[00:00:00] Jackie: Welcome to the latest episode of Nutrition Unlocked, the podcast celebrating innovations, advancing the role of nutrition in health, sponsored by Nestle Health Science. 

Coming up, we're joined by Dr. Amy Shah to explore how women can optimize their health at every age and stage.   

[00:00:17] Dr Amy: As we move through different phases of our life,the late thirties, forties and fifties can be a very big tumultuous hormonal change for women.  

I call it the 30-30-3. 30 grams of protein in your first meal, 30 grams of fiber throughout the day, and 3 servings of probiotic foods every single day.   

You can build muscle at any age. You can start a new career at any age. You can be your best self. Your best days can come at any age.  

[00:00:47] Jackie: Our host is Dr. Krys Araujo Torres, Head of Medical Affairs for Nestle Health Science in the U. S. 
Stay tuned.    

[00:00:57] Krys: I'm joined by Dr. Amy Shah. She's a medical doctor and a nutrition specialist. Welcome, Amy. 

[00:01:04] Dr Amy: Thank you for having me.

[00:01:05] Krys: I know you completed your studies at Cornell and you completed your residency at Harvard and Columbia. I know also that you're a published author of best selling books. But before we dive in on the topic, can you share with our audience a little bit more about yourself?

[00:01:22] Dr Amy: My parents brought me to America when I was about five years old. The purpose of that was to give me a better life as a girl. I was their only child and they knew that I would have more opportunities to share my gifts with the world in a country like America, as opposed to their small village in India.

And so, my journey started like many immigrants, very difficult New York lifestyle with a motel converted into apartments and then, I grew up in a very kind of diverse environment. But one of the biggest things that happened was within the first few years of us moving to the U. S., my dad and his five brothers, or five brothers in total, all got diagnosed with type 2 diabetes, like, um, All at the same time, because one got diagnosed and then he told the other one, like, why don't you go get checked?

 For them at the time it wasa very big death sentence, because they had come across the world. They were in their 30s. They were ready to build this new life and then they get this diagnosis, which to them, was really a life changing diagnosis. 
And so, I got interested in nutrition early because, as soon as they got diagnosed, it was like all the talk of the house and the family get togethers waswhat can you eat to help control diabetes or reverse it orstop the complications from it.A lot of the conversations and then the other conversations were like, why did this happen to us? We're healthy people, we look healthy on the outside. And so there was a lot of curiosity about what was happening and how food was affecting our bodies and how,this could change us in the future.

When Iwent to college, I knew I wanted to pursue nutrition.At that time, nutrition didn't have the heyday that it does right now. And there was not a lot of career choices after going to nutrition school. It was like dietitian, hospital dietitian. So I thought going to medical school was an extension of thistraining about how food affects diseases of the body and mind.

After I got out of practice, I learned quickly that I didn't have an avenue to talk about nutrition the way I really wanted to. , I had this bustling practice, but I really wasn't doing what I had set out to do from the beginning, which was nutrition and medicine.

And so I started to write blogs just for fun,for no payment, just free submissions, just creative writing. Andthat's really how my journey started. Blogs became social media and social media started to grow. I was able to get a voice and an avenue to sharenutrition knowledge.

[00:03:58] Krys: Wow. Well, talk about motivation, strong motivation to connect both things, nutrition and medicine. It's really fascinating. And when you think about your work and what you're doing, what arethe things in terms of nutrients or in terms of recommendations that you're really more passionate about, like that really tackle your interest? 

[00:04:22] Dr Amy: I think the more I learn and the more I study, and this always goes back to that gut is connected to the brain and connected to the immune system, connected to the hormones And so we think of the brain as like the center, but I really think of it as a control center between the gut and the brain and they're constantly communicating with each other about what to do with the immune system, what to do with the hormones of how to adjust things.

My passion has become how do we feed that gut microbiome the right foods so that it's communicating the most positive things to our brain, to our immune system, to our hormones and when we talk about women, especially as we move through different phases of our life,the late thirties, forties and fifties can be a very big tumultuous hormonal change for women.

However, there's good data that by changing your gut health, your nutrition, you can actually mitigate some of thispain of transition and even sometimes improve your health from where you were before. And so, I'm really excited about where that gut, microbiome nutrition comes into play.

