr. Dunsmoor-Su, the comprehensive Gennev Menopause Assessment asks women for information about their age, menstrual cycles, symptoms, and history.

Based on women’s responses and Dr. Dunsmoor-Su’s 20+ years of expertise as an OB/GYN with special expertise in menopause, we identified five distinct menopause types. From there, Dr. Dunsmoor-Su, along with our CEO Jill Angelo, created the first-of-its-kind Menopause Journey Map.

Why the map for menopause stages matters

Why is the map a big deal? According to Dr. Dunsmoor-Su, “We’re excited to deliver the Menopause Journey Map to help set expectations for women and offer predictive solutions for symptom relief, something that’s never been done before.”

If you’re a Type 1 (periods becoming irregular, occasional hot flashes), it might be very helpful to know what probably lies ahead in Type 2 (skipping periods, heavy periods, some hot flashes, poor sleep). You can start making lifestyle changes now to combat symptoms, and perhaps the first time you experience normal, harmless, hormonal heart palpitations, you’ll know how to distinguish them from something more serious.

Perimenopause is an opportunity to start practicing some serious self-care in terms of diet, exercise, sleep hygiene, and more. But many women miss a lot of this window, not knowing the symptoms they’re experiencing are hormonal. And if your primary physician isn’t well-educated on menopause (as many aren’t), they may not know either.

Too many women spend years being misdiagnosed, or worse, ignored, before getting the answers they need. But because our health in perimenopause can affect our longer-term, post-menopausal health (think brain, bones, and heart), it’s important that we know when we’re in it.

And no, your getting hormone levels tested probably won’t tell you.

Hear more about the map from the creator of the Menopause Assessment, Dr. Rebecca Dunsmoor-Su:

What are the Menopause Types?

Our Menopause Map breaks menopause into 5 types. (A detailed overview of Menopause Types is available here):

Knowing your symptoms and cycles is the best way of pinpointing your place in the journey, but to truly understand your body, it helps to discuss your experience with a menopause expert.

Know where you are in the journey

Cliché or not, knowledge truly is power as the power to take control: To manage perimenopause and menopause symptoms now, and to make good choices to preserve your health, independence, and quality of life for the many decades that come after menopause.

“For too long, women’s health 40+ has been treated as shameful, but with GenX women aging into midlife, demands for menopause information, community, and solutions are on the rise,” says Jill Angelo, co-founder and CEO of Gennev. “The healthcare industry has been stubborn to evolve, but now we have the data, software, diagnostics, products, and services that allow us to tackle menopause symptoms head on. We have the ability to create the What to Expect When You’re Expecting for menopause.”

If you’re ready to find out your Menopause Type and start charting your path on the Menopause Journey Map, the first step is to take the Gennev Menopause Assessment. This free and confidential questionnaire takes less than 10 minutes.

Once your Assessment is complete, you’ll be directed to create a free account on Gennev. From your personal, confidential dashboard, you can learn all about your menopause type, get product recommendations specific to your symptoms, find educational materials tailored for you, and connect with a Health Coach or OB/GYN. Then, with your Gennev menopause team, you can build the plan that’s right for you.

The definition of menopause is actually really simple: it’s just one day. Menopause is the one-year anniversary of your last period. This is perhaps the only thing about menopause that’s “simple.” But menopause doesn’t have to be unpleasant or something to dread. With knowledge and a Menopause Plan, you can survive and thrive through the transition and for many many years beyond.

 

Menopause Journey Map

 

From the wellness expert who brought you “sleep hacks: herbs for sleeplessness and anxiety“ comes another video packed to the eyeballs with healthy herbal goodness.

This time, Jovanka is taking on another common menopausal symptom: digestive disruption.

“Your digestion is at the cornerstone of your health.
Without a healthy gut, everything else will start to fall apart eventually.”

As estrogen levels fall in midlife, cortisol levels rise, bumping up both your blood pressure and your blood sugar levels. The hormonal imbalance can slow digestion, causing gas, bloating, constipation, pain, and indigestion.

There are lifestyle changes you can make to help control the problem: eat slowly, drink plenty of water with your food, choose foods in menopause that help with digestion (are high in fiber), get enough sleep, and exercise regularly. But for many women, lifestyle changes don’t provide sufficient relief, and digestive symptoms as and the risk of embarrassment as really cramp their social and professional lives along with their stomachs.

So if bumping up your intake of leafy greens isn’t enough, Jovanka has some great suggestions of herbs that can help regulate your digestion and get your gut back on track. 

 Want more herbal relief? Check out Jovanka’s ebook, 12 Libido-Enhancing Herbs, for even more support of your healthy, fabulous life.

Jovanka is a featured expert at People Magazine, Entertainment Tonight, Whole Foods, Veria Living, Fox News LA, NPR and CBS Radio. She’s also a regular contributor in Spanish-language media outlets like Telemundo and is a contributing guest expert at The Huffington Post, MindBodyGreen, BlogHer and PositivelyPositive. Jovanka gave her first TEDx talk on “Rethinking Failure” in November 2013. Want more Jovanka (and who doesn’t, frankly)? Check out her creation: the Wellness Smackdown , an online wellness & learning community for healthy living, which was featured on the first season of ABC’s “My Diet Is Better Than Yours.” Jovanka also offers lectures, workshops and wellness coaching in both English and Spanish.

 

Her older sisters told her that her symptoms were just part of perimenopause. 

But she knew her excessive nighttime sweating, severe fatigue, and especially her unexplained weight loss were signs of something more serious. She felt these were not just warning signs of menopause. She persisted and eventually received a diagnosis: a rare form of cancer. 

After several rounds of chemo and a stem cell transplant, she’s back to thriving””because she knew her body and her symptoms.

Midlife can be as confusing and full of changes as adolescence. Your body is going to do things that don’t feel normal to you but are a natural part of perimenopause and menopause. 

Unless they aren’t.

Chances are, what you’re experiencing is due to hormonal changes in perimenopause/menopause or to aging. But you know your body best, and if something feels more urgent, don’t hesitate to take it to a qualified medical professional. Pay attention to what and how you’re feeling; you may want to take extra precautions with some menopause symptoms if you have a personal or family history of certain conditions or symptoms that come with other discomforts.

If you are experiencing unbearable symptoms, a Gennev board-certified OB/GYN 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.

Talk to your doctor if you notice any of these red flag warning signs for menopause

