By Whitney Crouch, RDN, CLT
While running around being a “stay-at-home” mom, a “9-5” mom, or somewhere in between, it can be easy for mothers to forget about taking care of themselves. Breastfeeding mothers may face an added layer of stress when trying to do it all and be everything to everyone, but keeping nourished should be a top priority. In the previous parts of this series, we examined mothers’ challenges with producing adequate milk supply for their babies, as well as nutrition and supplements to support her supply. Motherhood and liquid gold Proper diet and hydration are often sacrificed when juggling the demands of a new baby, housework, career, other children, and any semblance of a social life. This altruistic sacrifice could unknowingly lead to negative consequences. Milk Production 101 While the need for nutrient-dense foods will always ring true, the number of calories required to allow healing and support adequate milk production varies from woman to woman. Calorie needs for breastfeeding moms depend on how much energy mom is exerting daily, plus how much milk she is producing. On average, an exclusively breastfeeding mother needs about 500-640 calories more per day than she did prepregnancy.1,2 The average baby consumes 19-30 ounces of milk per day, but mother’s hydration needs actually exceed the amount of milk produced and her prenursing hydration needs combined.3 According to the Dietary Reference Intakes (DRIs), mom needs around an extra 34 ounces (1 liter) of water each day, and if she still feels thirsty, she should drink more water.4 Fueling the nurturer It’s common for new moms to fall into the habit of always putting baby first. Of course, it’s important to keep baby out of harm’s way, but when baby’s needs are met, it’s okay to put baby down (or wear baby in carrier) so that mom can put on her own proverbial oxygen mask. The act of growing a baby and then giving birth is a tremendous stressor on a woman’s body. Albeit a completely natural, beautiful, and often relished stressor, a women’s body needs rest and nutrient-dense foods to heal properly and to continue to give life to her baby. Across various traditional cultures, there are heavy emphases on postpartum nutrition. While the dishes for postpartum nutrition vary by culture, there are many commonalities, with animal products, cooked vegetables, herbs, and spices as mainstays in most cultures.5 Eating to heal At a glance, traditional healing foods reveal that broths, soups, stews, and porridge are central to a new mother’s diet.6 Slow-cooked stews and broths are rich in collagen-building amino acids such as glycine and proline, electrolytes, and “warming” spices and herbs.5 Porridge-like foods and cooked vegetables provide fiber-rich carbohydrates. It’s no coincidence that these nutrient-dense foods are easy to digest and rich in iron, B vitamins, zinc, choline, DHA, protein, carbohydrates, and a number of other nutrients that support replenishing red blood cells, tissue healing, and the production of high-quality breastmilk.5 In addition to eating wholesome foods, new mothers should not reduce calories or carbohydrates in the months immediately following giving birth.7-9 If weight loss is desired once her breastmilk supply is established, mom can mindfully reduce carbohydrate intake while monitoring her milk supply and ensure her diet remains otherwise nutrient-dense.5 Nourishing baby Like adult food, human milk is made up of carbohydrates, fat, protein, vitamins, and minerals, plus the addition of nonnutritive bioactives. Some of the milk components remain at consistent levels across the breastfeeding relationship, while others vary from mother to mother and for each mother across time.10 Each mother’s milk is unique based on her dietary intake, body stores, time frames (time of day, season, circadian rhythms), time intervals (time of day, time since previous breast emptying and duration of feed), and time relative to maternal exposures (e.g., meals, pathogens, and supplements).10,11 Let’s explore these nutrients a little further… Fat Breastmilk fat quantity is mainly dependent on the feeding period, the stage of the feed, and the number of pregnancies mom has had, while maternal diet (energy intake, amount of dietary fat) and lifestyle are less relevant (except in cases of severe malnutrition).12 Fat is made up of subunits called fatty acids; the fatty acid profile of breastmilk is reliant upon both mom’s current diet and her dietary intake during the pregnancy.13 Interestingly, much of the fat in early breastmilk comes from mom’s longer-term food intake, mainly during the third trimester of pregnancy.13 And while the amount of fat in breastmilk is not directly related to diet, the composition of the fatty acids in the breastmilk is related to diet.13 Important to fetal and infant brain and vision development, eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) are two omega-3 fatty acids that may be lacking in mom’s diet. If she consumes a standard American diet (SAD) or a vegan diet, which are inherently lacking in fatty fish intake, baby is at an especially high risk of deficiency.14 Even though the human body holds the necessary enzymatic pathway to make DHA from its plant-based precursor alpha-linolenic acid (ALA), there is clear evidence that the conversion of ALA to EPA and DHA is insufficient to ensure adequate levels in baby.17 In fact, it has been shown that the efficiency of the conversion of ALA to EPA is lower than 10%; the conversion of ALA to DHA is even lower, and virtually nonexistent in boys and men.15 Pregnant and lactating women should aim to consume an average dietary intake of at least 200 mg DHA/d.16 In order to balance adequate amounts of EPA and DHA with lowered risk of environmental contaminants, more small fish (e.g., sardines, anchovies and mackerel) should be eaten over larger fish, and wild-caught or safely farmed salmon should also be preferred. Fortunately, nature has included selenium in fatty fish, which counteracts methylmercury toxicity in humans and protects against some neurological effects of mercury exposure.17 This is an important fact to note in light of weighing the risks to benefits of increased seafood intake with increasing exposure to harmful methylmercury, polychlorinated