You Turned 40. Now What?
Turning 40 is a great time to take charge of your health—and in this episode of The Savvy Patient, Erin and Gillian walk through the ultimate midlife health checklist, from tracking down your family medical history and finding a good primary care doctor to staying on top of mammograms, colonoscopies, and all the other glamorous milestones of adulthood. They also talk about sleep, diet, exercise, hydration, mental health, and the supplements you probably don't need despite what social media keeps trying to sell you. Packed with practical tips, relatable and expert advice, this episode is a roadmap for preventive healthcare, healthy aging, and advocating for yourself.
References:
This is the book Erin mentions about mental health: Your Brain Needs a Hug: Life, Love, Mental Health, and Sandwiches by Rae Earl.
We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.
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Visit www.thesavvypatient.com/podcast for episode transcripts.
Watch full podcast episodes @TheSavvyPatient on Youtube.com.
Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.
This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.
TRANSCRIPT
00:00 Family History
07:28 Establish Care with a Primary Care Physician
11:57 Gynecologist
13:45 Dentist and Optometrist
16:59 Dermatologist
19:28 Allergies
21:06 Gastroenterologist
22:51 Look into Unsolved Mysteries
27:55 Optimizing Health with Sleep, Diet, and Exercise
31:39 Dietary Changes and Cooking Habits
38:24 Exercise
43:16 Hydrate
45:38 Mental Health
47:44 Vitamins and Supplements: What You Really Need
53:14 OUTRO 260306 V02.mp4
Gillian Goddard: Hi and welcome to the Savvy Patient.
Erin Stein: Hello. Today I feel like is the most Savvy Patient of the Savvy Patient episodes that we've done so far because this is going to be all about taking charge of your health, and doing things for yourself. And you're not going to like it. It's going to feel like a long to do list, but it's important.
Gillian Goddard: 100%. It's super important. It's super important. You know, today we are using a certain birthday as the sort of trigger on the calendar to start thinking about these things. But even if you have passed that birthday, these are all things that you can still do.
Erin Stein: Also going to say, we're calling it this is 40 because it has a nice ring to it, but you could be doing this at 30 or 35. It does not only apply to turning 40, but insurance wise, there's a couple things that finally kick in. I felt like it's not entirely arbitrary, but somewhat, right? So, you turn 40. Now what?
Gillian Goddard: Yes, that is true. Right. Right. Now what?
Erin Stein: On so many levels, but now what with your healthcare? I have my number one thing you need to do.
Gillian Goddard: Yeah, what is it?
Erin Stein: My number one thing you need to do is get a family history from your family. Hopefully you have parents alive that you can talk to go to them first. But if not, go to aunts, uncles, grandparents, cousins, siblings, whoever will talk to you basically.
Gillian Goddard: Yes. Yes. Siblings.
Erin Stein: At a certain point, I emailed my parents, or I probably talked to them on the phone and texted them, and I said, can you type up every family illness that you can think of? I need a family history so I know what has happened because you've heard things about your grandparents maybe going through something at some point, but you don't remember the name of it. And at this point, my parents and my aunts and uncles have had recent health stuff because they're older and we tend to have more going on when we're older. So, there's new information that they're not always sharing. I have a lot of aunts and uncles, so there was a lot of medical items to cover, but grandparents, and they even had some stuff about my great grandparents, actually.
Gillian Goddard: Yeah, so when you're thinking about a family history, the most important people to focus on are your first-degree relatives. So, these are your parents, siblings, and children, if you have them. And then there can be some interesting information that can be helpful to get about grandparents, aunts and uncles. Grandmother and aunts can be especially helpful on your paternal side of the family because there are many things that women are much more likely to get than men and so just because your dad doesn't have it doesn't mean that you're not at risk.
Erin Stein: Not a fun fact, but a fact.
Gillian Goddard: Yes, I mean things I'm thinking about: so hypothyroidism is much more common in women and autoimmune disease in general. Breast cancer obviously is much more common in women, although if you have a familial-inherited mutation, men can get breast cancer, mostly in that situation. And so having some information about your paternal grandmother and paternal aunts can be helpful too.
Erin Stein: You just came up with the one thing we forgot to talk about in the breast cancer episodes, which is that men can get breast cancer too. It's pretty rare, but it does happen.
Gillian Goddard: Pretty rare, usually again it's with one of these like a BRCA mutation or something like that, but not always.
Erin Stein: So, get a family history. This is going to be useful to you in many ways, and you will want to occasionally update it too. But you will need it to answer the 80 million questionnaires that you'll be getting every time you go to a doctor's visit. And they're like, do you have a family history of these 30 things? Now you have a reference to refer to, to say yes, yes, yes, or no, no, no.
Gillian Goddard: Yes.
