Improving Women's Health Across the Lifespan

Michelle Tollefson, Nancy Eriksen, Neha Pathak, Michelle Tollefson, Nancy Eriksen, Neha Pathak

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000472493
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

The book is an evidence-based source of information on women's health issues for health professionals already practicing lifestyle medicine, as well as an entry level textbook for those new to the field of lifestyle medicine. The collective expertise of each of the editors along with content provided by leaders within the American College of Lifestyle Medicine fills a much-needed void within the specialty of Lifestyle Medicine and is for providers of women's health globally.

1

Optimal Nutrition for Women

Kayli Anderson, MS, RDN, DipABLM, ACSM-EP, Certified Intuitive Eating Counselor

Kayli Anderson Nutrition
Salida, CO

Kaitlyn Pauly, MS, RDN, DipABLM

The American College of Lifestyle Medicine
Spearfish, SD

Debra Shapiro, MD, FACOG, DipABLM

Premise Health
South San Francisco, CA

Vera Dubovoy, MD, FACOG, DipABLM, Board Certified OBGYN

Department of Obstetrics, Gynecology and Reproductive Sciences
University of Texas Health Science Center at Houston
Houston, TX

DOI: 10.1201/9781003110682-2

1.1Introduction

1.2Nutrition Basics

1.2.1Energy

1.2.2Nutrient Density

1.2.3Macronutrients

1.2.4Carbohydrates

1.2.5Fats

1.2.6Proteins

1.2.7Micronutrients

1.2.8Nutrients of Concern

1.2.9Phytonutrients and Antioxidants

1.2.10Water

1.3Standard Nutrition Guidelines

1.3.1National and Global Guidelines

1.4Health-Promoting and Health-Harming Foods

1.5The American College of Lifestyle Medicine’s Recommended Dietary Pattern

1.5.1The American College of Lifestyle Medicine Dietary Position

1.5.2The Dietary Spectrum

1.6Nutrition Recommendations for Women

1.6.1Women-Specific Health Risks

1.6.1.1Weight Concerns, Body Image, and Eating Disorders

1.6.1.2Women-Specific Cancers

1.6.1.3Bone Health

1.6.2Nutrients to Know for Women

1.6.2.1Vitamin B12

1.6.2.2Calcium

1.6.2.3Vitamin D

1.6.2.4Iron

1.6.2.5Folate

1.6.2.6Zinc

1.6.2.7Iodine

1.6.2.8Omega-3s

1.7Brief Overview of Nutrition Needs Across The Lifespan

1.7.1Nutrition and Fertility

1.7.2Nutrition and Pregnancy and Lactation

1.7.3Energy

1.7.4Macronutrients

1.7.5Micronutrients

1.7.5.1Iodine

1.7.5.2B12

1.7.5.3Folate

1.7.5.4Iron

1.7.5.5Choline

1.7.5.6Zinc

1.7.5.7Calcium

1.7.5.8Vitamin D

1.7.5.9Other Nutrients

1.7.6Nutrition and Menopause

1.7.7Nutrition and Female Athletes

1.8Practical Tools for Transitioning to a Whole Food Plant-Based Eating Pattern

1.8.1The WFPB Plate

1.8.2Tips for Transitioning

Key Points

• Women’s health shapes the nutrition and health status of the entire society. They still do the majority of the food shopping, meal planning, and cooking; they are the primary victims of messaging that encourages unscientific dieting practices; and they have the responsibility of growing and birthing the next generation. Therefore, knowledge of women-specific nutrition is critical for all clinicians.
• A large body of evidence suggests that plant-predominant dietary patterns have the power to prevent chronic diseases, and, when used as an intervention, can even treat and reverse certain diseases, including cardiovascular disease, obesity, and type 2 diabetes.
• Women’s nutrition needs change throughout the lifecycle, and certain nutrients are of particular importance to women’s health, including vitamin B12, vitamin D, calcium, iron, folate, zinc, iodine, and omega-3 fatty acids.