biphenyls (PCBs), and dioxins found in some seafood.18 Supplementation with DHA and EPA that has been third party-tested for contaminants (e.g. heavy metals, dioxins, etc.) can be a convenient way for mothers to ensure adequate omega-3 fatty acid intake. Protein Like fats, the protein composition of human milk is more affected by mother’s intake than the actual amount of protein in the milk or by maternal or gestational age.10 While the concentration of protein in the milk is not affected by mom’s diet, it does increase with maternal body weight for height and decreases in mothers producing higher amounts of milk.19 In addition, while the makeup of breastmilk shows a consistent level of protein regardless of time of day, although protein concentration does decrease through each lactation session.20 Carbohydrates The predominant carbohydrate in breastmilk is lactose; however, there are also nondigestible, nonnutritive carbohydrates. These nondigestible carbohydrates, called oligosaccharides, act as food for the beneficial gut bacteria that bloom into baby’s gut microbiome.10 Lactose concentrations are lowest in colostrum and increase through the first 4 months of lactation.21 Unlike the other macronutrients, lactose concentrations are fairly consistent across the milk of different mothers and are not influenced by maternal weight or number of pregnancies.10 Vitamins and minerals As mentioned earlier, some nutrients depend on mom’s current dietary intake, while others rely on her bodily stores.10 The following nutrients change with mother’s intake, adequacy or deficiency, and/or supplementation. Real food sources follow each nutrient:11,23
It’s important to note that it’s difficult to consume adequate vitamin D through food alone. Known as the “sunshine vitamin,” vitamin D is mostly obtained through unprotected skin’s exposure to ultraviolet (UV) light, but in geographic areas with poor seasonal UV exposure or in individuals who spend a lot of time indoors, supplementation may be necessary. Fortunately, a new randomized controlled trial found that for deficient mothers, supplementing with 6,000 IU of vitamin D3 safely optimizes maternal vitamin D status and improves milk vitamin D to maintain adequate infant serum vitamin D levels.24 Vitamin D levels should be monitored by a healthcare practitioner. Final thoughts… Breastmilk conveys immeasurable benefits, even if some of the nutrients are lacking at times, and is therefore baby’s preferred food.24 That said, fed is always best. References 1. Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 9, Meeting Maternal Nutrient Needs During Lactation. https://www.ncbi.nlm.nih.gov/books/NBK235579/ 2. Kominiarek MA et al. Nutrition recommendations in pregnancy and lactation. Med Clin North Am. 2016;100(6):1199–1215. 3. Dewey KG et al. Milk and nutrient intake of breast-fed infants from 1 to 6 months: relation to growth and fatness. J Pediatr Gastroenterol Nutr. 1983;2(3):497-506. 4. “‘Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate’ at NAP.edu.” National Academies Press: OpenBook, 2005, www.nap.edu/read/10925/chapter/1. 5. Nichols L. Real Food for Pregnancy. United States;2018:222-238. 6. Raman S et al. Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries. BMC Pregnancy Childbirth. 2016;16(1):192. 7. Sloan G et al. A rare cause of metabolic acidosis: ketoacidosis in a non-diabetic lactating woman. Endocrinol Diabetes Metab Case Rep. 2017;2017. pii: 17-0073. 8. Al Alawi AM et al. Lactation ketoacidosis: case presentation and literature review. BMJ Case Rep. 2018;2018. pii: bcr-2017-223494. 9. Gleeson S et al. Lactation ketoacidosis: an unusual entity and a review of the literature. Perm J. 2016;20(2):71–73. 10. Dror DK et al. Overview of Nutrients in Human Milk. Adv Nutr. 2018;9(suppl_1):278S-294S. 11. Casavale KO et al. NIH workshop on human milk composition: summary and visions. Am J Clin Nutr. 2019. pii: nqz123. doi: 10.1093/ajcn/nqz123. [Epub ahead of print] 12. Sauerwald TU et al. Polyunsaturated fatty acid supply with human milk. Lipids. 2001;36(9):991-996. 13. Mennitti LV et al. Type of fatty acids in maternal diets during pregnancy and/or lactation and metabolic consequences of the offspring. J Nutr Biochem. 2015;26:99–111. 14. Bzikowska-Jura A et al. The concentration of omega-3 fatty acids in human milk is related to their habitual but not current intake. Nutrients. 2019;11(7):1585. 15. Marangoni F et al. Maternal diet and nutrient requirements in pregnancy and breastfeeding. An Italian consensus document. Nutrients. 2016;8(10):629. 16. Koletzko B et al. Perinatal Lipid Intake Working Group; Child Health Foundation; Diabetic Pregnancy Study Group; European Association of Perinatal Medicine; European Association of Perinatal Medicine; European Society for Clinical Nutrition and Metabolism; European Society for Paediatric Gastroenterology, Hepatology and Nutrition, Committee on Nutrition; International Federation of Placenta Associations; International Society for the Study of Fatty Acids and Lipids. Dietary fat intakes for pregnant and lactating women. Br J Nutr. 2007;98(5):873-877. 17. Mania M et al. [Fish and seafood as a source of human exposure to methylmercury]. Rocz Panstw Zakl Hig. 2012;63(3):257-264. 18. Mozaffarian D et al. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006;296(15):1885-1899. 19. Nommsen LA et al. Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING Study. Am J Clin Nutr. 1991;53(2):457-465. 20. Hollanders JJ et al. The association between breastmilk glucocorticoid concentrations and macronutrient contents throughout the day. Nutrients. 2019;11(2):259. 21. Coppa GV et al. Changes in carbohydrate composition in human milk over 4 months of lactation. Pediatrics. 1993;91(3):637-641. 22. Micronutrient Information Center. Linus Pauling Institute. https://lpi.oregonstate.edu/mic. Published 2019. Accessed August 28, 2019. 23. Dawodu A et al. The effect of high-dose postpartum maternal vitamin D supplementation alone compared with maternal plus infant vitamin D supplementation in breastfeeding infants in a high-risk population. A randomized controlled trial. Nutrients. 2019;11(7). pii: E1632. 24. Zhu J et al. The Functional Power of the Human Milk Proteome. Nutrients. 2019;11(8). pii: E1834.