Erin Stein: But also provide this family history to your doctor and look at it with them or just get them to look at it and say, are there things I should be screened for based on this family history? Because we're not going to remember as a patient, like Gillian just told us, the paternal aunt, this means something. You don't have to remember that. Put it in front of your doctor at some point. I was able to just put it in the MyChart or whatever app you have, can just give them the whole thing. You're still going to have to fill out the questionnaire, which is super annoying, but I also just gave them the document so there's a record of it. Once you have this, you are going to refer to it.
Gillian Goddard: For sure. And updating is important. As our parents age, they often get diagnosed with things. our kids get older, they start getting diagnosed with things too. Hopefully nothing too scary, but it does happen. As our siblings age they get diagnosed with things. So, it is definitely important to revisit from time to time.
Erin Stein: It is so helpful to have it handy it helps with knowing things, but also with insurance sometimes as we discussed with breast cancer in particular, family history might mean you get more things covered, particularly screenings. So keep some basics even on your phone in your notes app or whatever.
Gillian Goddard: Yep, if you have mom, dad, siblings, and kids in your phone, that goes a long way.
Erin Stein: Yeah, so if you haven't already done this, you turn 40, go to your family and say, I need you to tell me what people have had and ask them to include things like anxiety and depression and mental health issues and ADHD. My parents didn't necessarily tell me about those things because they're my parents. It's important to have that kind of medical history as well for mental health and mental illness.
Gillian Goddard: Absolutely, absolutely. There's a lot of diseases that are heritable, they're genetic, but we think of them as being lifestyle related. Diabetes is my favorite example of this, type 2 diabetes. We think it's because people eat badly and don't exercise, but really the biggest factor that affects your personal risk for diabetes is your family history. And so don't just focus on the things that you think are genetic. Get it all.
Erin Stein: Get it all, so that's my number one thing. You've turned 40. The first thing you should do is get a family history or, update the family history. If you are so on the ball that you've already gotten one, Gillian, what's your number one thing to do?
Gillian Goddard: My number one thing to do when you turn 40 is to establish care with a primary care physician. So, it's very easy going through your 20s and 30s to see the OB-GYN if you're a woman and maybe a specialist here and there and to not ever really establish care with a primary care doctor. Especially if like me, if you spend your 30s pregnant and having babies. It can be really easy to forget that you have other organ systems and body parts that could use some attention and perhaps some screening and assessment. It's also just so much easier to talk to a doctor about a new problem that has come up when you have a relationship with that doctor. First of all, you're less likely to be waiting months and months to get in to see them. And we'll talk about some of those specialists where the waits tend to be very long But, with a primary care doctor, if you're having a new symptom, you don't want to have to wait a year to get in to have an appointment. And so, establishing care before you need them is really important. They are also the person who in theory should be making sure that you are getting all of the health maintenance that is indicated for you. So that's based on your age, but it's also based on your personal risk factors for different illnesses and chronic diseases. Your family history comes into play there. And so, this is a very important relationship to establish if you haven't established it already. In many cases, they are also the person who controls your access to specialists. Erin and I have the great privilege of living in the New York metro area where people are often able to self-refer to specialists because there's a lot of them available. But in most places, specialists are in short supply and you really almost always have to go through your primary care doctor because the specialist may not see you without that referral, even if you don't need it for insurance purposes.
Erin Stein: That's wild. I will rain on the parade a little bit just to say I've seen several primary care doctors in my life and not all of them are attentive and not all of them are doing all these wonderful things that Gillian just suggested they should be doing. This might also be a time to find a new primary care doctor if you are not getting what you would like and if you go in and they're not giving you time and looking over your family history with you and helping you see specialists, maybe it's time to find a new primary care doctor. I am at a crossroads myself, not that there's anything wrong with my primary care doctor, but it's very difficult to get in to see them and I'm getting tired of that. So I'm on the hunt for a new primary care doctor closer to home that will be easier to see. And so I can reestablish a relationship and start talking to them about everything because part of the reason we're having this conversation about doing all of this when you turn 40 is your body is changing, especially if you're a woman, it's actively changing.
Gillian Goddard: Yes.
Erin Stein: And so you do have to start paying more attention. Generally speaking, you're usually healthier in your twenties and thirties. You can power through a lot more than you can as you get older, but also your body is changing. Things are different. Things are going to develop.
Gillian Goddard: 100%.
Erin Stein: Things can be headed off if you're paying attention. You do have to shift gears a little bit and make this a priority and I think as women that's really hard for us to do. It feels like this is the least important thing to get your physical done.
Gillian Goddard: Yeah, yeah, but it's not it's so important. It's not the least important at all.
Erin Stein: It's so important; you got to make sure your partner, your kids, everybody else is going to the doctor, but you need to go to the doctor.
Gillian Goddard: Yep. 100%.
Erin Stein: And then as women, if you're not already seeing an OBGYN, a gynecologist for your lady parts, you should be. If you have not started doing that, you are overdue and you need to go get one.
