Author: Monica Reinagel, MS, LDN

Why weight loss is harder for some people

by Monica Reinagel, MS, LDN

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

For one thing, it takes a lot of work to change deeply ingrained habits and behavior patterns. It’s hard to move more when our workplaces are designed for sitting and our neighborhoods are designed for driving. It’s hard to eat less when you’re constantly surrounded by hyper-palatable food. It’s also challenging to eat less when you’ve learned to use food to cope with stress or soothe your emotions.

These are all issues that a good behavior modification program can help with. But It’s also really hard to eat less when your brain is sending you the wrong signals about whether you’ve had enough to eat.

This article is also available as a podcast. Click to listen.

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

Hunger (the urge to eat or to seek food) and satiation (the feeling that you’re full and don’t want more food) are both regulated in the hypothalamus, the most primitive part of the brain. The hypothalamus responds to hormonal signals being sent from different organs of the body via various chemical messengers. When this system is working as it should, our hunger increases when our body needs energy and decreases when it doesn’t. The result is a stable body weight.

But sometimes, the system goes awry. Dr. Gabriel Smolarz is an endocrinologist specializing in the treatment of obesity. Here’s how he explains it:

“The hypothalamus is receiving all of these different inputs and processing the situation to then say: Should we eat? Should we not eat? Should we stop eating? We conclude that there’s dysregulation when the gas tank is full, but the hypothalamus is indicating an empty tank.”

If your brain is receiving the wrong signals about whether or not you need food, this is obviously going to make it much more difficult for you to eat less.

Are genetics to blame for obesity?

Dysregulation of appetite signals can be due to genetics—similar to the way you might inherit a dysfunction in your body’s ability to regulate your cholesterol levels or blood pressure. This may be at least part of the reason that obesity, like high cholesterol, runs in families.

Of course, our genetics haven’t changed that much in the last 100 years, while the incidence of obesity has skyrocketed. But genes aren’t always destiny. Sometimes they need an environmental trigger to unfold. What’s changed in the last 100 years is not our genetics but the environmental triggers.

What’s changed in the last 100 years is not our genetics but the environmental triggers.

We are more sedentary than previous generations. And at the same time, our food supply has gotten cheaper, more convenient, and it’s processed in ways that make it more tempting. The combination of dysregulated appetite signals with cheap and abundant high-calorie, hyper-palatable food is clearly a recipe for disaster.

This situation can be compounded by something referred to as metabolic adaptation, in which the body responds to caloric restriction by burning fewer calories and amping up the urge to eat. Here’s Dr. Smolarz again:

“If you are fortunate enough to achieve a meaningful weight loss, it’s really hard to keep that weight off. It’s basically the body saying, Oh, no, this is not good. Higher weight is better, safer, and more conducive to reproduction and survival. So after the weight loss, you’re hungrier than you were before, because of this hormonal part of metabolic adaptation.

“And then the second half of this story has to do with how much energy you burn at rest. The body says, We’re now going to conserve as many calories as we can by burning less. So if it took you a hundred calories to walk around the block, your body says, Well, we can now do this in 80 calories.

“So you’ve increased your efficiency. And if you want to continue to lose weight, you need to consume even less than you did just a few weeks ago, because now your resting energy expenditure is lower than it was before.”

One of the reasons that I advocate a slower pace of weight loss than is commonly prescribed is to minimize the unwanted metabolic adaptation. However, those with a long history of crash or yo-yo dieting may have lasting effects that make weight loss increasingly difficult.

While it’s true that if you eat less you will lose weight, it’s not an even playing field.

So while it’s true that if you eat less you will lose weight, it’s not an even playing field. One person might be able to lose a couple of pounds by cutting out a dessert here and there and taking a walk after dinner. But some people have to eat a lot less (or go around feeling hungry all the time) in order to lose a pound or maintain a lower body weight.

Is there any way to fix appetite dysregulation?

