They say 50 is the new 20. Now more than ever, as the population ages, it seems that there is a revolution of sorts occurring in the “aging” space, especially for women. Maturing women from their early 40s are more excited than ever to be at the top of their games both mentally and physically. Historically, the media has placed significant emphasis on outwardly visible aesthetic characteristics when defining how “well” an individual ages, but in reality this is just part of the story. Beauty is most definitely more than skin deep.
In my 20+ years of clinical practice as a gynecologist, I’ve noticed one of the most effective means at optimizing the aging process begins with attitude. Having a positive attitude leads to specific health habits and definitive lifestyle choices that can help redefine what “beautiful” means.
Aging affects us on a cellular level. I would suggest that “beauty” with age implies promoting and maintaining health at a cellular level. Simply put: Health is beautiful.
On a cellular level, it’s important to note that a molecule known as NAD+ (nicotinamide adenine dinucleotide) is essential to energy generation. Cellular energy fuels all of the body’s most critical functions at every stage of life.
NAD+ is critical for mitochondria function as well, and healthy mitochondria are a vital part of healthy living as we age. Increasing NAD+ through supplementation may further boost energy levels before, during, and after the menopausal transition.
Although health begins at a cellular level, for most of my patients, it’s the outwardly visible signs of aging that seem most concerning. In no particular order of importance, changes in skin, posture, and weight top the list of worries I see in my practice.
Let’s face it: Wrinkles, sagging, rough skin, or pigment changes can make people look older than their chronological age. Supple, soft, toned skin with evenly distributed pigmentation implies good health. Chronic exposure to ultraviolet light causes wrinkles, loose, saggy, or rough skin with blotches, and broken capillaries (tiny blood vessels). These effects are cumulative over time. Even worse, sun damage can cause skin cancer including melanoma and eye damage.
Thankfully, it’s never too late to make a concerted effort to avoid excessive sun exposure.
A small dose of sunshine is welcome to sustain adequate vitamin D levels (10–15 minutes per day maximum).
Liberal use of broad-spectrum sunscreen (SPF 15 or greater) is recommended and protective against the sun’s damaging UVA and UVB rays.
Avoid sun exposure from 10am–2pm when the sun is strongest, and wear protective clothing.
Tanning beds are a no-no in all cases. To capture the youthful glow of the sun, try a luxurious bronzer.
While over-the-counter anti-wrinkle creams are popular, their effectiveness depends on active ingredients. For example, Retinol, a vitamin A derivative, is a strong antioxidant found in anti-wrinkle creams. Hyaluronic acid, a super moisturizer, is used in products for wound healing, stretch marks, and now, wrinkles.
As noted in the Mayo Clinic, nicotinamide is a potent antioxidant related to vitamin B3 (niacin) that helps reduce water loss in the skin and may improve skin elasticity.
Avoid tobacco and stay super hydrated for supple skin.
Nothing speaks aging more than outward physical signs of poor bone health. The dowager’s hump, altered posture, and impaired mobility are outward signs of such advancing age.
In women specifically, the marked decrease in estrogen at menopause is associated with rapid bone loss. The usual cellular activity in bone involves constant removal, replacement, and remodeling of bone. This process continues throughout life; however, peak bone mass typically occurs in the 20s, and is dependent on genetic influence, nutritional factors, and hormonal status. Lack of exercise, immobilization, and smoking can also have negative effects on bone mass and strength. Bone loss also increases risk of fracture.
I advise calcium intake 1200–1500mg/day through diet for optimal absorption and vitamin D3 800–1000IU/day for most women.
Weight-bearing exercise is a must for prevention of bone loss; even bearing one’s own weight with walking is acceptable (biking and swimming, not so much).
In some cases, medication to prevent ongoing bone loss and fracture are recommended.
Most women naturally gain weight over time. The good news is that there are habits to achieve and maintain a healthy weight. These are lifestyle choices, however, and not the often-sought-after crash diets or fast surgical fixes. Healthy heart and healthy weight mean higher energy and age defiance.
We often speak of the Mediterranean diet as ideal for protection against heart disease and cancer. I advise this diet as a lifestyle choice for my patients transitioning into the menopausal years. The Mediterranean diet is encouraged not only for weight control, but more importantly for prevention of major chronic diseases. This includes primarily heart disease and cancer, including breast cancer in women.
The Mediterranean diet emphasizes eating primarily plant-based foods including fruits and vegetables, whole grains, legumes, and nuts. Healthy fats such as olive oil and canola oil, instead of butter, are encouraged. This diet suggests limiting salt intake and replacing with herbs and spices for flavor. This may reduce hypertension (high blood pressure), an independent risk factor for heart disease. The low glycemic index in a plant- and lean protein-based diet promotes stable insulin and glucose levels and helps to reduce hot flashes, often associated with a high sugar intake. Sugar highs and subsequent lows or “sugar crashes” are avoided on this diet.
The Mediterranean diet is rich in complex but devoid of simple carbohydrates, and thus will help avoid weight gain and the dreaded “muffin top” so many menopausal women struggle with. This diet is naturally anti-inflammatory.