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Did you know your hormones affect your urinary tract and vaginal health?* Before menopause, your hormones rise and fall with your menstrual cycle, causing you to be more likely to develop an imbalance in your vaginal microbiome in the two weeks following the beginning of your period.1 Additionally, the hormonal shifts that come with perimenopause and menopause also affect urinary tract comfort.2 As well, disruption to your hormone levels may also cause a range of symptoms like PMS;3 heavy or light periods;3 tender or swollen breasts;4 weight gain around the butt, hips, waist, and back of arms;5-7 low mood; anxiousness; fatigue;7 and reduced libido.7 Here are some foods to eat and others to avoid to help keep your hormones in harmony: Another way to ensure you’re getting the nutrients you need to support your health is to add supplements like Wellness Essentials® Women or Wellness Essentials Women’s Prime to your daily regimen.
For additional urinary tract and vaginal health, consider taking a probiotic specific to urinary tract and vaginal health.* References
By Monazza Ahmad, B.Pharm, MSc
A healthy genital tract makes some of the most important phases in a woman’s life more enjoyable and easier to manage. Menstruation, intimacy, giving birth, and embracing menopause are all significant milestones. But you may not realize that good vaginal health plays a fundamental role in reaching these milestones with minimum hurdles. Importance of gut health is well-researched and well-understood for our overall health, concluding that the gut is vital to the health of most organs in our body. Gut health is defined by the microbiome that resides in it and influences the absorption and digestion of everything we consume. These microorganisms constantly and selectively translocate to different parts of the body, creating a unique microecosystem in each organ.1 Curious how the vaginal microbiome differentiates from the gut microbiome? To understand this concept better, we will briefly explore the diversity of the microbiome in the human body. Diversity of human microbiomeMicrobiome diversity in our body depends on factors like diet, environment, genetics, and early exposure to microbiota, meaning at birth. Just like skin and scalp, the female genital tract is also represented by its own community of microorganisms. The vaginal microbiota is evolved through a continuous translocation of species from gut to vagina or from a mother to child at birth.1 Driven by hormonal changes, the complex vaginal microbiome is continuously transformed throughout various cycles of the female lifetime—from birth to puberty, menstruation, pregnancy, menopause, and postmenopause.1 Difference between gut and vaginal microbiomeSimply put, gut microbiota is more diverse while vaginal microbiota is more selective in healthy bacterial strains. This means using the same interventions to protect vaginal flora as that for the gut may not always be optimal. Recognizing the difference between the native microbiome of gut and vagina helps us find the right and safe solutions to help avoid undesirable genital conditions.1 It is important to understand that the physiological and biochemical characteristics of microorganisms remain the same in the gut and vagina; however, their immune responses vary considerably between the two environments.1 In other words, the way each environment detects a substance as harmful or safe is different.1 For example, where the by-products of bacterial fermentation (such as short-chain fatty acids) have shown to prevent damage to the gastrointestinal tract, they have shown unfavorable effects in the genital tract, leading to negative outcomes in the reproductive and gynecological system.1 When the undesirable bacteria from the gut invade the vaginal or urethral area, they create an imbalance that may lead to various female concerns. What is the gut-vagina axis?Modern research has revealed a collection of intricate pathways, namely gut-vagina axis, which connects the vaginal tract to our gut. Despite the difference between intestinal flora and the vaginal flora, the former is found to be involved in the development of some vaginal imbalances. For example, bacteria from the gut pass to the rectum, from where they can travel to the vagina due to the close proximity, resulting in unfavorable conditions. Therefore, it is important to keep the communication smooth between the gut and vagina.2 Effects of vaginal microbial imbalanceVaginal microbial imbalances may result in several unfavorable conditions.
Factors affecting the vaginal microbiomeThe intricate and dynamic female genital tract requires special attention to care. Here are some of the factors that can create imbalance in the vaginal microbiome.
References: 1. Amabebe E et al. Front Immunol. 2020;11:2184. 2. Brannon JR et al. Nat Commun. 2020;11:2803. 3. Han Y et al. Front Micriobiol. 2021;12:643422. 4. Lehtoranta L et al. Front Micriobiol. 2022;13:819958. 5. Gholiof M et al. Front Reprod Health. 2022;4:963752. 6. Lewis FMT et al. Obstet Gynecol. 2017;129(4):643–654. 7. Cheng G et al. Eukaryot Cell. 2006;5(1):180–191. 8. Mirmonsef P et al. PLoS One. 2014;9(7):e102467. 9. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999. Accessed December 5, 2022. 10. Gupta K et al. J Infect Dis. 2000;181(2):595-601. 11. Szymański JK et al. Int J Environ Res Public Health. 2021;18(9):4935. 12. Neggers YH et al. J Nutr. 2007;137(9):2128-2133. 13. Tohill BC et al. Am J Clin Nutr. 2007;85(5):1327-1334. Every BODY and every age have unique nutritional needs. However, with every stage of life, there are common nutritional inadequacies that women are most likely to experience. Learn what supplements are best for YOU! 20s You may find yourself strapped for time and cash during these exciting transitional years, which could result in an unbalanced diet. What supplements should you consider taking?
In your 30s, you may be expanding your family and/or career, so you need all the energy you can get!
Your 40s are filled with possibilities; whether you are starting a new business, climbing the corporate ladder, juggling older kids, or welcoming a new addition, women in their 40s are thriving!
Your 50s and beyond can be a great time to reconnect with yourself and maybe your spouse too. Make sure to support all the amazing years ahead of you with high-quality supplements.