There are a variety of medications that work in the hypothalamus to regulate appetite signals. For those suffering from a dysregulation of appetite, where the hunger signals are out of sync with what their bodies actually need, these medications can make it easier to eat less and lose weight.

Several drugs have been approved by the FDA for the treatment of obesity. Some of these are similar to drugs that have been approved for the treatment of other conditions, such as Type 2 diabetes, but have been found in clinical trials to be effective in the treatment of obesity as well. (The two conditions frequently occur together.)

In the past few months, there’s been a lot of buzz about a Type 2 diabetes drug called semaglutide, which appears to be even more effective at promoting weight loss than some of the drugs approved to treat obesity.

In the most recent study, participants received intensive behavioral counseling along with a weekly injection of semaglutide or a placebo. Those receiving the behavioral counseling and a placebo succeeded in losing an average of 5% of their body weight … which is no small accomplishment. However, those who combined intensive behavior modification with the medication lost over 15% on average.

Important!
Disclosure: In addition to his work as a clinician and on the clinical teaching faculty of Rutgers Medical School, Dr. Smolarz also serves as Medical Director for Novo Nordisk, the company that developed semaglutide.

Why are these medications so under-utilized?

When you consider the prevalence of obesity and its enormous costs to individuals and society, you might think that these drugs would be more widely used.

If a person develops high blood pressure, high cholesterol, or high blood sugar, their doctor will probably suggest that they make some changes to their diet and get more exercise. And for some people, lifestyle change is sufficient to solve the problem. But for others, often those with a genetic predisposition, even the most diligent efforts with diet and lifestyle don’t fix it. At that point, the doctor will likely prescribe a medication to help modulate whatever aspect of their metabolism is out of whack.

Similarly, when a person has excess body weight, their doctor (if they mention it at all) will usually suggest that they eat less and move more. But if they are unable to get their weight down, rarely are medications discussed.

As pharmacist and obesity advocate Ted Kyle points out, 88% of people with Type 2 diabetes are prescribed medication to manage their blood sugar. And yet, anti-obesity medications are prescribed to only 3% of those with obesity. (And that’s doubled in the last ten years.)

I asked Dr. Smolarz why he thinks this is.

“I went to an allopathic medical school and a mainstream internal medicine residency program. I did a mainstream endocrinology fellowship. What I like to call essential obesity was not part of any curriculum. This dysregulation of appetite was not taught.

“Obesity is the most prevalent non-communicable disease on the planet. And we learn more about bioterrorism and how to use potassium iodide than how to use medicines in this regard.”

Not everyone who needs to lose weight needs an anti-obesity medication, of course.  Dr. Smolarz describes how he evaluates patients seeking treatment for obesity.

“You want to look for secondary causes of extra weight first, Are there other medicines that the person is taking that promote weight gain?

“There are also underlying medical conditions that could be causing this. An underactive thyroid can contribute to weight gain and be a cause of an inability to lose weight. So that’s something we would check for. Is this person perhaps an emotional eater or traumatic eater?  Maybe it’s a sleep problem.”

In addition to treating any underlying medication conditions that may be contributing to the problem, the first line of treatment is still to modify the diet, increase physical activity, and address behaviors that may be leading to overeating. But that’s not where treatment always ends.

Dr. Smolarz:

“There is no blood test that tells me you have an appetite signaling problem. I wish there was something like that. You cross things off the list, and then you say, Well, it’s not this, it’s not that. OK, I’m left with this. And so let’s approach that.

“The first part of the treatment is to ensure three key pieces: optimal nutrition, increasing physical activity, and behavior modification. I say someone is a candidate for medications when those three elements have been tried or are being currently tried, but we’re not seeing weight come off. “

However, even if appetite signals are out of whack, medication alone won’t solve the problem. Nutrition, physical activity, and behavior modification still need to be part of the program.