[00:05:28] Krys: Yeah. And I can see that really connected to your two books, because one is really tied to satiety to cravings, you know, is Why I'm So Effing Hungry. And the other one is Why I'm So Effing Tired, which is very connected to your gut brain access. And of course, how do you modulate energy or not feeling tired all the time.

So I can imagine that those two books speak very clearly to that interest.
[00:05:56] Dr Amy: Exactly. When you look at what people are complaining about the most when they come into their doctor, it's like they're tired or they're feeling out of control with their hunger or cravings. That was like some of the most common things I was seeing.

[00:06:08] Krys: But then, originally motivation was your dad and his brothers, but then how did you transition into women's health specifically?

[00:06:17] Dr Amy: It's so interesting, It's just by being a woman.

I think what happened is I started to talk about nutrition and gut health in general. And what I saw was a big hole in the information. I think what people are craving and what there isn't enough of is guidance for that woman. Starting from their thirties all the way through their sixties, there is very sparse information and partially because there's not enough research, there's not many recommendations, there's not so many tools.

What I noticed is as I was moving through this stage, it was just talking about what things that I was doing and it became very interesting to people, because I think there's just not enough information around there. And so that last piece really happened because of my own personal experience.

// Part 1: Nutritional Needs As We Grow into a Young Adult //

[00:07:08] Krys: So, you mentioned the thirties, but I want to take it a little bit earlier in the journey of women's health and nutrition. 

[00:07:21] Krys: When I was thinking of some of these questions, one thing that came to mind is that during our early teenage years, our parents make many decisions for us.

Yes, we have, the ability to do things. And I think that kids nowadays are a lot better informed and they probably come to parents and say, can I do this? I don't want to have that. These are my food preferences, et cetera. But in general, there is a certain amount of decisions that are made by parents.
So what recommendations would you give to parents about the nutrition that girls and teenagers should have to grow into a healthy adulthood?

[00:08:01] Dr Amy: Yeah, that's a really great question at parents, especially mothers, influence the choices of the family very heavily. As we educate the mothers about their own health, they start to be become advocates for a lot of this stuff. 
 
One of the biggest things I can say for girls, or parents of teens and girls, is to model good behavior when it comes to your choices of food that you bring into the home.

[00:08:28] Dr Amy: I always give this example, even something like a pasta with some veggies and a sauce, it could take you just as much time as it would to go to a drive through,but by using your own canned tomatoes or yourbroccoli that you're going to throw in there, just made, very simple olive oil that you use to cook it. And that is one of the biggest things I can say, because teenagers and a lot of the hormonal issues and problems of acne and fatigue andmood issues happen because of that gut brain connection.

That gut is not getting enough fiber. That gut is seeing a lot of simple sugars. That's one of the biggest things I will say to parents of teens. And then the other thing is giving them the knowledge about sugary drinks. So one of the biggest problems for teens, I have teens, so I know isthe sugary drinks often are coupled with caffeine, very high levels, which disturb your circadian rhythms, which won't let you sleep at night, and then make you tired in the morning, exacerbating the teen delayed sleep phase cycle already, They're already having trouble sleeping, and then the sugar in these drinks are so high, but they're not very satiating. They're not satisfying for food. So you end up havingsugary drinks and then you're still going to eat your food. 

Most people, if you ask them, would you rather have a sugary drink or would you rather have an actualpiece of cake, they would usually pick the piece of cake, that sugar content is much more satisfying, it feels, good, and so my kids, I usually say, either one. Pick one or the other. 

[00:10:06] Krys: So I also hear in your explanation is that there's an element of calorie control and I agree with you when you have a dessert in front of you, it feels a more of a prize, so it's rewarding in a different way, which is really good. And then I also hear, try to make some meals at home andsome of these, more natural ingredients that they can incorporate.

But I I heard you mention specifically fiber and I am interested, aside from fiber, what other nutrients do you really emphasize in this group of teenager girls?
[00:10:41] Dr Amy: Yeah. Iron is one that I think is really important in teenage girls, especially because of the high levels of deficiency in this group of menstruating young girls. 