1.1 Introduction

Humans make, on average, 221 food-related decisions each day,¹ and most people feel lost as to how to make the right decisions of what to eat.² As the field of nutrition research grows, it becomes more apparent as how important each of those 221 decisions is to a person’s health. Seven of the ten leading causes of death in the United States are chronic diseases, and almost half of Americans live with at least one chronic disease.³ Poor diet is one of the most important modifiable risk factors for preventing these diseases, along with sedentary lifestyle and tobacco use.⁴

Making it even more challenging to establish healthful eating habits is the modern American food culture. Companies spend about 2 billion dollars per year marketing processed, packaged food products to children.⁵ Americans of minority races and ethnicities experience higher rates of many chronic diseases due to the social, economic, and environmental disadvantages they face,⁶ and it is estimated that more than 23 million Americans live in food deserts without ready access to nutritious foods.⁷

Although nutrition is such an important factor in human health, most medical school curricula still lack nutrition education.⁸ However, the tides are beginning to shift as more healthcare providers awaken to the importance of healthy eating habits.

Women still do the majority of the food shopping, meal planning, and cooking, and, therefore, set the tone for their families’ eating habits.⁹ They are also the primary victims of cultural messaging about appearance that encourages unscientific dieting practices.¹⁰ Women also have the extraordinary responsibility of growing and birthing the next generation.

The months fetuses spend developing in the womb are now understood to be some of the most critical periods. The developmental origins of health and disease hypothesis is now widely accepted in the scientific community and puts the importance of women’s health prior to and during pregnancy into clear focus.¹¹ Gestational exposure to dietary factors,¹² maternal emotional stress,¹³ and environmental exposures¹⁴ is now recognized as critical for influencing the future health of the generations that follow.

Whether a woman is faced with feeding her family, nourishing herself in the climate of external pressures and expectations, or providing for her unborn child, her needs are unique, ever changing, and vital knowledge for every clinician caring for women.

1.2 Nutrition Basics

1.2.1 Energy

Foods and beverages contain energy that is measured in units known as calories. Each human needs a certain amount of calories to maintain basic metabolic functions like circulation, respiration, and mental processing, as well as daily activity. Physical traits, genetic variations, and lifestyle factors unique to each individual affect the amount of energy required.

Several predictive formulas are used by researchers and clinicians to estimate caloric needs and make tailored nutrition recommendations. These formulas include sex, height, weight, age, and physical activity level.

One of the most widely used formulas to estimate basal energy needs, also known as basal metabolic rate (BMR), is the Mifflin-St. Jeor equation. BMR accounts for 60–80% of total energy expenditure (TEE) and encompasses the energy required to perform basic metabolic functioning.¹⁵

Eq. 1.1 Mifflin-St. Jeor¹⁶

MenBMR(kcal/day)=(10×weightinkg)+(6.25×heightincm)−(5×ageinyears)+5WomenBMR(kcal/day)=(10×weightinkg)+(6.25×heightincm)−(5×ageinyears)−161

While this formula calculates basal energy needs, other components of TEE must also be added for an accurate estimate of energy requirements. To account for the energy expended through daily activity, the BMR must be multiplied by an activity factor that approximates physical activity level.

The following are general activity factor multipliers:

• Little to no exercise: BMR × 1.2
• Light exercise 1–3 days per week: BMR × 1.375
• Moderate exercise 3–5 days per week: BMR × 1.55
• Heavy exercise 6–7 days per week: BMR × 1.725
• Very heavy exercise twice per day, extra heavy workouts: BMR × 1.9

Of the factors that contribute to TEE, the smallest and least variable is the thermic effect of food (TEF), or the increase in energy expenditure that occurs after a meal. TEF usually accounts for eight to twelve percent of TEE.¹⁷

Predictive equations for estimating energy needs have limitations. Older adults and ethnic minorities were underrepresented in both the development and validation process of most of the formulas. The equations also fail to take body com...