Gillian Goddard: Yep. Correct. You should. You should be. Yes, 100%. You still need periodic cervical cancer screening. The gynecologist is often the person who gets you headed for your breast cancer screening. And they are often the person that remembers to send you for bone density tests when you need them, which won't be until your 50s or 60s. But nonetheless, they are an important person on your medical team, for sure.
Erin Stein: Yes, I go once a year to get the pap smear and I was getting the order for the mammogram and sonogram from the gynecologist, getting birth control. This is your main stop for these annual screenings that are so critical for our lady parts, as I like to call them. But also, that's where the conversation is going to start for perimenopause and menopause.
Gillian Goddard: I would hope so and you know I always tell people that their gynecologist is the person that they should start with if they're starting to have symptoms that need to be addressed. I know there's a lot in the media that says that they aren't adequately trained to manage perimenopause and menopause. I would say many of my gynecology colleagues are taking it upon themselves to seek out and get the extra training that they need. And many gynecologists feel quite comfortable managing perimenopause and those types of symptoms. It is the place I recommend starting.
Erin Stein: I think after that there's a couple basics. You should be going to the dentist.
Gillian Goddard: Yes, did you know gum health has a huge influence on your cardiovascular health?
Erin Stein: I did not know that.
Gillian Goddard: See, I'm a font of fun facts.
Erin Stein: That's a fun fact. That's a fun fact. Yeah, take care of your gums, your teeth. You need to clean them anyway, but if you had fillings as a younger person, those eventually need to be replaced. I cracked a tooth.
Gillian Goddard: Yep, hopefully before they fall out of their own accord.
Erin Stein: Ideally before they fall out. I mean, I did have half a tooth fall off and I had to have a crown put on. That was quite some granola bar that I bit into. Go to dentist. Go to your eye doctor.
Gillian Goddard: Yes, you need to start glaucoma screening around this time. You will 100% have vision changes in your 40s.
Erin Stein: Yay!
Gillian Goddard: Everyone's near vision changes in their 40s at some point between 40 and 50 and it's essentially the lens in your eye becomes stiff and so it cannot bend enough to focus your near vision in the same way that it can when you're younger at some point. Virtually everyone needs readers for near vision. Often if you have poor distance vision, it allows you to put off needing something for near vision for longer. But if you're like me and you've always had great distance vision and you haven't had a great reason to go into the eye doctor all the time, you'll notice.
Erin Stein: Yes, I have glasses to wear for distance vision and have since high school it's not a super strong prescription. But if I want to see somebody's face across the room instead of a blob, I need to put my glasses on but I do not need readers yet. And I did go to the eye doctor and get a check out because I have noticed differences. I have to move things a little bit more but I can still read a book without readers, but Gillian has been sporting some stylish readers for a little while now.
Gillian Goddard: I have been sporting readers for a while and I basically wear them throughout my entire work day. They've become a permanent fixture on the front of my face.
Erin Stein: Sorry, not sorry. Your eyes are going to change. So, you got to start getting them checked regularly.
Gillian Goddard: You do and maintaining good vision is so important to your future quality of life. there's lots of data around when people lose vision, how it affects other aspects of their life and not just can you read and do the things you want to do?
Erin Stein: Yeah, if you're a seeing person, losing that is a big change in all aspects, so get your eyes checked. A lot of women start getting dry eye and knee drops. You know, that's another thing to talk to the doctor about.
Gillian Goddard: Yes. Everything dries out.
Erin Stein: We're talking about eyeballs right now, Gillian. [laughs] Also, you should be going to the dermatologist. We've been in the sun for a few decades. If you're not already checking your moles and your freckles, go check them. Get them checked, ideally once a year.
Gillian Goddard: I say this as someone who has a grandmother and an uncle who had melanoma. It is so critically important to check these things out early and to have them addressed. This is one that can be a challenge. I recently waited a full year, a full calendar year to establish care with a new dermatologist. Some of that is because I wanted someone who specialized in skin cancer care because of my family history and I wanted someone who took insurance was not looking in this particular instance to get Botox or filler. No judgment.
Erin Stein: No judgment. It wasn't the priority. Yeah. I am seeing a dermatologist who does those services as well.
Gillian Goddard: That wasn't the priority. Yeah, so many of them do both. Some of them only do one or the other. But the wait time can be long. So, this is one that you want to just get it on the calendar. And once you get established with someone, it's easier to get in. But I made my next skin check as I was leaving my last skin check.
Erin Stein: Yep. It's important. I've always been pretty good about going to the dermatologist because I have had some moles removed that ended up being fine, but I'm happy to preemptively remove something. One of my family members had something removed and it was pre-cancerous, but I had to sort of pursue them a little bit to be like, but what had it been identified as, to know if it matters or not for my family history. So, this is another one in the family history you might have to chase a little bit. It might not come to the forefront because we think of it as a cosmetic thing, but it's not.
Gillian Goddard: Yes, as someone who grew up in Arizona and who has family members who grew up in Arizona before the advent of sunscreen. Skin cancer is very real thing.
