00:00:00
So in this part of the conversation I want to talk about exercise, nutrition, fasting, lifestyle, sleep, environmental
00:00:05
factors. And the first question is why does muscle matter as a woman in particular? Muscle matters because it helps your
00:00:11
brain produce more neurons and that's super important for brain health. As far as protection as we age, it's directly correlative to the amount of muscle that we have. And if you have something like
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PCOS or endometriosis, it's even more important for you because building muscle is going to fight insulin
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resistance and inflammation. I've got two questions to ask. Should women exercise differently across the menstrual cycle? And what is the reason
00:00:35
why women hear what you guys say and they don't do it? I'm so glad we're having this conversation. We're back with the
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leading voices in women's health to unlock the specific insights, data, and tools needed to combat the growing
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challenges women face throughout their lives. For women forever, it was all about aesthetics. I'm healthy. I'm thin.
00:00:53
Because they are under the assumption through socioultural ideas that a woman is coming to the gym to lose weight, not
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to get strong, not to gain muscle. But what we've ended up with is an epidemic of osteoporosis and frailty and really
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dementia where 40 to 50% of women will have low bone density. 70% of all hip fractures happen in women. And when you
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have that, 30% of the time you have a chance of dying in one year. Because most of it is based on male
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data. And I see a large number of women trying their hardest to be healthy but what they are choosing to do is actually
00:01:23
having a negative impact on their hormonal health and it's not your fault and this is where we have to educate and
00:01:29
it starts now. Which brings me to questions from the audience like what's the best and healthiest way to lose weight? Is there
00:01:34
a diet for fertility? Should women ask is there a link between environmental toxins and early menopause?
00:01:39
We think so. But also, if you were to design perfect workout regimes for menopause and permenopause, what would
00:01:46
you Oh, Stacy's clapping. Go ahead. This is part two of my conversation with four of the world's leading experts in women's health. And in this episode, we
00:01:58
go even deeper into actionable, practical things you can do to improve your health. And by the way, if you're a
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man and you've been sent this episode by a girlfriend, a wife, a daughter, uh whoever it might be, I know you might
00:02:10
not think this conversation is for you, but more than 50% of this planet are women. You have a tremendous advantage
00:02:17
in your relationships, at work, and just being a human being going through life. If you understand the majority of the
00:02:24
population and for so long, women's health, women's bodies, women's anatomy, their psychology and physiology has been a mystery because there hasn't been the same amount of scientific research done
00:02:36
to understand them. So, in this conversation, we're going to demystify all of that so that you can understand your wife, your partner, your daughter,
00:02:43
your colleague, your mother, your grandmother even better. [Music] So in this part of the conversation, I want to talk about exercise, nutrition,
00:02:54
fasting, lifestyle, sleep, environmental factors, and all the things that we kind of alluded to when we were referencing hormones and menopause, but in a more
00:03:01
actionable sense. And I guess the first question is similar to the first question in part one, which is why does
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it matter for us to have a conversation about women in this context versus fitness generally or nutrition
00:03:13
generally? Sport and exercise science in itself is a small subset of like sports
00:03:19
medicine and medical research and most of the research has been done on men. So if we look inherently at most of the recommendations of exercise, recovery,
00:03:29
nutrition, it's based on male data and we established earlier that's not generalizable. So when we really want to
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get into the nuances of how do we create an adaptive stress for women, we have to look at it differently to look through
00:03:42
the female lens. understand the female physiology and acutely how hormones can affect adaptations and how women respond
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to different environmental cues than men. Yeah, our hormones distinctly control a lot of our environment and the b our other cells that are not what we
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think of as our hormone cells work with our hormones. So, if we think about the gut, we think about the liver, our
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immune system. A lot of this is so hormonally derived, but it's a two-way street. Meaning, your hormones influence
00:04:13
what is happening in your gut, but your gut influences what is happening in your hormones. And because women have different hormones than men as far as
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what's predominant and when they are, we have to come at this and approach it a different way. There's so much to do
00:04:26
with messaging that women receive as far as their health goes. and this, you know, be small at any cost, you know,
00:04:34
you know, get to that number on the scale. And I see it on social media that the conversation is changing hopefully.
00:04:41
Now, GOP ones is tampering this a little bit, but strong over skinny, nutrition over calories. Like we are trying to build bigger, stronger bodies and take up more space
00:04:52
is the message that needs to have. I mean, forever it was all about aesthetics. You have to look young, feel young, be young, anti-age, you know, all
00:04:59
those things. And what we've ended up with now is an epidemic of osteoporosis and frailty and and really dementia. Should women exercise differently across
00:05:10
the menstrual cycle. So this is the nuance and this is something if you'd asked me maybe 5 years ago I would have
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said sure from a molecular level we see that there are certain things that happen with estrogen
00:05:22
being in isolation for the most part and then when you have estrogen progesterone we see their metabolic shifts we see
00:05:28
their temperature shifts but the caveat is we don't know if a woman ovulates or not and I'm sure that Natalie can you know give some stats about the an ovulatory incidences in most women if If
00:05:41
we were to understand and know when an woman ovulates in addition to how she feels across her cycle, then she can individually tailor her menstrual cycle to her training. But for general plan,
00:05:55
we can't do that. I think it's important that you know building muscle, using muscle, consistency is a huge part of
00:06:02
effectiveness when it comes to exercise or to building strength. And so one fear we have when we say do this in one phase
00:06:09
of your cycle and do that in another phase is that if you know 15% of patients are not ovulating or they have
00:06:16
no idea when their follicular and ludial phases are they then doing overall less
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because they're waiting on this directive to tell them what is not untrue though and how I frame this to
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patients is that strength and resistance training should be the core of what you're doing regardless of the phase of the cycle you're in regardless if you're
00:06:34
pregnant regardless if we're doing fertility treatments, building muscle, using your muscle. Now, what you do on
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other days is where you should allow yourself to say, "How do I feel this day? What do I need this day?" And be
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okay with giving yourself the grace that that may look different on your period, in your follicular phase, in your ludial
00:06:54
phase, and saying something and moving your body is still ultimately, we're all going to agree, better than sitting on the couch. Okay, many women will say they have more energy in that late
00:07:06
follicular phase. And so if you are looking at your workout structure, this is a day I want to try heavier weights or more reps, it can be smart to put
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that in a time where you have a higher chance of being successful. That's how I explain it. I'm like, if you have
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your own data and you know what days you feel really fantastic, that's where you want to put your higher intensity, your
00:07:25
heavier lifting because you know that you're going to hit those training metrics. What we don't want is for someone to go in to do a highintensity
00:07:31
session on days they feel flat cuz then they won't hit the metrics that they need to get the stimulus we're after.
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Can you explain this to me like I'm a 10-year-old in terms of where in the cycle typically women will have more
00:07:44
energy and really be able to push themselves right here 5 to 7 days before ovulation.
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Some women feel really great around ovulation. Some have a transient where they'll feel really awful on and around
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ovulation and maybe 24 hours later they feel really fantastic. Most women are variable through the early ludial phase. So if we think about day 6 to 14, that's
00:08:11
when we see women feel really robust and strong and feel like they can take on the world because estrogen is rising. Yeah. Exactly. And you see the physiological changes, heart rate variability, resting heart rate,
00:08:23
your immune system is um more prone to taking on virus and bacteria. It's not pro-inflammatory. So you have that working for you. Your core temperature is lower. You can ask access um carbohydrate a lot
00:08:35
easier. So you have more availability for fueling to hit high intensities. Then when we see with ovulation, like I
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said, some women feel really fantastic right around the time of ovulation because of the estrogen surge. Some have trans transient where they don't feel so great. They might when that follicle ruptures and the egg
00:08:53
is released the granulosa cells that are surrounding it which is what actually makes estrogen get disrupted. And so
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some women feel that transient breakage and their estrogen's dropping before it reforms to become the corpus ludium and make again. So you have this high peak estrogen and then some women are really
00:09:10
sensitive to these hormonal changes and they feel that drop. So that ovulation day may not always be your very best
00:09:17
feeling day, which makes women feel like it should be and like something's wrong with them. On a side note, we did um survey on
00:09:24
women experiencing pain on ovulation because it's something that was never talked about. Middle schmirts. Yes, exactly. Middles.
00:09:30
Middles. We had So you can feel the follicle rupturing and that's called middle. So it's German for in the middle because it
00:09:37
tends to happen in the middle of your cycle when you ovulate. And it's a it it's painful. It's a pain. It can't be painful.
00:09:43
It's like a cyst bursting inside your body. And then some women are down for the count because of it. So they can't they
00:09:49
don't plan any physical activity around that because they just can't from a physical and mental standpoint put
00:09:56
themselves through anything. So that's why I'm saying like ovulation some women feel bulletproof. Other women have this
00:10:02
transient feeling of really flatness and pain. And then afterwards in these early
00:10:08
ludial phase, so day 16 to about day 22, it's variable. Well, some women will feel like on top of the world still. Other women will feel m I can't quite
00:10:20
hit eye intensities. And then in general these few days about day 24 to 27 before
00:10:26
those hormones actually drop this is where you have your PMS your premenstrual syndrome and cramping and
00:10:33
fatigue and a lot of women are like not so great. That's when your progesterone when both of them drop. I just love how you guys explain it because what I see on social media is absolutes. You must
00:10:44
do this doing ficular. You must do this at ovulation. you must and I'm just like really you know and so I love how you're
00:10:51
like well some women it may affect them this way and others this we generally tend to see xyz so rather than like you
00:10:58
absolutely have to do this at these different times I think learning to listen to your body and the signals that
00:11:03
it's giving you I mean across the stages of your life that's that's really key to so many of the questions that we're
00:11:09
talking about because you want to understand your own response and where many women are falling short is that
00:11:16
they've been suppressing their cycle, so they don't know about it. And they were not taught all of these different
00:11:21
changes that are perfectly normal. And so it's very hard to then hear a social media post that says only do this in the
00:11:29
follicular phase and don't ever do cardio in the ludial phase. And you get a lot of mixed messages when in fact
00:11:36
there's no absolutes. No. And in terms of training, some people think moderate training is better for
00:11:42
women. Some people think high intensity training is better throughout the cycle. and sort of also considering what goals
00:11:49
you might have in fertility. What would you say there is is should I be doing highintensity interval training if I'm a
00:11:55
woman or throughout the cycle and throughout my life? So this is where we have to think about
00:12:02
periodization first lifestyle but also how a woman is feeling. We don't want people to do highintensity interval
00:12:08
training every day because that's just not going to create an adaptive response. We have to think about the reason why we're exercising is to create
00:12:15
a a stress that the body's going to respond to. We don't get fitter during exercise. We get fitter from the
00:12:21
stimulus of exercise and the recovery from it. So, if someone's doing highintensity interval training every
00:12:26
day or 5 days a week, they're not ever going to get that subsequent recovery to be able to hit those high intensities and that stress that we want. We talk about high intensity during our
00:12:37
reproductive years. you can pretty much get away with whatever you want to do during your rep reproductive years
00:12:42
because you have the benefit of our hormones working for us. We start getting into pmenopause and we start
00:12:48
getting into menopause. This is where we have to really carefully look at volume versus intensity. So that means if we're
00:12:55
doing lots of stuff or are we doing really purposeful high intensity versus low intensity because we're trying to create what we call a polarization of
00:13:06
the training so that when we hit high intensities we're actually hitting the intensities we need to create change.
00:13:12
But on the other side of it we want to hit really low intensity so that we can have recovery. It gets harder to recover
00:13:19
as we get older regardless if you're male or female. But in pmenopause, we don't have the benefit of estrogen
00:13:25
supporting anti-inflammatory responses. So we have to be very cognate that we need more recovery. So I'll give you an
00:13:32
example. So my office, my orthopedic office is in a fabulous performance center. Outside my windows, I have floor to ceiling windows. There's a football field inside. That field is filled seven
00:13:46
days a week with people taking a class I called Ignite. Ignite has a lot of midlife women in it who are never exercising at low enough
00:13:58
intensity to recover and never exercising at peak intensity to change their body. So what happens five or seven days a week they're out doing moderate mid-range
00:14:13
intensity training but they're not seeing body changes. They're not seeing recomposition. They're hurt every three
00:14:20
weeks and in my office wondering why they're hurt because they're doing a lot of reps of medium intensity. So, they're
00:14:26
not really recovering and they're not intense enough to really change their physiology. But that's really common.
00:14:35
There are whole brands built around mid-intensity and and that falls into the whole
00:14:41
socioultural thing where we've grown up that if you don't have a good sweat sesh and feel completely smashed when you
00:14:48
leave, it wasn't a good workout. But that's a misconception, right? So they are smashed. They're
00:14:54
dripping as sweat, but it's not at peak heart rate ranges for short bursts of time, right? So it's I
00:15:01
know. Look, it's very confusing because I don't know 20 years people have as they've switched from only cardio, they're like now we're going to do high intensity, which is fine. I'm not
00:15:13
opposed to that word. It's just that how do you define that? What is high intensity? And so like you, because I've
00:15:20
read your books, that we're we're exercising people at pretty low heart rate where they're about to flip from
00:15:27
burning fat to carbohydrates cuz that's really metabolically healthy, but not so intense that people are going to get
00:15:34
hurt. And I also prescribe really peak sprint interval training. And I did that myself in midlife, you know, to recompose my body, sprint interval
00:15:45
training because it's intense and lifting, right? Is the advice different for different
00:15:50
women at different stages of life here? So, if I'm if I'm before pmenopause, you get away with most stuff.
00:15:56
Assuming you have a regular menstrual cycle, right? I think there there's different time periods which we've
00:16:02
mentioned before PCOS, hypothalamic amenorhea, time periods where you're not making estrogen or making it reliably,
00:16:09
you can get away with less. And so we want to protect a little bit of that. But when it comes to exercise,
00:16:15
variety is the name of the game. You want to adapt. So you shouldn't be doing the same thing every day. That doesn't
00:16:20
mean you can't have a plan. There's seven days in a week. You don't have to move every single one. But you should
00:16:26
pick these different activities based on your life, your schedule, what you want to accomplish. And it it will vary some
00:16:32
in different phases of your life because your goals are going to be different. And so when it comes to exercise, we
00:16:38
always have to think about what needs to happen. Are you somebody who is overweight and needs to lose weight? Are
00:16:43
you somebody who's underweight and is trying to gain weight? Are you trying to get pregnant or going through fertility treatments or in menopause? So there's
00:16:50
nuance to it which always makes it hard. But there's not a one do this one exercise every single day. That's pretty much not the answer. So the most popular class for females
00:17:01
right now, I just saw the statistic somewhere is Pilates. And my daughter loves her lree and gets on that machine.
00:17:07
It's like, you know, where does that fall in all of this? I have a lot of um Pilates.
00:17:14
There's a social aspect to it. You know, there's people hate. Yeah. because um we did this real
00:17:20
talking about how Pilates was not appropriate as strength training, especially as a rehab. When we look at
00:17:26
Pilates, it's a complement to true strength training. What I mean by true strength training is you're lifting a
00:17:32
load that's heavy in multiple planes. With Pilates, it's really good for isometric control, core strength,
00:17:38
balance, propriception, but it isn't a stress that's going to create adequate muscle gain and strength of the bone, which is what we want from strength training. So, just like yoga, Pilates
00:17:51
has a place. It does definitely fit in the scheme of things, especially from the social and the fact that it does
00:17:57
give you control and propriception, but it isn't the beall end all for strength.
00:18:03
people that do pilateses frequently will be shouting. But I'm see it's so it hurts so much and
00:18:11
I know I hear well I'm sure it's hard the times I've done it it's not easy but the
00:18:17
but it doesn't uh set you up not to be frail. Mhm. It is not building strength and power. And I have women who have done so many
00:18:28
Pilates 1500. It's like a badge of they count their classes. 1,500 at the deficit of anything else.
00:18:35
It's all that goes on and and I think that is another, you know, you got to mix it up. Number one.
00:18:41
Number two, I say the same thing. So, I'm not very popular in those crowds, but it's great for the for the standard
00:18:49
that I ask people do of of flexibility and joint range of motion so that you don't become really stiff and hunched over and shuffling old person, but it will never give you strength and power
00:19:01
in the way to protect yourself from falling down because there's not enough weight
00:19:07
for the most part. Yes. And we also have to think about when you're doing strength training, you are in uh you're
00:19:12
creating a multidirectional force through the muscle and the tendons and the bones. With Pilates, especially if
00:19:18
you're looking at the reformer, it's not multi-directional in the movements. It each movement is one plane and you can
00:19:25
be yeah, you can be in in different planes, but each motion isn't multiplaner. So if we think about what are we trying to get out of out of Pilates, we're getting neuromuscular control. We're
00:19:37
getting core strength, we're getting some breath work, and all that is beneficial. But again, if we're trying
00:19:42
to grow muscle and bone, take up space, be strong, it doesn't quite hit the points that we need to in order to create this new strength to bring us to
00:19:54
that health span that women are looking for. So do it a couple times a week. Yeah. Not seven days a week. Correct.
00:20:00
So if my my partner, she's 33 years old, so she's not quite at per menopause yet.