  1. Fractures before menopause.  If you’ve broken a few bones, or even just one, after age 50 and before menopause, you’re at greater risk for  osteoporotic fractures after menopause, even after all other reasons for osteoporotic fractures (like maternal fracture history, bone mineral density, diet, and drug use) are ruled out. Talk to your doctor about preventative measures.
  2. Post-menopausal bleeding or discharge. Irregular, inconsistent bleeding or unusual or foul-smelling discharge should raise a red flag for people with uteruses at any point in their lives, but any bleeding or discharge after your periods stop in menopause is a major red flag; it could be a sign of uterine cancer. Your doctor may order some testing for you, including an ultrasound and biopsy.
  3. Weight gain, brain fog, fatigue, temperature regulation, and irregular periods if you have an autoimmune disease or family history of thyroid problems. Many of the symptoms of hypothyroidism can mimic the symptoms of perimenopause. The most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder that attacks the thyroid, which is why people with Type 1 diabetes or celiac disease especially should rule out Hashimoto’s. And, of course, if hypothyroidism runs in your family, you might want to talk to your doctor.
  4. You’ve had a major depressive episode prior to perimenopause. Fluctuating estrogen is enough to make anyone in menopause moody. But if you’ve had a major depressive episode in the past, you are 59% more likely to have another as you enter perimenopause. And if you haven’t, but are experiencing fatigue, headache, and a sense of prevailing sadness now that you’re in midlife, you may be depressed and not even realize it. Mental illness is no joke; talk to your doctor about your options before your mental health takes a downturn. There’s no shame in it, and no shame in seeking help.
  5. Excessive sweating. Hot flashes are a normal part of menopause, but excessive sweating, especially nighttime sweating, can be a sign of something more serious, along the lines of heart attack or lymphoma. If you’re soaking through the bed sheets every night, especially if you also have unexpected and unintended weight loss, and/or a lump in your armpit, neck, or groin, talk to your doctor.
  6. Incontinence. 30-40% of women experience midlife incontinence, but feeling pressure on your bladder or sudden urges to urinate when you haven’t had them before could be a sign of ovarian cancer. Ovarian cancer in its early stages has few to no symptoms, and in the later stages can easily be mistaken for menopause symptoms. If you have just incontinence, chances are you’re experiencing the normal issue that comes with estrogen withdrawal. However, if you’re also experiencing bloating, quickly feeling full when eating, unintended weight loss, pelvic pain, changes in elimination (like constipation), and incontinence, make an appointment with your doctor. 
  7. Cognitive challenges that go beyond brain fog. Menopause and brain fog is a normal combination or symptom. Mood fluctuations are a normal part of menopause. It’s not uncommon to forget where you put your keys every now and again or have a word right on the tip of your tongue. However, if you have trouble maintaining a conversation, regularly forget the month, year, or where you are, or can’t remember how to pay the bills, or if your friends and family begin to notice changes in your personality, see a doctor. It could be a sign of something more serious such as early-onset Alzheimer’s or dementia. 
  8. Headaches. If you’re someone who regularly suffers from headaches, the good news is that the prevalence of headaches tends to decrease in your 40s. The bad news is that headaches after menopause could be a sign of something more serious. If you didn’t have headaches before menopause or your headache is accompanied by fevers, chills, muscle aches, nausea, or weight loss, gets progressively worse, or hurts more when you stand up, call your doctor. But don’t let this stress you out: migraines and tension headaches are still the most common form of headache in midlife and beyond.
  9. Back pain. Pain is never a good thing, though we often see back pain as a normal part of getting older. Sitting too much, poor posture during exercise, and even your mattress can all contribute to spinal aches. But when the pain is localized or acute, you might want to get it checked out, especially if you have osteoporosis or a family history of cancer. If your pain gets worse at night, while you lie in bed, or when you take a deep breath, or occurs without activity, talk to your doctor””especially if you have a cough, unexplained weight loss, fatigue, or begin to cough up blood. 25% of lung cancer patients report mid to upper back pain before being diagnosed. Lower back pain, when combined with constipation, bloating, pelvic pain, loss of appetite or urinary issues, can be a warning sign of ovarian cancer. Best to talk to your doctor and get yourself checked out.
  10. Your doctor dismisses your concerns. If you can’t have an open conversation with your OB/GYN about your menopause symptoms or feel like he or she dismisses your concerns, find a new doctor. Seriously. Here’s more on what to look for when selecting an OB/GYN in menopause.

Know what’s normal and what isn’t.

Read up on what to expect in perimenopause and menopause.  

And always trust your gut. Talk to your doctor or one of ours if you have any concerns about your health, your body, and your journey through menopause.

 

More and more, experts are recommending a diet heavy in healthy, plant-based foods (vegetables, greens, fruits, nuts, grains, and legumes) and light on animal products (meat, eggs, cheese, milk, and other dairy products) and processed foods to improve health in midlife and beyond.

Every body is different, but there are a few reasons to consider eating more plants and less meat:

Whether your goal is to go fully vegan (consuming no animal products at all, including meat, eggs, and dairy), vegetarian, follow a Mediterranean diet, eat fewer animal products in general, or go meatless once a week (#MeatlessMonday), any new dietary change requires at least a little effort and commitment. 

Here are a few tips for making plant-based modifications stick.

Please note: while we do recommend products and books, none of this content is sponsored. These are resources we’ve found helpful and think may help you. Talk to your doctor (or one of our menopause practitioners) before making any dietary changes.

1. Remember: veggies are part of any healthy diet

Many people approach vegetarianism with the idea that you will be eating more produce (and hence, more kitchen prep time) than you did before, but they forget that fruits and vegetables should be a part of any healthy diet: 50% of your plate should be leafy greens and veggies.

If you think about it this way, you’re really just swapping out the protein. That’s not so hard, is it?

2. But don’t just eat vegetables

Plant-based doesn’t mean only eating fruits and vegetables; you still need protein (see below for more info on this), healthy fats, and carbs. You’ll become fatigued and hungry quickly if you remove animal products and don’t replace them with their nutritional equivalent: not a recipe for long-term success!

3. “Vegan” does not always mean “healthy”

Vegan donuts, cookies, cakes, ice cream, pizza, and burgers may not have cholesterol but are highly processed treats to be eaten in moderation. 

Still, a good vegan cupcake can be life-changing: plant-based eating doesn’t have to mean deprivation!

4. Educate yourself on nutrition

A healthy plant-based diet will give you almost all of the nutrients you need. The one exception is vitamin B-12, which is mainly found in animal products like meat, eggs, and dairy. When you’re limiting your consumption of animal products, consider shopping for a good quality supplement or research and eat some vitamin-fortified foods.  

“Wait,” you may ask, “I’m not going to get everything I need from the food I eat?” You may be surprised that many of your favorite nutritional powerhouses, like milk and bread, are actually fortified with minerals like iron or vitamins.

Educate yourself a bit on nutrition and, again, talk to your doctor before making any dietary changes. 

5. “Where do you get your protein?”

You may have been told your whole life that you need meat to get enough protein, but a healthy plant-based diet provides more than an adequate supply.

Beans and other legumes, grains, nuts and seeds, tofu, and even many vegetables are excellent sources of plant-based protein.

You’ve probably heard that to get a complete plant-based protein, you need to eat beans or tofu with rice or some other grain. While most plant-based protein sources are missing one or more of the nine amino acids that form a complete protein, your liver stores amino acids for later use, so as long as you’re getting everything you need in a 24-hour period, you don’t need to be militant about pairing complementary amino acids.

6. Say yes to soy in midlife

Soy sometimes gets a bad rap, but experts at Harvard University say that soy has either a beneficial or neutral effect in the body, especially as estrogen levels decline. 

The phytoestrogens in soy called isoflavones can mimic the protective effects of estrogen in the body, potentially helping with hot flashes, type 2 diabetes, depression, bone loss, cardiovascular disease, breast cancer, and dementia.

As with many nutrients, phytoestrogens are best when consumed through the diet; the American Cancer Society recommends against soy supplements. 

A note on tofu: Plain, raw tofu can be unappealing, but so is unseasoned chicken. It’s all about the flavor and texture: play around with marinades, sauces, and preparation methods, like pressing, frying, and grilling it.

7. Branch out and try new dishes at your favorite restaurants 

Chinese, Ethiopian, Indian, and Thai are just a few of the global cuisines with a focus on vegetables and are easily made without meat. Keep in mind that many Indian dishes are often cooked with clarified butter (ghee) and Thai curries generally have fish sauce, but most restaurants will be more than happy to work with your needs.

8. Dine at a few vegan restaurants

Who does plant-based food better than plant-based chefs? Vegan restaurants are popping up all over the country, and not just in big West Coast cities: Omaha, Nebraska is home to one of the top-rated vegan restaurants in the U.S.

A quick search on Google or HappyCow can help you find options in your area.

9. Cook like the pros

Try one of these cookbooks:

Your local library will have these or other options for you to explore with no financial commitment. And, of course, you can always search for recipes online for whatever you’re craving.

If you don’t even know where to start, a plant-based meal service (like Purple Carrot), online or offline cooking classes (like Rouxbe), or YouTube videos can give you the confidence you need.