Erin Stein: Yes. You got to check your skin. It is the largest organ on your body. Is it not?
Gillian Goddard: It is indeed. Look at you with your fun medical facts.
Erin Stein: Look at me learning things. The other thing that is interesting about changes in middle age is allergies. So, I am someone who had allergies but I had fewer as a kid and now I have so many more. It's so delightful to develop all these extra allergies, but I have had to go to the allergist and I recommend blood tests over scratch tests because I don't need both my arms to be itchy but if you suspect you may have developed some allergies, it's worth going to the allergist and finding out. My husband developed seasonal allergies in his 40s. Never had any problems before and that's all it is now. But I have all these other things that do include some food sensitivities, not much. It's mostly the plants outside trying to kill me. But the allergist is something to think about seriously for both skin itchiness, sneezing, but also for food.
Gillian Goddard: Some allergies can develop later; food allergies can develop later in life. Certain types of fruit are common to develop later as opposed to tree fruit.
Erin Stein: Like what fruit? Do you know what fruit?
Gillian Goddard: So, like peaches, nectarines, plums, stone fruit, After pregnancy, actually, apparently.
Erin Stein: Weird.
Gillian Goddard: Our immune systems do crazy things after pregnancy, but that's a topic for another day.
Erin Stein: Along that line, the other thing is to start thinking about gastroenterology.
Gillian Goddard: Yes, indeed. Gastroenterology. For one thing, the age for colonoscopy screening with a typical risk for colon cancer is now 45, not 50 like it used to be. So, if you've just turned 40, you are not far from the recommended age for your first colonoscopy. If you have a family history of somebody having colon cancer earlier, you may already be past due. The recommendation is actually to have a colonoscopy 10 years before your family member developed colon cancer, if it was before age 60.
Erin Stein: That is a hot tip right there.
Gillian Goddard: While you're there, they can look up both, they can go up both ends.
Erin Stein: Yeah, so I was going to add, my family history involves some digestive upset all along the track, if you will.
Gillian Goddard: Yes, from mouth to anus.
Erin Stein: God, I can't believe you just said that. And so, when I went to see the gastroenterologist, I'm like, I need to check my esophagus, I need to check my stomach. So, we did an endoscopy at the same time as the colonoscopy. And that is a great thing to do because you're out and you are not aware that they're doing both things. And it was worth to me to check and make sure what was happening in there, what I might need to manage with diet.
Gillian Goddard: Yeah.
Erin Stein: Start investigating weird things that you've always just dealt with. One of those weird things was that I got pills stuck in my throat all the time. I cannot swallow large pills. As a child, I choked on an M&M because I accidentally swallowed it before I chewed it. It was a very dramatic day at latchkey. I was dangled upside down in the air.
Gillian Goddard: Mmm, yes.
Erin Stein: Well, she shook it out of me.
Gillian Goddard: Gonna go ahead and say that even then that was not the recommended approach to a choking child.
Erin Stein: It was the eighties. It was a wild time, Gillian. Yeah. So that just fuels all those memes about why Gen X is tougher than everybody else. Anyway, so I always wondered if I had a small esophagus and that's why I got things stuck in there. That is a thing you can have. And apparently one distant family member did have that so I had that checked out. We did a swallow test and I just have unexplained difficulty swallowing. Apparently, it's a thing. You never know and if you don't tell your doctor about these things then you know you might be missing something that could be made better. And this was the case of me explaining all of this to my gastroenterologist and them being, that's weird. We should look into that and investigate that. What else, Gillian? I was going to say just continuing along those lines, what other weird stuff do you have going on that maybe you should talk to a doctor about. Allergies might be one thing; digestive issues might be another thing. I have lower back pain.
Gillian Goddard: Yes, orthopedic issues it's a great idea to start checking these out. Because when you address orthopedic issues early, a lot of times you can make headway with physical therapy and other more conservative treatments, as opposed to surgery. Sometimes when things get too far down the road, they don't have any other.
Erin Stein: Yes, all my, all the younger ladies listening to this, go to an orthopedist sooner rather than later. I wish I had started down that road sooner. I just put up with lower back pain for far too long.
Gillian Goddard: It is much easier to make inroads on problems if you address them early. And that applies to all different kinds of problems. There are not always things that they can do, but if there is, it's better to know.
Erin Stein: Yes, and I worked in publishing and spent all day long at a computer for decades. But now I feel like that is even worse. We're on our phones and or at the computer more of us even than before and it's not great on your posture and your spine. Who have you been going to, Gillian?
Gillian Goddard: Mmm. Well, a lot of the ones that we've mentioned, I haven't been to anybody super exciting. The gynecologist, the dermatologist, the gastroenterologist. One of my goals for several years running was to get up to date with my health maintenance. I had been flagging behind for a while and as of December 23rd of 2025, I was 100 % up to date. I'm now a couple weeks out of date, but I will get back there this summer.