00:20:06
If you were to design a perfect workout regime for her at that phase of her life, what would you Oh, Stacy's clapping, you know. Go ahead.
00:20:16
So, if she has three days that she can go to the gym and has, oh, I should say three 1-hour sessions that she could have at the gym in a week over seven days. Each one would start with
00:20:28
mobilization. So using resistance bands or maybe you're doing a Pilates reformer warm-up so you're getting through the
00:20:35
range of motion. Why? Just to open up the joint capsules, make sure you don't have any restriction so
00:20:41
that you can get really good range of motion for the movements you're going to do next. The next movements would be
00:20:47
does that stuff actually work? I do wonder this. So many of my friends are getting injured at this age because that they're my age and a bit older because
00:20:53
they walk into the gym and they start picking weights up. Oh yeah. No, I mean I spend more time mobilizing, I think, than I do actually
00:20:59
training now, just to keep range of motion going and keep the joint capsules open. And so
00:21:04
that's using the heavy resistance bands to distend and distract all the joint capsules to increase range of motion.
00:21:11
Stretching doesn't do that. Stretching will get to an end point of the muscle to allow you to have more flex in the
00:21:17
muscle, but it's not actually stretching in the joint capsule to give you range of motion. So when we talk about mobility work, we want to get into that
00:21:24
full range of motion. So if you have a stiffening, so as I was saying earlier about the guy and my voodoo flossing,
00:21:30
well voodoo floss is a way where you're creating some blood flow restriction, then you go in a range of motion and
00:21:36
that blood flow restriction, you take the voodoo band off and the blood flow comes back and you go in the range of motion get deeper in that range of
00:21:42
motion. So, it's all about accessing the tissues and making the tissues more viable for increased range of motion so
00:21:49
that when you go do the lifting, when you go put on a heavier load, you have better control, better range of motion
00:21:55
and avoid the small little sticky points that cause injury. Tears. The micro tears. Yeah. Yeah.
00:22:00
Uh so it's the micro tears that are going to lead to in injury and the micro tears come when I haven't warmed up warmed up properly. Yeah. So, like
00:22:11
shoulder, what would that look like? Or your shoulder. Uh I wish I had a rig. So, you can take one of those thick um
00:22:19
the big and wrap it around a rig or or something and you can pull and distend. So, you're actually pulling the shoulder
00:22:26
out in different ranges. So, you can rotate, roll, pull, extend, pull, extend. What about this? So, this is more trying to work the muscle, right? And you have paleo press
00:22:37
as well where you're working rotation, but that's not getting into the joint. So you want to be So if you're distending, you're pulling
00:22:44
back. You're not bending your elbow. You're actually pulling through the shoulder and distracting.
00:22:49
And then the band is going to pull you forward to give you resistance to pull your shoulder joint out. And it's not a
00:22:55
painful, but you're just really getting into that full joint capsule. You can do that with the hips. You can do a banded
00:23:01
pigeon stretch. just so many different ways of getting into the joint capsule, which not only gives you more range of motion and prevents injury, but it also
00:23:11
gives you more of the flexibility that people think they get when they're stretching. The reason this is important
00:23:17
as we age is because ligaments and tendons and uh the capsule the inside skin of a joint is made of collagen and the covealent bonding collagen is like
00:23:30
if you envision strands of rope the covealent bonding meaning the bonding between those strands becomes stronger
00:23:36
as you age and you uh become more and more stiff. Well, when we lose joint range of motion, we're injured more. Um, it's why we start shuffling down the
00:23:48
street, hunched over, shuffling instead of striding because we have full hip range of motion or full knee range of
00:23:55
motion. And so, one reason to do this is to maintain full range of motion through
00:24:00
all of our joints. We want full range of motion not only to avoid injury but for
00:24:08
instance if your knee is stiff whether it's an injury or because you just haven't maintained your motion it will
00:24:13
change something called your kinetic chain meaning we really are from our big toe to through our spine connected the
00:24:22
big toes connected to the footbone the footbone because the way each of those body segments works activates the next
00:24:29
body segment. So, if you've got a glitch in the system because your knee doesn't move or let's take this one, this is
00:24:35
easier. Your ankles get stiff because we've never worked on it. Your calves are tight, right? You're a jumper.
00:24:41
You've got tight calves. Your your hip your ankle doesn't flex. Well, then your shin bone or your tibia is not going to internally rotate. Well, without that, your knee is not going to bend as much
00:24:53
and your femur, your thigh bone is not going to rotate. You must have the rotation of these bones to activate your
00:25:00
glute. So if you're not activating your glute, your butt muscle, people are very hurt or they're not
00:25:08
getting as strong or they start having lateral thigh pain. So everything works together and it starts with among other
00:25:16
things the flexibility and range of motion exercises. We're talking about it right
00:25:21
now. So that the body works like a chain. I see messages all the time in the comments section that some of you didn't realize you didn't subscribe. So, if you could do me a favor and double check if you're a subscriber to this channel,
00:25:34
that would be tremendously appreciated. It's the simple, it's the free thing that anybody that watches this show frequently can do to help us here to
00:25:40
keep everything going in this show in the trajectory it's on. So, please do double check if you've subscribed and uh
00:25:46
thank you so much because in a strange way, you are you're part of our history and you're on this journey with us and I
00:25:51
appreciate you for that. So, yeah, thank you. If I lose my range of motion because I never did all these things,
00:25:57
can I get it back when I'm 50? So, like, you know, I'm 33 now and I'm think, damn, I've not been doing enough of this stuff.
00:26:02
Yeah. Yeah, you can. Unless you're having bone changes due to arthritis and it's blocked. Yes, you can.
00:26:08
So, I can start I could theoretically start at 40 cuz if you think about your muscle and how it responds to picking up a weight
00:26:14
and right, you're going to build the muscle. So if you're creating a force within the tendon and the ligament and
00:26:20
the collagen and it's a repetitive force, a positive force, you're going to invoke change.
00:26:26
Tissues are malleable. So people that think they're stiff and they say, you know, I can't touch my toes and
00:26:31
they can work on they can get it back. Here's another reason. So what happens in midlife men and women actually they
00:26:38
remember what they used to do and then they're like I'm going to start working out and I'm going to start
00:26:45
their success. This is when I get people who just show up on the basketball court after not
00:26:51
having been there for quite some time and they return to their memories of success but because they haven't lengthened their tendons, their joints aren't moving quite so well. They
00:27:02
rupture tendons because the load outstrips the ability of the tissue to be compliant. That makes sense. Friends have been getting injured and I think that's in part why because they're
00:27:13
trying to work out like they used to work out. Yeah. And listen, they can return to
00:27:19
really high level, but you can't stop. You can't start where you left off 20 years ago or 10 years ago. It takes a minute. Few weeks for me. It takes a minute. Yeah. So Mel's 33.
00:27:31
You mobility work when she gets to the gym first and foremost. Y on day one or every day?
00:27:37
Every day. Every day. So I'm assuming, and I could be wrong, that she already has a strength training history.
00:27:43
Yeah, she does. Yeah. Okay. So we do the mo mobility work for about 10 minutes. Really warm up. Well,
00:27:49
then we pick one compound movement we're going to work on. So could be squats on
00:27:55
the Monday. So we're going to work on loading in a squat pattern. So that's your knee forward, you know, quad
00:28:02
dominant type squat motion. Back squat, does it matter? Back squat, front squat. You could do Bulgarian split squats. So we're adding
00:28:08
load and we have a periodized program. So this is just a snippet of one day in a periodized program.
00:28:13
What if you didn't have that strength training history? Well, then we work on adding load
00:28:19
through our I want to see how she moves first and we want to make sure that you're moving well before you add load. So this is where we would work with lighter loads and more reps.
00:28:29
What if she's doesn't have you there? Yeah, that was my question. Like what if you're not there on her own?
00:28:35
Yeah. So this is still like how do you squat? Where are your sticking points? So you can assess, self assess. If
00:28:42
you've done your mobility, then you'll know like, oh, my hips really tight, so I need to work on that. So let me do
00:28:47
some air squats to see how I move. Then the next time you go in to do squats, maybe you're picking up um two 10 pound dumbbells and you're holding them and doing air squats with your dumbbells.
00:28:58
And eventually you're gonna move to the barbell. So it's all about small progression under load to get to a point
00:29:05
where you feel more confident to use a barbell back squat to get into more of those compound movements.
00:29:11
Why don't people exercise? Specifically, if we just focus here on women, what is
00:29:16
the reason why people hear what you guys say when you're talking about exercise and they don't do it? They don't start.
00:29:23
It's hard. For what what set of reasons make it hard? Well, for women, it's set up in a
00:29:29
gendered environment. Like I always use the example of a woman who has an interest in strength training. if they
00:29:35
go to a typical like 24-hour fitness or another brand gym that's out there, they'll walk in and they'll say, "Yep, I want to join." And the membership person
00:29:47
most often will say, "Great. Here's the class schedule. This is where we have our spin classes. This is where we do our our classes." They never direct them to the lifting
00:29:59
platforms. They never look and say, "Hey, here are are the way to get strong." Because they are under the
00:30:05
assumption through socioultural ideas that a woman is coming to the gym to lose weight, not to get strong, not to
00:30:11
gain muscle, not to recomposition. Yeah. Right. But if a man walks in, then it's
00:30:17
always the great, here's the lifting platforms, we have x amount of barbells, we have x amount of bumper plates. How
00:30:24
much weight do you want to gain? Do you do you want to work with someone to, you know, help you build that mass?
00:30:29
Vonda, why does it matter? You know, cuz there's a big social pressure on women to look a certain way
00:30:36
and it doesn't typically involve muscles in the especially in the upper body. Yeah. So, you know, we're still living under
00:30:43
the times of be as small as you can, but small doesn't mean lean. There's a concept of skinny fat which you know it's you can be as tiny as tiny but you
00:30:55
can be 50 you can have a body fat of 50% which means you're neither strong you're not metabolically healthy you're just
00:31:02
little right so it's there is also a misconception that lifting heavy is going to automatically turn you into a physique model or a bodybuilder shape
00:31:16
if that's your goal that's probably going to take you five years or a decade. It's a lot of hard work for a
00:31:22
long period of time with proper nutrition. So for a woman who's wants to feel better, the goal is to build muscle to be lean, to recompose,
00:31:35
not lose weight, right? I'm not really interested in somebody's weight. I'm interested in their body fat percentage
00:31:41
and their lean muscle mass. Um because it's what you're made of that matters, right? Not the size of the shell. And why does muscle matter as I age? As
00:31:53
a woman in particular, it matters for everyone, but for uh muscle matters because it's not just
00:32:00
part of locomotion. It's not just part of moving you around. It is a metabolic organ. It is critical for glucose
00:32:08
metabolism. It's critical for uh insulin sensitivity. It uh talks to the bone. Bone and bone and muscle are endocrine organs which cross communicate all the
00:32:20
time. So both bone and muscle have access to the brain. Right? Uh muscle will produce a hormone called irri which has multiple functions in the body.
00:32:32
The the axis between muscle and brain helps your brain produce more neurons. Right? bones access to the brain has a role in satiety. Isn't that amazing?
00:32:45
Which means not hungry anymore. Why would you think these locomotive structures, if that's what you limit
00:32:52
them to, would would even have those functions? It's because we put organs in a box. So to answer your question, muscle in men and women, but women in
00:33:03
particular for this conversation, we need as much muscle as possible to fight the insulin resistance that we get when
00:33:11
estrogen walks out the door. We need uh muscle for glucose metabolism. We need muscle for the pure strength of it because
00:33:24
we do not want to become frail and be one of the twothirds of nursing home residents who are women because we can't
00:33:31
do something as simple as get up out of a chair. But I could just get muscle when I'm 70. You can actually harder.
00:33:37
So why does it matter for Mel to be thinking about it when she's 33? Well, here's the great part for Mel is she still has all her estrogen. Mhm.
00:33:44
Estrogen has a profound effect on muscle protein synthesis. Um it is a significant anti-inflammatory. So high inflammation, chronic
00:33:57
inflammation, we've talked about decreases muscle synthesis. It decreases bone synthesis because inflammation with its high cytoine level I've mentioned
00:34:08
them before IL6 tumor crosis factor those are all detrimental to these normal metabolic pathways. So the wonderful thing for Mel who is entering
00:34:20
what I call the critical decade which is 35 to 45 estimated. It's the prime time
00:34:26
to set your physical activity standards and to build as much as you can while you still got all your estrogen. In addition to the fact that for proper
00:34:38
hormonal health, you think about inflammation coming in, it's like static on a walkie-talkie. The brain's trying
00:34:44
to interpret your hormones and when inflammation's coming in, it's making the signals really hard to hear. So, we
00:34:50
need to make sure that we're actively fighting that. And building muscle is one great way because it's going to use up glucose and fight insulin resistance,
00:34:56
which means makes your cells more sensitive to when it sees glucose and able to use it better. If you have
00:35:03
another thing that is pro-inflammatory such as PCOS or endometriosis, it's even more important for you because your inflammatory burden by default of what's happening at a cellular level is
00:35:14
higher. We now need to not just say, I need to not make it worse by being exposed to things. We have to say, I
00:35:21
need a plan to fight this because my world is pro-inflammatory on a daily basis. What is my game plan to fight
00:35:28
this? And building muscle. It's not just exercise is better than no exercise but
00:35:33
specifically building muscle because as everybody's saying it's has a metabolic function in your body is going to help
00:35:40
you the most. There's a term called geroprotective geroproction. So gerero is is the term we use for aging. So gerontology is the you know the part of medicine that focuses on the elderly
00:35:51
patients. And so when we look on in females and the organs that are, you know, are the most ger protective, it is
00:35:59
the muscle and the ovary and the ovaries go away. We have a shelf life in our ovaries. So then we're just really left
00:36:05
with our muscle as far as protecting us in those elderly years as we age. And it's directly correlative to the amount of muscle that we have because if you have a lot of muscle, you're going to
00:36:15
have stronger bones. And this this is where the intensity part where um Dr. I was talking about
00:36:22
seeing the ignite class and everyone's in that moderate intensity all the time. With moderate intensity, you don't have
00:36:28
the post exercise anti-inflammatory response. So, if we're trying to build muscle and we're trying to dampen
00:36:34
inflammation if we're always doing this moderate intensity cardio, then we're not one going to be building the muscle we want and two we're going to have this baseline elevation of total body
00:36:45
inflammation. So we need to mix it up and have that precedence on being muscle centric and building that muscle
00:36:52
one to help with aesthetics. I mean that's the byproduct of lifting weights. You tend to look better but it's more
00:36:59
than that. We see it improves brain health because of the neuro connections and the neuroplasticity of the brain and
00:37:05
I told sleep all of those things you get an incredible parasympathetic response when
00:37:11
you've done a significant heavy lifting session or a sprint interval session which you don't get with that moderate intensity cardiovascular work. Two questions to add to what you you're about to say here is um am I right in
00:37:23
thinking that at the end of that golden decade that you referenced 45 years old Because you have changes in estrogen, one will expect to see a a natural decline in muscle.
00:37:35
Yes. Um and an increased chance of osteoporosis, osteopenia, bone issues later in life? Do women, this is several questions, I apologize, but do women then also tend to have more frail bones
00:37:46
in later life and is that linked to the muscle loss? So this is how it works. So both men and
00:37:51
women build bone and peak about up to 25 some sometimes 30 and then bone loss plateaus for a little while. Men continue to lose about 1% a year. So men
00:38:05
do not arrive with hip fractures or devastating fractures until their 70s or 80s or older. Women
00:38:14
also decline slowly until we lose our estrogen. And then the rate of decline, and I'll tell you why it happens, for
00:38:21
bone doubles or triples such that you will lose 15 to 20% of your bone density during your pmenopausal period just from loss of estrogen alone because estrogen
00:38:32
plays many roles. I've already talked about estrogen being a huge anti-inflammatory. Bones are very
00:38:38
sensitive to inflammatory chemicals in your body. Estrogen also directly affects the balance of the two main cells that
00:38:49
subtract minerals from bone, the osteoclast and the cell that builds the bone, the osteoblast. And in well hormoned times,
00:39:02
there is a balance. The body loves balance. We take what we need, we build it back. But because estrogen has such a
00:39:08
profound effect on the osteoclast, the Pac-Man bone eating cell, there's a dis there's an imbalance and we take more bone than we're capable of building. We're still building bone, but
00:39:21
the rate cannot keep up with this. So with the inflammation, with the direct effects on the
00:39:27
osteoclass, women will lose bone density if they do nothing. Well, number one, they're going
00:39:34
to lose bone density, but they must do something about it. The reason it's so critical
00:39:40
for a 33y old is because you still have your estrogen. So, let's learn how to lift heavy. Let's take advantage of the
00:39:47
estrogen circulating. Let's learn to have a jumping practice and impact our bones. Right? So the the way our body tells our bones to build more is um
00:40:00
there's another little cell called the osteocy. It sits encased in bone but it's connected to these other uh cells
00:40:08
by little tunnels that contain fluid. When you jump, the biomechanical impulse of that fluid shifting in the little tunnels is translated into a biochemical
00:40:20
stimulation that tells the bone, "Oh my god, she's jumping around. I need to build more bone." So, we need that
00:40:26
impact to stimulate the laying down of more bone. I was looking at this graph, which is what you were describing. Yeah. um men and women aren't that far
00:40:37
away in terms of bone mass. So this is showing the fact that because of the way testosterone interacts with a man's bones, he will peak at a higher bone mass than a woman will.