10. Many of your favorite dishes are already plant-based (or close to it)

You don’t need to venture too far out of your comfort zone! Think about all the things you eat that are naturally plant-based or could easily be modified: hearty green salads, fruit salad, spaghetti and marinara sauce, vegetable or lentil soup, curries, falafel, burritos, banana bread, and even a good ol’ PB&J.

When you’re on the run, Burger King and White Castle offer the Impossible burger, and Chipotle and Taco Bell have many great options for vegetarians and vegans. Bonus: if you hold the meat in your Chipotle burrito, guac is free. #score

11. Keep it simple

Any transition is stressful enough, so stick with cooking easy meals: stir-fried veggies and tofu, smoothies, bean-based chili, pasta, tacos, kebabs with tofu and veggies, soups, and steel-cut oatmeal are approachable weekday options.

If you still don’t know where to start, fill your plate with salad and veggies.

12. Recreate your favorite dishes

Craving lasagna? Scalloped potatoes? With a few substitutions, almost anything you already love to cook can be made plant-based: mashed banana or egg replacer fill in for eggs in baked goods, tofu or a store-bought substitute like Beyond Meat can stand up against meat in many dishes, and a non-dairy milk like soy, almond, or oat subs for cow’s milk.

Look for a recipe online if you can’t convert one from a favorite cookbook.

13. Take it at your own pace

Some people change their diet cold turkey and never look back, while others prefer to gradually make the switch. 

Some people find that swapping out a beef patty for an Impossible burger is something they can stick to right away, while others prefer to start with whole foods that don’t imitate the meat or dairy they crave.

Over time, you’ll find it to be easier and easier to manage.

14. Plant-based diets have a reputation for being expensive, but they don’t have to be

Veggie meat and non-dairy options are better than they have ever been. There’s more variety, better quality, and you don’t even have to go to the “granola” grocery store to find them.

Still, processed foods are expensive and not always healthy. Save money by buying nuts, dry beans, and other staples in bulk and sticking to whole foods. 

And what’s cheaper than rice and beans? If this sounds punitive, you just haven’t had good rice and beans.

15. You may need to swap more than just the food

You and your partner used to love date night at the local steakhouse, but your only plant-based option there now is a sad garden salad.

If date night is really just about the meat, you’re out of luck (in many ways), but happy couples really just want to spend time together. 

Switch it up! Swap a food-date for an activity- or adventure-date. Explore new restaurants, go for a hike, play pool at the local dive, or find other ways the two of you can share a special connection.

16. Don’t restrict yourself

If you want to eat something that’s not plant-based, eat it. If date night needs steak, eat steak. If your mother will be upset if you don’t eat her famous lasagna “” and you want her famous lasagna “” then eat lasagna.

Restricting yourself too much will make you resentful. If you’re doing this for your health, you have the motivation to keep it up; a few missteps won’t hurt and could even improve your long-term approach.

17. One bad plant-based meal or product doesn’t mean that all plant-based food is bad

If you go to a bad burger joint, you don’t think that all burgers are bad. You just had a bad meal.

The same goes for plant-based dining and products. You may need to try different foods or, say, different brands of vegan cheese until you find what you like.

18. Your family doesn’t need to be on board (though it helps!)

If you’re the cook in the family, you know that it’s already hard enough to feed a picky teenager or spouse without adding another complication.

If you’re tempted to cook separate meals for yourself, opt instead for a la carte: serve meat, cheese, or dressing on the side with pasta or salad or put together a taco, burrito, or baked potato bar so that everyone can add what they want.

19. Find community

Everything is easier with a support network. You are going to have questions, question your commitment, and maybe even encounter a few other issues. If you don’t know anyone else who is trying to cut down on meat, eggs, and dairy, search for online communities on Facebook, Meet-up, or YouTube. And definitely join our Community too.

20. Remember why you’re doing this

You’re changing your diet so that you can see all the places you want to see in retirement. You’re doing it to take up that hobby you’re always wanted to try. You’re doing it to keep up with your grandchildren. You’re doing it to feel better and live longer. Remember this when the going gets tough. Feeling better and living better is worth it.

 

Are you ready to adopt and activate any of these tips toward eating a more plant-based diet? Share your favorites, and your progress in our Community. We’d love to cheer you on, too!

 

Dr. Rebecca Dunsmoor-Su

Friends, I am driven to write this article because of the press release about a large study published in The Lancet, which claims to show that hormone therapy definitively increases the risk of breast cancer.

Having read the study, guidance from the North American Menopause Society, as well as thoughts from Dr. Avrum Bluming, an oncologist and author of Estrogen Matters, I wanted to share with you my concerns about taking these results at face value.

The press loves to put out “scare headlines” even if the results are more complex and muddled than that. This is another example of this type of hype. I have four serious problems with this study and its results:

One: It’s based on observational studies

This is a type of meta-analysis of multiple observational (not randomized) studies run over more than 20 years with different complex regimens. They combine both previously published and some unpublished data (which can not be verified).

For those who do not have a working knowledge of epidemiology, a meta-analysis generally involves taking previously published data and combining it to make a bigger study.

In the epidemiology world, a common joke about meta-analyses is that they represent “garbage in, garbage out.” Unfortunately, this isn’t really a joke. When you bring a bunch of flawed studies together and make the numbers bigger, you magnify their faults.

We have several large randomized trials that, with all their faults, give us better, more reliable data, which do not show an increase in breast cancer on this scale.

Two: It doesn’t reflect current practices

The regimens used in many of the studies that go into this big mash up are, in many cases, higher doses and different types of hormones than are commonly used today.

This mix of past and present practice makes it hard to draw conclusions on what doctors are prescribing today, as different hormones can behave differently in the body.

Three: The study is overly complex

The methodology used to analyze the data from these studies is exceedingly complex and hard to follow, which means it is hard to judge the results.

Dr. Bluming noted in his response to the paper, “In the editorial accompanying this paper, Joanne Katsopoulos, of the Women’s College Research Institute in Toronto, wrote: “˜The complexity of the study design makes it difficult to appraise the results and most of us will take the results on face value.’ What? Meaning: This study is such a mish-mash of complicated analyses that even we professionals can’t make heads or tails of it, and must rely on the investigator’s word of what she found?”

I have to agree with this assessment. I have a master’s degree in epidemiology, and I could not make heads or tails of the study methodology.

Four: It focuses on breast cancer to the exclusion of other concerns

This study does not take into account the balance between length of life and quality of life. Breast cancer is just one risk women face as we age, and is not even the leading cause of death.

Estrogen is one of our best and most studied treatments for osteoporosis and may well protect women from heart disease and those at risk of Alzheimer’s disease.

Most importantly, for women with significant symptoms in menopause, estrogen can be life (and sanity) saving. As always, we need to look at the whole woman when making hormone decisions, as she is more than her breasts.

Professor Michael Baum, a leading breast cancer researcher in London, released a long statement about the study. This is a portion of that response, excerpted from Dr. Bluming’s letter on the subject:

“I think the press release put out by The Lancet is irresponsible and will undoubtedly lead to a drop in the use of HRT/ERT, plunging thousands of women into a life of misery and for all we know shorten the lives of millions around the world. Remember there are more important threats to women’s lives than breast cancer, which is now only 7th in the league whilst those higher up the league might increase as a result of the withdrawal of oestrogen replacement therapy. “˜Statistical significance’ does not always translate into “˜clinical significance.'”

As much as the WHI study published in 2017 had flaws in methodology and the conclusions it made, the data from that study are still better and more reliable than the associations made in this more-recent publication.

The WHI, in the end, showed estrogen replacement alone to be protective for breast cancer (even when started late in menopause) and the estrogen and progesterone arm had a slightly higher rate of breast cancer, but not a difference that was statistically significant (which means mathematically it could be a chance or incorrect finding). It is a randomized trial that showed hormones to be overall safe for women if used correctly.