So,iron rich foods, spinach,even using cast iron, I think it increases the levels of iron by up to 20 percent and lentils, all kinds of foods that are going to help you increase your iron levels. That's a special concern in that age group. I see a lot of girls and teens that are in that age, they're definitely not eating enough fiber. They're definitely not eating enoughiron. They're often not eating enough fruits and vegetables in general, because fruits and vegetables have a whole bunch of things besides fiber, like the polyphenol content, the micronutrient content, vitamin C. There's so many things that you can be getting just from eating more fruits and vegetables. And so I think that emphasizing that in that age group is really important as well.

[00:11:39] Krys: Yeah. That totally makes sense. From the perspective of complaints or things that they ask you about, you mentioned sleep and acne, you also mentioned mood.

[00:11:50] Dr Amy: Yeah.

[00:11:51] Krys: Amy, what are these nutrients that you focus on that you really want the teenagers to incorporate? If you think, okay, these are key things that you should be doing. What are those nutrients that you recommend?

[00:12:04] Dr Amy: Yeah, I love adding more fiber. 90 plus percent of Americans and probably 95 percent of teens are not getting enough fiber in their diets. And so adding fiber rich foods, fruits and vegetables, seeds, nuts, you know, leafy greens, berries. These are all amazing sources of fiber. And I think that is the number one thing. 

One thing that I think is under recognized, that I've been really talking a lot about recently is fermented foods. That's another thing to add to a teens diet. So something as simple as probiotic yogurtwould be something easy to add to a teen's diet, probiotic cottage cheese,kimchi, sauerkraut, there are so many different options for fermented food now, even adding this to their diet, just even once or twice a week to start with,even if we can't get it in daily is something I've been really starting to recommend highly.

[00:13:00] Krys: That's fabulous. And what about protein? 

[00:13:02] Dr Amy: The protein thing is also very difficult. Protein becomes so much more important as you move through middle age. I talk about a lot in my older women, but I think it's really important in the younger group as well, because this is the time you are building. It's like the building blocks.I actually recommend to women, not necessarily young girls, but once they're,over the age of 18 or 21, to really go up to that 20 to 30 grams of protein in your first meal of the day is what I recommend. I believe that when you feed your gut that protein, you really set your day up for less cravings, more fullness and you set the tone for the building blocks for say, if you go for a morning workout to help you build that muscle back.

[00:13:51] Krys: I think for parents, I think the biggest thing I can say, and I tell myself this all the time as a parent of teens, is model good behavior. What you are doing, whether they like it or not, what you are doing is setting the tone for them in the future. If they see you prioritizing fiber and protein and hydration and all of those good things, they are going to do that, whether or not they're smiling. I think what happens is whatat those ages ends up being a really big part of your life, even though the teens seem like they're rebelling from it, or they're not interested in it, all that stuff, but you're setting the stage. 
Right. 

// Part 2: Nutritional Needs As We Move into Middle Age //

[00:14:37] Krys: So let's dive into, we've been teenager, early adulthood, let's go into adulthood and I don't know if I love middle age, but I'm going to call it middle age. Probably it's because I'm there? 

[00:14:50] Dr Amy: Same.

[00:14:51] Krys: What changes in terms of what women should be doing with their nutrition. And by the way, I think we very importantly need to talk about physical activity. But, what are the main changes that we should be doing to optimize our health in this time of life?

[00:15:09] Dr Amy: When you are moving through those years, the big thing that happens, especially in your forties and fifties, is that as your hormone levels are declining, you're also seeing a decline in muscle mass and bone mass and a change in your microbiome, because of the hormonal changes that are happening. And so I speak to that when we're talking about how to change your nutrition and exercise and lifestyle, we want to counteract some of that.   
The microbiome is really good at regulating hormone levels. It's really good at helping you,feel full with cravings, with communication with your brain, with keeping the mood levels stable and anxiety on the lower end.