00:40:51
Yeah. So he's starting at a higher level. Yeah. So I would want young women to do
00:40:57
everything humanly possible to start at the highest possible level. But I see lots of 20 year olds, 30 year olds, really young women with poor bone density for a lot of reasons. And so I'm
00:41:11
a big proponent for having bones measured early. Don't wait until you're old so you know where you're starting,
00:41:17
but that's not the standard recommendation. No, the standard recommendation is 65, which
00:41:24
long way for that. But because I do do either a DEXA scan or a REM's ultrasound to look
00:41:30
at bone quality on everybody, um, we can catch it earlier. And that's really important to get in front of it because it's estimated, uh, research says that
00:41:41
in order to affect bone density, if you're going to use estrogen for instance, you need to have do it for 10 years.
00:41:47
And why should people care about bone density? Everyone cares about muscles, but very few people talk about bones. Fracture. can't carry your muscle around
00:41:54
if you have weak bones. So without bone, muscle is just a heaping pile of steaming metabolic
00:42:00
tissue sitting there, right? There would be no bicep to complement, right? Because it has to be connected to a
00:42:07
bone. So they're important for locomotion and giving support to the muscle. But bone is an endocrine organ
00:42:15
that secretes hormones that go to your brain to help build neurons to your pancreas to be active in insulin uh
00:42:23
release to the muscle for glucose metabolism. In men to the testes to build testosterone and that's only one of the many hormones that the bone produces. The bone is not not only
00:42:36
structural, not only hormonal. I've already talked about it being a storehouse, but it's an incubator in our
00:42:43
pelvis is where we build all of our blood cells. Mhm. And so it has these multifunctions.
00:42:51
But to Mary Claire's point, for women, 40 to 50% of women will have low bone density. And when you have that, 50% of the time you'll break a bone. So if
00:43:02
we're looking around at this table, if we all have osteoporosis, which we don't, uh, one in two of us will
00:43:09
fracture. When that fracture is a hip fracture, which is very common, 70% of all hip fractures happen in women. 30% of the time when you hit the floor
00:43:21
and something breaks, you have a chance of dying in one year. This quick, your life changes. 50% of the time, even if
00:43:30
you survive, you will never return to prefall function, meaning you can't go home. And that puts your family in this
00:43:37
situation of having to figure out 24-hour care or you move in with your eldest daughter or you go into a facility where you use
00:43:49
your life savings until you have no more and then you have to apply for Medicaid
00:43:55
and the government will pay for it. These are terrible situations to get at something that we could have
00:44:01
prevented had we started early enough. So, you want to start early. So, I'll have Mel. So, Mel's going to be doing
00:44:08
strength training, not just for the muscle benefits, but also because it's going to help her build strong, healthy bones in that critical decade.
00:44:14
Yep. And then we finish it with some jump training. Jump training. Yeah. So plyometric type work or if
00:44:22
we're looking at not having the robustness of doing straight pio then you can do banded assisted pogos. You
00:44:28
can do low depth jumps so you're getting some impact the bone because as um Dr. Roy is talking about it's a
00:44:33
multidirectional stress not people think oh I run I'm going to have strong bones
00:44:38
but running doesn't do it. You need multidirectional stress. So if you think about it when you land your body has to
00:44:44
move the ground doesn't. So it's called the ground reaction force that comes up through the bone to create that
00:44:50
strength. So that ideal situation in a workout for her would be some mobility, some heavy
00:44:57
lifting. If we're doing plyio, that's also strength or a sprint type training. So you're getting a metabolic stress. So
00:45:03
you're hitting all the major factors in one 1-hour workout. I read that um that there was a study done with some
00:45:09
Australian elderly ladies on bone growth on lifting and bone growth. Yes. Yeah. Lift more lift more study by Dr. Beck.
00:45:20
Yes. She was trying to dispel the myth which I hear every day that you've got osteoporosis, you can't lift weights.
00:45:26
Yes. And so her study because we're big proponents of teaching people to progressively lift heavier and heavier and that scares people. but especially if you think you're going to break. So
00:45:39
she did a study where the load was five reps, five sets under a supervised situation. So five reps means that it was heavy enough that at five reps they
00:45:50
were near failure. Right? So these women all osteoporotic not only were capable of lifting heavy under supervision, none of them broke
00:46:01
and uh they built bone. Yep. So that answers the question, right? Can you lift? Yes. Yes, you can. And the other thing that isn't really brought up into these
00:46:13
conversations is when you hit pmenopause, not only is estrogen sort of the stimulus for sat satellite cell
00:46:20
where we're building muscle cell, but it has a distinct um I guess influence on measin. So meosin and actin are are two contractile proteins. So if you think about a sliding filament or coming
00:46:33
together, you have meosin and actin that bond together to then pull and move and
00:46:39
pull and move and that's how you have a muscle contraction. Estrogen is responsible for how tightly meosin bonds
00:46:46
to actin. When we start to lose estrogen or we start to have variability in our estrogen, we get myosin dysfunction. So that means we're not going to get a very strong contraction.
00:46:57
So we get weaker. We get weaker. And this is one of the very first things that people complain about to me. I don't have power. I don't
00:47:03
have strength. I can't I my grip strength's gone. I don't know. But their body composition hasn't changed yet. So
00:47:09
if we think about lifting heavier loads, it's a neuromuscular response. And that
00:47:15
direct stimulus creates the adaptive change in measin that now estrogen isn't responsible for. It's a different external stress that creates that change in measin to go, yep, I have to grab
00:47:27
onto actin and have a very strong contraction. So we see that this dysfunction happens first before we
00:47:32
start seeing a change in our lean mass development. So if we are already in the habit of lifting heavier loads, then we can offshoot some of that measin dysfunction that occurs with the
00:47:44
estrogen change. So when my patients come in and they are looking to prevent osteoporosis or they've gotten a diagnosis of low bone density, you know, what can they do? I've discussed the
00:47:54
Lyftmore trial. The new study just came out May of this year of 2025 and they looked at very similar to the protocol used in Lyftmore. So there was a control group where they just did nothing. Then
00:48:06
a group that did the they did three days a week and they did resistance training and jump training. And then the third
00:48:13
group did all the same exercises and added HRT. And depending if they had a uterus, they got estrogen or estrogen
00:48:18
plus a progesterrogen. And so, of course, as expected, the do nothing group lost bone. You gained bone as
00:48:25
expected in the resistance group, but it seemed to be synergistic. When we added hormone therapy and the resistance
00:48:32
training together, they grew even more bone. They had even better results. So, when my patients are like, I want to
00:48:38
hedge my bets. My mother fell and fractured. she's broken her hip in a nursing home, whatever. And I'm trying to avoid this. I'm we're hitting all the
00:48:46
points and the only medication of it. Now, we have other medicines that will help slow down resorption of bone, the
00:48:51
bisphosphinates and stuff, but they, you know, there they can be hard to take and they have a lot of side effects. So, to me, prevention is always better than
00:48:58
cure, right? So, I'm trying to get them and get them early. I just ignore the guidelines that say you have to wait till 65 unless you have some chronic medical condition to get a bone density. I'm telling patients you can find it for
00:49:10
about $99 around I work in Houston and that is worth the investment for you to go get your baseline bone density. I don't know a single orthopedic surgeon you know a singer exercise physiologist
00:49:22
or anybody who deals with with osteoporosis who thinks 65 is a good idea. So if your listeners are like oh
00:49:28
well you know my insurance won't pay for it. I'm like, there are centers popping up now where you can go and get a DEXA
00:49:34
scan and just pay out of pocket and get a great, you know, and figure out where your starting base is.
00:49:39
A DEXA scan is a bone scan to see your bone density is the easiest way to describe it and your muscle mass.
00:49:45
Yeah, they can do that as well. This conversation is really important though to extend besides just menopause or
00:49:51
permenopause that there are women of reproductive age years who have profound periods of low estrogen who are also at
00:49:59
risk for serious problems with their bone density both now and down the road. And so if you come to me and you say,
00:50:06
"Oh, I haven't had a period for 7 years. No big deal." Well, that is a big deal. And depending on the reason why, many of
00:50:13
the causes will result that you had low estrogen and you were not ovulating and you have hit that graph you showed of while you're building your bone, that person's on a different trajectory. And
00:50:24
those women do need bone scans much earlier so that we can see where they are and see what treatment we need. But it's one of the biggest reasons. Bone health is one of the most acceptable
00:50:36
medical reasons for why we should put younger women who are have low estrogen time periods onto estrogen treatment
00:50:43
because it can so profoundly change their bone health long term. So in my uh niche of active women, we see there's a very very high incidence of recreational
00:50:54
active women and low energy availability, meaning they're not eating enough to support daily life as well as
00:51:01
their training. So the subclinical aspect of not eating enough creates a myriad of of issues that does create lower bone density, menstrual cycle
00:51:13
dysfunction, greater inflammatory responses. So you know the end result would be hypothalamic amenora. So their periods have stopped which is a low estrogen standpoint. So, you know,
00:51:26
keeping track of of your period, make sure you're eating enough is one of the first stop gaps that we have in the
00:51:32
athletic realm. It's like we want you to eat enough. And if you're looking at bookending our calories on either end of
00:51:39
the day, that's not appropriate. We have to look at how your circadian rhythm works because the circadian rhythm, like
00:51:44
we talked about in the first um half, was about the pulses of our hormones. So if we're holding our calories on either
00:51:51
end of the day, then there's this big space in the middle of the day where your body thinks it's under a starvation threat. So you start to have this down
00:51:59
downturn of all of our metabolic functions. We see after 4 days of low energy availability, there's a direct
00:52:05
impact on thyroid function. So we have to be very cognate that women who are saying, "I haven't had a period in seven
00:52:11
years or my periods are really irregular." We have to bring it back to the energy function as well. So, I know
00:52:17
unfortunately we're still in this environment of aesthetics and I'm always like, we need to eat. And if you eat in
00:52:23
and around your training and fueling appropriately for what you're doing, it has a positive impact on body
00:52:29
composition. You're not going to gain body fat, you're going to gain lean mass, you're
00:52:35
going to gain bone, and you're going to see a decrease in body fat. But it's a trusting the process that out in general socioultural concepts is just not
00:52:46
acceptable for so many women right now. And with that exercise regime I asked you to make for a woman that's pre
00:52:52
premenopause. Was there anything left off there? We had day one which is mobility works
00:52:57
strength training. So if you were to do three days a week in the gym that would be pretty similar
00:53:03
except for the compound movement. What are we doing for each of those compound movements? A different muscle. So it would be the knee forward squat motion
00:53:10
one day, push pull upper body next, and then uh posterior, so your hip thrust, your deadlifts, that kind of stuff. Because women are quad dominant to prevent injury, we really need to build
00:53:22
the posterior chain. And this is your glutes, your hamstrings, your deadlifts, your Yeah. So you're getting really uh strong around the knee joints, the hip joints because again that feeds forward
00:53:33
to better movement, movement economy and prevention of a misstep for a hip fracture later down. What about cardio? And so that's where like if we're looking at
00:53:44
those three days a week and we're finishing with pio or some sprint work, then the other days just walking, lowle
00:53:51
intensity walking or maybe you have soul food, you want to go for a bike ride, you want to go for a run. If you're not
00:53:57
training specifically for something, then those three strength training days are your key workouts and then you can
00:54:02
pepper in all the other things that you like to do. I hear a lot about V2 maxes, so I thought but we should all be driving our
00:54:08
cardiovascular performance up to get a high V2 max. Well, that's where the intensity is. Yeah, I think it's only I mean, and correct me
00:54:15
if I'm wrong, but my understanding after reading and watching everything is doesn't take that much to build V2 max.
00:54:20
doesn't it's that high intensity that's a little bit uncomfortable where you're pushing at that max for uh you know
00:54:27
about four minutes to build that V2 in the sports science world it's always been the 4x4 the Norwegian 4x4 4 minutes on four minutes off four minutes on four minutes
00:54:39
but that's not three days a week no protocol is once a week once a week at the most right
00:54:44
and the other sprints just to give you I tend to give my examples because it makes it more real but When I'm doing
00:54:50
sprint intervals, um, I do it the 30 seconds on and then complete recovery, meaning I'm for 30 seconds I'm taking my heart rate as high as I can get it
00:55:03
and then I'll completely recover, which takes me two to three minutes. I just happen to do it on a treadmill,
00:55:09
but the reality is you can do it on anything. It's a heart rate function, not an apparatus function. So, for me,
00:55:19
on a treadmill, after I'm done warming up, you can't do it cold or you'll hurt something. Exactly. After I'm done warming up, cuz I'm a really short person, I punch the
00:55:31
treadmill up to 11 and I am just working so hard I don't fly off the back. But that gets my heart rate up really high,
00:55:39
about 186. Everybody's top heart rate is different. And then I completely recover. And I do
00:55:45
that four times. And that's all you need. It doesn't take that long. And you feel so good when you're done.
00:55:51
Yeah. So I can't run at the moments. This morning I did explosive kettle bell swings. Why can't you run at the moment?
00:55:56
Uh torn hamstring and miniscus. So I can't run at the moment. Running is in. Run clubs have come in strong. It's back in. It's not happening.
00:56:08
Are you at all concerned with the fact that people are running all the time and doing resistance training less? Because running is cool like cool now. It's how people date. It's it's they're not going
00:56:19
to nightclubs. It's a sacrifice of other things. It's like we said about Pilates, you know, if all you do is running, then that is
00:56:26
definitely not the best way to be. It's not the healthiest for your whole body. It's not that you're unhealthy, but
00:56:32
we're really talking about how are we optimizing your body and your hormonal health for a variety of different goals.
00:56:38
But also, if we look very micro at running, 58% of runners have a ludal phase defect. That means that the second
00:56:45
half of their menstrual cycle is not going to be able to last as long as we want it to. Likely due to what Stacy was
00:56:52
talking about earlier, this relative energy deficiency coming back to the brain. the brain signals not as strong
00:56:59
to keep that corpus ludium what happens after the follicle alive and a lot of women say I still have my period so I'm
00:57:06
okay but if we're using our cycle as a vital sign we can actually say the ratio of energy balance is not great and it's often because we're doing it at sacrifice of other things. So, if you're
00:57:18
doing the strength training three times a week and you're running, however, you're spacing out your other days,
00:57:24
that's such a healthy balance. It's hard that you're going to be in a bad position with that and you'll actually improve your running more so than if you
00:57:30
were to run every day or every other day. Cuz if you're getting strong through full range of motion, then that feeds forward to better running economy.
00:57:37
Then you can vary your pace without getting injured. But for people who are running every day and they're shuffling
00:57:43
and they're getting stronger in their strong muscles and weaker in their weak muscles, then it perpetuates this.
00:57:49
And they're in my clinic. Yeah. People are very keen on doing marathons and half marathons at the moment and got
00:57:55
a couple of friends that are doing a lot of marathons at the moment and they're very very very skinny. Oh, welcome to my world of Texas.
00:58:02
Yeah. Is that healthy? I'm not even sure if that's that's the right question or one can judge from just looking but
00:58:09
being extremely skinny in that regard being that sort of marathon runner physique there are some that are naturally
00:58:14
predisposed to that right so naturally predisposed having really good running economy running
00:58:20
biomechanics having a leaner body and this is what we were talking about the Olympics earlier where we can see the
00:58:26
ideal body type for that particular sport and then there are those like me who build muscle naturally it's pretty
00:58:32
easy so I'd never be a skinny little runner and my running economy is a little bit off because of where I build
00:58:39
muscle versus not. So, not everyone is meant to be a long-distance runner and there are some that are meant to be
00:58:45
long-distance runners. So, if we're talking about your friends who are like super skinny, are they e economically
00:58:51
viable for being a long-distance runner? Possibly. But we also have to look are they male or female? What is their
00:58:58
injury rate? What is their fueling? And then for me, I'd want to see the dexas of the women that are just training long
00:59:05
distance and super skinny because most of the time we see a higher visceral fat in um in and around the organs as we're talking about. Even though on the outside look super lean, but they have a
00:59:18
really high percentage of visceral fat because of the inflammation, the low energy intake and most likely estradile
00:59:25
suppression. And that's the skinny fat thing you you talked earlier. Is is there an
00:59:30
evolutionary lens on this? I always think about this when we're having these conversations like what what used to happen thousands of years ago.