At Gennev we believe every woman has a right to valid data and information when making a personal decision about whether hormones are right for her. We try to provide a balanced interpretation of complex medical studies. We also try to reach out to other experts to see what they have to say.

On balance, this latest publication in The Lancet probably does not add much to the conversation around hormones, except to stoke fear.

Rebecca Dunsmoor-Su, MD MSCE NCMP
Chief Medical Officer, gennev.com

Want to learn more or discuss HRT with other women? Join our community forums and be part of the conversation!

 

Americas future surrounding women’s empowerment and the new presidency

This morning I watched Kate McKinnon’s performance (as Hillary Clinton) of Leonard Cohen’s “Hallelujah”.

And I finally cried.

It’s taken me a while to process last week’s election. As a woman, let alone a CEO of a women-focused business, I knew that I needed to make a statement. Take a stand. Be part of the solution. Not be a victim.

And yet, I couldn’t sift through the disbelief, the anger, the sadness, and the understanding and empathy for the millions of people who believe the outcome is right for them.

So I took some time and just buried myself in life with the reassurance that I indeed will process the outcome and share how I see it with you””women who aspire to be the best versions of themselves.

We started Gennev with the profound belief that women should feel fabulous in their bodies. No matter their age. That comes with taking care of the symptoms life’s aging and processing throws our way. The vast majority of Gennev-ers that we reach everyday with our articles and our healthy products are in the most vibrant years of their lives. They’re at an age where they’ve got confidence, they know what they want in life, they’re financially OK, their kids are relatively self-sufficient, their careers are in a good place, and their relationships are well-grounded or becoming more clear.

For many of us, the outcome of this election threatens the path for women’s empowerment and feeling fabulous. And for others, their lives are not threatened. They either believe that the new president will not impact their day-to-day, because they frankly don’t stand for many of the womanly things that a women-led, democratic administration would have stood for. OR, they’ve risen above it to say, “I’m the boss of me” and are taking action to sustain the path of success, confidence-building and support for other women they believe in.

I’m in the latter camp.

I grew up in North Dakota on a cattle ranch and farm. It was awesome, because there was beauty, peace, fun things to do every day, hard work (which I didn’t mind), and family. The days where we gathered, dirty and tired in the house at 10 p.m. after a long hard day of work for a drink and a late-night snack were blissful. It was a very conservative culture””both morally and politically. I understand it well, because I grew up in it. I don’t share the same conservative views today, but I certainly have empathy and love for the culture of people who do. Conservatives don’t represent all the bad parts of the incoming president””in fact, many have love and compassion for all types of people. But, in this election, many of those people didn’t have a better choice, and when needing to select a candidate that most closely represented what they stood for, Trump was their person. For others filled with hate and anger, I simply don’t understand them and only hope there is a uniting force that brings our country together in a way that I cannot see at this point.

I voted for Hillary. I was with her and still am. Am I ready to band together and work through our differences? I don’t genuinely feel that way””like a kid who’s been instructed to say they’re sorry when indeed they’re not. And yet, I know it’s the right thing to do, and I’ll get there. At my own pace.

The tears I finally shed today were a lot for Hillary. I feel so badly for her. In spite of her short-comings (hell, we’ve all got “˜em), she cares deeply for doing what’s right. She’s had to rise up to levels of strength that most of us will never comprehend in our lives. She’s had to fight back amongst highly public humiliations and allegations. And she’s always done so with confidence. She may not have the charisma of people we love to love””like many celebrities (that’s likely part of why they’re so famous)””but we don’t always need to like people in positions of decision, leadership and power. We just have to believe in their ability to lead on our behalf. We have to be able to respect them.

You may have seen the photo of Hillary hiking the leafy paths of Chappaqua, NY last week. I love how human she looked”¦still with a smile on her face. That’s the image we need to be reminded of and replicate when we’re feeling down in the dumps. I hope she gets more time for hiking in the woods in the coming days. I’m going to follow her lead and keep living my life with confidence, grace and a positive outlook”¦but not let go of all the things I stand for when it comes to women’s development, rights, health, and success.

Hallelujah for women like Hillary who dare to take such a bold stand!

 

As I look back on 2019, it was an amazing year for women in the second half of life.

Everywhere we turned, we saw women owning their lives. From celebrities to politicians; career-focused women to those who have mastered their family needs, we witnessed women taking charge. We also heard from women who were suffering from changes in their health, and from others making huge strides in their well-being.

This article is dedicated to you. As a community, you grew thirty-percent: 85% of you are from the U.S. and 15% of you are from countries around the world.

You showed us that you’re hungry for information, so we recapped the Top 10 articles most read by this community to bring 2019 to a close.

As the team and I curated this special edition, we were struck by the diversity of what women in midlife must deal with. It’s not just menopause. It’s also aging parents, kids, careers, discerning fact from fiction, feeling appreciated in life and finding gratitude and contentment.

We hope you enjoy “” even share “” this recap of 2019. Here’s to an incredible year for women’s health. The best is yet to come!

Happy New Year!

 

 

 

 

Jill Angelo,

Co-Founder and CEO, Gennev

Compounded bioidentical hormones

Looking for a more “natural” solution for menopause symptoms, many women are choose bioidentical hormone replacement therapy. But what is BHRT? Is it safer than HRT? Get the facts on hormones, compounding, hormone “matching,” and how to be your own best advocate when it comes to your care. Read the full article.

Is this normal?

It’s the question we at Gennev hear most often: I’m experiencing X as is this normal? Chances are, yes. Yes, it is. And we’re so glad you asked. We believe the more women (and others) know about the changes of menopause, the safer we’ll all be. So keep asking, and we’ll keep helping you find answers. Read more on what’s “normal” in perimenopause.

Benefit from a gratitude practice

Gratitude is good for you. It may be hard to come by when you’re waking up and changing PJs for the third time in one night, but gratitude is actually a powerful healer. Find things to be grateful for, and you may find you have more than you imagined. Learn more about the benefits of gratitude.

Helping caregivers take care of themselves 

The “average” caregiver is a 49-year-old woman “” likely also in the throes of the menopause transition. If you’re caring for an elderly parent, ailing partner, young children, etc., you’re at more risk of injury and depression. Find out how to care for you while you’re caring for everyone else.

Internet hygiene in menopause

This term, coined by OB/GYN Dr. Jen Gunter, is about how to parse through all the health “information” you find on the Internet. Our own Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, provides some wisdom around vetting online sources to keep yourself safe and informed.

The right way to get calcium in menopause

Remember when “getting calcium” just meant drinking a glass of milk? As we age, our nutrient needs change, and calcium is a biggie. Be sure you know the best ways and times to get your calcium to maximize its benefits to your body.

I think I had my first hot flash

Gennev CEO Jill Angelo talks about having her first hot flash, and how modern women and companies like Gennev are changing the definition of “menopause as the beginning of the end” to better reflect the truth: that it’s the start of a second chapter that can be just as rewarding as the first. 

Healing from a hysterectomy

About a third of American women will have a hysterectomy by age 60. Because it’s so common, and because it’s serious surgery, our Docs of Physical Therapy took us through ways women can prepare for it, recover from it, and move forward in a healthful way. Read more about how to heal from a hysterectomy.

Practicing safe supplements

You suspect you probably need to take a supplement or two to meet all your nutrient needs. You head for the grocery store vitamin aisle and immediately want to give up. There are just too many choices and not enough information. Until now! Practice safe supplementing.

Flash Count Diary podcast with Darcey Steinke

Writer Darcey Steinke had a hot flash and started identifying with whales “” in a good way. Certain whales experience menopause because their experience and wisdom is more important to their communities than their ability to have babies. Sound familiar? Listen to this fun podcast with a gifted writer on the transformative experience menopause can and should be.

