Protein Requirements and Key Supplements

Welcome to Everyday Wellness podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives This is Bonus Monday, your most downloaded favorite podcast. I love that this community runs the gamut from medical professionals, research scientists, science writers, personal trainers, and more. These are your favorite, most loved podcasts of the last five years. I could not be more proud of The diversification of guests that appeal to all of you. Thanks for tuning in Today I have the honor of connecting with doctor Stacey Sims. She's a forward thinking international exercise physiologist and nutrition scientist who aims to revolutionize exercise nutrition, performance and especially in women. Today we spoke about how women have been excluded from research in the modern science era Diffnces between genders that starts in utero why tracking our menstrual cycles is so important, as well as key differences between follicular and luteal phases and why anovulatory cycles are so problematic The role of contraception and current research around oral contraceptives, the impact of the women's Health initiative What type of training is critically important for women in perimenopause and menopause? It incorporates resistance training training and compound movements keey physiologic changes in perimenopause and menopause thoughts around weight loss resistance, SCO, and why under ereating is problematic importance of protein and lastly, key supplements, including creatine monohydrate for middle aged women. This is an invaluable conversation that I know you will love Well, Dr. Sims, I've been really looking forward to this discussion. Thank you so much for carving time out of your busy schedule Yeah, no, it's great One of the things that I think is so interesting, you know, as a clinician myself is really understanding at the basis of why women have been excluded from research for such a lengthy period of time. Do you feel like as a research scientist yourself, is this a byproduct of concerns over women's safety? or is this more a complication of thinking about women's physiology, know dealing and addressing with the menstrual cycle and how much hormonal flux that goes on in a woman's body day to day week to week when they're still in their peak fertile years and perimenopause A lookook at it from a historical perspective, right? So if we think back to when we had modernization of medicine and we think about who was in the room Before that, it was the women that were the healers primarily and the caretakers, right? But then we see that men started coming To their own saying, well, women aren't as smart as us. Even Darwin said women had smaller brains, so I count that against him. just became who was in the room? And women were excluded from being involved in higher education, university, medical settings, that kind of stuff So when science first came to be modernized as we see it now, as the hypothesis driven answers through research Who was in the room was men? Right. And so when they were designing studies, they were designing studies based on them and based on what they knew from male cadavers And so when you start moving it forward, it didn't really enter the conversation or enter the minds of the people who were designing studies that, hey, wait, maybe we should be looking at women differently Because the isolation of our sex hormones wasn until the early nineteen twenties, nineteen thirties, for the most part. So as we see from the early nineteen hundreds to now, there has been a shift, but we have a long way to go. But it's a relatively small period of time when we look at that whole aspect of what is modern medicine and what is science. So I'm happy to see that things are moving forward, but it still it was like nineteen nineties, I think. NIH put out a mandate saying we have to include women and you have to have a biological or some other reason why you would not include women and people still found loopholes. And this is where that conversation, o, women are too difficult to study because they have so many different hormone perturbations They might have anovulatory cycles. We don't really know how to test for it. It's too burdensome. And the language of recruitment as well. So we look at the language of recruitment and the attrition rate, it's all very masculinized because science comes from that masculine and patriarchal background. Because we've been able to unpack all of that, we're seeing a lot of movement forward in the space of looking for women to be involved in female studies to be involved in sex difference studies, even right down to mouse models now have to have female mice versus male mice. So there's still, like I said, a long way to go with regards to getting equality and closing that gender data gap But we have come a long way from that initial who was in the room interesting because as I was getting prepared for a conversation, I was looking at current statistics and even though women are now better represented, we still are only forty one percent, which it seemedite actually quite high. Only forty one percent of research that goes on actually goes on in females. and it didn't break it down based on animal models versus human subjects And so from so many different perspectives, I think as a clinician, you know ug therapy we prescribe certain kinds of medications and why I knew over time certain drugs I'd use teeny tiny doses in my elderly female patients versus my elderly male patients. But yet there was no data to support that. It was just clinical experience that I was drawing upon Yeah, I mean, I see that now. I mean, I've talked about it before. My husband and both have had surgeries by the same surgeon and we get released with the same type of drug and the same dosage. I like, wait a second He's one hundred and eighty pound six something dude and I'm a, you know, a hundred and thirty pound five, six woman So there is still that discrepancy Absolutely. And so let's Like I would love to kind of unpack some of the physiologic differences between men and women based on the research. I know that what I found really interesting, you know from conversations that you've had is it actually starts in utero. So when our moms are pregnant with us or we're pregnant with our children, the impact of stress is different on a fetus depending on the gender and how that can impact, you know from a starting point, from a physiologic starting pointoint, can impact the way that we evolve differently as men and women Yeah, so I remember giving a lecture when I was pregnant with my daughter and it was all about strength training and exercise when you're pregnant. And so when you start looking at the literature and the research to give a lecture, you realize that there really isn't anything there So I was like, okay, this is really interesting, but I want to dig in a little bit more about blood flow and fertility because I want to understand from the very basic cellular level. So when you start looking