References
By Monazza Ahmad, B.Pharm, MSc
One of the symptoms of menopause that women wish had a permanent cure is hot flashes! The most uncomfortable and rather embarrassing aspect of hot flashes is that they visit unexpectedly. It doesn’t matter if you’re in a work meeting with executives, teaching to kindergarteners, at an intimate dinner, or just by yourself, there is no time and place for its occurrence.1 The sudden attack of heat and an outburst of sweating is enough to make anyone nervous. Prescription treatment options are usually costly and not suitable for some health conditions,2,3 leaving many women with no choice but to ignore it despite the distressful effect hot flashes have on their quality of life.4,5 But don’t be disappointed. In this post, you will find various natural ways and nonhormonal options to find relief from hot flashes until they disappear after completing their course. The severity and duration vary from woman to woman, so let the treatment take its time.5 Let’s understand what’s going on behind the scenes with hot flashes so we can mitigate the chaos it creates based on our body’s bioindividual needs. How do I know it’s a hot flash? During a hot flash, there is a sudden burst of heat from chest up that may result in red blotches on your skin and uncontrollable sweat. The untimely sweating, flushing, heat, and chills a few times a week or several times in a day is normal during menopause but definitely frustrating. A single episode of hot flashes can last anywhere from one to five minutes and up to an hour. The hot flashes range anywhere from 1 to 10 daily with the duration from a few years to a couple of decades.5 What’s causing this gush of sweat? Research suggests that hot flashes are a possible result of hypothalamus activity in regulating body’s temperature due to estrogen fluctuation. Here’s what that means: Reduced estrogen levels can cause blood vessels near the skin to dilate, increasing the blood flow that elevates body temperature. This increase in temperature triggers hypothalamus (your body’s thermostat) to detect warmth so it starts to cool down the body by a process called sweating.4,5 We all know that sweat is an important mechanism of temperature control in the body. It helps dissipate body heat by turning heat vapors into liquid (sweat) to keep the body cool. So you really don’t want to stop a hot flash, since it’s protecting our bodies from getting overheated. What is needed is hormone regulation so the hot flashes are less severe. How to squash hot flashes While hot flashes subside on their own and may not require treatment, those experiencing severe effects may want to seek safe relief options. Here are some lifestyle improvements and natural remedies that might be helpful in tackling hot flashes safely. Make sure to consult with your healthcare practitioner before taking any action; they will advise you on the best options and the right dosage for your specific health needs. NUTRITIONAL SUPPORT Vitamin D: Reduced levels of vitamin D are associated with many health conditions, including hot flashes. Try getting at least 15 minutes of sun every day and eat vitamin D-rich foods.6,7 Vitamin E and curcumin: Both these supplements have shown to reduce the severity and number of hot flashes. The dose of 200 to 400 IU for vitamin E and 500 mg for curcumin is found to be effective.8,9 Give at least four weeks to curcumin and up to eight weeks to vitamin E to work.3 Folic acid: About 1 mg of folic acid, a form of vitamin B, has shown weekly gradual improvement in severity. It may take about 3-4 weeks to reduce frequency and the duration of hot flashes.10 Vitamin B6 and oily fish: The impact of this vitamin on brain health, immune system, nerve function, and the breakdown of macronutrients explains its positive effect on vasomotor symptoms of menopause.11,12 To avoid pills, taking this vitamin in the form of oily fish has shown great results, too.13 ALTERNATIVE APPROACHES Plant-derived solutions: Black cohosh,14,15 phytoestrogens, and some other herbs are commonly used for hot-flashes relief.16 Read more about these options on our blog: “Consider Using Plant-Derived Solutions to Treat Menopausal Symptoms.” ERr 731®:* An extract of Siberian rhubarb, is the nonhormonal and generally safe solution16 to have shown significant improvements in all 11 major menopausal symptoms.17* It also has a high recommendation rate not only from providers but also from women who use it. Acupuncture: This form of complementary therapy, in addition to usual care, has shown marked improvement in hot flashes and other menopausal symptoms. Acupuncture is commonly used for stress management, pain relief, and overall wellness with neurological stimulation.3,18,19 LIFESTYLE FACTORS Resistance training: Lifting safe weights and isometric and plyometric exercises helps reduce hot flashes. In a study of menopausal women, hot flashes reduced by more than 40% in less than four months in women who performed these exercises regularly for at least three times per week. Active women experience less severe symptoms than inactive women.20,21 Eating: Food intake at regular intervals can reduce hot-flash frequency. So have a healthy snack between meals to avoid letting your blood glucose levels fall too low.22 Diet: A low-fat, plant-based diet including half cup of cooked soybeans 3-4 times daily along with TLC diet can significantly reduce the frequency and severity of hot flashes and other menopausal symptoms.23,24 Stress management: Anxiety and stress are the common triggers for many health conditions. Stress reduction techniques such as meditation, yoga, deep breathing, and resting can all help with hot flashes.25 Also of vital importance: Avoiding alcohol, smoking, spicy food, caffeine, and sugar, along with physical exertion and managing weight all contribute toward reducing the severity of hot flashes.26,27 Menopause and its symptoms are unavoidable, but you can definitely take these steps to minimize the discomfort and enjoy your daily activities. A piece of advice for younger women and those who haven’t reached menopause yet: Start taking care of your body early on in life. Eat healthy food and do regular physical activity to keep your hormones regulated. So when menopause hits, your body will be prepared to handle the ups and downs of aging and can recover faster. References: 1. Mayo Clinic. Hot flashes: symptoms & causes. https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790. Accessed February 14, 2023. 2. Rosenberg V et al. Hormone-replacement therapy and its association with breast cancer subtypes: a large retrospective cohort study. Int. J Womens Health. 2021;1:1207-1216. 3. Mayo Clinic. Hot flashes: diagnosis & treatment. https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795. Accessed February 14, 2023. 