What articles did you get the most from this year? Did you share any articles with friends? If so, which ones? We’d love to know, so please share your thoughts with us on the Gennev community forums!

 

Life is nothing if not the opportunity to continuously learn about, well, anything you’re interested in, especially yourself. In our ongoing quest to help answer questions around the hormonal journey, we thought it would be fun to test your menopause knowledge. A fun test? Absolutely, because this one provides helpful clarification around some of the common questions you might have. And, afterall, knowledge is power.

Get ready. Get set. Let’s take the Gennev team’s 10 Question Menopause Quiz!

If you are dealing with unbearable symptoms, 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.

The 10 Question Quiz For Menopause

  1. Should you continue to use birth control even if the frequency of your periods decreases?
  2. Does the arrival of perimenopause mean no more PMS?
  3. What’s the average age for menopause to begin?
  4. Could smoking bring menopause on sooner? 
  5. Is it true that soy products may help alleviate some menopause symptoms?
  6. Are there any mammals that experience menopause?
  7. Is there a test that will confirm the onset of perimenopause?
  8. “Manopause.” Does it exist?
  9. Are there natural medicinal alternatives that may help with perimenopause and menopausal symptoms?
  10. Will menopause spell the end of my sex life?

Answers

  1. True! Until you’ve gone a full year with no periods (which is the definition of “menopause”), you may still be fertile, so continue using birth control because you may still get pregnant until your one-year meno-versary (and yes, we just made that term up). Also, you should probably check in with your doctor if your periods are changing in any way.*
  2. Wouldn’t that be awesome? But it’s false. The onset of perimenopause may actually make PMS symptoms worse for a while. Irregular ovulation, fluctuating hormones–even perhaps our lessening ability to deal with PMS because of perimenopausal symptoms–all contribute to this fact. Talk to your doctor* about treatments that can help relieve some of the symptoms of PMS.
  3. The average age of menopause is 51 for women in the US. If you chose 42, that’s probably because it’s the answer to life, the universe, and everything. It’s just not the answer to this question. It is important to note, though, that this is just an average. We’re all individuals, and our hormonal journeys will be unique to us.
  4. Smoking can cause menopause to start as much as two years sooner. While two extra period-free years may sound like a bonus, it’s important to remember that estrogen protects us from many health concerns. Two extra years of no periods can also mean two years of increased bone loss and increased risk of heart disease, Alzheimer’s, diabetes, and some kinds of cancer.
  5. Soy lovers rejoice: It’s true! Certain plants such as soy contain phytoestrogens which can mimic some of the behavior of women’s natural estrogen. Eating tofu, edamame, miso, and tempeh may help reduce hot flashes and other menopausal symptoms. However, there are potential drawbacks to over-consumption of soy. Soy can lead to a possible higher risk of breast cancer, so, as always, talk to your doctor.*
  6. Orcas also experience menopause, and we think the ocean sounds like the perfect place to be during a hot flash, frankly. Scientists theorize one reason orcas and human women cease reproduction relatively early in their lives is because the community benefits more from their wisdom than their reproduction. We think society can benefit from women’s wisdom any time in their lives. Probably pods, too.
  7. While most women assume menopause is the reason for their symptoms and don’t get a formal diagnosis, it is possible to determine onset of menopause by taking a test. A blood test can determine if FSH””the follicle stimulating hormone””is at menopausal levels. Women with a history of thyroid issues may want to be tested to be sure the issues they’re experiencing are menopause or perimenopause and not due to thyroid malfunction.
  8. “Manopause” (OK, it’s actually “andropause” but come on, “manopause” is much funnier) is actually a decrease in the male sexual hormone testosterone. Defined as “a syndrome associated with a decrease in sexual satisfaction or a decline in a feeling of general well-being with low levels of testosterone in older men,” this hormonal decline happens much more gradually than the drop off in estrogen in women, and therefore symptoms are usually less dramatic. So yes, it’s true that men experience hormonal changes, too–though we’re not willing to go so far as to say their experience is on par with what a woman goes through in menopause.
  9. Very true! Many women report great success in managing a variety of menopausal symptoms through the use of natural medicine. You may lower menopause symptoms through acupuncture, herbal supplements, and meditation. And it’s entirely possible that one of the above or many of the options not mentioned will help you. As always, though, check with your doctor before exploring any options outside of what you’re currently using to manage your perimenopausal or menopausal symptoms.*
  10. False, though you’re going to have to work a bit harder to keep sex fun, easy, and something you’re just as interested in as you were before menopause. Don’t settle for a sexless marriage in menopause. Changes in hormones can make for painful sex, so you’ll be investigating various lubes, sex toys (we recommend you try the Lionness Vibrator), and such to see what helps. Also, your desire for sex may wane, so more homework may be required to identify erotic options that stimulate both your mind and your body. Honestly, though, can tht even be called homework? We think not.

How did you do?

8 as 10 correct: You are a Hot Flash! (in a good way)

Menopause holds few mysteries for you. Go forth and spread your wisdom to the uneducated masses. You probably give menopausal colleagues tiny fans for their desks and bring your special, hot-flash-relieving soy-slaw to every office picnic. You are adored. Bask in your awesomeness.

4 – 7 correct: Congratulations, Menomaven!

Your knowledge of menopause, while not perfect, exceeds most folks’, and for that you should be proud. We’re guessing what you don’t know, you’re always willing to learn and share, and you are probably the office go-to for resources. You don’t shy away from hormone conversations and can say the word “vaginal” in public. Celebrate your greatness.

1 – 3 correct: So, just FYI, “menarche” is not the queen of England.

(It’s actually the onset of periods.) So, you’ve got a few gaps. Who doesn’t? Having the facts on menopause and women’s hormonal journeys generally can increase understanding, empathy, and all manner of good things. You’re here on this blog, taking this quiz, so we can only believe you know that and are bumping up your meno-smarts as we speak. And for that, we thank you.

*It is not Gennev’s intention to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and Gennev urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.

Looking to learn more from your peers? We’d love to hear about your experience, so please share in our  community forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group

Have you taken our menopause assessment? Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey.

Interested in finding a doctor who specializes in menopause? Didn’t even know they existed? Read our article on not only how to find the best menopause specialist near you.

One of the many reasons we love walking for exercise in midlife and menopause is because it is an easy, accessible way for most women to stay active and get outdoors. But what do you do when hot and humid, cold and rainy, or snowy and icy weather keeps you inside?  Don’t use it as an excuse to skip your workout!

Keep Moving With An Indoor Walking Workout 

Most days, you can make some adjustments, dress appropriately, and weather the storm or the heat. For the days when it’s unsafe or impractical to walk outside, turn to our three indoor workouts that will boost your mood, fight belly fat, give you more energy, and help ease those menopause symptoms. The change of pace will also challenge your body in new ways and add variety to your usual routine. Plus, consistency is the key to seeing results from your exercise efforts.

These three workouts can be done in the comfort of your home (or at the gym) no matter what the weather may be.

Workout 1:  The 30-Minute Treadmill Trio

One of the great things about walking on a treadmill is that you’re in command. You control the climate. You can easily walk a precise distance and track your progress. You can add hills when you want them and get rid of them when you don’t. You can multitask while you walk, watching TV, talking on the phone, scrolling social media, or checking your email. Or you can get focused and crank out a heart-pumping, calorie-blasting walk like this one. Adding speed and incline intervals will rev up the fat-burning power of your walk.