00:59:35
If we talk about the evolutionary biological theories and there are a lot of sociologists that will counter what
00:59:42
I'm getting ready to say, so I'll apologize in advance. We look at original huntergatherer type
00:59:48
communities. The male body was designed to go out to find the calories. The women body was designed to stay and take care of the offspring and make sure that home was set. If it was low calorie,
01:00:00
menstrual cycle would stop because you didn't want to reproduce in a time of low calories. Body fat would come on
01:00:06
because there weren't a lot of calories. And so the equival now is that I'm not eating enough or I'm burning more than
01:00:12
I'm consuming. Exactly. So I'm in a calorie deficit in some way. Exactly. In an energy deficit. So with
01:00:18
the male body and we see this their brain and hypothalamus is not as sensitive to those nutrient deficits as much as a woman's body because we have
01:00:30
menstrual cycle and menstrual cycle function. A man will lean up and get more cognitively focused in times of low
01:00:37
calorie intake. So this is what we see with fasting data and we see with restrictive diets
01:00:43
and that was we need to bring it back to that biological lens. low calorie, I have to go find the calories. I have to
01:00:49
be fit to go find the calories. Low calories, I need to not have to eat as much. So, I need to store fat and I
01:00:55
can't have a baby because we don't have enough calories. And then stress, when we add modern stress onto that,
01:01:00
that's a comprehensive addition of cortisol and addition of inflammation and that also perpetuates body fat. I mean, like stress 10,000 years ago would have been like a lion.
01:01:12
Oh, yeah. It's a lionic, right? We had stress and that this is a natural stress response. We have to have them to
01:01:18
survive. But these were episodic, right, stresses. Well, and your hormones would change for a very specific purpose that
01:01:25
you would then go do. Your body would free up glucose from your liver. You're getting it ready in your bloodstream so
01:01:30
you can go run from the lion and then things would shift back to normal. And what's happening with chronic stress is
01:01:37
you're getting all the hormone shifts because your body's really getting ready for the lion except it's just that bad meeting you had and then you're just
01:01:43
sitting there longer and you're not using that glucose up. Exactly. Exactly. Are women increasingly overtraining?
01:01:50
I think the problem in this country is not maybe in the women who are really intentional maybe there are some that are overex exercising but if we look at a population
01:02:02
nobody is exercising enough. Exactly. I mean, I would take People ask me all the time, "Tell me the first thing
01:02:08
people need to do." I'm like, "I'll take anything." I mean, I'll take getting off the couch with any method, whatever makes you
01:02:15
happy. I'll say, get off the couch and do 10 air squats. Thank you. That's enough. Yeah, that's enough. Resistance train.
01:02:20
So, so in the crowd that's like, I'm going to invest in my health every day. That is not the majority of people. Yeah, that's my bubble. Yeah, but who the people who listen to your show might be
01:02:33
a different demographic we have to acknowledge, right, than population of America. I mean like a lot of people who
01:02:38
listen to your show, Stephen, are interested in health and their body and achieving certain goals. And so
01:02:45
certainly, you know, I have practiced fertility in North Carolina and in Austin and I see a completely different patient population, you know, in Austin, Texas, which is a very fit area. PE
01:02:57
women are constantly overtraining. But to Stacy's point earlier about this maybe evolutionary what happens
01:03:05
women go into this hypothalamic dysfunction even before it's what we call like amenora. Hypothamic amenorhea
01:03:11
is essentially where the brain where the hypothalamus is shuts off says can't reproduce right now. XYZ reason no FSH
01:03:19
and LH are coming out. You're not ovulating. You're not making estrogen. You're not going to get pregnant. So you're more likely to survive.
01:03:25
Yeah. It's a survival mechanism. Pregnancy is dangerous as in hunter gatherers, but there's state modern medicine acts
01:03:32
like you're perfect or it's turned off. And the reality is there's all these shades of gray in between where these
01:03:38
different chronic stressors and your insulin resistance and your inflammation and you're overex exercising and you're
01:03:44
under fueling come in and make it so the hypothalamus is not responding correctly. And that's what we're trying
01:03:50
to get people to intervene there before it gets too bad. And I see a large number of women who do fall into that zone where they are trying their hardest
01:04:00
to be healthy, but what they are choosing to do is actually having a negative impact on their hormonal health
01:04:07
and how their brain is interpreting their hormones. And you it's very rare to see that in a man. Meaning the number
01:04:13
one reason why I will see low testosterone is purely because many men are taking testosterone or because of
01:04:19
other exogenous factors like marijuana use. It is very rarely my brain is not sending out the signals to cause my testicles to make testosterone. I like to frame it where women are under
01:04:30
recovering not overtraining. So if we're under recovery then it makes it more acceptable to fuel and I always want to bring it back to it doesn't matter like because I come from high
01:04:42
performance I'm going to use those words where it's like you're not recovering enough. We want to focus on recovery on
01:04:47
these days. We want to make sure that you're eating and fueling around. So, it's never overtraining. It's always
01:04:53
under the balance is wrong. They're not. So, what do you say to all the voices on social media that are just yelling at
01:05:01
mostly women and telling them it's just a matter of willpower and you don't have the body composition
01:05:06
you deserve. Well, you swipe left and don't talk to those people. But that's me, right? But I mean, I'm
01:05:12
talking to the woman in Ohio who's feeling defeated and stumbles across someone screaming at her on the internet
01:05:18
that her body composition that she's not happy with is her fault. I hate that because it's a
01:05:24
construct of society, right? Especially western society. This is where we have to educate. It's not your fault. These are the things that have come into play and lined up to create this situation.
01:05:37
But now we have tools to offer you to take one step out of that situation and let's see how many more steps we can get you away from the situation to improve your health. Yeah.
01:05:48
And are the rules of exercise slightly different once you've entered permenopause? So, this is where we really need to look
01:05:55
at how we can use exercise and some environmental stress to create a really strong adaptive stress and a really strong recovery stress. Stacey, can you explain adaptive stress?
01:06:06
Because I'm thinking of the 10,000 people who follow me who will be like, "You have no idea what adaptive stress is." So, if I go and I uh do some
01:06:15
resistance training, some heavy lifting, I want to create a stress on my body that's going to then have a signaling
01:06:23
cascade to repair the muscle in a stronger way than when I first lifting the muscle damages the muscle. Yes. And it creates a series of feedback mechanisms that make it repair stronger
01:06:36
than when you first went in. So, that's an adaptive stress. And we're looking at
01:06:41
what levels of stress we can put. So it's a training stress or what levels of stress we can use through exercise to
01:06:49
really really create an environment that improves our health. Okay. So if we talk about sprint interval training, the 30 seconds on and the two to three minute recovery, the reason why
01:07:00
we want that super high-end stress of our heart rate is it then creates a eventual epigenetic change. So, it's that environment that's going to create a change within the muscle that's going
01:07:12
to allow that glute 4 protein that I mentioned earlier to open up and have glucose come in, reducing insulin
01:07:19
resistance. Also, with that really high high heart rate, we're having a lot of stress on the muscle that's going to
01:07:25
release some myioines, which are little hormone signals that then will go to the liver and say, "Wait a second, we don't
01:07:32
need to store visceral fat. we need to create non-estrified fatty acids which can then go into our skeletal muscle to be used in the mitochondria as fuel. So
01:07:43
we want to have the stress that's strong enough to create these cascades of feedback mechanisms to improve our
01:07:49
overall health. If we stay in that moderate intensity zone, we aren't creating a strong enough
01:07:55
stress to create that signaling. What are we doing? We are exacerbating inflammation. we're exacerbating cortisol. Now, cortisol isn't the demon, but when we have an elevation of it, and
01:08:08
especially in pmenopause, when we're sympathetically driven and we already have a higher level of baseline
01:08:13
cortisol, if we are continuously in this moderate intensity zone, we never get a signal to allow that to drop. So if
01:08:21
we're looking at polarizing which is top top end and low recovery end then with the top end we get the signal cascade of improving body comproving uh insulin
01:08:33
sensitivity as well as getting growth hormone and testosterone responses which then feed back to drop cortisol. So am I right in thinking the solution if I'm permenopausal is to do
01:08:44
highintensity interval training for short periods of time. So, we look at the quality of the training, not the
01:08:51
volume of the training. So, if we're in our reproductive years, then yes, you can do the moderate intensity stuff because you have estrogen and some of
01:08:58
our other hormone feedback signals that are going to drop cortisol. It's going to allow your body to recover and repair. And when you what makes quality training? What is quality training?
01:09:09
So, this is your polar. So, you have a very specific session that you're going to do. So, for Vonda, it's your 30 seconds on
01:09:15
as hard as possible, 2 to 3 minutes recovery. You do that four times. That's your session.
01:09:20
Okay. I'm going to try and summarize this. See if this is a test. See if I understood all of this stuff. So, if I
01:09:27
do a lot of volume, but I I play in that sort of medium intensity range, I'm basically just like stressing out my body in all the worst ways. Exactly. Like the inflammation, it's just not good for my body necessarily. If I don't
01:09:40
do vigorous enough exercise, then that's also bad because nothing's going to break and therefore build. it's nothing's going to adapt, nothing's going to grow. If I do it for long periods of time,
01:09:53
really anything for long periods of time, that's also stress. But the key thing to do is to do
01:09:59
shorter, higher intensity exercise that will cause my body to adapt, but won't put it into that
01:10:06
inflamed stressful state. And you also have to pepper in some lower intensity work. So this is your
01:10:14
flexibility. Mhm. so that you have recovery, you're getting u blood flow circulating, you're
01:10:19
tapping into some mitochondrial work so that you are still getting benefit of exercise but it's not in that modern
01:10:26
intensity. So that's what we mean by polarizing. So if we were to talk in like the zones talk that everyone talks
01:10:33
is out there, right? We're looking at what is zones? So if we're talking about heart rate and the way that your body works, we have
01:10:40
zone one, which is just sitting around, you know, like you're Yeah, we're in zone one. in zone.
01:10:45
Zone two is the bro science kind of thing where you're like, let's let's work in this zone two area where we're
01:10:53
working. I was in zone two when you were talking about menstrual cycle. Okay, there you go. That's it. A little elevated.
01:10:58
Your heart rate's elevating. Still a little bit have a conversation. Um, for women, it's good for recovery, stress
01:11:05
release. For men, it's good to improve metabolic flexibility. When we're looking at zone 3, four, that's the area
01:11:12
you want to stay out of unless you're specifically training for something that requires you to be there. So that would
01:11:18
be your half marathons, your endurance races, that kind of stuff. Everyone wants to stay out of zone
01:11:25
3, four, during cuz that's the medium range, right? Yeah, that's medium range. So you want to jump into zone five, hang around for five, six. Yeah. Okay. A couple of minutes and then get
01:11:36
out of there. Yeah. But in a week, this is what Yeah, let's be clear. So, two to four days a week, you should be lifting progressively to lift heavy,
01:11:47
meaning um heavier weights, fewer reps, right? One compound lift a day, plus the
01:11:55
augmentive lifts that go behind it, right? So, you're warming up first, then you're going to do one lift, and then
01:12:01
you're going to do your jumping or your balance work. The other days of the week
01:12:07
you will do preferably low intensity doing anything. Walking briskly down the New York street could count as that. It's it's continuous motion. And then a couple days a week
01:12:20
add in your sprint intervals, your really high zone five six high intensity. And then when you've got that, you can add in your 4x4 V2 max
01:12:36
on one of the other days because it sounds like a lot, but when I work with non-pro alathletes, I layer on
01:12:42
behaviors. Absolutely. Because if I say all of this at once, Yeah. nobody's going to do anything.
01:12:49
I always describe it as we have these pillars, right? First, we have to nail sleep. Doesn't matter who you are, you
01:12:54
have to because you cannot sleep is non-negotiable. Yeah. We cannot invoke any kind of metabolic or body composition change
01:13:00
without adequate sleep. Also improves stress resilience. Then we look at nutrition and physical activity. The
01:13:07
behaviors that go with both of those are somewhat independent. You have some people that are more motivated to do
01:13:12
physical activity and some people who are more motivated to change nutritional habits. Most of the time they're two
01:13:18
different personalities. So we have to look at what comes next. And then we also have which isn't lesser importance
01:13:24
but often neglected is the mindfulness and community. So this is being out in nature. It's connecting with friends.
01:13:30
Might be going to a group exercise class. It might be just having coffee but that is really really important for
01:13:36
parasympathetic and whole like whole being response. Exactly. So there's a new book out um coming out
01:13:43
called Joycepan. I don't know if you've spoken with her. So she's a gerontologist and works with the very
01:13:48
elderly and she has a very specific, you know, what determines who's going to kill it in that last decade of life. And that community part using your brain,
01:13:59
you know, having interactions with human beings seems to be the key. And if you don't keep that going through this 40s,
01:14:07
50s, 60s, when you get to 70 and 80, you're not going to have a great end of your life.
01:14:13
What about the last phase then? So someone's post menopausal, does their exercise recommendations
01:14:19
change at all? We like to start the habits early and continue them through. If you haven't
01:14:24
started, it's not too late. As we're seeing like with Lyftmore and some other of the older age resources coming out,
01:14:31
it's never too late to start. We just have to be very careful of how you start to have support and phase you into these
01:14:37
different exercise mo modalities. Is it the same exercises though? meaning you know the three days a week the mobility the strength I am firmly postmenopausal and I am
01:14:49
doing all these things but it's different different people always ask me what does heavy lifting mean right it's relative
01:14:55
it's relative my heavy is not going to be Stacy's heavy or I should say it the other way Stacy's very heavy is not going to be my heavy in lift more they just the authors describe the one the one rep max and so
01:15:07
one rep max is like safely what is the heaviest you can do one rep, you know. So, for a bicep curl, what is the heaviest weight I can do one to fail? You know, I'm going to fail after this
01:15:18
one. And for me, that was about 20 pounds with good form. Exactly. Safely with good form. And so,
01:15:24
I could nail 20. And so, then they took them down to about 70 80% of that. Um, which for me was about 15 16 pounds. So, that you can usually do about five reps
01:15:37
before you hit failure. And that is what they consider lifting heavy. That seemed to really resonate with my followers to
01:15:43
understand what that meant. And there's so many women that underestimate their strength.
01:15:49
See them and they gravitate towards the 10 lb dumbbells. It's like, put that away. Go to the next one. Do a couple of
01:15:57
lifts with that. And then ideally, I want you to put that away and pick up the next one cuz that's going to challenge you. Because women have been
01:16:04
so conditioned to do 10 to 15 reps to get quote toned and not really put in the work they need to to build muscle and to get the benefit out of strength training. And I always telling women,
01:16:15
you're underestimating yourself in so many facets. Don't cheat yourself with the strength training as well because
01:16:22
people have to remember what we're what we're training for now. It's different than I had a woman recently say, "I was
01:16:28
taught to do biceps curls five pounds 30 times." Well, after 30 times, not only are you bored, but you'll probably be at failure 30 times. That will build endurance. I am training
01:16:40
to be as strong as possible. And when I'm a when I have strength down, then I start playing with tempo so that I could build replace some of the explosive muscle fibers that I'm going to lose
01:16:53
over time. to your point wonder I um just been writing my book in Cape Town as I was I told you before we started
01:16:58
recording and one of the studies that I read about while I was writing the book was a study done by some a guy called
01:17:05
Hal Hersshfield and his colleagues where they asked they put people in these MRI
01:17:10
scanners and they asked them to think about a famous celebrity and then they asked them to think about themselves today and then they asked them to think
01:17:16
about themselves in 10 years time and in 10 years time the same brain regions lit
01:17:22
up as if they were thinking about the celebrity which kind kind of led them to conclude
01:17:27
that in our brain we almost see our future selves as a bit of a stranger. Yes, that's right. And so when we think about long-term
01:17:33
planning, this is in part why a lot of this advice is often most effective when it's put in the context of like
01:17:39
short-term performance or cognitive benefits because we really do struggle to like care about ourselves at 90.
01:17:46
Yeah. And we I think we all kind of think we can just I figure it out later. I think what's different for women, especially
01:17:52
in menopause, is because we're also taking care of our parents in so many ways. You know, we're in this like
01:17:58
raising kids, going through our own hormonal upheaval, and then watching our mothers, our grandmothers, our aunts
01:18:03
age. And we, the way society is set up, women become the caretakers of their parents, generally the oldest daughter.
01:18:10
And I have to give full credit to my sister who lives in the same town as my mom and is a nurse. So, she really is
01:18:15
bearing the brunt of taking care of mama because I'm living this life. So, thank you Leah if you're watching. It is such
01:18:21
a tremendous stress, you know, and so our motivation, my sister and I, is like we don't want to do this to our daughters. Exactly. The other thing I want to bring in is the brain health component, right?