4. Bansal R et al. Menopausal hot flashes: a concise review. J Midlife Health. 2019;10(1):6-13. 5. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115-120. 6. Arslanca T et al. The relationship between vitamin D and vasomotor symptoms during the postmenopausal period. Clin Lab. 2020;66(7). 7. Religi A et al. Estimation of exposure durations for vitamin D production and sunburn risk in Switzerland. J Expo Sci Environ Epidemiol. 2019;29(6):742-752. 8. Ataei-Almanghadim K et al. The effect of oral capsule of curcumin and vitamin E on the hot flashes and anxiety in postmenopausal women: a triple blind randomised controlled trial. Complement Ther Med. 2020;48:102267. 9. Ziaei S et al. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest. 2007;64(4):204-207. 10. Bani S et al. The effect of folic acid on menopausal hot flashes: a randomized clinical trial. J Caring Sci. 2013;2(2):131-140. 11. Harvard T.H. Chan School of Public Health. Vitamin B6. https://www.hsph.harvard.edu/nutritionsource/vitamin-b6. Accessed February 14, 2023. 12. National Institutes of Health. Vitamin B6 fact sheet for consumers. https://ods.od.nih.gov/factsheets/VitaminB6-Consumer. Accessed February 14, 2023. 13. Odai T et al. Severity of hot flushes is inversely associated with dietary intake of vitamin B6 and oily fish. Climacteric. 2019;22(6):617-621. 14. National Institutes of Health. Black cohosh. https://www.nccih.nih.gov/health/black-cohosh. Accessed February 14, 2023. 15. Geller SE et al. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt). 2005;14(7):6340649. 16. Chang JL et al. Rheum rhaponticum extract (ERr 731): postmarketing data on safety surveillance and consumer complaints. Integr Med (Encinitas). 2016;15(3):34-39. 17. Kaszkin-Bettag M et al. Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med. 2009;15(1):24-34. 18. Kim KH et al. Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women–a multicenter randomized clinical trial. Menopause. 2010;17(2):269-280. 19. Mayo Clinic. Acupuncture. https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763. Accessed February 14, 2023. 20. Berin E et al. Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas. 2019;126:55-60. 21. Dabrowska-Galas M et al. High physical activity level may reduce menopausal symptoms. Medicina (Kaunas). 2019;55(8):466. 22. Dormire S et al. The effect of dietary intake on hot flashes in menopausal women. J Obstet Gynecol Neonatal Nurs. 2007;36(3):255–262. 23. Barnard ND et al. The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause. 2021;28(10):1150-1156. 24. Welty FK et al. The association between soy nut consumption and decreased menopausal symptoms. J Womens Health (Larchmt). 2007;16(3):361-369. 25. Freeman EW et al. Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn ovarian aging cohort. Menopause. 2016;23(9):942–949. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993654/ 26. NIH. Hot flashes: what can I do? https://www.nia.nih.gov/health/hot-flashes-what-can-i-do. Accessed February 14, 2023. 27. Herber-Gast GCM et al. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013;97(5):1092-1099. By Melissa Blake, ND
Our bodies have an amazing natural ability of keeping to a daily schedule via an internal 24-hour master clock.1 This clock contributes to the patterns, also known as circadian rhythms, of many biological activities including sleep-wake cycles, eating patterns, and hormone function.1 Finding ways to support and balance this clock, along with the many systems it regulates, may offer a novel way to optimize health. One way to optimize is through diet timing. The circadian diet as a way of eating takes into account not only what we eat, but when.2 It is an approach to eating that synchronizes food intake around our biological clocks, emphasizing eating in sync with the body’s natural tendencies and instincts. This means eating during daylight hours or hours when we are naturally more active. Eating in this way can help support circadian rhythms and contribute to overall health and wellness.2 As diets and terms including intermittent fasting, circadian diet, and time-restricted eating gain popularity, the question may arise as to whether the principle on which this “circadian approach” applies to other aspects of nutrition, including supplementation. 5 common supplements Although there’s still much to learn about optimal timing for both food and supplements, current evidence suggests it may play a role.3 Here are a few general guidelines for five common supplements to help you add the extra layer of timing and optimize your plan: B complex B vitamins are often recommended to support healthy energy and mood.4 There is some evidence that taking B vitamins before bed can have a negative effect on sleep quality.5 Consider taking any B vitamins, including a B complex, earlier in the day with food. Fish oil The most common complaints I hear about fish oil are burping or nausea. Taking fish oil supplements with food, divided into two doses, may help reduce these harmless yet annoying side effects. Magnesium Magnesium is an essential micronutrient that plays a role in hundreds of reactions in the body.6 Due to the overall benefits of magnesium supplementation, consistency is more important than any timing in this case. Known for muscle relaxation and improved sleep, taking magnesium before bed may enhance those benefits in some people.7 Others may notice digestive issues and may choose to take with food. Probiotics Any recommendation related to probiotic supplementation should be based on the specific strain; however, much of this detailed evidence does not yet exist. Meal timing has more or less of an impact on probiotics depending on the strain, the dose, delivery method, etc.8 The consensus, however, is to take probiotics 30 minutes before or during a meal versus after eating.9 Another guideline is to space probiotics away from antibiotic medications by two hours to reduce interaction. Vitamin D Along with vitamins A, E, and K, vitamin D is a fat-soluble vitamin that is better absorbed when taken with a fat-containing meal (ex. fatty fish, avocado, olive oil, cheese, eggs).10 Although we do not have substantial evidence to support specific timing, it may make sense to take vitamin D supplements in the morning with breakfast to mimic the timing of exposure to natural sunlight. Summary As we continue to learn about specific supplements and optimal timing, consider that the best timing is the one you can stick with. You cannot benefit from a supplement you do not take. The most important thing is to take your supplements at a time that is convenient for you so you can be consistent. Work with a knowledgeable healthcare provider to determine the optimal plan for you that includes quality, quantity, and timing. References:
By Whitney Crouch, RDN, CLT While running around being a “stay-at-home” mom, a “9-5” mom, or somewhere in between, it can be easy for mothers to forget about taking care of themselves. Breastfeeding mothers may face an added layer of stress when trying to do it all and be everything to everyone, but keeping nourished should be a top priority. In the previous parts of this series, we examined mothers’ challenges with producing adequate milk supply for their babies, as well as nutrition and supplements to support her supply. Motherhood and liquid gold Proper diet and hydration are often sacrificed when juggling the demands of a new baby, housework, career, other children, and any semblance of a social life. This altruistic sacrifice could unknowingly lead to negative consequences. Milk Production 101 While the need for nutrient-dense foods will always ring true, the number of calories required to allow healing and support adequate milk production varies from woman to woman. Calorie needs for breastfeeding moms depend on how much energy mom is exerting daily, plus how much milk she is producing. On average, an exclusively breastfeeding mother needs about 500-640 calories more per day than she did prepregnancy.1,2 The average baby consumes 19-30 ounces of milk per day, but mother’s hydration needs actually exceed the amount of milk produced and her prenursing hydration needs combined.3 According to the Dietary Reference Intakes (DRIs), mom needs around an extra 34 ounces (1 liter) of water each day, and if she still feels thirsty, she should drink more water.4 Fueling the nurturer It’s common for new moms to fall into the habit of always putting baby first. Of course, it’s important to keep baby out of harm’s way, but when baby’s needs are met, it’s okay to put baby down (or wear baby in carrier) so that mom can put on her own proverbial oxygen mask. The act of growing a baby and then giving birth is a tremendous stressor on a woman’s body. Albeit a completely natural, beautiful, and often relished stressor, a women’s body needs rest and nutrient-dense foods to heal properly and to continue to give life to her baby. Across various traditional cultures, there are heavy emphases on postpartum nutrition. While the dishes for postpartum nutrition vary by culture, there are many commonalities, with animal products, cooked vegetables, herbs, and spices as mainstays in most cultures.5 Eating to heal At a glance, traditional healing foods reveal that broths, soups, stews, and porridge are central to a new mother’s diet.6 Slow-cooked stews and broths are rich in collagen-building amino acids such as glycine and proline, electrolytes, and “warming” spices and herbs.5 Porridge-like foods and cooked vegetables provide fiber-rich carbohydrates. It’s no coincidence that these nutrient-dense foods are easy to digest and rich in iron, B vitamins, zinc, choline, DHA, protein, carbohydrates, and a number of other nutrients that support replenishing red blood cells, tissue healing, and the production of high-quality breastmilk.5 In addition to eating wholesome foods, new mothers should not reduce calories or carbohydrates in the months immediately following giving birth.7-9 If weight loss is desired once her breastmilk supply is established, mom can mindfully reduce carbohydrate intake while monitoring her milk supply and ensure her diet remains otherwise nutrient-dense.5 Nourishing baby Like adult food, human milk is made up of carbohydrates, fat, protein, vitamins, and minerals, plus the addition of nonnutritive bioactives. Some of the milk components remain at consistent levels across the breastfeeding relationship, while others vary from mother to mother and for each mother across time.10 Each mother’s milk is unique based on her dietary intake, body stores, time frames (time of day, season, circadian rhythms), time intervals (time of day, time since previous breast emptying and duration of feed), and time relative to maternal exposures (e.g., meals, pathogens, and supplements).10,11 Let’s explore these nutrients a little further… Fat Breastmilk fat quantity is mainly dependent on the feeding period, the stage of the feed, and the number of pregnancies mom has had, while maternal diet (energy intake, amount of dietary fat) and lifestyle are less relevant (except in cases of severe malnutrition).12 Fat is made up of subunits called fatty acids; the fatty acid profile of breastmilk is reliant upon both mom’s current diet and her dietary intake during the pregnancy.13 Interestingly, much of the fat in early breastmilk comes from mom’s longer-term food intake, mainly during the third trimester of pregnancy.13 And while the amount of fat in breastmilk is not directly related to diet, the composition of the fatty acids in the breastmilk is related to diet.13 Important to fetal and infant brain and vision development, eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) are two omega-3 fatty acids that may be lacking in mom’s diet. If she consumes a standard American diet (SAD) or a vegan diet, which are inherently lacking in fatty fish intake, baby is at an especially high risk of deficiency.14 Even though the human body holds the necessary enzymatic pathway to make DHA from its plant-based precursor alpha-linolenic acid (ALA), there is clear evidence that the conversion of ALA to EPA and DHA is insufficient to ensure adequate levels in baby.17 In fact, it has been shown that the efficiency of the conversion of ALA to EPA is lower than 10%; the conversion of ALA to DHA is even lower, and virtually nonexistent in boys and men.15 Pregnant and lactating women should aim to consume an average dietary intake of at least 200 mg DHA/d.16 In order to balance adequate amounts of EPA and DHA with lowered risk of environmental contaminants, more small fish (e.g., sardines, anchovies and mackerel) should be eaten over larger fish, and wild-caught or safely farmed salmon should also be preferred. Fortunately, nature has included selenium in fatty fish, which counteracts methylmercury toxicity in humans and protects against some neurological effects of mercury exposure.17 This is an important fact to note in light of weighing the risks to benefits of increased seafood intake with increasing exposure to harmful methylmercury, polychlorinated biphenyls (PCBs), and dioxins found in some seafood.18 Supplementation with DHA and EPA that has been third party-tested for contaminants (e.g. heavy metals, dioxins, etc.) can be a convenient way for mothers to ensure adequate omega-3 fatty acid intake. Protein Like fats, the protein composition of human milk is more affected by mother’s intake than the actual amount of protein in the milk or by maternal or gestational age.10 While the concentration of protein in the milk