Warm-up (easy to moderate intensity)

Part 1: Steady pace (moderate intensity)

Part 2: Speed intervals (moderate to hard intensity)

Part 3: Hill climb burst (moderate to very hard intensity)

Cool-down (moderate to easy intensity)

Workout 2:  15-minute High-Energy Indoor Workout

You don’t need any equipment or a lot of space to get an indoor, energy-boosting walk. Unlike walking outdoors, you can safely change the direction and ways your moving””going side-to-side and forward and backward and adding moves like kicks and knee lifts””to work more muscles, which prevents muscle imbalances and boosts your calorie burn. So, turn up your favorite tunes and get moving.

Warm-up

1 minute: march in place

Part 1: Fancy Footwork

30 seconds: walk on your heels with your toes off the floor

30 seconds: walk on your toes with your heels off the floor

Repeat Part 1 one more time

Part 2: Fast Feet

1 minute: speed walk around your house, exploring as many rooms as possible

Repeat Part 2 one more time

Part 3: Multi-direction Moves

1 minute: climb stairs (no stairs? Step up and down on a single step, exercise step bench, or sturdy low bench, or speed walk around your house again)

Repeat Part 3 one more time

Cool-down

1 minute: march in place

Workout 3:  Add 5 Moves for Total-Body Toning

Add these moves to either the 30-minute Treadmill Trio or 15-minute High Energy Indoor Workout. You can turn either of those previous walking workouts into a total body, toning workout by adding our strength moves for walkers. These multi-muscle exercises will build strength to protect your joints, preserve muscle to keep you active, and improve your balance.

Here’s how to do it: After each part of the workouts above, including the warm-ups and cool-downs, do one of the moves in our strength moves for walkers video, completing 10 to 12 reps of each.

For example:

Want to get more from your walks? Join the Get Moving Walking Program for Women to receive two 30-day walking programs designed by women for women, support from certified fitness instructors and Gennev menopause specialists, as well as special offers and incentives.

Always check with your physician before beginning any new exercise program.  

 

Guest blog from Anne M

What it means to go into menopause early

Going into menopause early means you need to love yourself more and get the medical attention you need, now.

Thirty is the new 20, 40 is the new 30″¦. until it’s not. My 40th birthday was to be the beginning of fertility treatments and the excitement of planning to be a single mom after years of dating that had proven fruitless. Forty had another surprise in store for me, however, with the abrupt stop of my menses.

There was nothing in my family history that would have predicted this. My mom and aunts had gone into menopause in their late 40s, early 50s, “like normal.” Having started at age 11 and never once missed a month since, I naively, secretly, and happily thought I might have been pregnant from a relationship that had ended the month before when my period stopped.

The next month I had a very light period, however, so I scratched that idea but thought I should see my ob-gyn when the month after that was extremely light (spotty almost) as well.

Hard to forget that day. The ob-gyn came in, did an exam, ran a menopause test, and left. And then came back in. I can still see her face as she told me, somewhat glibly, that I was in menopause. I asked””dumbfounded and shocked”””so, wait, you mean I can’t have babies?” No. “Well, what about having eggs harvested?” “Nope. Too late.” And she left.

Nope, too late

I numbly got dressed, walked out and didn’t go to an ob-gyn doctor again for five years. Denial and rebellion ensued.

My period pretty much stopped immediately, and the menopause hot flashes and urinary tract infections (UTIs) began. The mental head games weren’t fun either, as I dated and battled with how I would tell my boyfriends (another post, another day).

Odd things happened as well””my handwriting that had often been praised as beautiful started to become incoherent. I went to a psychiatrist about my mental fog and he gave me Prozac. Never made the connection. Of course it would have helped had I told him. He never suspected, given my “youth.”

Fast forward to 45. I decided it was time to accept my fate and went to an ob-gyn. While I had been “playing” with some herbal remedies, I still was apprehensive. The doctor I saw was lovely. He recommended hormone therapy as a trial for three months to see if it improved my symptoms and scheduled a bone density test for me that afternoon. I left feeling better, optimistic, and had my test.

At 10 the next morning the nurse called and said the doctor wanted to see me back immediately. I was petrified, thinking maybe I had cancer, an STD, anything. The doctor told me that my bone density was extremely low and that my hormone replacement was no longer a trial but permanent and very necessary for me to maintain supple bones as I grew older. I had the bone mass density of a 63-year-old, at 45.

My five-year, self-imposed menopause denial and consequent medical hiatus was a mistake, and it cost me my health in many regards.

Lessons learned from early onset menopause

You cannot control when your body goes into perimenopause or full-on menopause. What you can do is get educated, re-examine the best time for you to have your own biological children if this is important to you, and understand your body and what you can do to best take care of yourself before, during and after.

  1. Realize that not everyone goes through a perimenopause stage. I didn’t. My period was normal the month before it stopped, and no other symptoms were present (that I was aware of) up until the day it stopped.
  2. Continue to have regular checkups. Your doctors, health practitioners, holistic shamans are your friends and ready to help.
  3. Ask questions. While I had been having regular checkups throughout my 30s, I treated them like I did when I was 18. Get educated about perimenopause.
  4. Consider your timeframe for children and plan accordingly””perhaps earlier than you may otherwise have. Even my married friends with kids had trouble conceiving in their 40s. The Hollywood lies we had believed in the 90s weren’t really accurate.
  5. Realize that there are some good things””I was the envy of many friends on numerous trips with no cramps or soiled sheets, and many boyfriends were actually pleasantly surprised to not have to deal with a four-day hiatus in our sex lives. Many boyfriends didn’t want children, and therefore my menopause was a non-issue for them.
  6. Your body has brought you far and deserves to be taken care of””by you. By the time you reach menopause. you have both been through a lot. Perhaps you had kids, or not, or maybe not as many as you desired. Either way, your body is the vehicle that hosts your beautiful soul, and it needs to be taken care of as you age. Not getting the medical attention you need is not the answer.

Feeling alone in your menopause journey? Work with a Menopause Health Coach. Learn more.

 

February is Heart Health Month, which makes sense, since the holiday of hearts is smack in the middle of it. However, despite all the information that’s out there, heart disease remains the #1 killer of men and women in the US.

Dr. Sarah Speck of POTENTRx – Heart disease is the #1 killer of men and women in the US

The good news is, as much as 80 percent of your risk of heart disease may be within your control, says Dr. Sarah Speck, cardiologist, internist, and co-founder of POTENTRx, a medical fitness company. Exercise, stress-management, avoiding tobacco exposure: all of these can go a long way to protecting your heart health.

“Preventing illness is the best approach to managing health
and maintaining vitality at whatever stage of life.”

as Dr. Sarah Speck

Dr. Speck partners with her patients to identify health risks and put together a plan to help them be proactive in maximizing their health. She is an educator in illness prevention, disease-reversal and disease-management techniques, teaching patients and the public about lifestyle choices that protect their hearts and health. (Read the full transcription below.)

What about that other 20 percent?

Dr. Speck’s focus on a heart-healthy lifestyle came about in part due to her own experience. When she started to experience the signs of menopause, she decided not to go on Hormone Replacement Therapy (HRT) to ease the symptoms, because the Women’s Health Initiative study seemed to indicate there was a higher risk of heart disease from HRT.

However, after a string of sleepless nights started to impact her ability to make the best medical decisions for her patients, she decided to go on the patch.

She did this for a decade. When the time came to go off HRT, Dr. Speck was astonished to see her LDL (bad) cholesterol numbers shoot through the roof. Despite a very healthy lifestyle, she had inherited her mother’s high cholesterol as and without the protective benefits of estrogen, her “inheritance” had kicked in full force.

This served to reinforce Dr. Speck’s decision to promote preventative, proactive care for her patients. Even those with genetic risks can see huge benefits to their health by making the right lifestyle choices.

What will you do to be heart healthy?

In honor of Heart Health Month, team Gennev wants to issue a challenge to our community: pick one thing you’ll start doing today to increase your wellness and reduce your risk of heart disease.