Erin Stein: There are always a couple appointments that need to be made and a couple of appointments that have been made that are coming up. You become much more empathetic toward older people who talk about nothing but going to the doctor because you are seeing different doctors for all of these things. And it's a hamster wheel that you're on but you need to do it. My to-do list always has a doctor related things that need to be done. And also, I don't like talking to people on the phone, which sometimes is necessary to get an appointment.
Gillian Goddard: Yeah, to be healthy. This must be a generational thing. I hate talking to people on the phone too.
Erin Stein: I know I just, don't want to talk to you on the phone. If I can do it on the computer, amazing, but it doesn't always work. And sometimes you need to get in sooner. You can't wait till when it says you can get in six months from now. So, if you call the office, you can often get put in the schedule because you have a need.
Gillian Goddard: Mm-hmm. Yep, or waitlisted and then they'll call you when something opens up.
Erin Stein: I tend to save them up and then sit down and be like, okay, I'm going to do it. I'm going to make two phone calls. So, what I'm saying is it's okay if you're not 100 % on top of it all the time. Give yourself a goal once a week. Make an effort. Eventually you'll get there.
Gillian Goddard: Correct. I like that. Once you've armed yourself with a team, there are some other things that you can do to improve your health if you're not doing them already.
Erin Stein: I know what you're going to say and I was not and I'm still not doing it regularly.
Gillian Goddard: So, let's start with sleep.
Erin Stein: Oh, well, I sleep. I thought you were going to start with exercise.
Gillian Goddard: No, we'll get there, don't you worry.
Erin Stein: I'm a good sleeper, generally speaking.
Gillian Goddard: I struggle because I have two days a week where I have to get up super early and then the rest of the week I can get up at a slightly more humane hour. And so that means that I'm really looking at a total sleep over the course of a week. And so, some days I'm a little under slept but the rest of the time I really try to make up for it. But I do one thing that I think everyone should do as a grown up and that is have a bed time.
Erin Stein: Why are you attacking me? I'm a night owl. So I stay up late and even when I had to go to the office every day. I still would stay up fairly late and I had difficulty falling asleep earlier. Everyone's like, just go to bed earlier. And, that is challenging for some of us. I struggled to get up on time, even though I was not going to work super early because thankfully I worked in publishing in New York City. But even by Friday I was running on a sleep deficit, because also I sleep a lot.
Gillian Goddard: Yeah.
Erin Stein: I need a lot. Gillian does not need as much sleep as other humans.
Gillian Goddard: Mm-hmm. I need about seven and a half hours of sleep a night on average. That's, that's in the seven to nine hours a night window. That is true. I am definitely a lark as they say.
Erin Stein: I guess so, but you're also a morning person.
Gillian Goddard: That is true. I am definitely a lark as they say.
Erin Stein: Yes. So, my schedule would change every day based on what I could get away with, like based on when I had to get up the next day or whether I could sleep in or not. Actually, now that my husband has a job where he has to get up super early, his bedtime is way earlier. And he's actually tired enough that he's falling asleep earlier. So whereas I was sort of pulling our bedtime later, now he's pulling our bedtime earlier. And so I am going to bed a little earlier and falling asleep a little earlier. I still read after he falls asleep.
Gillian Goddard: Fair enough. I did say in there the average person needs something between seven and nine hours a night of sleep. But usually, people have a fairly narrow set point within that range. So, as I said, I tend to sleep about seven and a half hours a night on average. So not crazy short, but some of those nights are six-hour nights and some of those nights are more like eight or eight and a half.
Erin Stein: To your point, having a stable routine is healthier than not. And also, if your quality of sleep is terrible and it's not because you have a newborn baby at home or, know, like obvious reasons that are going to disrupt your sleep, it's worth having that checked out because you need sleep. You cannot function and you will realize in your 40s you really cannot function unless you've gotten some sleep.
Gillian Goddard: Well, and when you're under slept, it raises your cortisol levels, which puts you at risk for all kinds of metabolic issues. So, we know that people with sleep apnea, for example, are more likely to have heart disease and diabetes and all kinds of other health problems. And so, it's definitely worth addressing any sleep issues that you're having.
Erin Stein: So, if you got to give yourself a complicated nighttime bedtime ritual routine, don't let anyone give you shit for it. Just say, this is me taking charge of my health. So there.
Gillian Goddard: Exactly. Alright, now let's talk about your two most favorite topics ever, diet and exercise.
Erin Stein: I hate these topics. I know, I know.
Gillian Goddard: I know, but they're important. They're more important as we get older too.
Erin Stein: I know, listen, my diet is so much better than it used to be.
Gillian Goddard: There might even be a vegetable involved.