01:18:34
We talk about Alzheimer's and dementia and one of the reasons I really preface doing highintensity work is the lactate production because we're finding more and more research coming out um showing
01:18:45
that part of the development of dementia and Alzheimer and the plaque is a misstep in brain metabolism. So when
01:18:52
we're looking at brain metabolism and the brain uses a lot of glucose, it also uses lactate. Now for women, we have
01:18:59
less of the glycolytic or lactate producing fibers and we tend to lose those with age. Men are born with more
01:19:06
tend to hold on to them more. So it's not necessarily as big an issue for lactate production. Men need to spend
01:19:12
more time in the low intensity being able to produce more of our fat burning capacity. But for women, doing that
01:19:19
highintensity work and being able to produce lactate to then allow the heart and the brain to use that preferential
01:19:25
fuel feeds forward to reducing the misstep in this brain metabolism component that occurs and it's such a sex difference. We're
01:19:36
seeing a a change in glucose metabolism in and around perry menopause into menopause. M
01:19:42
so it's that lactate production that I is kind of the offshoot of the highintensity work that's super
01:19:48
important for brain health as well as when you look at glucose metabolism in the brain I'm talking specifically
01:19:55
coming out of Arizona and and from Lisa Muscone's work and they looked at glucose utilization in the brain
01:20:01
especially the forebrain through the transition it's wildly different based on what phase of pmenopause menopause and postmenopause that they're in. And it's it's
01:20:13
absolutely astounding. And they're seeing patterns that can give clues that may be the women who are headed towards
01:20:19
the dementia route versus those who aren't. And women are significantly more likely than men to develop dementia and
01:20:24
Alzheimer's largely because they have certain unique biological risk factors and also because they live longer. Um
01:20:31
and the socioultural component. I keep bringing it up because I work stress. Yeah. But also, if we're looking at
01:20:36
women who are 80, 90 years old now, their upbringing to this point is completely different than ours. Meaning that the job availability and the brain stimulation they had when they were in
01:20:48
their 40s, 30s, 40s, 50s, completely different than what we have now. Better or worse,
01:20:54
worse. So, they didn't have necessarily opportunity to be scientists, lawyers, medical doctors. So, they didn't have as
01:21:00
much stimulation of brain and and implications on that neuroplasticity. So, we're seeing a higher
01:21:07
episodic issue of dementia and Alzheimer's in older women now because they didn't have
01:21:14
the same lay down effect that we have now as 50 year olds, 40, 50 year olds. And this and the stimulus we have for neuroplasticity. Oh, so like you're laying down brain pathways
01:21:26
and neural fibers. So, neuroplastic, think about it like the bone, but you're creating pathways in your brain to make you healthier by
01:21:32
resilient more resilient um But but they're also going to have more stronger brain younger
01:21:38
are they not going to have more stress if they're working maybe more hours. Fascinating study and this one shot me
01:21:44
out of a cannon emotionally was if you choose to become a caretaker of a parent with dementia you have a 60% increased risk. Now there's a genetic component, but when they took the genetics out of
01:21:56
it and they feel like it's the stress of caregiving for that parent, you are signing your own death warrant because now you are increasing your risk of death. Am I cuz Yeah, cuz I'm right in thinking
01:22:07
that women are still both caregiver and now in the corporate world. Yes. Yep. Yes, that's right. So it's both. Yep. Stress from both ends. Lactate
01:22:19
production for the win. Get that glucose. You have to have an active plan to combat this, right? We're not going
01:22:24
to live in a world that is stress free. If you're a woman in the world, you are likely to have a caretaking role in some
01:22:31
fashion, even if you are chasing other dreams when it comes to professionally. Building good brain pathways is wonderful as far as a way to help start
01:22:42
from a higher standpoint before you have brain loss. However, we've just like we've said on these other tangents, the
01:22:48
brain is that too. We need to think about active ways we're going to combat what is happening in today's world
01:22:55
naturally. And some of the factors are modern society that put us into this pro-in inflammatory state. But we need
01:23:02
to think about making lactate. What you know what's important for us? And it really is a plan. This whole I'm going
01:23:08
to figure it out when I'm 90 and the problems in front of me is too late for these medical problems.
01:23:13
So, and back to your point about neuroplasticity, we're not reading as much. We're on our phones and so not in
01:23:21
my house. Yeah. And so as as a culture there's there's this worry that all this time on
01:23:27
the phone and these dopamine hits and but not creating stories in your head and and reading for pleasure at night.
01:23:34
You know, a lot of women are on their phones now before bed rather than developing that neuroplasticity that we
01:23:41
get from storytelling. I did something at 24 years old that has had a profound impact on my life. I set
01:23:47
myself the challenge of posting every single day on my social media channels. And at the time, I was doing it to grow my following. But it had this profound
01:23:54
impact on my life. And two remarkable things happened when I did that. I managed to learn faster because every
01:24:00
single day, I'm capturing what is happening to me and trying to distill it down into something that I can share with the world. But more remarkably, it
01:24:07
led me to building a following of many millions of people. And that's the basis that I used to launch the diary of a SEO. And that's why I want to tell you
01:24:13
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then head to adobe. Steven and get started with Adobe Express. That's adobe. slashsteeen. The next question that came in from the
01:24:47
audience, we we asked a thousand women to submit their questions. The next one is, what's the best and healthiest way
01:24:54
for a woman to lose weight? Lift weights. Lift weights and eat. And eat. Yes, absolutely. And you could
01:25:02
have a very slight calorie deficit towards the end of the evening. Running as a way of burning calories. The problem is people think that they can out exercise a bad diet and you can't.
01:25:16
Composition of your diet matters immensely. And I hate calling it lose weight. I now call it recomposition.
01:25:21
Yeah. But let me put it in context. Yeah. Go run. You're going to burn 100 calories a
01:25:27
mile. Three Girl Scout cookies, three thin mints, US favorites, is 180 calories. My fave. So you have to run two miles to eat
01:25:37
three cookies. Most of us, if you're going to eat cookies, don't eat three Thin Mints. You eat the whole sleeve. Right. To your point, it is impossible to out exercise food unless you're a
01:25:50
high level athlete, thousand calories. Even then, no. Because we look at diet composition. And we see that um endurance athletes who use a lot of high sugary type
01:26:01
carbohydrate like the gels and the sports stuff, they've interrupted their gut microbiome so much that they have
01:26:06
sugar alcohols. Yeah. Well, it's not even that. It's the fillet change. We're seeing a decrease
01:26:12
in the diversity. Even though they're exercising and we see that exercise increases the diversity of the gut
01:26:18
microbiome, is what they're eating during the training with the heat and hypoxic stress that is creating the
01:26:24
growth of the fermicis fil that's associated with o obese outcomes. So that's it changes the gut the gut bacteria. Yeah. if they are.
01:26:36
So, we have this mis Yeah, we have this misconception that if you're an elite athlete and you're burning all these
01:26:41
calories, then you're just eating to fuel, right? But it's not. It's the quality of the diet. If we want to
01:26:47
perform well, whatever performance means, if you're Olympic athlete down to recreational person who just wants to
01:26:53
accomplish a 5K, the composition of your diet is immensely important. What about Zmp? Everybody seems to be on a Zen GLP1s. I prescribe it and our clinic is all permenopause and menopause
01:27:06
and so we always start with let's see how you do with lifestyle changes first. So we give that 3 to 6 months. When they come back, every time they come back, we're doing another body composition
01:27:16
chen for probably 50% of the patients lifestyle plus or minus HRT. They're their body composition changes. They're happy. They're health, you know, they're much healthier. Everything's moving in the right direction. So now we're left
01:27:29
with the people who are doing all the things. This isn't the typical story of people that start a Zen though. They see it on
01:27:35
Instagram and then a week after I'll be at their house and I'll be like, "We" and they'll tell me, "Yeah, I'm on a Zen." And it's really it's usually just
01:27:42
someone sees it online, they hear it on a podcast, and they're on it within a couple of days. That access is getting easier, the price
01:27:48
is coming down. And there is for any medication, there are risks, there are benefits, and there's
01:27:56
ways that will promote health. And with any medication, you can not promote health if you give
01:28:01
I mean, GLP1s can be revolutionary for certain people. A lot of people are not training for a 5K, let alone anything
01:28:07
else. And we know if we go very simply, fat cells, right, they make a different type of estrogen. They're inflammatory.
01:28:14
You have insulin resistance. And all of this sets you up at a deficit to say, "I
01:28:19
want to get healthier." It for women, we'll say who have PCOS who already have a predisposition for insulin resistance.
01:28:25
Gio, they have a harder time losing weight because now they're also storing visceral fat. We know they get on this
01:28:30
cycle with hormonal change. you know, being on ozimic allows them to lose weight and combat insulin resistance in
01:28:39
a faster way than they've ever been able to do before. And especially when it comes to fertility and you're on a
01:28:44
timeline, that can be really revolutionary when you lose weight because that estone decreases. Many
01:28:50
women with PCOS if they were overweight will start ovulating again because that suppression from the additional estrogen
01:28:57
is gone and their inflam inflammation markers go down their insulin resistance decreases. So there's a subset of people
01:29:04
who have found their life changed by them and we never want to discredit that. Many people have had difficulty
01:29:11
losing weight, chronic medical conditions have been able to reverse them and this has been a tool in the
01:29:17
tool box because about 70% of Americans would fit in that category of chronic health conditions, difficulty losing weight.
01:29:23
Yeah, 73% right now are overweight or obese. So should 73% of Americans be on GLP
01:29:28
once and was higher in women? Yeah. Well, we always one common thing is having tools in the toolbox and being
01:29:35
able to know when to use them, when to offer them. Just like when we have the HRT discussion, we don't want to see
01:29:41
people, we'll say women for this discussion, not being offered a therapeutic option because or not
01:29:47
choosing it out of fear. Well, when I hear that it's going to help me lose weight and I've got two options. I can go out
01:29:53
and lift all these weights, Stacy, and I can which you know, one I don't Yeah, it's hard, isn't it? go to the gym, I
01:29:59
have to put my shoes on or all these all these things. Or I can take this injection and lose all your muscle and lose your
01:30:05
bone and end up like the little floating figure in Wall-E movie that I've talked about before, right? And that's that's
01:30:13
my fear of just blanket people using you're also whether you mean to or not giving the illusion that, you know, willpower is all you need to lose weight
01:30:24
by what you said, right? I can either do these hard things or I can choose this medication which appears to be the
01:30:30
easier way out. And two things can be true at once. People can work extremely hard. Maybe they don't understand
01:30:35
exactly what they should be doing and that's part of what we're trying to change the discussion on. But reversing
01:30:41
some metabolic change even initially can make a big difference in their game plan. But you will lose body weight on
01:30:49
these medications. And so you have to have somebody you know guiding the ship. I think what we all don't love is the
01:30:56
access without oversight. Meaning, nobody's helping you say, "How are you not losing muscle? How are you doing
01:31:02
this in a safe fashion?" You can just text somebody on an app and suddenly have the medication shipped to your house. You know, in our clinic, it is an hourong. Now, they're coming in to discuss the GLP1 option. It is an
01:31:14
hourong visit of risks, benefits, side effects, protein intake, resistance training,
01:31:20
mandatory. We will follow your bone density. We will follow your bone mass. I mean, your muscle mass. You know, we
01:31:26
have these scanners. These are great available. And we're not going to get to a number on the scale and sacrifice your
01:31:32
long-term health. And my patients are drinking the Kool-Aid. They're coming in. They they've found, you know,
01:31:37
they're coming to you for a reason. Yeah. And so, I'm a little bit unique in my clinic in that I have a social media
01:31:42
following and people kind of watch a few things before they come see me. So, they know my they're not shocked by me giving
01:31:48
this advice because I give it all day on social media. So if you give them the ismpeek but they still don't go to the
01:31:53
gym, they still don't do anything else, then we'll stop giving it to you. They won't be healthy and they know that. We've talked to them about that.
01:31:59
We've explained it on the front end that this is a tool in your toolkit because we can see their muscle mass. We won't
01:32:06
renew the prescription if they've lost the muscle. So if you are losing weight and not lifting and eating enough
01:32:13
protein on ompic or any way else and you do a body composition, you may see total
01:32:19
weight lost. You will see pounds of muscle loss, you may see body fat percentage loss. But if you do this correctly with enough protein in your diet and lifting weights, the amount of
01:32:33
muscle loss will be very small versus amount of fat loss. So you we know we are going to lose a little muscle, but you can't lose 8
01:32:43
pounds of muscle. Right. Right. So we can tell and I give them the hard numbers like 10% is acceptable.
01:32:50
We're going over that. We're getting into the danger zone. We're going to cut back on your dose. we're going to, you know, but they commit to the the work on
01:32:58
the front end. I think that's the important point is that these GLP1 antagonists don't burn
01:33:03
your fat. They burn they stop you eating as much. They stop there, which is going to mess up which is going
01:33:09
to reduce everything. Cuz I was thinking about myself. I was thinking, well, I I go to the gym every day. I'm going to keep going. So maybe if I had a a little
01:33:15
bit of a Zanek or whatever it's called, then my it would burn my fat. But actually, that's not it's just gonna
01:33:20
stop me eating, which is gonna reduce my muscle, my burden. Right. Goodbye biceps. Yeah, that's the that's the thing. It's
01:33:27
like I'll lose my subscribers and Exactly. Exactly. Yeah. Okay, that makes sense. So to this person asking what's the best and healthiest way to lose weight? The
01:33:38
response is stop eating the cookies and start lifting some weights. Oh, the 8020 rule, right? So 80% of the time
01:33:45
you're on it, right? You're paying attention to a high quality diet. You are eating according circadian rhythm. You are doing the strength training. You're getting the good sleep. And then
01:33:57
20% is life where I'm going to stay up late. I'm going to have some wine or whiskey. I'm going to go out. I'm going
01:34:02
to be on vacation. So, you're not excluding all the fun things in life. If it comes to a point where you're like,
01:34:09
I'm still not budging the needle, then maybe it's a 9010 rule where 90% of the time you're on it and 10% is the life
01:34:15
factor. There's these hard and fast rules I've been accused of giving. I don't give rules. I give optimization
01:34:22
ideas. So, it's not following strict 8020 or 9010. It's what fits in your life. And if you're really motivated on losing weight, the first thing I tell people to do is ditch alcohol.
01:34:34
Mhm. Everyone wants to lose the the part on the belly. Sure. Is there not like an exercise I can do
01:34:40
just to burn the part on the belly? Exercise burn. So visceral fat's a little bit different. It's like a whole different
01:34:46
organ. So you know when we talk about visceral fat, it has different drivers. You know, we drive fat to the intraabdominal cavity. It has it creates different cytoines. Subcutaneous fat is
01:34:58
a storage facility. It is when we overeat calories, we will drive fat under the skin. And it's kind of genetically determined. Females tend to
01:35:05
gain about their hips and thighs. Okay. And actually that hip and thigh fat is protective for cardiovascular disease in
01:35:11
a premenopausal women. Not in men but in women. And so it is so but when that fat shifts
01:35:18
to the intraabdominal cavity, it starts that fat is metabolically active than the fat under our skin and it creates these pro-inflammatory cytoines. And then you end up in this negative
01:35:29
feedback cycle of, you know, your liver starts becoming dysfunctional, insulin resistance increases, that drives more
01:35:35
fat to the visceral cavity, increases inflammation, and it just goes on and on and on. So get liposuction.
01:35:41
No, no, no. You can't lipo the viscra inside. That fat that's really inside the abdominal cavity is what we're
01:35:47
talking about. That visceral fat, which is the worst kind. What about liposuction? Can't I just suck it out? People are doing all kinds
01:35:52
with their under the skin. Under the skin, you can. That's an aesthetic decision. What was the stuff under the skin?
01:35:58
Oh, lipo suction it out. Is that a good idea or a bad idea? No, it'll come back. All these things we're talking about, it
01:36:04
sounds like a lot of instructions, and it is actually, but when you layer them on, it becomes your lifestyle. It's not a diet. It's not an exercise program.
01:36:15
It's just how I live. Which brings me to my next question from the audience, which is, what is the best
01:36:20
diet for a woman who is permenopausal? plant forward, plant heavy. Yeah. Yeah. Because you're getting you're getting So, when I'm talking to patients,
01:36:32
we talk about the quality of their nutrition. So, is your is your pattern of eating I hate to call it diet because
01:36:38
it's four-letter word now, but is the pattern that you're eating pro pro-inflammatory or anti-inflammatory?
01:36:44
What's pro-inflammatory? So, meaning the things that you put in your body, are they likely to cause inflammation? And we know there are
01:36:50
certain things that do that like heavily ultrarocessed foods, you know, in large amounts. Everybody can tolerate a little
01:36:56
bit of everything. But if the majority of your diet, and for most Americans, the majority of their diet is 60% is
01:37:03
ultrarocessed foods. Okay. Those are by and large plurinflammatory. What about red meat?
01:37:09
Red meat in moderation and especially leaner ones seems to be a a very reliable source of protein. As far as inflammation goes, it seems to be neutral in small amounts, not heavily
01:37:19
like highfat meats or processed meats. Then you're flipping over into pro-inflammatory. Is there a diet for fertility?
01:37:26
It's very much what we're saying right here that plants have fiber that's going to feed your gut microbiome that's going
01:37:31
to decrease inflammation. So fruits and vegetables, getting enough fiber is the number one change that most people need
01:37:37
to make. From there, we want to of course decrease all your ultrarocessed foods, healthy fats. Fat is the backbone
01:37:44
of chole like cholesterol is the backbone of your steroid hormones. So if you want to make hormones, we've got to
01:37:50
have some cholesterol, some healthy fats coming in to provide the backbone for that. That's essential. So things like
01:37:56
olive oil, nuts, your avocados, seeds, these are going to provide some of those healthier fats that are easier to use
01:38:02
for you. And when it comes to protein, there's a lot of different protein sources. We know that the the data is so
01:38:09
hard on nutrition because I can quote a study that says for every serving of plant protein that you take over animal
01:38:14
protein, you have a higher chance of ovulating regularly. And that's true. A lot of that though is nuanced by the
01:38:20
fact that people who eat plant-based sources of proteins tend to eat other plants in general and less ultrarocessed
01:38:26
foods than people have the highest cortile of meat intake. If we go to a micro level though, not all meat, animal
01:38:31
meat is created equal. Animal meat does not have fiber in it. So we know it's not feeding our gut microbiome. So if we
01:38:39
want to talk about carnivore diet, things like that is definitely not microbiome friendly for you and not
01:38:45
hormonally healthy. So we really want to really have those whole foods, the fruits, vegetables, the healthy fats,
01:38:52
the proteins that are going to be good sources. And just like we talked about other things, it's not all or nothing.
