Transcription:
Women's Health: Eat Healthy, Be Healthy

Caitlin Whyte: Diet, weight and nutrition are the topic of many conversations with my girlfriends these days. And with May being Women's Health Month, we thought it was the perfect time to talk about women and nutrition. Joining us for this conversation is Joanna Murray, a physician assistant at WakeMed Primary Care.

This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm your host, Caitlin Whyte. So Joanna, why is focusing on nutrition so important to women's health?

Joanna Murray, MPH, PA-C: Well, for everybody, good nutrition can help us feel better, give us more energy and prevent certain chronic diseases. For women, it's good to focus on it because honestly, with the demands of work life, home life, the way that we stretch ourselves pretty thin, it's hard for us to take the time to take care of ourselves and nutrition is one of those places that we need to do that.

And on the other side, we have commercials and social media putting pressure on girls and women to be a certain size. And sometimes we get really bad advice on how to achieve that goal. So hopefully, I can help clear some of that up today.

Caitlin Whyte: Yeah. So a bit broader question off that one, what are some basic nutritional guidelines we can follow?

Joanna Murray, MPH, PA-C: Well, I think a good place to go is probably the United States dietary guidelines. The dietary guidelines for 2020-2025 are found at www.dietaryguidelines -- that's all one word -- dot gov. And they kind of make broad statements that are pretty easy to follow. The first being follow a healthy dietary pattern at every life stage to meet nutrient needs, help achieve a healthy body weight and reduce the risk of chronic disease.

The second goal that they focus on is meeting food group needs with nutrient-dense foods and beverages and staying within calorie limits. And that's done mainly with eating fresh fruits and vegetables; grains, focusing on whole grains; dairy, focusing on low fat and fat free; higher protein foods and choosing oils from monounsaturated fat sources.

And then the last is limiting foods and beverages that are higher in added sugars, saturated fat and sodium, and limiting alcoholic beverages. So I think that's a good starting point.

Caitlin Whyte: Yeah, you kind of touched on it, but how does alcohol affect women specifically? Is there any like reasonable amount we can consume?

Joanna Murray, MPH, PA-C: That's a great question. Moderation is defined for men as two drinks per day and women, no more than one drink per day. So when I'm talking to a patient about their alcohol intake, if it's a woman who has greater than seven drinks per week, then I'm concerned that maybe we're not drinking alcohol in the moderate amount. And honestly, with COVID right now, that is a very common conversation that I'm having with people staying home. I'm having the conversation of, you know, we've gotten into habits that we probably shouldn't have gotten into, and it's probably time to take a look at how to back off. And I mean, it's empty calories for one, but it's not good for our livers to have to process out alcohol on a regular basis of that amount

Caitlin Whyte: Looking at things like vitamins, supplements, other nutrients, are there any that women specifically should be focusing on getting more of?

Joanna Murray, MPH, PA-C: Yeah. Iron is one. Another is folic acid. And then I always like to talk about calcium and vitamin D. Would you like for me to talk specifically about each?

Caitlin Whyte: Yeah, that'd be great.

Joanna Murray, MPH, PA-C: Okay. So let's start with iron. Iron is a mineral. And its main purpose is to carry oxygen in the hemoglobin of red blood cells. And that oxygen is carried around to different cells and help the cells produce energy.

When your body's iron stores become so low that not enough normal red blood cells can carry the oxygen efficiently, you can get iron-deficiency anemia. Women need more iron than men. Specifically, females age 14 through 18 need about 11 milligrams of iron per day. Women ages 19 through 50 need about 18 milligrams of iron per day. And this number drops greatly once you're in menopause, down to 8 milligrams per day, which is closer to the male needs. Those numbers. I just say just so you can be aware of how much iron you're getting. I don't think you need to calculate those numbers and look specifically at what you're getting, but taking a look at what iron rich foods are and seeing if you're getting enough of those in your diet.

So when you're thinking about iron-rich foods, it's good to remember that the body absorbs about two to three times more iron from animal sources than from plants. And some of the best animal sources of iron are lean beef, oysters, chicken and turkey. If you're a vegetarian, don't worry. There are plenty of iron-rich foods to choose from, but just remember that you're not going to absorb them like you do from meat.

A good thing to keep in mind, if you are a vegetarian, that you do absorb the iron better if you're also getting enough vitamin C. So good vegetarian sources or vegetable sources for iron are beans and lentils, tofu, baked potatoes. cashews' dark green leafy vegetables like spinach; fortified breakfast cereals and whole grain and enriched breads.

So folic acid is a B vitamin, and it's also important in red blood cell formation. And it's also important in making genetic materials such as DNA. Folic acid is essential during pregnancy to reduce the risk of spine and brain abnormalities in the fetus. Most women need about 400 micrograms daily folic acid and women who are pregnant should aim for around 600 micrograms or more.

Folic acid is found in enriched grains like breads and pastas, fortified breakfast cereals and dietary supplements. Since it is so important in pregnancy, I always advise my patients who desire to become pregnant to begin taking a multivitamin that includes at least 600 micrograms of folic acid daily.

When it comes to calcium, calcium works together with vitamin D to do a lot more than just keep the bones healthy and strong and for your teeth, which it does that too. But getting enough calcium also helps your heart muscles stay strong and helps reduce the risk of blood pressure and certain cancers like colon cancer.

A good goal for calcium intake is about a thousand milligrams per day. And for women who are 51 years old and older, they need about 1200 milligrams per day. For vitamin D, vitamin D it's about 600 International Units per day what you need. Foods that are higher in calcium include dairy, preferably low fat, calcium-set tofu, green leafy vegetables, like kale, collard greens, broccoli, spinach, and calcium-fortified 100% juice, including orange juice.