Dr. Smolarz:

“The medications are enabling those fundamentals to be even more successful.  The medicines allow you to tolerate a reduced caloric intake. So it’s one thing to say, You need to eat salad twice a day. You may be very hungry at 1200 or 1500 calories a day. The medicines that act as appetite suppressants make that feasible.”

Like all medications, the drugs used to treat obesity have a risk of side effects. Patients and doctors need to weigh the costs and benefits of the various medication options and select the one that is the best match for their situation. And this may be another reason that family doctors are reluctant to prescribe anti-obesity medications.

Here’s Dr. Smolarz again:

“All the drugs work a little bit differently, so it’s a bit of a challenge to master it all. Then the last piece is [the] fundamental misunderstanding of obesity as just a failure of willpower, that people just need to eat better and they should get a handle on their obesity. That’s just not the clinical reality.”

How to find help

If your health is at risk because of excess body weight and you and your doctor feel you have run out of solutions, you might consider consulting with a practitioner specifically trained in obesity medicine, which involves much more than just writing prescriptions or scheduling bariatric surgery.

The American Board of Obesity Medicine trains and certifies physicians in obesity management. Their website includes a directory where you can find Diplomates by location. The Obesity Medicine Association is another resource that can help you locate clinicians with specific training in obesity medicine.

Originally published at QuickandDirtyTips.com

What’s the latest on A2 milk?

by Monica Reinagel, MS, LDN

[Transcript]

There’s a certain amount of a genetic variation in dairy cows, just the way there is with people. That’s why some of us are left-handed and some of us have red hair!  And for Dairy cattle, one of those genetic variations leads to tiny differences in the proteins in their milk.

Beta-casein is the main protein in cow’s milk. And most of the dairy cattle here in the U.S. produce milk that contains two forms of beta casein…the A1 form and the A2 forms.  But some cattle produce milk that contains only the A2 form of beta casein.

The milk looks and tastes exactly the same. It has the same nutritional profile—same amount of protein, calcium, same amount of lactose. 

About 25% of the Western population experiences some degree of digestive discomfort after consuming cow’s milk…things like gas, bloating, or loose stools. We’re not talking about a milk allergy…that’s far less common and potentially more serious.  These digestive symptoms are relatively harmless and temporary but they can be uncomfortable and inconvenient.  And they are thought to be due to an inability to breakdown lactose, which is sugar in milk.

There are a few things you can do: You can avoid dairy products. You can take a lactase supplement when you eat dairy products, that’s an enzyme that helps break down the lactose so that it doesn’t cause problems. Or you can buy dairy products that have the lactose removed or reduced. 

And there are now a handful of studies showing that for people with known lactose intolerance or who suspect they are lactose intolerant, drinking A2 milk, which  only contains the A2 form of beta casein protein, may cause fewer digestive symptoms. 

I think this is something that individuals will need to try for themselves to see whether or not it makes a difference for them. And if it doesn’t, there are other options for people who have trouble with dairy, such as the lactase supplements and lactose free milk.

It’s important to note that at this time there no other known benefits to consuming only the A2 protein and no other known risks of consuming the A1 form.

Related listening

Is protein powder too processed to be healthy?

by Monica Reinagel, MS, LDN

Catherine writes:

“Virtually everyone says to cut down on processed foods.  It’s  one of the few things everyone from different camps generally agrees on.  Yet a large number of nutrition “influencers” recommend smoothies that include protein pea powder, or “beef powder”.  How the heck are those not processed food?”

You’re right: Pea protein and beef powder (yuck) would both be considered processed foods. As would soy or almond milk, yogurt, or frozen strawberries.

Virtually everything we eat is processed to some degree. Perhaps it’s helpful more to think of processing on a spectrum.  A grape still on the vine would be at one end and a grape-flavored jelly bean on the other. Somewhere in between those extremes would be raisins, grape juice, and grape jelly.

The goal is not to completely eliminate processed foods (which wouldn’t even be possible).  It’s more realistic to think about choosing foods that are closer to the less processed end of the spectrum as often as we can.