01:38:57
Red meat every day is probably going to be inflammatory. Having it on the weekend is probably okay. And the way I
01:39:04
describe this to patients is let's imagine a scale where every decision you make can kind of tick up the inflammatory marker or bring it back
01:39:10
down. If you are making active decisions that are more anti-inflammatory, you can tolerate the glass of champagne,
01:39:18
the birthday cake, these little things that we know will cause inflammation in your body, but your body is meant to
01:39:24
respond to inflammation and get back to normal. The problem is when it's constantly challenged, when 70% of the
01:39:30
things that you eat cause this chronic inflammation inside of you, your body can no longer respond appropriately when
01:39:37
it's challenged again. Things that are pro-inflammatory tend to also disrupt the gut microbiome. Tend to
01:39:43
like it all makes sense when you think about it. And there's quite a few studies that are coming out in the four to five years
01:39:50
before the one point in time called menopause. So in late pmenopause that there's a
01:39:57
significant decrease in gut microbiome digest. Oh, Zoe did that work? Yes. Yeah. And it's really interesting because of
01:40:04
the second pass and the way that hormones are metabolized. When we have uh our natural cycle and we have a an
01:40:13
exposure of our sex hormones, yeah, the common cycle, then we have more of diversity because the gut bugs help unwind. I guess is that
01:40:24
so we metabolize estrogen into inactive metabolites and then they get excreted in the feces. So it goes through the
01:40:29
liver and then dumped into the bile. And does that mean that if I if my microbiome is likely to be less diverse as I age, I need to be thinking more
01:40:36
about the divers diversity of your plant foods. And this is why it's really probiotics, probiotics, etc.
01:40:42
Not over the counter. Okay, you first start with food, but not a pill that you're trying to take, but actually the food that you're putting into your body is the the best
01:40:53
fiber. What about protein blunder? The way I like to approach nutrition for people is first having people notice what they're eating and then from that
01:41:04
break it down into well, how much of it is protein, how much it is fat, how much is carbs. Without that kind of
01:41:10
education, it's almost meaningless. So when we've done that and uh I'm making recommen recommendations for protein, we will not build the muscle we need to
01:41:22
build. We will not get stronger the way we're capable of getting stronger. A if we're not eating enough and B if we're not taking enough protein. So the RDA recommendations of8 gram per kilogram is
01:41:36
survival doses of protein like sitting on a chair like a mushroom preventing malnutrition is the goal of
01:41:42
itable. It is not for active people. It is not for living your best life people eight the recommended daily intake is8 gram per kilogram of lean body mass.
01:41:55
So it's low it's very low. So the research uh supports easily supports let's use pounds.86
01:42:08
grams per pound for lifting people. I recommend over a gram. A gram for ideal pound because I'm presuming
01:42:20
that the people I'm taking care of are going to start being active, that we're trying to build muscle, that we're not
01:42:26
in starvation mode. So 0.8 grams per pound. I recommend one um gram per ideal pound. So there's some
01:42:40
other research that's come out looking at skinny fat. So that's normal weight obesity. So not as we're talking
01:42:47
normal BMI, normal BMI, but internal high body fat. And then at the And what happens is they
01:42:54
have low muscle mass. Low muscle mass. So they took a group of of women, split them up. So
01:43:00
you had a control group and then you had this intervention group. And the only change they made, there's no exercise,
01:43:06
and the only change they made was they brought the intervention group up to 1.6 grams of protein per kilogram. So
01:43:13
this is8 per pound and over the course of 12 weeks of eating that protein intake, this intervention group completely recmped their body. So their muscle quality came
01:43:25
up, body fat went down. Control group, of course, nothing happened. So it just shows the importance of having that
01:43:31
higher protein intake just to support basic muscle function and the frailty data out of the WHI. So the women's health initiative looked at multiple things not just breast cancer and heart disease but you know they followed these
01:43:43
women even off of HRT for decades. Y and when they looked at frailty scores in the elderly and protein intake above 1.6 six grams per kilogram
01:43:56
had the lowest frailty scores just based on protein intake alone. Yep. What about fasting? I know so many people that are doing water fasts and
01:44:07
juice fasts and it's impact. Have they told you why? I've had an evolution with the way I think about fasting. um when I first
01:44:15
kind of you know was stepping out of the box and what's happening in menopause and why was my body composition I didn't
01:44:20
know what to call it back then but what was all this going on that was new and all my patients were having it as well
01:44:25
and these were my my girlfriends I worked in a small town with a big university and these were PhDs and we're
01:44:30
running marathons we're doing all this stuff and everyone's kind of complaining of the same thing and so fasting seemed to be helpful and my girlfriends were
01:44:36
trying we all kind of did this fasting thing and I was like super excited about it everybody felt better blah blah blah
01:44:42
blah blah okay So, fast forward, I'm learning more about hormones, body composition, protein intake, all of
01:44:49
these needs. And suddenly, as I'm counseling my patients, I'm realizing I can't meet my own protein goals if I'm
01:44:55
trying to fast at the same time. And I quickly realized if we're looking at health span, if we're looking at body
01:45:01
composition, there may not be a lot of room for fasting for these patients, you know, or for my girlfriends, you know,
01:45:07
and it is really difficult for my patients to reach their nutrition goals. So, never at the expense of meeting your basic nutrition goals and your calorie needs. And it is really, really hard to
01:45:19
do while fasting. So, you may get a short-term benefit with weight loss, but there really doesn't. Now Dr. Sims
01:45:25
can get into the nitty-gritty of you know but the basic idea of fasting if we want to use the term fasting we have to look
01:45:34
at it is are we talking about intermittent fasting or timerestricted eating. So intermittent fasting is kind
01:45:39
of like you know your water fast your 5day 2day all that kind of crazy stuff which for the most part men can get away with and have a positive impact on body composition but women can't. If we want
01:45:52
to talk about timerestricted eating and working with our circadian rhythm, which is optimal, then you have breakfast
01:45:57
within or food within a half an hour of waking up that helps dampen that um geroline and cortisol response I talked
01:46:04
about before so that everything is coming down. Your hormones are starting to work properly and your body's like
01:46:10
great, I'm ready to go. I can I can handle this. And then you're eating at regular intervals. And I try to have
01:46:16
people have protein and fiber at every eating interval so that they are maximizing protein and fiber intake.
01:46:22
Then you have dinner and then you don't eat after dinner. Every eating interval. So breakfast, maybe you have a snack. If
01:46:29
we're looking at training or exercise, if you're splitting your breakfast, then you're having some protein and carb
01:46:35
before having the rest of your protein or more protein afterwards. And then you're having uh uh some protein and
01:46:42
some fiber at lunch. So you're having maybe tempeh or tofu or salmon with salad or fruit and veg. So every time you're eating, you have a a protein and fiber focus.
01:46:53
So timerestricted eating is within a 24-hour period. So you're looking at I'm going to eat
01:46:59
during the day when my body needs it. Yeah. And I'm going to stop eating when I finish dinner. So I have about a two
01:47:04
maybe three-hour break before I go to bed. So that when I go to bed, I'm not trying to digest food. my body can get
01:47:10
into the parasympathetic responses it needs to to sleep well for reparation and then I eat again at what time
01:47:15
when you wake up in the morning it's typically about 12 hours of eating and 12 hours of not so you're trying to follow that circadian rhythm and work
01:47:21
with your hormones it can also when you do have that period of time which maybe that sounds very intuitive but a lot of
01:47:27
people are eating at 1000 p.m. they're snacking on food, then they're trying to go to bed, and then they're getting up.
01:47:33
When you give your body a little bit longer, so at 12 hours time is when your body will really efficiently be using up
01:47:41
all your glucose, really dropping some of those insulin levels, but it's not so much that it's stressful. And we're
01:47:46
using stress very generically here, but on a cellular level, long periods of fasting for women specifically can be
01:47:53
very stressful to the body. And that's why if you think about Stacy's example of what happened in two fasting periods to, you know, a man and a woman, different things are going to happen to
01:48:04
your body if it thinks it's being in starvation. So, we don't want to put your body in a starve state. We're just
01:48:09
trying to give it a time period without food so that it can start to process the energy that's available differently.
01:48:16
Why? Why not, though? What's going to happen? And I understand from what we talked about earlier that my fertility my my cycle is going to change.
01:48:23
But is that well there's there's adaptive stress and then there's stress to the point of
01:48:28
you're you're hurting yourself. Men can you said that men can do longer fasts. They can they can do longer fasts and it
01:48:34
can show to actually you know be something that might be advantageous for them for how their body is made. Might
01:48:41
increase their focus and some other metrics. But for women, these longer periods are actually going to promote
01:48:46
more visceral fat storage and become pro-inflammatory. And you said it a little casually, but
01:48:52
disrupting your hypothalamus and shutting off your hormone system will cause a low estrogen state. And that's very problematic as we've talked about.
01:48:59
So thinking about your body should not be in a starved state. So utilizing timerestricted eating meaning I'm going to eat within my circadian rhythm the hours that there is sun outside back
01:49:12
what how your body is made to function is working with your biology. If you're saying I'm going to not eat for 3 days
01:49:19
because I'm doing this fasting period for women that's going to induce a stressful state where you're going to
01:49:25
start to store more as visceral fat and cause more inflammation. And if we bring it into the, you know, people holding a
01:49:32
fast till noon or after you're phase shifting. So it's like you're having social jet lag where if you're phase shifting your hormone responses, your appetite hormones, then you're not going
01:49:44
to get into a good sleep because your body is like it's not time to go to sleep. Your melatonin peak in women
01:49:49
usually peaks around 9:00. So you start to get sleepy. That gets shifted to 11, 12. So you're not actually going to get
01:49:56
good sleep because you now have reset your melatonin responses. So we want women to understand that timerestricted
01:50:04
eating when you're not eating when in the dark is really beneficial. Easiest way to say it. Easiest way to say it. Yeah. You're fueling for your body during the day because that's when it needs the fuel.
01:50:16
That's when we want to be able to create uh an environment that's supportive to hormone health, supportive to muscle growth, to brain health, to all the things and reducing stress when we can
01:50:30
control that stress. So when you start phase shifting and holding fast and creating this stress on a circadian
01:50:36
level knowing that there's a circadian response on every cell as well as a total body circadian rhythm that if you
01:50:43
shift that then we start seeing a lot of metabolic dysfunction poor sleep and unfortunately we see this in shift workers because that's what's happening. They're having circadian shift
01:50:53
and they have significantly lower longevity. They live what? I I think I heard 14 years less if you're working
01:51:00
night shifts. I don't know. You have higher rates of infertility, higher rates of pregnancy loss. You you're more metabolically unhealthy. Of
01:51:06
course, we're generalizing a group of people. And sometime I think we've all had moments of time of life where shift
01:51:12
work was part of what we had to do. But night shift work, most people are not getting enough sleep during the day and they're what we call flipping back and forth, right? because you want to be on
01:51:22
a daytime schedule on your off days and live your life that you're constantly sacrificing what your body needs. And
01:51:30
what I tell people is you may if you can get off of that, it it will be a healthier life pattern. But in moments
01:51:37
where it's not, you need to really prioritize trying to get enough sleep, making sure that you're taking care of yourself in the other time periods because you're set up for a place that
01:51:49
is going to cause hormone dysfunction and impact your metabolic health. Mhm. You believe the same. I believe
01:51:55
I uh advocate uh feeding ourselves for optimum health. To be any kind of active, you must feed yourself. and um stop eating three time 3 hours before
01:52:08
bed. So, what do you think of people that do these longer fasts? Do you think that they've just been given poor advice?
01:52:14
Because I know I was talking about Mel and I know she does frequently does three-day fasts
01:52:21
because I think people think they've heard this term autophagy. Autophagy is the term. Take it Stacy.
01:52:26
So, this is the thing with autophagy. You get that with exercise. So the idea of autophagy is recycling the some of
01:52:33
the parts of cells that have broken down or somehow become dysfunctional. So your body's really good at cleaning that out.
01:52:41
We see with exercise, it invokes that autophagy. With fasting, it invokes that too, but not the severe fasting like
01:52:48
three-day fast, that kind of stuff. When we're looking at the telomeir changes that people say with fasting, you get that with exercise. So telomeir is um points that we look on the DNA to see
01:52:59
how you're aging. So we want longer telomeir length because that means you are more stress resilient. You get that
01:53:06
with exercise cuz exercise is a big stress. It creates a a change within like we were talking about before. Yeah.
01:53:13
Adaptive stress, epigenetic changes which improves all of those markers that people are so adamant fasting does. What about fasting and then doing exercise? So fasted exercise is that
01:53:26
for women? No. That's what she taught me. For men, it I'm going to say no as well
01:53:32
because when we're looking at the fueling mechanics of exercise, muscle is a very metabolically active tissue. If your body is trying to fuel itself,
01:53:44
it's going to break down the very first thing that's creating a energetic need, which is muscle. We see in women, women, you're going to lose muscle. You're going to break it down and use
01:53:55
the amino acids as fuel. You can tap into blood glucose and some fat, but when you aren't bringing blood glucose up through eating first, it's really
01:54:06
hard for your body to understand that this is what you want it to do. So, it's like, okay, I need to conserve fat. I'm
01:54:13
I don't want to go through all the glucose that I have because I need it for brain health. So, I'm going to start
01:54:18
feeding more amino acids in to fuel what I'm doing. For women, we already use more amino
01:54:24
acid than men. So, if we're looking at fasted training, then we're already increasing the amount of lean mass that
01:54:30
our body is going to break down to use as fuel. I'm pretty sure it was you that told me there's this part of the brain that's
01:54:36
kind of checking if there's energy in our blood, if there's glucose in our blood. That's part of our hypothalamus.
01:54:42
And so, the hypothalamus is this sensor that's kind of checking. And in a woman, again, correct me when I butcher this,
01:54:47
but if it understands that there's no glucose in the blood, then it's going to go into that survival state, which is going to start to shut things down, which means growth of muscle isn't going
01:54:59
to be possible. Um, because once upon a time, I guess that stress without the fuel would have
01:55:04
been a threat, especially in the context of like my menstrual cycle and my reproductive health.
01:55:09
That's a good way of of wrapping it up. Yeah. It's not that we don't have blood glucose, it's low blood glucose and no
01:55:16
nutrients coming in that the hypothalamus is sensing. So, we're looking at neuropeptide responses within
01:55:22
the brain within the hypothalamus that controls appetite hormone uh the way that your body's using fuel. So, if we
01:55:29
don't have stuff coming in, the hypothalamus is like, "Oh, wait a second. What's going on here?" Is it fair to say the woman's body is more I
01:55:36
was going to say stubborn but that's a slightly negative word less flexible than than a man's
01:55:41
more complex complex it's complex and more stress defend itself it's very much stress resilient so it's
01:55:48
very defendable it's trying to protect you it really is looking at how what is it going to do to
01:55:54
keep your functions happening balance in balance but because women can get pregnant and pregnancy is not a health
01:56:00
neutral state it's a huge strain on the body that is an extra layer of one of the things that sometimes decides I'm going
01:56:06
to put this to your side because I'm going to to protect keep you functioning. I want to work on
01:56:13
all of our other body functions. We're going to shut off that side that's not sending out FSH and LH and making
01:56:19
reproductive hormones cuz we can't afford to keep you healthy. Then we definitely can't afford to grow a baby
01:56:25
and keep you healthy. If you are pregnant and go through times of severe stress, illness, injury,
01:56:32
your body will eject what is in the womb through a miscarriage or, you know, early pregnancy loss or mis or preterm labor
01:56:42
because it is always going to try to protect you first. So, you're at high risk of a failed
01:56:49
pregnancy. I wonder if I could frame Mel's your question about Mel and the way I I frame
01:56:56
all the advice whether it's research advice or internet advice is you have to know what your goal is. What is Mel's goal or your goal or because listen they're exclusive longevity if longevity
01:57:10
is your goal like live longer at any cost well then there's a lot of research about severe calorie restriction and lifestyle and just lots of severe ways
01:57:23
to live. Okay, if that's longevity is your goal that's your goal. If your goal is peak
01:57:28
performance like a pro alete, that is a different kind of life and training and reps and peak performance
01:57:36
at the pro level doesn't necessarily get you longevity. Proathletes live less, at
01:57:41
least contact athletes live less than people focus on longevity. But the third bucket that most of us live in is health span and wellness. It's neither high
01:57:53
performance live less time. And it's neither austerity live the longest possible. It is the middle ground. It's
01:58:01
the homeostasis balance. And so when questions like that come up, the first question in my mind is which bucket are you in? Are you in a peak performance? You're going to do different kind of training, different kind of eating. We
01:58:14
know you may have a decreased lifespan because of the stress you put on versus this. So, what are we working for?