So, when I'm talking to that woman that is moving through their late thirties, forties, and fifties, I talk a lot about prioritizing protein, because of the decrease in muscle mass. I talk a lot about weight trainingas a way to counteract that decrease in muscle mass and bone mass. I talk about increasing fiber to support that gut bacteria microbiome. And I talk about probiotic foods. So I call it the 30-30-3. 30 grams of protein in your first meal, 30 grams of fiber throughout the day, and 3 servings of probiotic foods every single day. The  30-30-3. That's my template for women that are going through this phase. 

[00:16:38] Krys: And actually, very smartly targets where you can see in the literature, the deficits of protein intake in adults, which is in the morning.

[00:16:49] Dr Amy: Yes.

[00:16:50] Krys: And what about for physical activity, you mentioned resistance training. Do women understand what that means? What that is? What's the frequency? How to make it effective?

[00:17:02] Dr Amy: Yeah. One of the biggest things I tell women is it's the equivalent of pushing or pulling. Pushing and pulling is something that you should be doing at all times. So push ups and pull ups and squats andthat kind of activity is the activity that you need. You need a little bit of pull on the muscle and the bone to stimulate growth. I talk a lot about weighted vests for women. Weighted vests give a little bit of more challenge to your body just while it's walking and it's something easy that you can just throw on for 30 minutes to an hour a day. It should be about 10 percent of your body weight or you can work up to 10 percent of your body weight. So you can start low and then work it up and it's a nice way to get that resistance training in a non gym fashion like people often ask me, what about if I can't go to the gym? A weighted vest walk is a great way to add some resistance. Or going on a hill walk is another way to add a little bit more resistance to your muscles.` `and` then the traditional, can you do twice a week, can you do 20 to 30 minutes of a class, like any kind of pushing, pulling or muscle stimulating activity. And that's,the minimum is two times a week.

[00:18:17] Krys: That's perfect. I think that one of the things is emphasizing to all women that there is a certain amount of activity that we can all do in the home environment. it doesn't require a lot of,extra resources or extra time. It's just more about consistency and their frequency andbeing able to do these small tweaks.
I love that you defined it push and pull because I think it's very visual, knowing what you need to do. 

[00:18:45] Dr Amy: I talk a lot about exercise snacks with women. Exercise snacks means if you know this concept of push and pull and you're in your bathroom and you have five minutes before you have to go to your next meeting or you have to leave, go against your sink and do 10 pushups or do 10 squats. 

I call it exercise snack because most people, and I am included, I used to think that if I can't make it to the gym for one hour, forget it, I'm not doing anything. And I think the concept that I'm trying to share and that's why I say push and pull, you can push and pull anything. You can stand and pull your doors open and do a squat like it is something you can do anywhere, anytime. 

I remember when I was a kid and we had moved to America already, but I'd go back to India for the summers and I had already started to become more interested in nutrition and exercise. And I remember when I would go to India and I'd be like trying to figure out little ways that I could get a little workout in, I would take the stairs or I would just do pushups against the wall, against a sink or a counter. So now that I see this concept of exercise snacks, I'm like, oh, that's what I was doing. And so that's something I often tell women, becausewe're all so busy and everyone is running around trying to figure out how to get the most out of their time. And so that's a really good way to incorporate it.   

[00:20:07] Krys: I like those between meeting and meeting. I think it also, wakes me up, so I'm, I'm totally, in agreement with you. 

What about specific nutrients? And I'm thinking right now of magnesium, because it's such a hot topic. But of course we could discuss other nutrients that come as supplements, for example, but what are the benefits of magnesium?

What are the differences? Because there are different forms. What are women seeking to understand about magnesium and what do you want to tell them about it?

[00:20:39] Dr Amy: Oh, I love talking about magnesium. It's one of the things that when I tell people about it and they start to increase their magnesium intake or start to also supplement or whatever to combination, they just feel better within days. And so I love talking about it because it's such a game changer. And there's new emerging science that looks at higher levels of magnesium, especially in women, seems to be associated with slower brain aging. Not only does it make you feel better in the short term, which I'll talk about. It also has some benefits in the long term. 
 
Magnesium is necessary in our body for over 200 different processes. And having magnesium in our diet is really important. And when there are certain types of magnesium supplements thatpeople can take for different reasons.