It's good to note that if you take a multivitamin, that includes calcium, it's likely that you're probably not absorbing a large amount of that calcium and so you still need to find other good sources and not just think that you're getting enough from that multivitamin. Supplement of calcium is absolutely fine, but you probably want to take it not with your multivitamin if you're taking both of those.

Foods that are higher in vitamin D include fish and those are fish that are higher in fat, things like salmon, herring, mackerel, red meat, liver, egg yolks, and fortified foods such as cereal.

Caitlin Whyte: So, you know, as we head towards summer, it feels like so many of my girlfriends are starting to diet and count their calories. I got weddings coming up and just beach season in general. So how can women balance calories with activity to maintain a healthy lifestyle?

Joanna Murray, MPH, PA-C: Great question. So the calorie-activity balance is important for everybody to reach and/or maintain a healthy body weight. In general, this is a little more difficult of a balancing act for women than it is for men.

Typically, we have less muscle. Typically, we have just naturally more body fat. And generally, we're smaller than men. This means that we need fewer calories to maintain a healthy weight. As you've probably noticed, sometimes a couple can go on a "diet" and the man can lose weight very quickly. And it's frustrating for the woman. And that's exactly what I just said there.

How to do so? Weight management is a huge topic and it's multifactorial. There are looking into why we eat, why we eat the foods that we eat, the habits that we have, why do we have these habits. But if you boil all of it down to the simple facts, it is about calories in versus calories out. And so how many calories are you getting in from the foods and beverages that you're taking in versus how many calories are you burning with physical activity?

So when you think about calories in, there are some ways that you can look at getting fewer calories. I typically tell people, the first thing you need to do is be honest with how many calories you're actually getting. And not that we were trying to really deceive ourselves, but I think most of us aren't aware of how many calories we get per day. And so a good activity for someone to try is to write down everything that you have. Every time you put something in your mouth, write it down on a sheet of paper for about three days. And take a look at that sheet of paper and see if there are ways or places that you can get in fewer empty calories.

And by empty calories, I'm talking about those foods that give you calories, possibly fat, possibly salt, possibly sugar, but not lots of good vitamins and minerals, fiber and protein that your body needs. Sources of empty calories typically are things like snacks, dessert, and drinks. And so when you're taking a look at that list of food, take a look and see if there's a place where you're snacking on things like maybe potato chips, where you're having dessert every meal or every evening that you can cut back on or what you're drinking, are you drinking sodas throughout the day? That's a lot of calories that you can cut out.

And you can either find ways to cut that out. For example, if you snack in the evening to relax and watch TV, finding either something different to snack on other than the potato chips or deciding to do something totally different and go for a walk instead of sitting there eating those potato chips. If it's desert, a good example of something that you can do is instead of having that piece of cake or that piece of pie is if you love chocolate, having a little chocolate bar, you know, those little small individually wrapped chocolate bars, opening that, enjoying it after your meal and then being done and knowing that that was your sweet after your meal. So there are ways that you can look at what you're doing and cut out those empty calories and exchange them for foods that give you more than just calories.

If we were talking about the calories out, you can set a realistic goal for yourself to start off. I know some people do not do any physical activity other than what is needed for home life, for working. And generally, most of us, to get the calories out that we need for not just weight management, but for cardiovascular health, we need to do more.

So finding places that fit with your lifestyle, whether it be, you know, if you have a 30-minute lunch period and you have a safe place to walk outside of your work, deciding for 20 minutes of that lunch period that you're going to go walk outside. Or if you like to watch TV in the evening, getting some light weights. And while the TV's on, instead of sitting there, getting up and lifting some weights with your arms, with your shoulders and learning how to do that well and increasing your physical activity that way. And once you've made that goal, then try to push yourself and try to push yourself to make more goals and to increase the time that you're doing this physical activity and the intensity.

And I know, like I said, this is a huge subject. Thankfully, there are good resources to help with this. One is the American Dietetic Association, which is at www.eatright.org. That's E-A-T-R-I-G-H-T, one word, dot org.

There are also great professional dieticians, who this is what they study for at least four years. And they are a wealth of nutrition knowledge and meeting with them and setting goals. Thankfully, a lot of insurance plans now will help you cover dieticians. And so talking to your insurance company, if you have insurance, and saying, "Hey, is meeting with the dietician covered? And you have a list of dieticians that are under my plan," and starting there.

Another good resource if you're wanting to learn better how to exercise, there are some great trainers out there and there's some great exercise physiology professionals out there who can help you learn how to meet exercise goals and how to, if you're interested in building more lean body mass, which helps you burn calories quicker, who can help you do that in a way that's not going to hurt you, because especially lifting, if you don't lift correctly, you can possibly hurt yourself.

So if you don't want to meet with a trainer, you can even find some great videos now online and make sure that this is, of course, from a reputable source of how to lift properly and how to use small weights starting off properly. Those are all great resources.

Caitlin Whyte: And wrapping up here, any last tips or advice for women when it comes to staying healthy, you know, in a safe and really healthy way?

Joanna Murray, MPH, PA-C: Be nice to you. I think that's probably my biggest tip. Take care of you. And I know we are caretakers at heart, many of us, and taking time to really take care of yourself and take care of what you put in your body and take care of how you treat your body. And this is not exactly on the subject, but taking care of your mind. I think everybody seems stressed out these days. And I think if we could take some moments to combine the exercise piece of it with taking a breath or taking a moment for ourselves, I think that will go a long way with how well we're feeling overall.

Caitlin Whyte: Well, thank you for your sound advice today, Joanna. To learn more about WakeMed Primary Care, please visit WakeMed.org. And thank you for listening. I'm Caitlin Whyte with WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh North Carolina. Stay well.