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A (South Asian) women's health special
Q&A with a nutritionist
How much starch is too much? How much protein do you really need? How does metabolic disease tend to manifest in South Asian women? What kind of exercise is best if you’re suffering from a chronic condition such as PCOS?
For women’s history month, here is an interview I did with Anita Mirchandani, a registered dietitian nutritionist who specializes in women’s health, and is also a prenatal and postnatal exercise specialist. Anita is from Texas with a South Indian background, and practices in the NYC area. We connected over social media, and have been discussing the dominance of starch in a vegetarian diet, and the South Asian predisposition to metabolic risk factors. The information provided is not limited to a South Asian demographic - hope everyone finds this useful.
[My interview with Anita was conducted over Zoom on Feb 8, 2023. It has been paraphrased and edited for brevity in this post. You can watch the full interview here]
How did you come to specialize in women’s health?
I started in the wellness space about 15 years ago as a personal trainer and fitness instructor. When I had several members ask me nutrition-related questions after workouts, I decided to get my Masters in nutrition at NYU. At this point, I was almost 30, and had started to think about having kids. Going through those lifecycle phases on my own without guidance, I realized that I want to optimize other women’s experience - help them get healthy and feel their best before they conceive, during pregnancy and then post-partum.
Were there any personal health issues you struggled with and how did that impact your practice?
I grew up in Texas in the 80’s and early 90’s where everything was big! Portion sizes, unlimited refills, all you can eat buffets. My household had a love of good food and a firm philosophy of finishing your meals. We did not have much understanding of what portion sizes should be, or calories. As I entered my teenage years, the perception was that I was a heavier child and I didn’t like it. I started ‘exercising to anorexia’ - to a point where you work out to offset the calories and reach a net of zero. I became anemic. I didn’t even know about protein at the time. In my vegetarian household, protein came from lentils and a little dairy. I ended up going on a rollercoaster of gaining and losing weight until I was about 25. All of this has propelled my desire journey into nutrition and helping others.
How should we be thinking about nutrition across all the stages in a woman’s life - puberty, childbearing, perimenopause and menopause?
Across the board, protein is important, whether age 9 or 55. What those sources are, and what works for you can be customized. Maybe you don’t need to get the balance between macros exactly right until your early 20’s, you have the room to pull all-nighters and eat pizza - unless you’ve been diagnosed with an issue, of course.
But when you get into your mid 20’s, the starch has to be controlled. That’s when the predisposition to diabetes or other conditions may be kicking in. It starts to become difficult to lose weight. You need to figure out the right balance of calories and macros. Maybe add a protein shake in, or try to get it from your diet through a combination of plant and animal protein.
What are some chronic conditions South Asian women in particular need to be aware of?
The predisposition to diabetes is interesting, because now what I’m seeing at an earlier age is PCOS, which is connected to insulin resistance and diabetes. It’s also connected to inflammation - autoimmune disease, Hashimoto’s, thyroid issues conditions. These are conditions that affect your metabolism - swaying from weight gain to weight loss, and experiencing mood disorders. Fertility issues are connected to both of these symptoms and I see a lot of South Asian women struggling with reproductive health. The post-partum weight loss journey often has issues triggered by a susceptibility for high cholesterol, an elevated hba1c- wavering on the state of prediabetes but not quite diabetic. And some other conditions related to inflammation - GI issues and gut health issues such as IBD are becoming much more prevalent. These days, cardiac complications tend to be more common as well. The common thread tends to be a lack of education in the macronutrients - eating too much starch and not enough protein.
Tell us a bit about PCOS and fertility issues. What are some early warning signs?
There are 4 types of PCOS. Recently I’ve been seeing a lot of asymptomatic PCOS - women don’t know they have it until they’ve been trying to conceive, and arrive at the diagnosis through a process of elimination. Could they have been told that sooner and tried to fix some of it before trying to conceive? Because now they have the added pressure of trying to conceive, which elevates the stress and cortisol and manifests inflammation in the body which presents more barriers to conception.
Some early warning signs could be unexplained abdominal adiposity, unexplained weight gain or loss, mood changes, appetite changes, skin disruption, darkening of certain skin areas, irregular hair growth, or inconsistent periods. The problem is that the symptoms are not always the same the condition is common but could manifest differently.
Are there certain types of exercise that you recommend for these conditions?
With the boutique fitness boom in recent years, High Intensity Interval Training (HIIT) has become very popular. The issue with that is with these chronic conditions in a state of inflammation and baseline level of elevated cortisol - high intensity exercise tends to raise cortisol and does not benefit you. In this state, I emphasize low intensity interval training, power walking, cycling, swimming or a sport like tennis.
Every woman needs to have some form of strength training with the complement of dietary protein - it could be just bodyweight training. One of the biggest things as we age is the loss of calcium from our bones. This can contribute to chronic conditions that appear later in life. 2 days a week. Walking should be incorporated int o your life. Take the long way home or the stairs.
How much starch is too much?
An example of excessive starch is just one cup of cooked rice! 1/3 cup is considered a portion, and that’s so little. It doesn’t matter whether it’s white rice or brown rice. Same goes for flour tortillas, bread, white potatoes, and so on. It depends on the person, but I typically don’t recommend more than 60-75g carbs per day from starch carbs (bread, rice, potatoes). That works out to 20-25g per meal. So read those nutrition labels! If you’re still feeling hungry after you hit 60g, maybe you need to up your protein intake because protein makes you feel full and reduces cravings. For example, if you enjoy something traditional in South Asian cuisine, you can still eat them in a smaller portion and amplify protein on the side. If you eat 2 scrambled eggs along with your dosa and sambar, then you won’t feel like you need that second portion.
If you don’t metabolize the starch (move!), it turns to fat. Exercise uses up the glucose in your blood. With a pattern of excessive starch consumption (not just one day), and if you don’t get enough protein or sleep or exercise, all of a sudden you’ve gained 15 pounds, don’t feel as good, energy levels decline, more bloating than usual. This is linked to insulin resistance.
How would you approach more severe cases of PCOS or diabetes?
I tend to start with Time Restricted Eating - no woman should be eating dinner after 7.30! Nourishment has to happen in the daytime so that it works with the body’s circadian rhythm - ideally you should be full by 7pm. Often we are so busy with work that we don’t eat enough throughout the day and then dinner unfortunately becomes the heaviest meal.
For more severe cases, I may bring the limit for carbs from starch down to 40-45g, at least initially.
How much protein should we get?
Traditionally, the protein formula has been 0.8g/kg of body weight. i.e., your weight in pounds divided by 2.2 to get weight in kilograms, then multiplied by 0.8. It’s important to note this is the baseline recommendation, to survive.
I recommend multiplying by 1.2-1.5g/kg of body weight to thrive and achieve the conversion from fat to muscle. Even a basic level of activity like cleaning your house may require a protein shake. Initially it may feel overwhelming, but once you start getting the hang of it and see which protein sources work better for you, it becomes second nature. Peel the onion, layer by layer.
To put Anita’s protein recommendation in context - for me, a woman who weighs ~140 lb., i.e. 63kg, this is about 50g protein per day to survive. And 75-100g per day to build muscle, gain strength and thrive. For vegetarian protein ideas, read this post.
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