[00:21:25] Dr Amy: For example, magnesium bound to a glycinate molecule, it is the glycinate helps bring down stress,anxiety levels. Can help with helping to fall asleep. And so it's great for that perimenopausal woman who's maybe struggling with sleep issues as well as cortisol issues and anxiety. So that's a really good one. 

[00:21:46] Dr Amy: Then there's magnesium threonate, which crosses the blood brain barrier and helps with memory and cognition. And then there's magnesium citrate, which is great for women, or men, with constipation, because it helpsyou go to the bathroom. So like when I'm traveling, I often will take a magnesium citrate.
 
And then there's magnesium oxide. There's a whole bunch of different magnesium. There's probably like 20 different forms at this point. But the oxide form is not as well absorbed, but you can use it as like a salt or, a topical or something like 

[00:22:20] Krys: Okay. 

[00:22:21] Dr Amy: And so there's so many different forms. And then, of course, increasing the magnesium in your foods in your diet like beans and nuts and seeds and leafy greens and I love pumpkin seeds. That's one of my favorite ways to get magnesium, because they're a high magnesium food And pumpkin seeds also have zinc in them, which is a great thing that women can benefit from too.

[00:22:41] Krys: Yeah, and pumpkin seeds and salads, fantastic. I agree. Really good. Okay. Love it. So that means that really you can tailor some of these recommendations to the concerns that your patients come at the office. 

[00:22:57] Dr Amy: Exactly. I would say magnesium, omega 3s, and vitamin D. Those are the three things that I talk to women all the time about. It's the only three that I believe that everybody should be talking about. I mean, everybody has their own concerns. So, you know, you may want to take so many other things and that's great, but there's some universal ones, almost universal, because vitamin D depends on your levels, obviously. And with omega 3 and magnesium, it can be a combination of dietary and supplementation or just diet. And you can get it that way. But those are the three I really talk a lot about with the women that are going through this transition.

[00:23:38] Krys: Fabulous. And I will tell you, I totally agree with vitamin D. I live in sunny Florida. I think I manage a pretty good diet. I've been supplementing with vitamin D and still was a little bit deficient. 

So we had to amp it up. 

[00:23:55] Dr Amy: It's almost, it's 90 plus percent of the people I see have the vitamin D issue.

Yes. And then I'm taking care of my bones. Yep.

// Part 3: Nutritional Needs in Later Life // 
  
[00:24:09] Krys: Okay, now let's go later in life. Let's say, okay, you've moved a little bit ahead of these big hormonal changes that happen in your 40s and your 50s. 
One thing that concerned me as my parents were aging, as my mom was aging, was her change in appetite and also the changes in what she wanted to eat. It was not only appetite, but also the types of foods.There's also different prevalences of other conditions. My concern is, of course, it was,their functional health, their muscle mass and their functional health. What recommendations do you give to these women as they grow older?

[00:24:55] Dr Amy: One of the biggest recommendations I give to women as they grow older is to stay active. So what happens is I think that in the middle ages of life, everyone gets busy often with children and families and jobs and all this stuff. And they become more sedentary over the years. 

And what I often say is it's not too late. It's not too late to get up, go for walks, pick up weights. I know that there's a lot of fear around, like I know for my mom, for example, she was like, I don't know how to pick up weights. And so that's why that push pull is really good, because you can just say it's okay, it's body weight. You can do body weight. But having activity is one of the best ways to stay functionally independent as you get older.
 
If in your seventies you're not active, then how do you expect in your nineties to be able toreach for the cups at the higher level of the cupboard or balance yourself out of a chair? So I think that really emphasizing to people in their fifties, sixties, and seventies to say, hey, this is the time that you need to start getting to the habits of being very active, so that well into your nineties, you will be functional and independent.

[00:26:09] Krys: Right. Even if you haven't done it before.

[00:26:12] Dr Amy: Even if you haven't done it before. Yeah. That's what's magical about it. You can build strength even at 70 plus.

[00:26:19] Krys: Right. Does the 30-30-3 rule stand?