At the end of February, find us on Facebook. Let us know what you’ve been doing and how it’s working for you. Get inspired, be inspirational as we can’t wait to hear what you come up with!

Need ideas? Be sure to listen to the podcast above, and you’ll get some great ones.

 

Next up on the Gennev podcast: we talk with author and motivational speaker Juju Hook. We reviewed her book on “rebranding” midlife as Hotflashes, Carpools, and Dirty Martinis as and enjoyed it so much we had to invite her to speak with us. Her fresh, feisty, irreverent look at the myths and stereotypes of midlife are really good for your heart too, if in a different way”¦.

Have you dealt with heart disease, are you managing it now, are you worried about your risks due to genetic or lifestyle factors? We’d love for you to share with us. Please share in the comments below, on Gennev’s Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.

Transcription:

Jill: February is Heart Health Month, and heart disease is the number one killer of women, I understand. Can you tell us a little bit more about that statistic, because I think that’s really shocking?

Dr. Speck: Well, it’s an unfortunate statistic, but in fact more women die of heart disease every year than men do. By the time we reach menopause, it’s an equal opportunity disease for men and women. But unfortunately, by the age of 45, one in nine women will have some form of heart disease as opposed to one in five men. By the age of 65, one in three women will have heart disease as opposed to one in two men. So, we have a real opportunity, if we can turn that around, in early menopause to impact our risk of developing heart disease later in life.

Jill: Why is that statistic; why are women more prone to this than men? It sounds like women catch up to be an equal opportunity player, sadly. I’d rather we were equal opportunity in lots of other ways, but why do women catch up, and why is it killing women as a number one killer?

Dr. Speck: Well, I think, I take your first question: the fact that we lose our natural estrogens, we lose elasticity in our skin, our hair changes, our eyes change, and our blood vessels change. And our blood vessels “¦ the further away we get from our natural menopause, the more difficult, the more brittle, if you will, our blood vessels become. And more vulnerable to developing cholesterol-related plaque. So, that’s really why we catch up. Even taking synthetic estrogens don’t really restore the health of our blood vessels that we had pre-menopause.

Jill: That’s fascinating. So, taking synthetic estrogen, how about the bio-identical? Is there any form of estrogen in HRT or any hormone-related therapy that can reverse that damage to our blood vessels?

Dr. Speck: We’ve not been able to identify a hormone replacement therapy as either bio-identical or whether it’s patch or whether it’s oral therapy as that actually reverses or restores the flexibility. So, what we really want to do is to concentrate on those risk factors that we know can create more inflammation than just losing our natural estrogens. And those are high blood pressure, diabetes, having high cholesterol, being obese, being exposed to tobacco products. Those are the big five, if you will. For men and for women. But the women become much more vulnerable to those after their menopause.

As to your second question, I think the reason women may die more of heart disease is because we don’t recognize that we are necessarily at risk. So, if you have any of those big risk factors, you may have atherosclerosis. Even if you are just having nausea. Even if you are just having unusual shortness of breath. Even if you are just unusually tired. It may be that your arteries are clogged, and your heart isn’t able to function as well as it used to. And so, those individuals that have those risk factors, need to seek attention from their providers.

Jill: So, I was about to say the word “fascinating,” because I think it is.  When I think about heart disease versus a heart attack, I know what a heart attack is, but heart disease as a disease, what is that? How do you know when you’ve now got it? And then obviously it’s something you manage, but is it like other diseases where there are symptoms, you do things to control it but it never really goes away?

Dr. Speck: Good question. There are several aspects of the heart obviously; there’s the muscle, the valves, there are the electrical fibers and there are the blood vessels that supply the heart. So, any of those can become diseased, and there are congenital reasons for people to have heart disease that they are born with. But what we wanted to talk about today, I think, are the diseases of the blood vessels that are more or less acquired. Those individuals that have diseases of blood vessels, again, that can be very insidious. It can happen over decades before it actually declares symptoms. So, that’s why we want to pay so much attention to those risk factors. Because really what causes heart disease that causes heart attacks or those that cause strokes also, is that there is inflammation on the inside lining of the blood vessel. And when there’s inflammation on the inside lining of the blood vessel, it looks very much like the skin of someone who is having a bad outbreak of psoriasis or eczema; it’s cracked, it’s weepy, it’s red, it’s angry. And as the blood goes flowing by, the particles of bad cholesterol, the lousy cholesterol, the LDL cholesterol, literally drop through the cracks and start to form plaque in that little layer between the lining of the blood vessel and the muscle layer. That can happen decades before anyone develops any symptoms.

Jill: The symptoms that you mentioned earlier: feeling tired, shortness of breath; they’re kind of everyday symptoms. What are the top symptoms you encourage women to look for? And at what point should they take those symptoms seriously enough to come in and get checked?

Dr. Speck: Well, women may have symptoms that are unique to them and somewhat different than men. The reason women have symptoms of heart disease is the same, and that is the heart muscle is not getting enough oxygen to be able to pump the blood forward effectively to the rest of the body. So, like any pump when it doesn’t pump well, it creates a back pressure. Often at times, the first place it creates that back pressure is in the lungs, so you start to feel short of breath. So, if on your routine walk you’re feeling like, “wow, I don’t know why I can’t get through this today.” And you have high blood pressure, or you have diabetes, or you’re overweight, or you have high cholesterol, or you have a family history of heart disease, that’s something to pay attention to. Certainly, if you walk up James Street from the ferry dock, and you’re gasping for breath and there’s an elephant sitting on your chest, whether you are a man or a woman, you need to seek medical attention. More or less immediately.

Jill: It seems pretty straightforward, but do you see in the majority of your patients, people waiting far too long? What are trends you see in terms of that level of awareness of people coming to you to say, “I think I need to get checked.” Or do they wait far too long? Where do people line up?

Dr. Speck: In the immediate throes of having a heart attack, women traditionally wait an hour longer than men do to call 911. Because they think, “Oh, it’s just indigestion,” or “I don’t want to upset anybody, I don’t really want to wake my husband, I don’t really want to call my daughter, particularly if I’m living alone.” So, they may not be getting the life-saving treatments that are offered, fast enough to delay the consequences of having a serious heart attack. But in the more preventive sense, I think again women need to be aware that heart disease is the biggest killer. And just like we get our annual mammograms, we need to know our numbers annually. What’s your blood pressure? We all know what our weight is, what’s your waist measurement? If your waist measurement is greater than 35 inches, you are at significantly increased risk of heart disease and diabetes, and you need to take care of that. If your blood pressure is greater than 130/80 now, according to the American Heart Association standards, that needs to be addressed. It doesn’t necessarily need medication, but it needs to be addressed and it needs to be followed. If your blood sugar is greater than 100, certainly if it’s greater than 110 or 125, you need to be addressing diabetes or pre-diabetes. If you’re smoking, or if you’re exposed to tobacco, stop.

Jill: Very simple.

Dr. Speck: But the other thing that is unique to women, that I think is now coming forward, is if you’ve had gestational diabetes, high blood sugar during pregnancy, if you’ve had high blood pressure during pregnancy as even if you don’t have a family history of heart disease asat age 50, you are more likely to develop high blood pressure or diabetes than someone who hasn’t had that during their pregnancy. So, you’re that one who is carrying that information, you’re the one that needs to be taking care of that for yourself.

The other thing I think is really important is that we all start to think about building our own health portfolio, just as carefully as we do building our own financial portfolio. We find a provider we can work with, we find somebody we can trust, to put investment in that health portfolio, we take care of what we need to, and we go forward building it together.

Jill: I think that’s a fascinating way to think about it because even you just listed out a number of numbers that you should know and be aware of, which as you called them out, I’m certainly not aware of mine, and it shows how important it is for a person, a woman or a man, to be tracking their own numbers.