01:58:22
I think a lot of the people that talk about these fasts often say to me, especially when they're referring to juice fasts that it's kind of like
01:58:28
cleaning out the system. They say it's like it's like cleaning house. You don't need to clean out your That's
01:58:34
not how you clean out your system. Taking the fiber out of those fruits and vegetables,
01:58:39
taking away all the things that you need. Juice is 500 calories of pure glucose. Yeah. What if it's vegetable juicing?
01:58:47
Why not just eat the vegetables and get the fiber for your gut? But you have a liver. Your liver.
01:58:52
I think it's marketing. I think they're falling prey to marketing. And that's a big wellness trend. I know. But it's it's massive. Honestly,
01:58:58
you would. Yeah. I know so many people, so many of my best friends going on detox wellness retreats. Well, even when I ask them why they're
01:59:04
doing a water fast, they say, "I'm just detoxing." Or when I ask them why they're grinding up this fruit and vegetable and, as you say, pulling out
01:59:10
all the fiber from it. It feels more attainable to say, I'm doing this crazy thing for 3 days, then I'm going to make
01:59:16
a life switch to just live a more preventive anti-inflammatory lifestyle. Before the Diario was what it is today, it was just an idea. And it started with me, a cheap plug-in microphone, and my
01:59:30
Mac right here. And I have to say when I first had the idea for the diary of a CEO, my thinking was that the world
01:59:35
might want to see into the diaries of some of the most interesting, successful people really in high places that were
01:59:41
doing interesting things. So after recording that first episode under my duvet, I sat on my Mac by our sponsor
01:59:47
Apple and spent hours editing on Garage Band and eventually uploaded it and honestly I thought that would probably
01:59:53
be it. But a couple of my friends said they enjoyed it, so I kept on recording. And over time, the microphone has
01:59:59
changed and we now have this incredible setup here. But the thing that has stayed the same is I'm still using the
02:00:05
Mac. Even today, my entire team across our studio still uses the Mac. Our first few episodes maybe had tens of people
02:00:12
listening, but now tens of millions of people tune in all over the world, which is still absolutely crazy to me. So, if
02:00:18
there is an idea that keeps tapping you on the shoulder, this is your sign to start. Your great ideas start on Mac and
02:00:25
you can find out more at apple.com/mack. Have you ever heard about this before? This thing I'm holding in my hands now. This is called Ketone IQ. The website is ketone.com. You've heard me on this
02:00:36
podcast talking about the fact that I stay much of the year in a ketogenic state, which is a highly restricted
02:00:42
diet. And the reason I do that is plenty. One of them is I spend hours and hours talking to people for a living. So
02:00:47
I want to make sure my brain is firing in an optimal way. And the other reason that I do the ketogenic diet is because
02:00:53
I just feel better. So when I discovered this, which is what they call an exogenous ketone product where you can
02:01:00
drink it and it increases your blood's ketone levels, I was blown away. I contacted them, I met them, I invested extremely heavily into their company and I've become a co-owner of the company
02:01:11
accordingly and they sponsor this show now. So if you want to try this out for yourself, I recommend you try it. Just
02:01:17
visit ketone.com/stephven and you'll get 30% off your first subscription order. You'll also get a
02:01:23
free gift with your second shipment. That's ketone.com/stephven. And in terms of supplements generally, do you know, again, not to bring Melon to this for the thousandth time today,
02:01:34
but a couple of um couple of Christmases ago, I told her that she should be having creatine because I all these people on my podcast told me it and she
02:01:41
said, "No, it's for bodybuilders." Yeah, that's the old school thought. When we're thinking about creatine and how it
02:01:47
got its chops in the supplement world, we're looking at muscle performance and taking five grams four times a day with
02:01:53
some carbohydrate to enhance muscle performance is how it started. But when you start really disseminating down into
02:01:59
the health aspects of creatine, creatine is used in every fast energetic of the body. So that means your brain, your
02:02:05
heart, your gut, muscle, everything that requires energy from 0 to 30 seconds, creatine is involved. Women have about 70 80% of the stores of men. And when we
02:02:17
start looking at all the different types of diets that are out there, lots of exclusionary food diets, then the intake
02:02:23
of creatine is lower. What we're finding in the research from health perspective is that it does so many positive things
02:02:30
when you're able to saturate the tissues to bring it up with even a small dose of 3 to five grams a day. Our liver makes
02:02:37
about three, but we don't necessarily eat enough to help supplement all of the tissues. How much would it take? Like 12 chicken breasts or something? 22. Okay. 22 chicken breast. A lot. So when we
02:02:49
look at the supplementation and being able to saturate all of our tissues thoroughly to support those fast
02:02:55
energetics, we see things like better cognition focus. We see a faster recovery from small brain traumatic like a friend's daughter hit her head on the
02:03:07
um the laundry door of the dryer and got a TBI or a small concussion from that, started using creatine, came out of it a lot faster. I mean, there are things that help with brain metatasm. We see
02:03:19
women who have incidences with IBS or gut issues and they're using creatine. It helps decrease the symptomology.
02:03:26
We're seeing now studies coming out about fatigue. And this is where the 38 g per kilogram of body weight or the equivalent of 20 gram if you're 60 kilos
02:03:37
helps with fatigue and focus. Especially if you're under a lot of high stress. Because if you're under a lot of high
02:03:43
stress, your body's going through a lot of blood glucose trying to keep up with that stress. So creatine isn't just the
02:03:49
bodybuilding set. There's so many different health benefits and it keeps coming out with more and more research
02:03:54
to show how beneficial creatine is. Could you give me the menopause supplements, if there is such a
02:04:01
Okay, so in general, um, we're not going to cure menopause with supplements. Let me just take straight up. Okay. Most
02:04:08
women are going to be deficient in fiber and most women are going to be deficient in vitamin D. And vitamin D is hugely
02:04:16
important in multiple enzyatic processes in our body. And it's really hard to get enough through our nutrition, even
02:04:22
eating stacks of salmon a day, which is really high in vitamin D. So about 80% of my patients are not only just low in
02:04:28
vitamin D, they're deficient. So, that is one that we can supplement safely up to about 4,000 IUs international units
02:04:35
is how vitamin D is measured a day without worries of becoming toxic or having too much vitamin D, which is
02:04:41
possible. And so, usually I'm having creatine. Absolutely. It's like a go-to. And we're looking at her nutritional profile. We're looking at her fiber intake. And then we're adding in a fiber supplement if she needs it.
02:04:54
Natalie, in terms of fertility, what is the fertility supplement stack, Percy? And first and foremost, we're going to say that if you are trying to
02:05:00
get pregnant, which by asking fertility, we're going to presume, we want to make sure you have folic acid on board. So folic acid is the essential component,
02:05:08
one very important part in cell division, but it's essential for a baby when it comes to brain development and
02:05:14
spinal cord development. We call these neural tube defects. And the reason why I'm bringing it up is that there's a lot
02:05:20
of chatter about folic acid out there, but it is the only supplement folic acid in its folic acid form that is proven to prevent these neural tube defects such
02:05:30
as your baby being born without a brain. And interestingly, in today's world, a lot of foods are also fortified with
02:05:37
folic acid. But these are some foods that are often processed and people are consuming less. So we are having less
02:05:43
consumption of folic acid in our diet. Therefore making it even more important that we are supplementing with folic
02:05:49
acid. As Dr. Haver said, vitamin D, vitamin D is essential for your entire body. But when it comes to hormone
02:05:55
metabolism and fertility as well, we even see women who are going through IVF with donor eggs and we know they're very
02:06:02
good quality, have lower success rates if they have lower vitamin D levels. This is something that almost everybody
02:06:07
is deficient in. We do test and then target treatment to try to get you to an optimal level. But also omega-3 fatty
02:06:13
acids are really important in your entire body, but especially in your reproductive years if you might get pregnant. And I often recommend
02:06:20
magnesium for most patients as well. And then from a fertility standpoint, if you have infertility, there are studies that
02:06:27
show that co-enzyme Q10 can be highly beneficial when it comes to egg quality. This is important in our mitochondrial
02:06:33
health. And for the sake of the one question you asked, remember when we talked about eggs, we've got our genetic
02:06:39
health, which is largely dependent on age. We have our metabolic health. The mitochondria from the egg controls all
02:06:46
development for the embryo. And in fact, the cellular functions for an embryo, the first three days of life, solely
02:06:52
come from the egg. The male genome doesn't even kick in until day three of embryo life. So the function of the egg
02:06:58
to be able to divide and do normal cell functions is very important. And sometimes we see that reduced in infertility patients and co-enzyme Q10 is an easy thing we can get over the
02:07:08
counter. Doesn't appear to have any harmful side effects and has potential benefits in some subsets. So my infertility patients I add that on. Wonder all things
02:07:21
aging, performance, strength, bone. Mhm. What is the supplement stack for for longevity? vitamin D, magnesium is critically important for a variety of uh
02:07:32
metabolic functions. Omega-3 for anti-inflammation, creatine, I'm a big fan of. If we move looking at uh scinesscent cell load and
02:07:43
inflammation, we haven't really talked about longevity, but scinsesscent cells are those B those cells left over from
02:07:50
normal function that are so damaged that they can't flip into programmed cell death. So they circulate around and
02:07:56
produce noxious um chemicals that can lead to a variety of disease. So we want to minimize those and one way to do it
02:08:03
is lifestyle. Another way is to use an herb called fiseten. So I add that on and then also I do myself and check
02:08:15
levels on my people of intracellular NAD+. NAD is a co-enzyme in 300 metabolic reactions. It's an it's an uh an energetic pathway. Now, it's very
02:08:30
popular right now. And the critical differentiator for me is that taking whole molecule NAD such as in IVs, our body needs to make it. So for myself and
02:08:43
for my people, I supplement with NMN, which is the immediate precursor of NAD+ so that my body can then turn it into NAD+ and it can work intracellularly. It
02:08:56
can also be delivered two reactions out uh in the form of NR. These are in the B
02:09:02
vitamin categories. So that in two reactions your body makes NAD+. So the data does not show that you can IV NAD+ for ac efficacy cuz it works
02:09:14
intracellularly. So you supplement its precursor. I've heard so many people talking about
02:09:19
NMN recently. Yes, that's right. That's what I'm talking about. Is there clinical evidence to show that
02:09:25
it's effective? So you know those the lab that I work with uh I happen to know the scientist and he has hundreds of thousands of data points checking before
02:09:36
NAD+ levels intracellularly supplementing and then after and he can elevate those levels and it's associated with longevity like intrinsically associated with longevity
02:09:46
a lot of the the bro science I guess longevity well it's intrinsic intrinsically related to lots of normal metabolic
02:09:53
function and uh energy in the body. Whether or not it makes you live longer, I don't have that data. Is it a tablet? It is a powder the way I take it.
02:10:04
Mhm. What about collagen? People talk a lot about collagen. It's in all the protein powders now. I know, but it's not a protein as we
02:10:11
think about it. Like you'll see all these collagen protein. It doesn't count as dietary protein for muscle
02:10:17
development. Does it work as a supplement? There depends on what you're looking for. Yeah, exactly. and Mike Orsby out of um
02:10:23
University of Southern Florida, he has been doing quite a bit of research on collagen and joint pain um and found that there is some efficacy in taking the type 2 collagen to reduce joint
02:10:36
pain. It doesn't help with cartilage regeneration. It doesn't help with osteoarthritis, but it does dampen
02:10:42
inflammation and joint pain. So again, it depends on what you want to use it for. In the first episode, we talked a
02:10:48
little bit about environmental toxins and I wanted to before we talk about sleep and close off, I wanted to just mention environmental toxins and the
02:10:54
role they play. The term microplastics has been very very popular of late. When we talk about environmental toxins, are we talking about microplastics in the air and maybe the water? What do we
02:11:05
mean? Essentially, it's anything in our world that is impacting your body and how it
02:11:10
functions. There's a few different types, right? So, we have endocrine disrupting chemicals. These are actual toxins in the environment, in cosmetics,
02:11:18
cosmetics, our kitchen, our food that change how our endocrine system works, our hormones. There's also things like
02:11:25
microplastics like you mentioned, which are actually going to deposit in our body and can cause fibrosis even in our
02:11:30
ovaries, therefore changing how an organ's able to respond even if it is given normal hormone signals. And then I
02:11:37
also lump into this category behavioral toxins, right? things like alcohol, marijuana, cigarettes, the the choices
02:11:44
that are toxic in our world as well. So that toxins is kind of a large category.
02:11:49
There are some toxins you can control. You can try to filter your water. You can learn what is in your water so that
02:11:55
you can say at the, you know, EWG, this is my zip code. This is what's in my tap water. What type of filter might I need
02:12:02
to try to have healthier drinking water in my home? You can change what you're cooking with, not using non-stick
02:12:08
cookware or teflon. you can get rid of plastics and especially what you're putting hot foods and beverages in
02:12:14
because the heat is allowing those toxins to leak into those things. And then as Dr. Haber said, our cosmetics,
02:12:21
things that you use every single day that you put in and on your body are things that you're having a higher
02:12:27
exposure to. And it's really important to decrease those because things like air quality, you might not have as much
02:12:33
control over based on where you live. And there's so many toxins in our world in general that it's unrealistic to say,
02:12:40
"Let's avoid all of them." And because of this, we have that same mentality that we see with exercise sometimes.
02:12:46
Well, it's just there's too many. I can't avoid them all. So, I will ignore this category because it's easier to
02:12:51
just do nothing instead of making active decisions to start to live a less toxic
02:12:57
life. What changes have you made to remove pollutants and environmental toxins from
02:13:03
your lives? Because we're in that fertility journey. I remember I came home in one day and like all my shampoo and stuff had gone. Yeah. So my nice stuff is
02:13:09
starting to look through your products and get getting rid of things that have endocrine disruptors in them. You want to look the kitchen is probably the
02:13:16
greatest source of exposure for most people. So there's really no need to have any plastics in your kitchen. So
02:13:22
getting rid of them. But many people don't think about when you do have processed foods. The wrapping, the
02:13:27
container, anything that's coming packaged likely has toxins in it. When you order Door Dash and it comes and you
02:13:34
have it in a container, that's often hot food in a container that is leeching chemicals into it. So, a simple thing is
02:13:40
take it out of that right away, even if you're not eating it. Put it into something glass or a different type of container. So, you can try to minimize
02:13:47
that exposure. Thinking about hot beverages, things that go in the microwave or the dishwasher, especially,
02:13:53
but then other things like thermal receipts. So, getting receipts, uh, thermal receipts have BPA in them. So,
02:13:58
getting receipts or receipts. Yeah. So the airline tickets or that thermal paper. So just the
02:14:04
receipt from the grocery store when they say, "Stephen, do you want your receipt?" You can just say, "No." And
02:14:09
then if you work with thermal paper, maybe you're a cashier and you touch it over and over. I highly recommend you wear gloves because your exposure to
02:14:16
that thermal paper is so much higher that it can become problematic for you. Does it really make a difference if I
02:14:21
take the receipt or not? You know, there's a lot of things where you can do that say that person touched receipts
02:14:27
all day and they still got pregnant or their sperm was great or they lived a long time. We can list a whole lot of
02:14:33
negative behaviors or habits or exposures that one person might tolerate just fine. And for somebody else, the
02:14:40
sum of all of these behaviors add up to be something that puts them in a place that is very pro-inflammatory, not healthy for the now or for the
02:14:50
future. That to me is an easy dec on the scale of decisions that are hard or that
02:14:55
are easy. Trying to change the things that you're exposed to in your world. You have to spend some time to learn about it. You might have to buy some new
02:15:02
things. But over time, those decisions are ultimately easier than how you eat, your exercise. Those those take longer commitment. And especially if you're partnered, if you live with somebody,
02:15:14
then the foods that you eat, your sleeping habits depend on them. You both have to be together on this. So
02:15:21
sometimes I always say toxins are to one place a thing you can do. You can look at your products. You can start to when
02:15:27
they run out say is this one healthy for me? Should I get something that's going to have less of an impact? That one time
02:15:34
of using very scented hand wash is no big deal. But when you wash your hands with that highly scented hand wash five times a day over and over, it is just an
02:15:44
avenue of endocrine disruption that can add up to the litany of the other ones that you're experiencing. So we're all saying these little changes on one hand
02:15:55
singularly probably do not matter much, but together they do. And there's a link between environmental
02:16:02
toxins and menopause or early menopause. Early menopause, we think so. So, you know, you were born with a shelf life, a genetically predisposition shelf life on the ovary. Okay? And we don't know a lot
02:16:13
of things to extend that shelf life cuz we have a certain number of eggs. But there are a lot of things we can do to
02:16:19
speed that process up. So, that's going to be smoking. Women who smoke cigarettes or, you know, um even we're
02:16:27
looking at vaping now because it's a newer thing, but definitely tobacco consumption, you know, in the form of
02:16:32
smoking. We see earlier menopause. um the so there was this incredible study where they looked at women who were sexually abused who then had children who were sexually abused went through
02:16:46
menopause I think nine years sooner so and it's the only study that looked at this and it happened to be the stress
02:16:52
they looked at was sexual abuse in the mother and the child and so they went through menopause nine years sooner so there is a component of emotional stress and long-term chronic emotional stress
02:17:04
it does cause chronic inflam- And the ovaries are highly sensitive to chronic inflammation. We know that BPA
02:17:10
exposure has shown that if you have a higher level of BPA exposure, you have lower ovarian reserve, meaning less eggs
02:17:17
in your ovary will go into menopause earlier. And what is BPA? BPA is one of those environmental
02:17:23
chemicals that we're exposed to largely through plastics, but it's also one that's in the thermal receipt paper that
02:17:29
we're trying to avoid our exposure to. And that's where some of the data even when it comes back to food where soy
02:17:35
intaking soy products can actually be very protective because it combats BPA. So how it works. So when people say,
02:17:42
"Oh, you shouldn't have tofu. You're a man. Soy is so bad for you." That's actually false. And we found that people
02:17:49
who had greater exposure to soy products actually had the lowest level of BPA and
02:17:55
improved reproductive performance because of that. So there's definitely correlation with these toxins in our
02:18:01
world and we might say, "Oh, is it linked to menopause? Maybe nobody's done that exact study, but it absolutely is.