Erin Stein: There's occasionally a vegetable. Listen, some backstory on Erin. I lived on processed sugar for a long period of my life; I get a sweet tooth from my mother. Interestingly enough, on the topic of changes, I do feel like my taste buds have changed. I am not as keen to ingest all the processed sugar items as I once was. And that has helped to a certain extent, but then also we bought a house and we have a kitchen and we started cooking. When we were living in an apartment. We were ordering in all the time and it wasn't totally unhealthy, but it wasn't super healthy but now we're cooking ourselves the majority of our meals, and that has automatically made it healthier.
Gillian Goddard: 100% cooking is the number one thing you can do to make your diet healthier. And it doesn't have to be complicated. You don't have to be churning out, James Beard award level meals in order to be.
Erin Stein: We want that, but sometimes it's just some chicken or broccoli. I was also, not shocking, a super picky child. As an adult, I've gotten a lot more adventurous and willing to try foods and embraced all different kinds of cuisines and that has made it a lot easier to find things to make at home.
Gillian Goddard: The things that I tell people to focus on are reducing processed sugar and carbohydrates, increasing fiber—so fruit, veg, legumes. And for women in midlife, this is the time to start thinking about protein. Although I've seen some estimates out there that are wild as far as how much protein a person needs. Most of us probably need more than the old recommendations, which were very, very low. It was only 0.4 grams of protein for every kilogram of body weight, which of course, because we don't use any of those measurements in the United States mean nothing to anyone, but equaled out to something like, 50 or 60 grams of protein a day, which is not very much. Most women probably need between 80 and 100 grams of protein per day.
Erin Stein: You say I need protein. So, I think I need to eat a chicken breast. And that's probably because I edited a bodybuilding book and not for any other reason. But does it mean eating more meat to get protein in your diet?
Gillian Goddard: So, meat is high in protein. Your chicken breast has 43 grams of protein. Indeed, foods like chicken and fish are great ways to get protein. But some of us would like to get some protein without increasing our meat intake. Eggs and dairy are still animal products, but they can be great sources of protein and the tricky thing about plant sources of protein is that they come along with other stuff. So only animal products are pure protein. And then, when you think about plant sources, they always come with some carbs, but oftentimes they also come with a healthy dose of fiber. So, when we think about like beans, lentils, those kinds of things, and whole grains, so quinoa and farro have fiber, protein, and yes, a little carb. Working some of those things into your diet can really kill two birds with one stone because you can increase your fiber and your protein with the same food.
Erin Stein: Is it all beans?
Gillian Goddard: It's mostly beans of various types. So like, nuts and seeds also.
Erin Stein: I'm going to try and eat more nuts. Even though I ate a lot of garbage for a long time, I did always cook with olive oil. And I have always snacked on air popped popcorn. Dressed with olive oil.
Gillian Goddard: Mm-hmm, healthy fats. There you go. Which is basically like eating air and fiber.
Erin Stein: Yeah, it's great. I think that has helped; my body is not just made out of sugar and it does okay on bloodwork. But it was a big shift away from the crap I was willing to eat as a child, here's the thing. If you eat crappy, I've been there, so I'm with you.
Gillian Goddard: Yeah.
Erin Stein: You can shift your eating habits without having to think about every single bite going into your mouth. And I think that's important because I have made gradual changes and shifts in how I eat.
Gillian Goddard: 100%.
Erin Stein: And it was never going to happen overnight and it was never going to happen super organized and one thing my husband and I did, we did want to start cooking more ourselves and we used one of those food services to get started.
Gillian Goddard: To get ideas, yeah, that's a great idea.
Erin Stein: You know, they would bring the ingredients for making dinners, you know, like three nights a week or whatever. And it just got us in the habit of doing it, but we didn't have to come up with what we were making and we didn't have to do the grocery shopping. We did have to chop all the vegetables, which could be time consuming, but it was like training wheels for getting used to making meals. it was very helpful for us.
Gillian Goddard: Exactly. Yeah, it's a great idea.
Erin Stein: And then after a certain point, we didn't want to eat what they were offering anymore, but then we had a habit. We were more used to doing it.
Gillian Goddard: But you had ideas and you were already in the habit. Yeah.
Erin Stein: This is a good point when you turn 40 to start thinking more about your food habits more than anything.
Gillian Goddard: Exactly, exactly. And along with that, it's a good time to think about your exercise habits.
Erin Stein: Ugh. Or lack thereof?
Gillian Goddard: This is not an area where you need to make huge changes overnight, but small movement in the right direction will go a long way toward keeping you healthy from a cardiovascular point of view, keeping you strong so that you don't become frail later in life. We want you to be able to move around and do the things that you want to do if you're not already doing those things at this point, this is a great time to start. It's never going to get easier to start.
Erin Stein: This is where I admire Gillian very much for giving herself some exercise goals and sticking to them because I start things and stop things all the time.
Gillian Goddard: And you're not unusual. I think many, many, many people do that. In part because they don't think about how the exercise is going to fit into their life. They think that they're going to do it, but then they don't actually figure out how and when.
Erin Stein: Well, there's that, but also, speaking for myself, I find exercise boring.
