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Common mistakes in women's health and longevity, and how to avoid them: Part 1

This the first part of a 3 part series blog.

If you are a woman of any age, here are some common mistakes that I see during my consultations when it comes to applying lifestyle strategies for goals for improving energy, mood, body composition, skin health and quality of life for longevity.

I won't go into the reasons why here; that is for another blog, post or podcast.

Mis-applying nutrition strategies:

To be clear, I am not a dietitian or nutritionist. Nutrition education is insufficient in medical school. It is of no surprise that many doctors are ill-equipped in this area to provide practical advice and do not have the skills or time to critically evaluate nutritional research. Due to the lack of training and knowledge in the medical profession, popular media becomes the source of health and lifestyle information for many. However, in this type of medium a lot of important details are not reported. My training in nutritional medicine after medical school has taught me to evaluate nutrition science and assess food in context with other aspects of lifestyle such as sleep, physical activity, stress and emotional health. I mostly see women in my practice and a very popular nutrition approach they started adopting is a form of calorie restriction known as intermittent fasting, alternate day fasting, time-restricted eating (16:8, 14:10) and prolonged fasts (more than 48 hours) for non-religious purposes.

I recall when it first came out in 2012, many of my patients who were early adopters started this for weight loss and health benefits. The results were variable and sometimes detrimental. Some who did not benefit included those who were already normal weight and others had a short period of improvement but then plateaued. If you look closely at the reported benefits in the studies, they were in overweight or obese men, women or diabetics and not in healthy normal weight women. One lady (of slim build) who did it to reduce her waist line, also lost a noticeable amount of muscle mass in her lower body.

Fast forward 10 years, it has become even more popular due to celebrity endorsement and a renewed interest for adopting fasting to increase lifespan. While there are benefits in disease populations (diabetes, cardiometabolic syndrome, cancer and neurodegenerative conditions), the benefits in healthy normal weight populations are still lacking. I’m not suggesting normal weight individuals should not fast, but we have to be careful not to extrapolate data from one population and assume it has the same benefits in another. We call this external validity in research. This is possibly one of the reasons why some individuals did not benefit and some even experienced a negative effect. What popular media often fail to mention is that calorie restriction and some fasting techniques can be problematic and potentially detrimental to those that have eating disorders, very young or old, pregnant, very lean or suffer from osteosarcopenia.

Another population where caution is required are women who are physically active, training regularly, and with increasing frequency or intensity. Women in the perimenopause and menopause transition have a heightened response to stress. While regular exercise is a beneficial type of stress, in women, relative energy deficiency (or not eating enough for exercise recovery), could further exacerbate a heightened stress response. One of the stress hormones, cortisol secreted by the adrenal glands after prolonged exercise or glycogen depletion, remains high without adequate refuelling with nutrients, in particular carbohydrates and protein. Chronic high levels of cortisol predisposes to fat storage, especially in the mid-section, worsening weight gain in this area. To avoid this, refuelling in a timely manner after and sometimes even before exercise is important in managing the hormonal and metabolic impact of exercise. While total calories do matter, the addition of exercise and the metabolic health of the individual means that it is not just a simple matter of eating less and doing more (calories in and out).

Women are also particularly susceptible to a metabolic-hormone signalling protein called kisspeptin. The complex interaction between women's hormones, ovarian function, fertility and energy balance is regulated in the brain and directly impacted by nutrient availability.

Short-changing sleep:

The Sleep Foundation recommends adults 18 years and over get between 7-9 hours of sleep. Sleep deprivation increases the risks of heart disease, diabetes, mental health issues, hormone imbalances, worsened immunity, obesity and overall risk of death. Chronic sleep deprivation of < 6hrs per night was associated with a higher body mass index, increase hunger and intake of foods higher in fat, sugars and fast foods to combat fatigue. Studies showed that participants who slept 5.5 hours lost less fat compared with those that slept 8.5 hours per day. In addition, insufficient sleep slows down the metabolic rate. Even a short term sleep reduction of 2/3 of usual sleep duration in healthy normal weight men and women, led to an average net increase in energy intake of 677 calories per day over an 8 days period in normal weight healthy individuals and an average weight gain of 0.9kg without any change or differences in level of physical activity. Studies also suggest that sleep quality matters, and that an irregular sleep schedule and disruption of our Circadian Clock has a negative impact on health.

Some of you may think that perhaps you could eat less and exercise more to overcome this. (More of the calories in and out approach). Make no mistake that while this may work in the short-term, the metabolic and hormonal adaptations (partly discussed in point 1 above) that occur with calorie restriction with exercise in the long-term are difficult to overcome solely based on manipulating calorie intake or expenditure. Sleep deprivation increases cortisol, ghrelin (hunger hormones) and insulin resistance, which all affect energy homeostasis.

If you are finding that the usual nutrition and exercise strategies are not working or have plateaued, looking at your sleep quantity and quality and prioritising this could be the key. If you are experiencing difficulty getting to sleep, staying asleep or have light sleep, seek professional help in excluding underlying medical causes (eg. Obstructive sleep apnea, mood disorders, perimenopause, menopause, overactive thyroid, restless legs) and address your sleep hygiene (eg. eating too late before bedtime, mobile and computer devices, bedroom temperature, pets, noise, social jetlag). We all have different ways in which we respond to stress and sleep based on our biology, genetics and behavioural patterns.

Women in the perimenopause and menopause often suffer from sleep disturbance with or without hot flashes, due to the important role estrogen plays on our brain chemistry. Menopausal symptoms can occur even with periods and the average length of time when symptoms appear is 5-7 years before the onset of menopause. Any woman can experience hormonal related sleep disturbance and many treatment options are available, there is no need to suffer through it. While short term use of sleeping pills can be helpful, long-term chronic sleep problems should not be dismissed as the long-term use of psychotropics are associated with cognitive impairment and decline in older adults.

Make sure you subscribe to our blog for part 2 of this series. Feel free to comment and share this blog if you have found it helpful. You can contact us for more evidence-based and evidence informed information.


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