What’s the purpose of the processing?

Rather than painting all processed foods with the same brush, it’s also worth considering what the purpose of the processing is.  Is it to concentrate the sugar, increase the intensity of the flavor, or otherwise create a product that hyper-stimulates the reward centers of the brain?  Is it to increase the profit margin of a cheap ingredient?

Or does it serve to extend shelf life, increase the nutritional value of a food, improve its digestibility, or make a nutritious food safer or more convenient to prepare?

Obviously, the processing required to turn peas or whey into protein powder serves a different purpose than the processing required to turn an ear of corn into a bag of Cool Ranch Doritos.

If you enjoy smoothies, you can consider whether the benefit of the additional protein justifies the use of a somewhat processed ingredient like protein powder.  Your answer might depend on how easy it is for you to meet your protein needs from other foods in your diet.

Either way, though, even though it is somewhat processed, a smoothie would be closer to the less processed end of the spectrum than a strawberry-flavored McFrosty.

Metabolism Myths

by Monica Reinagel, MS, LDN

Despite the recent popularity of intermittent fasting, there’s still a widespread belief that eating several small meals a day promotes weight loss by stoking your metabolism. Or that going too long between meals will cause your metabolism to slow down. I think one of the reasons that these notions have gotten so much traction is that people haul out some very scientific-sounding explanations that seem, well, very scientific and, therefore, believable.

There are two basic arguments and we’ll tackle them one at a time:

This article is also available as a podcast. Click to listen:

Going into power-saving mode

The first goes like this: your body, when deprived of food for a period of time, will go into “starvation mode.”   This is when the body burns fewer calories in order to conserve energy, just in case the food shortage continues. During a famine, you’d need to live on your stored fat. Down-regulating your metabolism is a way to make those fat stores go a bit further.

It’s similar to the way your laptop adjusts its energy usage when it’s running on batteries, by making the screen a little dimmer, for example. When food is plentiful again, your metabolism goes back to normal, just the way your screen gets brighter when you plug your laptop back in.

If there were actually a famine, you’d be glad that your body is designed this way. But, if you’re trying to lose weight, the last thing you want is increased fuel efficiency. You want to be burning through stored fat like an Escalade burns through a tank of gas. So, the trick is to reassure your body that there is no shortage of food by eating every few hours. Your body will oblige you by continuing to burn calories with reckless metabolic abandon. Or so the story goes.

It makes sense, doesn’t it? And, it’s sort of true. Your body does respond to a prolonged fast by slowing your metabolism to conserve energy. Here’s the thing, though: your body doesn’t go into starvation mode if you go four hours without food. In fact, it takes about three days of fasting or serious caloric restriction for your body to respond with any sort of metabolic adjustment.

The cost of doing business

The second argument, which sounds even more technical and is, therefore, even more impressive, has to do with something called the thermic effect of food.  This is a term that scientists use to describe the energy that your body expends releasing energy from your food.

Think of it as a sort of transaction tax that your body charges you to convert the energy in your food into a form of energy your cells can use. If meal contains 300 calories worth of food energy, converting that food energy into cellular energy might use up 30 calories or so. So you’d end up with just 270 calories worth of energy when it’s all over. It’s a little like changing money in a foreign country. In order to convert your dollars into euros, you have to pay the money-changer a fee.

Some people have interpreted this to mean that if your body is constantly in the process of digesting food, it will constantly be burning calories (via the thermic effect of food) and that if you go too long between meals, you will be missing out on this calorie-burning opportunity.

Bosh! Just like at the money-changer, the fee to exchange food energy into body energy is simply a percentage of how much you’re changing. It doesn’t matter whether you exchange all your money in one lump sum at the beginning of your trip or change small amounts of money three times a day. The fees will be based on how much money you convert. And the thermic effect of food is based on how much you eat, not when you eat it.