These days, women are more stressed out than ever. We ladies deal with day-to-day multitasking, trying to manage our professional careers, a home, children, spouses, and the struggles our society faces regularly. Stress causes increased and persistent cortisol production by the adrenal glands, so we find ourselves in a constant “fight or flight” state.
This can have health implications, including altered immune function and difficulty with weight control, not to mention mental health effects like depression and anxiety. It should come as no surprise that we cannot run at 100mph 24/7/365.
Regular exercise reduces stress.
Activities such as meditation and yoga done regularly are helpful. I often recommend simple mindfulness exercises.
Apps such as Headspace allow for stress reduction with only a 10-minute daily commitment.
We can take a lesson from Eastern cultures and practice Chi Dong or Tai Chi. Choose a suitable avenue in which to “be present.”
Sexual health and general health go hand in hand. Women who engage in regular sex enjoy stronger immunity, less depression, and less chronic disease. As such, it’s important to maintain a healthy vagina.
Unlike hot flashes and night sweats related to menopause which subside over time, vaginal changes tend to be chronic and progressive. Less estrogen means less blood flow to the vagina and subsequent cellular changes which translates into less lubrication, dryness, and the potential for painful sex. The loss of vaginal moisture and elasticity can make a woman feel older and as if she has lost her femininity.
Vaginal moisturizers used regularly, lubricants for on-demand use, and hormonal treatments are super helpful in combatting this and restoring a youthful vagina. The old adage “use it or lose it” is crucial when it comes to vaginal health.
Tobacco is off limits. Generally speaking, cell damage can be due to physical, chemical, infectious, nutritional, and immunological factors and in some cases, can be irreversible. Hypoxia (oxygen deprivation) causes cell injury and death. Smoking causes cell hypoxia in all cells. Just don’t smoke.
Exercise sounds like a chore on the to-do list, and for many folks, it is just that—a dreaded chore. The standard American Heart Association recommendation is at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). Thirty minutes a day, five times a week is usually spoken about.
I try to reframe this for women. Getting a move on doesn’t have to mean becoming a gym rat or engaging endlessly in treadmill or elliptical machine workouts.
Find an activity that’s enjoyable for you. Hiking, running, brisk walking, biking, swimming, tennis, yoga, ballroom dancing, or boot camp; whatever works for you.
Mixing it up makes your workout cross-training and helps the experience never get boring.
Add weight or resistance training and exercises to help with balance and flexibility as well.
Avoid being sedentary. For example, use a Fitbit or activity monitor for positive feedback and aim for 10,000 steps per day.
Get a standing desk if you have an office job, and take the stairs regularly.
Most importantly, I try to lead by example. I enjoy an early morning run for my physical and mental health.
I often hear women say, “sleep is overrated” as they try to maximize efficiency in their frenetic lives. This couldn’t be further from the truth. Sleep is when we repair and recharge. A minimum seven to eight hours is required for most.
You see, in simple terms, telomeres are the caps found at the end of our DNA, our genetic material. In general, telomeres protect DNA. Sleep seems to influence telomere length.
A study published in the Journal of Aging Research suggests that those with poor sleep quality have shorter telomeres than those with healthier sleep patterns. You do the math.
Take advantage of downtime and optimize sleep hygiene. Turn off all electronics just prior to and during sleep. Make the bedroom a quiet and peaceful sleep chamber with a comfortable temperature and minimal stimulation.
We often consider acute or temporary inflammation a normal response to infection or injury. Chronic inflammation, however, occurs when your immune system is on overdrive all the time. It’s likely a risk factor for many age-related diseases including cardiovascular disease, diabetes, and cancer.
Aging, poor diet, and sex-hormone-deficient states including menopause, and smoking cause a low-grade chronic inflammatory state. How can one avoid this? Here are a few tips:
Avoid pro-inflammatory foods including sugar, artificial chemicals, and gluten.
The Mediterranean diet is ideal. Exercise including meditation can counter inflammation.
Be mindful of environmental toxins which are found in everyday hygiene and cleaning products, for example parabens and harsh fragrances.
Avoid herbicides and pesticides and consider organic alternatives if able.
Maintain a normal vitamin D level since deficiency is associated with inflammation.
Take an active role in your aging and embrace strategies to help optimize health and discover beauty below the surface, at a cellular level. Perhaps this empowering attitude is more a revelation than revolution after all, helping us to redefine what beauty in aging really looks like…inside and out.
ALYSSA DWECK, MS, MD, FACOG is a practicing gynecologist and ChromaDex spokesperson in Westchester County, New York and Assistant Clinical Professor in the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai School of Medicine. As an author of three books, a Massachusetts General Hospital, Vincent Memorial OB/GYN Service consultant, and accomplished triathlete, Dr. Dweck offers her expertise across various platforms in an effort to destigmatize gynecologic issues and support women’s health across the country. She resides in Westchester County with her husband, their two sons, and their extraordinarily girly English bulldog.