Friday Q&A: Diet Coke; Stomach Woes; Strength Training for Beginners; & Finding the Right Doctor for Menopause

You ask the best questions!

It’s Friday Q&A time! Click here to submit your questions for future posts!

The first question (about Diet Coke) is free for everyone. The remaining questions (about stomach issues; strength training for beginners; and finding a doctor who is knowledgeable about menopause) are for paid subscribers.

You can check out my recent Q&As about:

• Treating Heartburn; Selecting the Best Doctor; Insomnia; & How to Triage Your Medical “To-Dos”

• Choosing a Doctor; Ozempic Downsides; Long COVID & Caregiver Burnout

• Ozempic; Alcohol; Hormones & Breast Cancer; & How to Ask for Help

Photo by Matt Seymour on Unsplash

Let’s dive in!

QUESTION #1

Am I negating all my efforts to eat clean and avoid processed food by having a daily Diet Coke? I feel so guilty. I try to focus on organic fruits, veggies and meats/fish. I only drink wine on the weekends and I exercise regularly. But I can’t seem to give up my daily diet Coke!

- Julie 

Dear Julie, 

The short answer is no—your healthy habits aren’t negated by soda. Would swapping your can of Diet Coke for a glass of water be healthier? Probably yes. The caffeine in Diet Coke can quicken our pulse, stir up stomach acid, interfere with sleep, and dehydrate us. The artificial sweeteners and chemicals in Diet Coke probably aren’t great for us, but there’s also no credible evidence that they cause cancer.

It also sounds like Diet Coke provides you great pleasure.

So I’d ditch the guilt and reframe your question to, “What are the pros and cons of Diet Coke for me?”—and then weigh the downsides of Diet Coke for you against the upsides. 

If your insomnia, irritability, and guilty conscience improve when you consume less Diet Coke, you might decide to limit it. If you decide that the benefit of a mid-day energy boost outweighs the frequent trips to the bathroom, then keep it!

Everything we put into our body has pros and cons. Everything we do carries risk and reward. Health is about mitigating risks while optimizing rewards. Sometimes that means enjoying Diet Coke and tolerating the downsides. Sometimes it means quitting a joyful habit because we took stock of the harms.

Nice work with your generally healthy lifestyle, Julie! Nothing—not even Diet Coke—can undo that.

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QUESTION #2

What is the best way to deal with gas, bloating, and irregular poops? Is a probiotic any help? Everyone I ask has a different suggestion.

- Hungry for answers

Dear Hungry,

My patients commonly report exactly the kind of bowel irregularity that you describe. In the U.S., irritable bowel symptoms account for 25 to 50 percent of all referrals to gastroenterologists. The root cause will be different for each person, so it’s important to talk to your doctor to get to the bottom of the issue (no pun intended.)

In the meantime, here are a few things you might do to help alleviate the symptoms.

• Identify and avoid trigger foods: Certain foods such as beans, onions, broccoli, cabbage, and carbonated drinks can produce more gas in the digestive tract. Many of my patients like using the list of FODMAPs as a guide. (These are foods that commonly irritate the gut.) The gut also tends not to like alcohol, caffeine, and heavy meals. Try keeping a food diary to identify which foods may be causing your symptoms and do your best to avoid them.

• Eat slowly and chew food thoroughly: When we eat too quickly, we swallow air that can lead to gas and bloating. Chewing your food properly can also help break down food more effectively, which can reduce the amount of gas produced.

• Take a walk after meals: Going for a short walk after meals can help stimulate digestion and move gas through the digestive tract.

• Try over-the-counter medications and supplements: Over-the-counter medications such as simethicone (GasX) can help break up gas bubbles and relieve symptoms of bloating and discomfort. Peppermint is lovely for calming the gut. 

• Work on stress management: Stress lives in our bodies, and it commonly finds a home in the GI tract! So be sure to talk with your doctor about how you might better manage your stress. You might consider relaxation techniques (i.e., deep breathing, yoga, or meditation), talking to a friend or loved one, or asking for professional help to help reduce stress and its effect on your whole health.

I don’t put too much stock in probiotics unless I have a particular reason—for example, in a patient who is taking antibiotics for Strep throat. As with anything in medicine, there is no one-size-fits all prescription here. I hope that is helpful!

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QUESTION #3

Where can beginners find routines that target the most important 'strength and elasticity' pieces that won't be overwhelming or carry the risk of injury? I just don't even know where to start, but I desperately want to.

- Sarah

Dear Sarah,

Terrific question! Maintaining elasticity of our skeleton means stretching out our muscles (in addition to toning them). It also means caring for our connective tissue—the tendons, ligaments, and fascia—aka the “glue” of our skeletal health.

What is fascia? Fascia is a thin, tough, and elastic connective tissue that surrounds and supports muscles, bones, and organs throughout the body. It forms a complex network that extends from head to toe, creating a three-dimensional web that encases and separates different structures in the body.

Fascia is made up of collagen and other proteins, and it has the ability to stretch and recoil, allowing it to transmit force and distribute tension throughout the body. It also helps to provide structural support, maintain posture, and protect tissues from injury.

Dysfunction or damage to the fascia can lead to a variety of conditions, including pain, inflammation, and restricted movement.

Here are some tips to take care of your fascia and connective tissues:

• Stay hydrated: Drinking plenty of water and staying hydrated helps keep the fascia supple and flexible.

• Stay active: Regular physical activity helps prevent fascia (and muscles, too!) from becoming stiff or tight. Exercises that involve stretching and movement in combination (i.e., yoga, Pilates, ballet barre, and foam rolling) are particularly helpful.

• Avoid prolonged sitting or standing: Parking your skeleton in the same position for extended periods of time can cause the fascia to become tight and restrict movement. Take breaks and move around periodically to prevent this from happening.

• Manage stress: Stress can cause the fascia to become tense and tight. Finding ways to manage stress, such as through meditation or deep breathing, can help keep the fascia—and your whole kit ‘n’ caboodle—healthy.

• Seek professional help: As always, seeking help from a good body mechanic (physical therapist, trainer, chiropractor, or massage therapist, for example) can be a great investment in your whole health. 

I say to my patients all the time: The Golden Triangle of fitness is the combination of cardiovascular activity, strength training, and stretching. 

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QUESTION #4

How do we find a reputable doctor who actually knows/studies/is willing to walk the walk of menopause with you?

-Jenny

Dear Jenny, 

One suggestion is to check the North American Menopause Society (NAMS) website to locate a certified menopause practitioner in your area. The link is here. The other idea is to bring a copy of the NAMS expert statement to your own gynecologist or  primary care doctor to help them understand the most current data on hormone replacement therapy and the nuances of the risks and benefits. Because of the bias against hormone replacement therapy, it can be very helpful to present the latest data to your own doctor. It takes a village to get women the information they need!

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