[00:26:25] Dr Amy: Yes, even for women, as you get older. The protein is going to help you with the building blocks of muscle. Like I said, you can build muscle at any age. And so if you really are doing the work to push and pull and be active, you will need to supplement your diet with the adequate amount of protein so that you can build those muscles. I say 30 grams in the first meal because everybody's individual needs are going to be different. It depends on your activity level, on your starting weight, on your gender, you know, there's so many things. And so I know that if you start your day with that amount of protein, you are going to be on track for whatever your protein goals may end up being.

[00:27:11] Krys: Okay. Get it going early. I get that.   

Is there any recommendation that you provide to women in terms of when should they eat the protein or certain nutrients in relationship to exercise or to sleep? I'm thinking about throughout the day, how should they be incorporating both the nutrients, the supplements, et cetera?  

[00:27:36] Dr Amy: We used to think that the window for eating protein after a workout is really short. But now we're understanding that a meal around your workout, either,within two hours before or after is pretty good for the average person, the non athlete, the non bodybuilderto be able to get your nutrients in.  
I would say the window within one to two hours of your workout is a great time to really time that protein. In my ideal world, I would say get some kind of movement in the morning, either before or after your breakfast and that way that protein can be used to start building some of those muscle building blocks.

[00:28:16] Krys: Nice. Are there other nutrients that you want to emphasize at an older age? 

[00:28:22] Dr Amy: Yeah, like I said about the omega threes and magnesium and vitamin D that have starts happening, becoming more important in midlife, it remains important as you get into your later part of, I don't want to say older age, even postmenopausal. 

So, omega 3 fatty acids, keeping your vitamin D levels adequate, as well as your magnesium intake high, is going to help you with brain aging, for example, with the magnesium and the omega 3s and with inflammation with the omega 3s.
[00:28:59] Krys: Amy, one last question for this age group, because I think that one of the frequent complaints that people have when you grow older is energy, feeling tired. 

What do you recommend specifically for that in terms of nutrition or any other general recommendations?

[00:29:18] Dr Amy: This is such a common question and I think having a broader view of what energy is, I think a lot of people think of energy like, oh, I have to just drink more caffeine, or that's how I get more energy. But energy is really a result of nutrition and your lifestyle, how much you're exercising, how you mind your circadian rhythm. So that's sleep and the sunlight. All of those are really important. 

I am actually a fan of coffee and tea. I think there's good evidence to show now that they are beneficial for health. So I think there is a role for a morning cup of coffee or a morning cup of tea. But I think energy really does come from that overall quality of your diet, the overall activity levels, are you sleeping regularly and at regular times? 

So one of the ways to improve your energy levels, sleep and wake at the same time, get some sunlight in the morning, really tell your brain and body that it is time to wake up and that can really help with energy. 

The reason why I like that 30-30-3 is because that protein in the morning really helps you balance that blood sugar, that fiber, keep your blood sugar even, so that you're not facing peaks and valleys all day long.

[00:30:30] Krys: Fantastic. Okay. So I think we covered all ages, final words of wisdom for women at any time of their lives. What would you want to share?

[00:30:41] Dr Amy: What I share all the time is that it's not too late. I think society tells us that there's an age for everything and that at a certain age, you just stop trying. What I want to say is you can build muscle at any age. You can build parts of your brain at any age. You can start a new career at any age. You can be your best self. Your best days can come at any age.

[00:31:02] Krys: Oh, I love that. It's such a positive message. It's really fantastic, because also you can incorporate any of these changes and it's never too late to start doing some of those great things for yourself. I very much appreciate that final message.

Amy, this was such a wonderful conversation and, you know, it's a reminder that women at all ages have specific nutritional needs, but that really, you can work on your nutrition goals, on your physical activity goals, and make the most of your health. And what I love about this podcast is that we continue to encourage listeners to prioritize their health and their relationship with food and nutrition. So I really appreciate your time, your knowledge, your ease of explanations. So thank you so much for being my guest today and for such an informative conversation.

[00:31:57] Dr Amy: Thank you, Krys, so much for having me.

// Outro // 
  
[00:32:00] Krys: Thanks again to Dr. Shah for being my guest today and sharing all her knowledge and experience on such a relevant topic. I hope you enjoyed this episode of Nutrition Unlocked. 

And if you haven't already, please subscribe so you don't miss an episode.   
See you next time on Nutrition Unlocked.

// End //