The bottom line

There’s nothing wrong with eating six small meals a day instead of the traditional three-square. Some people find this works better for them. For example, you may find that you make better dietary choices if you don’t let yourself get as hungry between meals. But rest assured that going 4—or even 12—hours between meals will have virtually no effect on your metabolism.

It’s also not necessary to eat every few hours in order to keep your blood sugar steady. In fact, spacing your meals out more can have some very beneficial effects on your blood sugar and on other aspects of your health, as well.

Evidence-based nutrition: 3 ways to increase TEF and burn more calories

1. Eat your biggest meals early in the day

Eating more often won’t necessarily affect the TEF. But eating earlier in the day might. Although the research is limited, you might use 30% more calories digesting a meal eaten in the morning than you would if you ate the same meal in the evening. In one study, that amounted to 90 extra calories a day. And this may be one of the reasons that people who eat more of their calories earlier in the day lose more weight. However, most of us follow the opposite pattern, eating most of our calories in the second half of the day.

2. Eat more protein and less fat

The balance of macronutrients (protein, fat, and carbs) in a meal also affects TEF. It takes more energy to digest protein than it does to digest carbs or fat. In other words, the metabolic money changer levies a higher transaction tax to exchange protein into energy, much the way you might pay a surcharge to exchange traveler’s checks rather than cash. As a result, you’ll burn more calories digesting a high protein meal than you would digesting a low protein meal that has the same number of calories.

Protein is definitely king when it comes to TEF, but is there any meaningful difference between carbs and fat? Again, the research is quite limited, but some studies suggest that a meal that is higher in carbohydrates and/or fiber will have a higher TEF than one that is high in fat.

3. Eat less processed foods

One interesting study found that more highly-processed foods have a lower TEF than more minimally-processed foods. It’s more costly for your body to release the stored energy in whole grains, vegetables, or legumes than it is to release the same amount of stored energy in chips, doughnuts, and energy drinks.

The bottom line

In terms of the thermic effect of foods, it doesn’t matter how often you eat. If you want to maximize the effect of diet-induced thermogenesis, eat earlier and increase your protein. It may also help to avoid meals that are high in fat and/or highly processed foods.

But rest assured that going 4—or even 12—hours between meals will have virtually no effect on your metabolism. It’s also not necessary to eat every few hours in order to keep your blood sugar steady. In fact, spacing your meals out more can have some very beneficial effects on your blood sugar and on other aspects of your health, as well.

Sources

  1. W P Verboeket-van de Venne. Influence of the feeding frequency on nutrient utilization in man: consequences for energy metabolism. European Journal of Clinical Nutrition. 1991. https://pubmed.ncbi.nlm.nih.gov/1905998/.
  2. Bo, et al.. Is the timing of caloric intake associated with variation in diet-induced thermogenesis and in the metabolic pattern? A randomized cross-over study. International Journal of Obesity. 2015. https://www.ncbi.nlm.nih.gov/pubmed/26219416.
  3. Anne Raben, et al.. Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake. American Journal of Clinical Nutrition. 2003. https://www.ncbi.nlm.nih.gov/pubmed/12499328.
  4. Neal D Barnard, et al. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. American Journal of Medicine. 2005. https://pubmed.ncbi.nlm.nih.gov/16164885/.
  5. Sadie B. Barr. Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure. Food and Nutrition Research. 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897733/.

This article was originally published at QuickandDirtyTips.com

My diet is super healthy. Why isn’t my Nutrition GPA higher?

by Monica Reinagel, MS, LDN

I received the following email from a frustrated user of the Nutrition GPA app.  I’m posting it here, along with my response, in case other app users might find it useful as well.

“I have been somewhat frustrated with the scores I’ve been getting on the Nutrition GPA app.  I know I definitely do not eat enough fresh fruits and vegetables some days. But I think my diet is very good otherwise–just not in ways the app measures!