02:18:07
If you have lower eggs at an earlier time period, that's going to give you an earlier menopause going." You know, the flip
02:18:13
side of fertility is menopause. So, and lastly, I wanted to talk about sleep. Well, it's all of our favorites and we're doing it last. So, yeah, Vonda, I've heard you refer to sleep as the pillar of everything. Mhm.
02:18:26
And I say that because we think sleep is just passing out like we're not conscious. Well, that may be true from a
02:18:33
from a uh our viewpoint, but it is the most regenerative period in our day. Actually, the brain is processing information, getting rid of toxins. The body is able to uh settle and again get
02:18:47
rid of toxins. But many women in midlife have completely disrupted sleep because
02:18:52
estrogen is critical. Yes, 80% very high. Um, estrogen is critical for uh sleep patterns. Um,
02:19:05
many women wake up at 3:37 or thereabouts either with a plummeting blood sugar or that seems to be around the time in the middle of the night that the sleep disruption has. So this broken
02:19:19
up sleep, if you don't do it, then all the lifestyle things Stacy and the rest of us have been talking about are nearly
02:19:25
impossible to do if you're underreovered. And so I have made after nearly 11 years of not sleeping because of training and child a religion almost
02:19:36
like I am dedicated to this function. I do not eat 3 hours before I go to sleep.
02:19:43
Uh, it's one of the primary reasons that I made the decision to stop drinking alcohol because that completely
02:19:48
disrupted my sleep. And I am more conscious of circadian rhythm than I've ever been in my life. Meaning I go to bed when I'm except except probably when
02:19:59
I'm traveling, but at the exact same time every night, but more importantly get up at the exact same time every day
02:20:06
to start my circadian uh day. um and to start my adenazine usage so that by 9:30 at night I'm ready to rest. It's that
02:20:17
important. A woman's guide to a aging with power. Unbreakable. Yes. Unbreakable. And central to that is circadian rhythms and sleep, right?
02:20:27
Yeah. It is because the premise of this book is that uh women are already winning the longevity race but we suffer longer and we have this vision of women
02:20:40
aging which is usually a vision of frailty. But through the mindset changes through the behavior such as sleep and lifting and considering hormones
02:20:53
we can age in a different way. So I'm trying to re-educate the world that a woman's destiny is not frailty. A woman can age powerfully but not if we sit
02:21:04
around and wait for time to make us its victim. We must be proactive. And sleep is one component of that. This should be the very first thing you do. Sleep sets
02:21:15
the stage for your entire day. It's really that foundation of your health. If you are going to start the day in a
02:21:22
sleep deficit, you're starting out stressed, inflamed, insulin resistant. There's going to be no behaviors you can
02:21:28
do during the day that are going to overcome the deficit. And we know that women who get less sleep, they take
02:21:35
longer to get pregnant. They have higher rates of infertility. We know that men who get less sleep have lower sperm
02:21:40
parameters and lower testosterone levels. So if we are saying you Stephen, you know, what's one thing you might be
02:21:46
able to do? Well, are you sleeping well? That's one of the first things you can start to do to say, am I getting 7 to N
02:21:52
hours of good quality sleep? That's not just time in bed because Mary Cla has her phone on her. That is actual
02:21:59
sleeping time. And that makes a huge difference in trying to achieve, you know, a hormonal health, which is really
02:22:05
what we're all saying here is how do we get our body in the best quote unquote balance that we can, which means working
02:22:12
with the different building blocks of our body in the most optimal way for as long as possible to be healthy. And even
02:22:19
if we're not looking from a fertility standpoint, you can't invoke any kind of metabolic or body composition change
02:22:26
without adequate sleep. So that's what I mean. It's like when we're talking about the pillars and sleep being one of the
02:22:32
first things we have to work on, you can't invoke any kind of change with we're not talking about ambient induced
02:22:37
sleep. No, medication induced sleep doesn't count. This is not medication induced sleep. There's a huge percentage of patients
02:22:43
out there who are addicted to these medications and it has become the only way that they can sleep. I've been really shocked at several of
02:22:50
the women in my life that are between the ages of I'm going to say 35. Yeah. 35 and 45 who have like three to four hours sleep and they appear to be
02:23:01
perfectly fine. They are not. They are not. Their cells are not fine, Stephen. No. Cuz obviously cuz I do this a lot. I I
02:23:06
learned from all these scientists. But there's one partic there mean there's two particular women that I'm very close to that I actually work with in different capacities who showed me their
02:23:13
Whoop data and would often tell me they would say I get three hours four hours sleep. And I thought there's no way
02:23:19
because she did a 5K this morning at 6:00 a.m. So there's no way she's getting three to four hours sleep. to
02:23:24
put a sleep tracker on her and she was getting 3 to 4 hours sleep and her restorative sleep is like 45 minutes
02:23:30
but she's springing into the makeup chair next to me and she's all she's got all the energy I'm thinking what the hell is going on
02:23:37
youth but I'm younger than her yeah I mean when I was in training I was getting 3 to 5 hours and getting up and
02:23:43
operating but I cannot do that now if I got 3 to four hours I was good for the day
02:23:49
how because I was 20 years 25 years younger Mhm. M I think we all got through like I was telling some of my earlier years breastfeeding mother is getting 3 to
02:24:00
four hours you know that is part of the wow we're built we can function but age will take that resilience away from us
02:24:07
because permenopause causes sleep fluctuations as well that because of the change in hormones right
02:24:12
exactly and are women just assuming that's normal and rolling with it or is it okay
02:24:20
I think we have more at public education about how important sleep is and and the number of hours you need and the quality
02:24:26
of the sleep. So, I think years ago it was their normal and I'm just going to keep going, but now they're coming in
02:24:32
saying, "This is a problem." Yep. I need help. And I would be interested to see your
02:24:38
glucose monitor. When you first used it, because that's how we can kind of navigate sleep, too,
02:24:44
is showing hypoglycemic effects for women who are exercising in pmenopause and not eating enough. Melatonin is that a solution? No, it can be a tool in the toolkit. Most of
02:24:56
the time, you know, most people are taking too high a dose of melatonin, which is actually doing more harm than
02:25:03
good. What harm is it doing? Well, it's actually shutting off part of the brain to be able to help control their circadian rhythm and then they're
02:25:10
completely dependent upon it. And it's such an artificial induction, it's going to w wear out of their system. So your
02:25:16
melatonin is supposed to rise, help you go to sleep, and then it falls at a rate for when you're going to wake up so that
02:25:22
when it's lower, you're going to wake up and your cortisol will naturally rise. Melatonin can be helpful in very low
02:25:28
doses, like three. Most people are taking 5 to 10. 10. Yeah. Yeah. So I often recommend, you know,
02:25:33
the patients take maybe like a milligram, but you have to buy a children's melatonin very often for that dose of it because people are taking
02:25:40
these huge huge amounts over the counter. You can just get so much. And so what you want to make sure is that if
02:25:46
you're using it, you're going to take melatonin at a time where you're going to be able to go to sleep about 30 minutes afterward, too. Because people
02:25:52
are also using melatonin and then not allowing themselves the restful moment when it's trying to kick in and then they're taking more or they're staying up later and they're suppressing their
02:26:03
brain's ability to make their own melatonin. One of the questions we had from the audience was from a young girl that
02:26:09
said, a young woman that said, "I'm 24 years old and I struggle so much to fall asleep. How can I fix my sleeping
02:26:15
naturally if I have disturbed set circadian rhythm and especially during my menration my sleeping pattern seems to get worse. This one would be interesting to see
02:26:26
like what is her daily like what are her daily habits if we can kind of bring calorie intake and all those things back into the day so she's not phase shifting and then use things like eltheanine
02:26:41
which is a a nonproin amino acid that works the GABA right trying to bring parasympathetic activation back and
02:26:48
making calm down yeah and seeing what is what are your sleep hygiene habits is your phone out of your room do you have um like a cool
02:26:55
bedroom. Do you have earplugs to block out some of the extraneous noises that might partner doing?
02:27:01
Yeah, sleep sleep is really a lifestyle problem for most people, isn't it? But magnesium can be advantageous as
02:27:06
well, especially if you're on your menstrual cycle and you're having menstrual related sleep. So, I think that's an important thing.
02:27:13
Well, it's just many women run low in magnesium, especially when your hormones are very low, especially when your estrogen and progesterone low, you're having, you know, contractility of your
02:27:23
uterus, when you're having menstrual cramps. Magnesium can help counter some of that and can also help you, if you're
02:27:29
taking it at night, get into a more restful pattern. So, um I've been working with a sleep medicine specialist
02:27:36
um and one of the things she points out which I now discuss with my patients is listen if we're women wake up in
02:27:43
menopause from hot flashes from night sweats and then the the relaxation we get from progesterone is gone so we can
02:27:48
add that back in. So say we we've done all the things we've given her a touch of melatonin we've put her on hormones
02:27:53
she is still waking up at 3 in the morning consistently. Mhm. She deserves a workup for sleep apnea
02:28:00
because women disease differently than men. And men with sleep apnnea, it's a very common presentation of snoring. They're waking up the partner, you know, all these things. Women are much quieter
02:28:11
about it. They still have the pallet that falls back and the relaxation. And that's hormonally driven for a lot of
02:28:17
women. And so they're becoming hypoxic in the middle of the night from you know that's one of those side effects of of
02:28:23
having sleep apnea is you stop breathing and you lo your oxygen levels decline you become hypoxic but we are not
02:28:29
recognizing it in women more than 50% of women are going undiagnosed and are living shorter lives having more
02:28:35
Alzheimer's because of this. So if I have a patient coming in and we've done everything and she is still consistently
02:28:40
getting up I'm sending her for a sleep apnea evaluation. M I've also been reading literature on um CBT, so
02:28:48
insomnia CBT that they've done with a lot of veterans and shift workers and that seems really interesting
02:28:54
to help them fall back. Yes. To break the pattern because your body and your brain learn that wake up
02:29:00
pattern. So if you can reset it, then that's very helpful as well. Yeah. What is the most important thing we should have talked about that we didn't talk about? Dr. All right.
02:29:10
I think we covered an amazing array of information, but what I want women to walk away from this is with there's that there's a hope for feeling like themselves again.
02:29:23
Yeah. and that they are worth investigating to the ends of the earth to find the answers they need and not simply giving up the first time somebody says no to them or doesn't hear them
02:29:36
when they say that they don't feel like themselves. They must continue to pursue it. And number three, that they are
02:29:44
worth the work that it takes to age with power. Beautifully said, Octavia, you really kn do need to be the CEO of your own healthcare. Um, we have a
02:29:59
medical system that was not built to serve the aging woman. Um, after reproduction ends, it's just we become small men with rust and uteruses to quote Dr. Sims.
02:30:10
And you, it's okay to educate yourself. It's okay to read the books. It's okay to go in educated with checklists and you're going to probably have to do that and to
02:30:22
go find someone who's educated in the health of women after reproduction ends. And that could be your internist. It
02:30:28
could be family medicine. But like there's no no one owns menopause life after reproduction ends.
02:30:35
You know, no specialty really owns it. And so you are going to have to quarterback this a lot of it yourself
02:30:40
until you find the right partner in this care. But it is worth it. Beautifully said as well. Yeah, I think
02:30:47
when it comes to your health journey, nobody is really responsible for it except you. But there's this idea that
02:30:54
we should wait until things are wrong to then go get them fixed. And what we are
02:30:59
all trying to do across the spectrum of you know women's health and their lifespan is to say many of these things
02:31:05
if we start focusing on them much earlier and take a preventive approach which is often against some of these
02:31:11
recommendations about when you should screen or when you should do testing. But if we say, well, what is best for
02:31:16
you as an individual? Focus on setting up a life that is going to help prevent some of these diseased outcomes. Start testing things earlier. You're going to be in a position of power to make the
02:31:28
decisions that are right for you from a place of education and not be left making them out of fear or
02:31:33
misinformation or not knowing because when it women will go through these stages. Time will make your fertility
02:31:39
decisions for you if you do not. that that's a fact that your ovaries will stop functioning. You will go into
02:31:46
menopause. So, we need to both prepare for our reproductive years, optimize our fertility the best we can if that's a
02:31:52
life goal for us, but to realize that it doesn't stop there. That you're have to prepare for the next stage of the
02:31:58
journey and what that's going to look like for you. But the steps to take care of yourself start well before if you're
02:32:04
able to. I look at the the research and the health outcomes right now for women and it is a very confusing space. So I always preface with the fact that I want
02:32:16
women to be empowered and how do you do that? You can't Google things and find out. So it's asking questions. It's
02:32:22
sharing information. Most of all taking up the space because you've earned it. I
02:32:27
get so tired of the rhetoric that women should be small and demure and be like a delicate flower and things are happening
02:32:34
to them that they can't control. I want the narrative to shift. I want people to say I own the space. I'm taking up the
02:32:40
space and it's my I don't like to use the word right because it invokes a lot of angst. But it is your ability to understand your own body and advocate
02:32:51
for yourself that's going to allow you to take up that space and get the answers that you want. I've been
02:32:57
advocating for so many women, myself included, and the push back that you get from the medical society is real. It's not that they necessarily are trying to gaslight you, but it's just a product of
02:33:09
the system. So, you do have to push those boundaries. You do have to ask those hard questions. You do have to go
02:33:15
in prepared to have that push back, but take that space because everybody deserves a place at the table and women's healthcare is being shunted in a way right now that is really
02:33:27
unacceptable and we need to have ground swell movement to push back. Thank you all so much.
02:33:32
Thank you. Thank you. I really mean that. I I'm thanking you on behalf of the many millions of people that are probably listening to to this
02:33:39
conversation um because you know your conversations on this show have delivered more than 30 million downloads
02:33:46
between you so across YouTube and across audio. I was looking at the numbers and it's staggering and you think about the
02:33:52
impact of reaching potentially 30 million people just on this show in long form and then their friends and then
02:33:57
their family and then the advice that they give to everybody they know and that domino effect is causing this
02:34:02
wonderful ripple across the planet and it's turning the lights on in different households and within families and
02:34:09
amongst business owners like myself so that we can all cater to the the plight I guess of women's health in a more
02:34:15
effective way cuz you know even as a man I've learned oh god so much from you for
02:34:21
great and the impact it's had on my life through improving how I show up for the
02:34:27
women in my life but also the the way that I'm able to respond and support my partner, my
02:34:35
sister, my mother in difficult times has been profound and I think some you know
02:34:40
and well done to all the men that have listened to this conversation and have gotten to this stage because I know you
02:34:46
don't kind of you often don't think it's a problem that you're going to deal with but when 51% or 52% of the planet are
02:34:53
women is going to be a huge part of your life whether as a as you having daughters or sisters or or mothers and
02:34:59
through all of the work that you've done I've been able to understand the women in my life better and actually that's protected my relationships and if it's
02:35:05
protected my relationships it's protecting me and um I've really noticed that I've noticed how I've changed
02:35:11
especially through understanding the menstrual cycle um how I treat treat my partner but but it's you four you are
02:35:17
like the avengers of what you do. You're the you're the very best in your industries and um drink it.
02:35:23
I highly recommend everybody goes and checks out. I'm going to link all of your books below. Uh Unbreakable, the
02:35:28
fertility formula, the new menopause. I believe you've got a new book on the way menopause. The new permenopause. I'll link that as
02:35:34
well if it's available for pre-order and raw, but also just your you'll make content, have Instagram pages, and have
02:35:40
websites. So, all of that will be linked in the description below. And if you want to go deeper on these subjects that we've talked about today, then those are
02:35:47
the doorways into a a deeper understanding. I appreciate you all so so much. We've been for what 9 hours now and uh
02:35:55
I'm sure it's a lot of people. So thank you. [Music] Heat. Heat. N. [Music]