Gillian Goddard: Mmm, yes, this is a common issue too.
Erin Stein: So, trying to figure out something that I will do and stick with, not just because I'm forcing myself to do it, but because I get some enjoyment out of it is the challenge for me. And for some people, the answer to that is just to go to classes or go to the gym. I don't like exercising in public. So...
Gillian Goddard: Yeah, or make it social. So, you know, like making it social where you go for a run with a friend. When I was really trying to establish an exercise routine, gosh, a decade ago now when my son was born, I started running every Saturday morning with a friend. And so, it was social and there was accountability. I still pay somebody to make me accountable for doing strength training. Sometimes you gotta throw money at a problem.
Erin Stein: Well, that's the other thing, is a lot of things require money, right? Like I would love to have a personal trainer come to the house and just force me to do it, but I don't have the extra cash for that at the moment.
Gillian Goddard: Yes. Fair.
Erin Stein: So, find things to do, even just going for a walk is something you should be doing and so that's easier for me to do when it's warm out of course. I have a little trampoline in the backyard. I'll go jump on it a little bit. There's plenty of exercise videos for free on YouTube and wherever else so just do something and it doesn't have to be the same thing over and over again. I you do that and that works for you great but some of us are flightier.
Gillian Goddard: And that's okay. I think one way to think about this is if you're just getting started, I'm going to aim to do some physical exercise two days this week. You could even start with one day.
Erin Stein: Thanks. Everyone wants to know, what's the minimum I can get away with? Not everyone, but people like me. What is the minimum I can get away with?
Gillian Goddard: The sort of minimum goal is 150 minutes per week of aerobic exercise. So that's moderate intensity, which means getting your heart rate between 50 and 80 % of your maximum heart rate, which means that you're mildly breathless, but you can carry on a conversation. You want to get 150 minutes of that type of exercise, walking, biking, swimming, running, stationary bike, all those things work. And it can be divided up into whatever chunks work for you. I do this by running three to five miles, four days a week. It takes me about 40 minutes. So that's 4 times 40 is 160 minutes. So I'm just getting to that 150-ish. And then you're supposed to do strength training on two nonconsecutive days. And the purpose of doing it on nonconsecutive days is to allow for muscle recovery in between so that we can build muscle.
Erin Stein: You do need to figure out some exercise you're willing to do and do it. You need to work toward adjusting your diet. The other thing is hydration. Just drink water. Just drink some water.
Gillian Goddard: Yes, you get some hydration from coffee. You don't want it to be your only source of fluid. You don't want your liquids to contain a lot of sugar, because that tends to be really simple sugars that really can spike the blood sugar a lot. But seltzer counts, and there are flavored seltzers that only have a couple calories per serving and aren't just full of artificial flavors either. So like Spindrift, for example, has like real actual lemon juice or I like the grapefruit one, grapefruit juice, but it's not very much. And so, there's only like 10 calories in a can. Other types of sparkling water are great. My favorite thing for summer is herbal iced tea. Just to give you some non-caffeinated, non-sugary options that aren't just plain water. You can also just squeeze some lemon or lime into your water.
Erin Stein: Infused water is delicious actually. Another change I made was I started using monk fruit sweetener in my tea instead of spoonfuls of sugar to cut down.
Gillian Goddard: Yep. Monkfruit is good. Stevia is good. It's also like monkfruit from a plant that is just very, very, very, very sweet. So you need very little to get the sweetness that you're looking for. And they're from natural sources.
Erin Stein: I drink tea almost every day. like other people drink coffee every day. And so that was a big way for me to cut a lot of sugar out.
Gillian Goddard: Yeah, yeah. Your coffee drink that you buy at Starbucks or whatever is usually chock full of sugar. So that's a place to look at eliminating some sugar. At least some of the time. That doesn't mean you can never have the flavored coffee. It just means it shouldn't be your go-to.
Erin Stein: It used to be my Friday treat when I was dragging my ass to the office on Friday. I would go in a little bit later and I would get myself a Starbucks treat full of sugar.
Gillian Goddard: Well, see, a Friday treat is fine. I think that's a reasonable thing to do because it's limited to Friday.
Erin Stein: That's a nice little... nice reward for myself. You should also look after your mental health at this point. If you have not been, I had a circumstantial change that led me to do it, but if you're having anxiety, if you're having depression, if you're having trouble coping, and in midlife we are having a lot to cope with, with our kids, our parents, our friends, things are happening, the world, start taking care of your mental health too, if you have not begun that journey. I think everyone could benefit from taking a pause, going to talk to someone, making sure your brain is as healthy as everything else. I published a book actually that I loved because the author said your brain is part of your body, just like everything else. And it should also be healthy.
Gillian Goddard: Agreed! Agreed!
Erin Stein: Right. We talk about mental health like it's some extra add-on thing that we don't need or that emotions are extra. Emotions are a physical chemical process in your brain. They serve a purpose too. And if your brain is always anxious or always depressed, that's a brain health problem. And you should get it taken care of. probably a lot of women don't again, don't prioritize themselves and keep saying they're going to do something, we'll do it now. Cause you're going to need it.