“For instance, I don’t eat any meat, I eat no dairy on an average day, I rarely eat eggs, I obsess over sodium, I rarely eat baked goods–and when I do, they’re homemade, low sugar, low sodium, dairy-free, etc., and the only white flour I eat is in baguettes, Portuguese rolls, or occasional pasta. Nevertheless, I’m getting Cs and  even a D!”

How does the Nutrition GPA assess your diet?

The questions in the Nutrition GPA quiz represent the foods most strongly associated with overall diet quality, risk factors, and health outcomes.  If your grade is not as high as you think it should be, perhaps aspects of your diet that you think are “not so bad” or “occasional” are having more of an impact than you realize.
Conversely, aspects of your diet that you think of as  “very good” may not have as much impact (or be as consistent) as you think.
Let’s take a closer look at some of the details you mentioned:
  • If you don’t eat any meat, then you are always getting points on Q9.  So that’s certainly not responsible for your low grade!
  • Avoiding diary and eggs is not associated with improved diet quality or reduced health risks.  So they don’t impact your grade one way or the other.
  • If you have high blood pressure and are sensitive to the effects of sodium, then that might be an important thing for you to watch. But for the majority of the population, avoiding sodium does not improve their health or their risks. So it’s not monitored in the Nutrition GPA.
  • Baked goods that contain white flour will impact your grade–even when they are homemade, low sugar, low sodium, and dairy-free! If you’re only eating them occasionally, it shouldn’t affect your GPA too much.  But research shows that replacing white flour with whole grain flour (or avoiding it altogether) improves health and nutrition.  And that’s why you get a higher grade on days when you don’t eat things made with white flour.

There are also a few things that you DIDN’T mention. But if you are frequently having more than one alcoholic drink, more than 25 grams of added sugar, eating fried foods and/or you rarely eat fish, legumes, and nuts, this will drag down your Nutrition GPA.

All of which is to say that the whole point of the Nutrition GPA is to shine a light on those areas of our diet that could stand improving. And sometimes it reveals things that we may have over or under-estimated.  In which case, it’s working exactly as designed–and presents a great opportunity to improve your nutrition!

 

Are wild blueberries pesticide free?

by Monica Reinagel, MS, LDN

Q. I buy wild blueberries because I assume they are not treated with pesticides. Am I correct about this?

A. Not necessarily. It’s possible that growers may cultivate “wild” blueberries for the commercial market and they may apply pesticides to reduce weeds or insects. (Here, for example, is some information from the Maine Extension for farmers who want to improve the yield of their wild blueberry crops.

For that matter, wild blueberries growing next to a farm could potentially be exposed to pesticides used on other crops.

Wild blueberries that are certified organic should be free of all but organic-approved pesticides. But either way, I don’t think that pesticides on blueberries poses a concern for your health.
According to the pesticide residue calculator at Safe Fruits and Veggies, you could consume over 13,000 servings of blueberries in a day without being exposed to a harmful amount of pesticide reside, even if the blueberries had the highest level of pesticides residue ever measured by the USDA.

How sleep affects weight gain with Dr. Jade Wu

by Monica Reinagel, MS, LDN

Many people have more difficulty sleeping when they reach midlife, which is also when they start to see their weight creeping up. In this episode of the Nutrition Diva podcast, sleep medicine specialist Dr. Jade Wu talks about the relationship between sleep, appetite, weight gain, and midlife changes.

Highlights from our conversation

Monica Reinagel: I’ve written a lot about the connection between sleep and hunger, appetite, and weight management. But I’m looking at this problem as a nutritionist. How do you see the relationship between sleep, appetite, and weight management as a sleep expert?Jade Wu:  When we are sleep deprived, the body compensates for lack of energy by craving more calories and tends to reach out for more saturated fats, carbs, and sweets. We also have less leptin and more ghrelin levels in our blood after a night of not enough sleep, which is how these hormones behave when we’re very hungry.

What’s less talked about is the role that our circadian clocks play in all of this. We all have biological clocks that follow a roughly 24-hour rhythm, and these clocks love to run on time. Having a disrupted circadian rhythm (jet lag, shift work) can slow down our metabolism, make us crave more high-fat foods, and generally increase the stress on our bodies.