Dr. Speck: That is very correct. The sooner you jump on it the more opportunity you have to not develop serious disease in the future. The other thing is we now have a variety of techniques that can detect early atherosclerosis or early plaque development. One is called Carotid IMT Scanning. Basically, it is just an ultrasound of the carotid artery that looks for early development of plaque. That’s paid for by your insurance after you’ve had a stroke, but that means you had a plaque build-up that’s 80, 85, 90 percent. I’m talking about detecting something that’s 10 or 15 percent. Well, at 10 or 15 percent you are not going to have any symptoms, but if you’ve got it, you can stop it by paying attention to the risk factors that may contribute to it over time. While it’s not covered by insurance, it’s usually an out-of-pocket expense somewhere between $100 and $200. Those kinds of things are readily available in the medical community. So, even if your insurance company doesn’t pay for it, doesn’t mean it’s not worthwhile.

Jill: Now here at Speck Health, you are big on prevention and you’re starting to go there in our conversation. Tell me about POTENTRx as it’s a program you have here as and how you’re really advocating for prevention with your patients.

Dr. Speck: So, we pronounce it POTENTRx, Your Prescription for Your Full Potential. It grew out of my experience as the Medical Director for Cardiac Rehabilitation Services at Swedish Medical Center for the last two decades. Again, after you’ve had a heart attack, after you’ve had bypass surgery, your insurance company will pay for you to learn about proper nutrition and how to exercise, to prevent your second event. That seemed a little backwards to me.

Jill: That you have to have an event first before”¦

Dr. Speck: Exactly. There are all kinds of guidelines from the American Heart Association, the American College of Cardiology, the American Medical Association, telling people that exercise and nutrition will prevent disease. But again, unfortunately, our medical system doesn’t pay for that under the insurance system. So, I partnered with Dr Dan Tripps, who’s a PhD exercise physiologist and psychologist, and he and I looked at what people were getting in cardiac rehab and said, “I think we could do this beforehand.” Help people who are concerned about disease, or have early risk factors, or have early disease, prevent them from developing more severe and more debilitating illness.

So, what we do is basically take the same science that does assessments for elite athletes, where these people know exactly what their body’s burning, exactly what their body’s using, exactly what nutrition so they can get that extra 100th second across the finish line. And we bring it to the world of mere mortals, because we are all on the same physical performance curve. And what we do is precisely measure an individual’s body, how they use carbohydrates, how they use fats, how their muscles work, and we design a nutrition and exercise prescription for them that will help them lower their blood sugar, lower their body weight, improve their heart’s performance, lower their cholesterol, whatever their goal is, and then we assist them through that.

Jill: Fantastic. So, you are like a quote-unquote personal trainer but much more in depth?

Dr. Speck: We like to talk of ourselves as a “medical fitness company.” Again, I think personal trainers are very valuable, but I think they don’t have that medical knowledge as to how a person’s body truly performs to reach their medical goals as opposed to getting down the slopes a little faster.

Jill: So then, approaching the medical goals, how do you price this? Just to go there? Because I’m assuming it’s not covered under insurance. But if I were to think of the mental model, a lot of us spend a lot of money on classes or a personal trainer, or a health club membership.

Dr. Speck: So, the assessment services range anywhere from $200 to $700. And then depending on what kind of ongoing coaching you would like, that can be done over the web, through email, or through fitness apps; again, it depends on what the client is trying to achieve.

Jill: I love the whole notion that you have taken the recipe that elite athletes use and brought it down to”¦ I shouldn’t say “down,” brought it over to those that are aging and want to manage their personal health in this area.

Dr. Speck: We’re all on a continuum of performance. We’re fit, we’re athletic, but that fit and athletic can become injured, and that’s where we’re injured and impaired when trying to deal with health issues. And we are just trying to move you toward more healthy and more fit.

Jill: So, going back to the topic of women versus men, are the indicators or symptoms that you are having a heart attack the same across both, or do women have to watch for different things? Not just isolated to heart attack, but heart disease? Are the symptoms the same across both sexes?

Dr. Speck: Again, if you’re having chest pain while you’re walking up a hill, whether you are a man or a woman, that should indicate this could potentially be heart disease. If you are knowing you have high blood pressure, if you are knowing you have high blood sugar, if you know you have high cholesterol, you have a family history of heart disease, and you developed chest pain because your daughter came home and told you she was getting divorced as that’s a symptom woman have more often than men do. Those kinds of emotions produce very real biochemical change that can alter the way your heart’s blood vessels react to that change and can produce a symptom of chest pain. Undue shortness of breath: again, what I mean by “undue” is if suddenly you are pushing a cart around a grocery store and you’re [imitating gasping for breath], then that’s unusual. And that needs to be investigated. Heart disease is something that is progressive. So, if you have a symptom one week and the next week you have it three times, again, that’s something to listen to and not dismiss. Not “oh that was just indigestion” or “oh I was just kind of tired that day” or “my asthma was acting up.”

Jill: What would you recommend to women who are on the other side of menopause or even going through it? Obviously the impacts of lower estrogen in the body have taken effect, what would you recommend for just lifestyle and prevention? It’s probably quite apparent in terms of no smoking, diet, exercise etc., but I think it’s good to just remind and reiterate.

Dr. Speck: If we think of this as a disease of inflammation, and you think your blood vessels are on fire, inside; and what you want to do is calm the fire. So, what we know does that is regular exercise. If you move the muscles between your waist and your knees, which are big muscles, as all women know, for thirty minutes every day, that reduces inflammation in your blood vessels. It may not cause you to lose weight. It may not make you more fit, but it reduces inflammation inside your blood vessels. And it doesn’t even have to be all at once. Ten minutes three times a day is just as good as thirty minutes all at once. So, that’s where those Fitbit counters come in, those step counters are helpful to get people to move more. That’s number one.

Number two is eating a double cheeseburger is like putting a Brillo pad inside your blood vessels. So, what you want to do is eat more sensibly. Eat more responsibly. Eat more plant-based foods. The American Heart Association recommends 5/5: five servings of fruit everyday and five servings of vegetables. A serving is a half a cup. So if you have an apple, you’ve had two servings of fruit. If you have a salad, throw in some Craisins, throw in some nuts. It’s not too hard to get there if you pay attention. Those things are pretty easy and accessible to most of us.

I think the other thing is to try and embrace joy every day. Find a way to manage your stress so your stress doesn’t manage you. If you can do just those three things, you’ll create an environment where you can start to look at your own health portfolio more seriously and more proactively.

Jill: That’s fantastic. Are there any innovations in this space that are coming, that you are really excited about?

Dr. Speck: There are several, actually. First of all, I’m really excited about the fact that people in the medical community now realize that heart disease can be prevented. So, even though our insurance system is lacking in terms of actually paying for prevention, your provider is going to ask you what your blood pressure is. Your provider is going to be checking for these things and embracing your efforts to improve them over time and early. I think that level of awareness is just going to continue to grow.

I think that cardiac genomics, the whole genomic revolution, is not only going to revolutionize cancer but also the treatment for heart disease. We have now commercially identified four or five genes that you can just get a simple blood test to see whether or not you are carriers of those. It doesn’t mean you are going to get heart disease, but it means you’ve had them since you were born. And so they have been interacting with whatever else you have been doing to try and cause heart disease. So, once you identify whether or not you are a carrier of those, you can be even more proactive in reducing the things you know you can control. Because even with people who have a family history of heart disease, 80 percent of getting heart disease is still under our control. That’s phenomenal!

Jill: In a world where we don’t get to control a whole lot, that’s pretty fantastic. This has been a pleasure. Oh my gosh, you know, we hear so much about heart disease and yet we never really understand what it is and that it is so preventable. So, thank you.

Dr. Speck: Thank you very much for having me and good luck to you and to your health portfolio.

Jill: Thank you so much.