is not affected by mom’s diet, it does increase with maternal body weight for height and decreases in mothers producing higher amounts of milk.19 In addition, while the makeup of breastmilk shows a consistent level of protein regardless of time of day, although protein concentration does decrease through each lactation session.20 Carbohydrates The predominant carbohydrate in breastmilk is lactose; however, there are also nondigestible, nonnutritive carbohydrates. These nondigestible carbohydrates, called oligosaccharides, act as food for the beneficial gut bacteria that bloom into baby’s gut microbiome.10 Lactose concentrations are lowest in colostrum and increase through the first 4 months of lactation.21 Unlike the other macronutrients, lactose concentrations are fairly consistent across the milk of different mothers and are not influenced by maternal weight or number of pregnancies.10 Vitamins and minerals As mentioned earlier, some nutrients depend on mom’s current dietary intake, while others rely on her bodily stores.10 The following nutrients change with mother’s intake, adequacy or deficiency, and/or supplementation. Real food sources follow each nutrient:11,23
It’s important to note that it’s difficult to consume adequate vitamin D through food alone. Known as the “sunshine vitamin,” vitamin D is mostly obtained through unprotected skin’s exposure to ultraviolet (UV) light, but in geographic areas with poor seasonal UV exposure or in individuals who spend a lot of time indoors, supplementation may be necessary. Fortunately, a new randomized controlled trial found that for deficient mothers, supplementing with 6,000 IU of vitamin D3 safely optimizes maternal vitamin D status and improves milk vitamin D to maintain adequate infant serum vitamin D levels.24 Vitamin D levels should be monitored by a healthcare practitioner. Final thoughts… Breastmilk conveys immeasurable benefits, even if some of the nutrients are lacking at times, and is therefore baby’s preferred food.24 That said, fed is always best. References
We all want healthy, glowing skin, right? But no matter how many creams, serums, or treatments emerge, the fact remains that healthy, luminous skin comes from within! Here are eight ways to glow from the inside out. Collagen Collagen supports skin repair and can be obtained through the consumption of meat or in supplement form. Supplementation with high-quality collagen has been shown to increase dermal collagen density, skin elasticity, and hydration.1 Diet A healthy diet is related to fewer lines and wrinkles.2,3 Additional studies have also linked healthcentric diets to fewer changes in pigment and reduced skin dryness and atrophy.4,5 Eat the rainbow by filling your plate with a full spectrum of different colored fruits, veggies, whole grains, and lean protein. Exercise Exercise is good for more than your physique. Endurance exercise has been shown to positively impact the aging process. During exercise the body produces an exercise-stimulated compound called IL-15, which plays a significant role in repairing skin tissue.6 Hydrate Adequate hydration helps support glowing skin from the inside out; according to a recent study, increased dietary water intake positively impacts skin physiology.7 Omega-3s Supplementation with omega-3s has been shown to help reduce acne.8 Recent studies suggest that omega-3s, particularly EPA, may support skin health and photoaging due to UV radiation.9 Probiotics Gut health has been shown to impact the health of your skin. Probiotics have been shown to help control P. acnes bacteria and reduce sebum production. Excess sebum encourages the colonization of P. acnes, which leads to acne.10,11 Sleep One night of missed sleep can leave you bleary-eyed and reaching for your coffee cup, but did you know that consistently poor sleep can lead to increased signs of aging, reduced barrier function of skin, and dissatisfaction with appearance?12 Prioritize sleep to care for your overall health and skin.12 Vitamin C Healthy skin needs lots of vitamin C, which helps stimulate collagen production.13 Vitamin C is also a powerful antioxidant that helps to protect against photodamage from UV rays.13 Your skin protects you, so return the favor by making small changes to protect your skin from the inside out. Whether it’s establishing healthy sleep hygiene, working on your gut health, or just making sure you’re getting enough vitamins and minerals. Your skin will thank you. References:
As women, we’re constantly seeking balance. Balancing our families and careers, time and energy, work and fun can be a struggle. But balancing that delicate microbiome in our guts doesn’t have to be a challenge, thanks to probiotics. Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”1 There are many myths about probiotics, but the health benefits aren’t one of them. If you’re curious why you should consider taking a daily probiotic and how it can benefit you, consider the following six reasons. 1. Probiotics support immune health. It’s a well-known stereotype that women tend to put others first. The downside of this is that we don’t always take the time to take care of ourselves. The gut plays an active role in immune health, with intestinal bacteria helping to regulate immune cell activity.2 Taking a daily probiotic may be helpful for supporting immune function.3 2. Probiotics can provide self-care for “down there.” Yes, that “down there.” The vagina is an ecosystem that requires a delicate balance, just like the gut. Luckily, there are clinically researched probiotic strains that have been shown specifically to impact feminine health.4 Two such probiotic strains are Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®, which work by traveling through the digestive tract to the vagina.5 Research shows that once there, the two probiotic strains work to help maintain a healthy vaginal environment by increasing the number of good bacteria.4,6,7 3. Certain probiotic strains support weight maintenance. Most people know that a healthy weight correlates to a healthy life.8 But did you know that probiotics can help you maintain that healthy weight? One probiotic strain in particular, Bifidobacterium lactis B-420™, has shown in clinical research that it can help weight maintenance by controlling body fat.9 4. Probiotics support gut health. Women aren’t the only ones whose guts benefit from daily probiotics; this one’s for everyone, even kids! Much research has been done on the benefits of probiotics on gut and digestive health, so it’s no wonder it’s a common reason practitioners recommend this first line therapy for patients seeking digestive support. Look for strains like Bifidobacterium lactis Bi-07® and Lactobacillus acidophilus NCFM®, both of which have been researched for their relationship