Gillian Goddard: Yep.
Erin Stein: Some women are already dealing with some perimenopause symptoms at 40, but your body's going to go through change and, and or continue to go through change. You're going to be dealing with a lot. You're going to need support for that. So there's nothing to be ashamed of. There's nothing to feel like a failure about. It's part of taking care of your body.
Gillian Goddard: Yeah, 100%. Yeah, this is also when people tend to head into the sandwich generation. This is when our parents are getting older, our kids still need us even if they're getting big, and it can be a lot to deal with.
Erin Stein: Yes, that too. Even if everything's going well, it's a lot.
Gillian Goddard: So, let's wrap up with something you probably don't need to do.
Erin Stein: Okay.
Gillian Goddard: Let's talk about supplements.
Erin Stein: Yeah, let's talk about that because a lot of advice for women in midlife is to get your calcium, get your magnesium, get your vitamin D, get your this, get your that.
Gillian Goddard: Yep. So, what do you really need? Most people don't need nearly as much as the people marketing to midlife women would have them think they need. You, for example, do not need a multivitamin. Multivitamins have never been proven to be beneficial.
Erin Stein: This is shocking.
Gillian Goddard: They contain lots of things you probably don't need and they contain not enough of them that if you were actually deficient that it would be helpful.
Erin Stein: I find this so shocking. As a child who grew up on Flintstone vitamins that's just, that's going to save me so much money.
Gillian Goddard: I know, right? So, but what are the things, that you do need? If you are over age 50, it is recommended that you take a calcium supplement.
Erin Stein: Or if you think your bones might be crappy. Well, listen, be preventative. I am thin and I am tall and my mother has osteoporosis. And so I have already asked for and gotten a bone scan. And I already know that I should be getting some calcium. And that happened before I turned 50. Circling back, family history, people!
Gillian Goddard: Well, that's fair, but if you haven't had that, at 50. Yes, you want to start a calcium supplement by age 50, it doesn't need to be great gobs of calcium. We found out that that actually wasn't so beneficial. You only need probably five to 600 milligrams per day in a supplement because you get the other 600-ish milligrams a day that you need from your diet. And that's if you eat just a sort of moderately healthy diet, it's not if you're like living on Greek yogurt. There are some things that women are more likely to be deficient in. Iron deficiency is very common in women. And so asking your doctor to check your iron, especially if you're symptomatic. Brain fog can be one of those symptoms. Taking an iron supplement can be helpful if you are deficient. If you're not deficient, can 100 % OD on iron, so don't take it just because you think it's good. You want to make sure you're deficient. And then there are some supplements that can be helpful in specific situations. If you're struggling to get the amount of protein that you need something like a protein drink might be a way to help you do that. There's data that suggests that creatine can be helpful for women in midlife So you could consider adding that especially if you're looking to build muscle. There are certain situations in which collagen can be helpful. Collagen is also protein, although it's not a complete protein. And so you get a little added protein. And then magnesium can be helpful for treating specific things. Magnesium can be helpful for reducing headache frequency and some people find it helpful for sleep and it's a great treatment for constipation. But you don't just need magnesium because you're in midlife. You want to be using it for something specific. And that's it.
Erin Stein: Okay, so rattle those off again.
Gillian Goddard: Calcium if you're over 50. Protein if you're not getting enough. Creatine if you're in midlife, especially if you're a having brain fog or trying to build muscle. Ion if you're deficient, which is really common
Erin Stein: But only if you're deficient.
Gillian Goddard: But only if you're deficient and magnesium if you need it for a specific purpose. And that's it.
Erin Stein: I will say, I was told to take calcium and vitamin D.
Gillian Goddard: When you have low bone mass, we do recommend vitamin D as well. But if you don't know that you have low bone mass, we do not routinely recommend vitamin D. Calcium and creatine and protein, if you're not getting enough from your diet, are probably the only things that everybody needs.
Erin Stein: Everything else is if you have a need for it, but that's still such a short list of things. And there's so many, so many things out there being sold to us.
Gillian Goddard: Exactly. I know, we're like sitting ducks for marketers.
Erin Stein: Well, we are because we want solutions, right? the conclusion we will come to is that to take charge of your health, you should go to the doctor and get screenings, get tests, find out what's really going on and then deal with that instead of just randomly taking all the things sold to us.
Gillian Goddard: That is very sound advice.
Erin Stein: That's our advice. I'm sorry it's not more fun, but make all the appointments. You just got to do it. Use it as an excuse to buy another pretty journal with a fun cover to write down all your medical appointments and to-do lists. You don't have to use one of the ones you already have sitting there in the pile. You can buy another one just for this. I give you permission. So that is the beginning of what happens when you turn 40. Thanks for listening. Good luck making those appointments.