Psychologically, this stress from a disrupted body clock (together with the stress of insufficient sleep) makes us less motivated to stick to healthful behaviors… it makes us more cranky so we’re more likely to eat as a way of regulating our emotions… it makes us less energetic and less likely to be active.

So there are both biological and psychological ways that insufficient sleep and a disrupted circadian rhythm can affect weight loss and nutrition.

MR: Most of us the basics of good sleep hygiene (avoiding screens, caffeine, alcohol, keeping a consistent schedule, cool, dark rooms, etc.). But a lot of people still struggle to sleep through the night, despite taking all of those steps. You’ve suggested that sleep hygiene may not be all that. So what is the solution?

JW: Sleep hygiene is a good place to start. It’s like dental hygiene… good as a general baseline, but not enough if you already have a cavity.

If you do have a sleep disorder, like insomnia or sleep apnea, it’s important to get those addressed using evidence-based treatments. Like you mentioned, sleep hygiene is the placebo condition in our clinical trials… not enough to cure insomnia. What is recommended by the American Academy of Sleep Medicine as a first-line treatment is cognitive behavioral therapy for insomnia (CBT-I).

MR: A lot of people develop sleep issues for the first time as they get into midlife–which is also when many of them start to see their weight creeping up. First, Is there something physiological that occurs in midlife that affects sleep rhythms? Or have we just had longer to develop bad habits? Or more to worry about?

JW: There are physical and psychological changes. In terms of physical changes:

  • We need less sleep as we age
  • Our sleep tends to be more often punctuated by wakefulness, and we tend to have less deep sleep
  • Hormonal changes like menopause can certainly disrupt sleep… but this should not permanently make you a bad sleeper
  • More aches and pains, less physically and socially active

As for psychological changes, our expectations need to move along with the physical changes.

  • We may get more anxious about sleep and health
  • We may become increasingly psychologically dependent on sleep aids
  • We’ve had longer to learn unhelpful things… like our brains learning that the bed is an awake place

MR: In your opinion, then, how much of an impact does midlife sleep difficulty have on midlife weight gain?

JW: This is hard to tease out because there are so many things that are changing mid-life… perhaps our activity levels, our social lives, our stress levels, our eating habits. I see this time as an opportunity to tune up health in all domains, such as learning to cook more nutritious meals now that the kids have left the house and you have more time. Or doing more self-care, taking up meditation… all good things for sleep and overall health. There’s no reason why sleep has to be bad in midlife or after.  It will change, but if you listen to your body and change with it, you can still have great sleep health.

Recommended Sleep Resources

Behavioralsleep.org

Penn CBT-I Provider Directory

American Academy of Sleep Medicine

www.jadewuphd.com

This article originally published at QuickandDirtyTips.com

How to make Socca

by Monica Reinagel, MS, LDN

Socca is a flatbread made from chickpea flour and is one of our favorite weekday suppers.  Grain and gluten free and rich in protein and fiber. You can top it however you like or just eat it plain.  Here’s a quick video tutorial.  (Instructions below.)

 

Instructions

Combine 1 cup chickpea flour, 1 cup water, 2 cloves crushed garlic, 1 tablespoon olive oil, and 1 teaspoon each salt and fresh ground pepper.  Whisk until blended and let sit for 1 hour.

Meanwhile, slice 1-2 onions, toss with olive oil and and place in a cast iron or ovenproof skillet. Roast in a 400 degree oven for 15 minutes.

Pour the batter over the onions, turn up the oven to 500 degrees and return the pan to the oven. Bake for around 15 minutes, or until it’s starting to brown at the edges.

Slide the socca onto a cutting board and gently flip it over. At that point, you can cut into pieces and serve as an appetizer or with soup or salad. Or, slide it back onto the pan, top with veggies and cheese and run it under the broiler to melt the cheese.