to good gut health.10,11 5. Probiotics can help get mild diarrhea under control. Sometimes we just need a little help getting back to regular. Luckily, there have been many studies done on the relationship between probiotics and gastrointestinal comfort.12 Probiotics like Saccharomyces boulardii and the strain Bifidobacterium lactis HN019 have been studied extensively for their gastrointestinal benefits.13,14 6. Probiotics may help support mood & cognition. Our guts and brains communicate through what’s known as the gut-brain axis.15 In other words, just as stress or unhappiness can lead to an upset tummy, an upset microbiome can affect our mood.14 The opposite works as well: Recent studies have shown that probiotics may help support mood as well as cognition, even to the point of lowering stress levels.16,17 Curious which probiotics would be best for your specific needs? Your healthcare practitioner can help to guide you. For more information on nutrition and gut health, please visit the Metagenics blog. References: 1. Hill C et al. Natur Revs Gastro Hepatol. 2014;11(8):506—514. 2. Bermudez-Brito M et al. Ann Nutr Metab. 2012;61(2):160-174. 3. Kang E-J et al. Korean J Fam Med. 2013;34(1):2-10. 4. Reid G et al. FEMS Immunol Med Microbiol. 2001;32(1):37-41. 5. Reid G et al. FEMS Immunol Med Microbiol. 2006;30(1):49-52. 6. Reid G et al. J Med Food. 2004;7(2):223-228. 7. Reid G et al. FEMS Immunol Med Microbiol. 2003;35(2):131-134. 8. Loman T et al. BMC Public Health. 2013;13:259. 9. Stenman LK et al. EBioMedicine. 2016;13:190-200. 10. Ringel-Kulka T et al. J Clin Gastroenter. 2011;45:518-525. 11. Leyer GJ et al. Pediatrics. 2009;124:e172-179. 12. Vitetta L et al. Inflammopharmacol. 2014;22(3):135-154. 13. Kelesidis T. Therap Adv Gastroenterol. 2012;5(2):111–125. 14. Waller PA et al. Scand J Gastroenterol. 2011;46(9):1057–1064. 15. Carabotti M et al. Ann Gastroenterol. 2015:28(2):203-209. 16. Papalini S et al. Neurobiology of Stress. 2019;10:100141. 17. Akbari E et al. Front Aging Neurosci. 2016. https://www.frontiersin.org/articles/10.3389/fnagi.2016.00256/full. Accessed February 19, 2021. NCFM® and Bi-07® are registered trademarks licensed by DuPont. Submitted by the Metagenics team We sat down with Joel Evans, MD to talk about Functional Medicine options for common women’s health issues.
What kind of options do you suggest for women entering perimenopause to help address discomfort/symptoms? Perimenopause is a challenging time of life for many women because just as their ovaries are beginning to put them into perimenopause, life stressors hit. They’re dealing with teenagers—and the stressors associated with raising teenagers—they’re applying to college or leaving home; they’re dealing with aging parents that require more attention. There are financial stressors, and all of those stressors can put stress on marriages. So, there are a lot of challenging life events that coincide exactly with the perimenopausal period. To make matters worse, stress makes all the physical manifestations of perimenopause worse. We have this hormonal roller coaster taking place at the same time as the occurrence of stressful life events. The first change that we see is a decrease in progesterone in the second half of the cycle. Progesterone has anti-anxiety effects, and progesterone helps with sleep. The second thing we see is an increase in estrogen levels, which changes the relationship between estrogen and progesterone. Elevated estrogen also causes symptoms like breast tenderness and breast pain, as well as building up the lining of the uterus, which can cause changes in the bleeding pattern in perimenopause. There can be longer intervals between periods, the blood flow can be heavier because the lining is thicker, and more material has to come out during the menstrual flow. There can be sleeplessness, anxiety, and depressed mood. If a woman has entered perimenopause and is having hot flashes, many times I’ll recommend ERr 731®. It is a plant-derived ingredient that has been shown in clinical studies to reduce daily hot flashes from 12 to 2 in as little as 12 weeks—an 83% reduction.* Patients have found it can be an effective relief for a wide range of other menopausal symptoms including: sleep disturbances, mood, irritability, and anxiety. I’ve also had great success with chasteberry and black cohosh to help support menstrual regularity, ease menstrual cramps, and support reproductive health. If this is a concern, I’ll also suggest they try ashwagandha, an herb to help support healthy libido.† What is the typical relationship between stress and fatigue? What testing do you do, and what are your typical recommendations?Stress causes hormone imbalance and dysfunction and metabolic abnormalities, and both the metabolic abnormalities and the hormone imbalances create fatigue. Stress causes imbalances in adrenal function. It will lead to elevated cortisol and ultimately lowered DHEA-S. Cortisol helps the body with metabolism. Elevated cortisol directly causes diminished thyroid function, and when the thyroid is underperforming, hypothyroidism leads to fatigue. Low DHEA-S levels also lead to fatigue. Ultimately, when the body has been producing cortisol for too long, it can’t continue that, so less cortisol is produced, and that leads to fatigue. I like doing an adrenal stress profile, a 24-hour test of adrenal function with four salivary samples. I see what cortisol is on wakening, during the day, and right before bed. People who are stressed and wired may have too much cortisol at night, and they can’t sleep. I will recommend taking herbal supplements that contain ingredients like Schisandra, jujube, and Rehmannia root at night to address organs and systems involved in the stress response. Adrenal adaptogens such as Asian (Panax) ginseng, Cordyceps, and Rhodiola work great in the morning to support adrenal function. Many times I’ll also recommend DHEA, which is associated with healthy adrenal function. Pantothenic acid and pyridoxine (vitamins B5 and B6) as well as licorice root extract can also help increase cortisol production and decrease cortisol breakdown.† *Compared with perimenopausal women receiving placebo, those receiving ERr 731® experienced a median 83% decrease in daily hot flashes over the course of 12 weeks (Kaszkin-Bettag M, et al. Altern Ther Health Med. 2009;15(1): 24-34) |
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Certain persons, considered experts, may disagree with one or more of the foregoing statements, but the same are deemed, nevertheless, to be based on sound and reliable authority. No such statements shall be construed as a claim or representation as to Metagenics products, that they are offered for the diagnosis, cure, mitigation, treatment or prevention of any disease. PAIA Manual |