at what's happening in utero and you start looking at how stress affects things like how vascularized the placenta is. So we see that small bits of hypoxia through exercise will increase the blood flow and the vascularization of the placenta, which means better blood flow and better nutrition to They're developing feeda When you see the opposite side of high stress rates where we're having elevated cortisol poor blood lipid, poor blood sugar control It becomes a fight for controlling the stress in the mom's body versus to fight for all the stuff that the developing fetus needs And we see that under high, high levels of stress like that, there's often more miscarriage and it's more often the male fetus that does not survive. So it comes right down to the stress and stress resilience of the developing cells and how they're expressed. And then that feeds forward to, okay, the baby is born, what was it in utero experience? Was there high stress and resilience and was there exercise which causes an epigenetic or, you know, that surface conversation change within the DNA to improve the stress resilience and the metabolic outcomes of the kid into adulthood. So when I was giving this lecture, I was trying to unpack and explain it all. It's like, okay, well, yes, exercise is great And the whole idea of keeping your heart rate low and just walking is all because men who started the guidelines were afraid that women were delicate flowers. But when you start looking at more the modern research You see that the body is really resilient and we want to tell women, you don't want to try to build muscle and build your fitness You want to maintain what you have, but if you haven't done anything, then you want to build. You want to build your fitness so that you have better metabolic control, so that you have strength, so that you can have a robust pregnancy with a really stress resilient fetus in that development phase. Well I can remember when I was pregnant with than my boys, I had two singletons that my O be really stressed I know you like to work out I don't want you to get your heart rateated above one hundred and twenty. Oh my gosh. And I can remember, you know, dautifully wearing, you know, my garmin watch and looking at my chest strap and one hundred and twenty wasn't much. didn't I mean it gave you it buffered what I did. Although I did a lot of walking, I did some light strength training But I now have a nineteen year old and a seventeen year old. And so that's twenty years ago, but realizing now It's actually of benefit for women to remain physically active throughout more physically active throughout their pregnancies. And so my hope and intent is to get people thinking and discussing these topics so that we can all advocate for ourselves. What are some of the differences in terms of You know, lung volume, blood volume The impact of puberty on our bodies as we're kind of navigating growing up as children into teenagers and young adults, you know, based on the research What are the physiologic like kind of broad stroke physiologic differences between men and women beyond the obvious? So when we look at things like muscle morphology, which is the muscle fiber types, and have full disclosure. when I'm talking about the sex differences, I'm talking about the biological XX versus XY because we don't have enough research on other perturbations of our sex hormones. So I have to just go with literature that's there. So when we're looking at XX versus XY The by the nature being XX, you have more endurant or oxidative muscle fibers. So we have less calacallytic, less fast switch We have better mitochondrial proteins within our muscle for mitochondrial respiration. We're more metabolically flexible. because we have more mitochondria, more robust mitochondria, we have better oxidative capacities, better anti inflammatory capacities. We have better ability for transferring lactate So when we do higher intensity exercise, we don't have a lot of glycolytic fibber, so we don't produce a lot of lactate. but when we do, our body's like, yeah, we know what to do with this. So there's a really good uptake to the brain, which helps with brain metabolism. When we' looking at structural differences, we know that women have smaller hearts and lungs and less hemoglobin that's all by the nature of You being X X When we get to puberty, this is where it's interesting in its shift because we start to see changes, I guess when kids are between seven and eight years old. we see it on the elementary school playground where we start seeing this more divergence of the boys are off being more rough and tumble and the girls are like, okay, I'm going to do more monkey bars and have more of that motor control type work But then we start seeing the divergence of ten eleven, twelve year olds, right? And we're seeing more and more girls are not going to monkey bars And they're feeling less confident in their bodies, where the boys are still out there rough and tumble and playing and pushing and trying to get, you know more of the soccer fields and that kind of stuff. And no matter what kind of conversations you have, it just happens by human nature. And it has really to do with what's happening with girls' bodies becausecause as we start to get that early exposure of our sex hormones before a menstrual cycle actually happens We see that girl's center of gravity changes. so it goes from more upper chest down to lower abdomen area. So we have lower center of gravity in the pelvis area. We have a widening of our hips, so that changes the angle of the hip to the knee. We have widening of our shoulder girdle to have more balance. and all of this creates an ungangly and Girls tend to grow their periphery faster so their limbs grow a lot faster than the rest of their body, so tend not to have a lot of core strength So this comes more into why now they're not on the monkey bars because they can't do what they did before and they feel really kind of a bit missteppped. And when you're seeing girls playing volleyball or basketball or soccer in their're you know middle school or sixth grade to ninth grade, you don't actually know how old they are because there's so many different changes there and how fast puberty goes for some and how slow it goes for others. Its a very confusing time boys, however, with that epigenetic exposure of testosterone, they get leaner, they get fitter, they get faster, they get more aggressive, which creates us more more divergence in this increase of that discrepancy of trying to keep girls active and in sport versus it's a natural progression for boys to keep doing their sport and activity So when we're bringing it back down to puberty, we're like, okay, if we want to keep our girls in sport, yes, there's a conversation of your body is changing We know that you're going to have a menstrual cycle. When it actually comes, that's arbitrary between ages eleven and fourteen But what we do want to do is we want to teach you again, how to run, how to throw, how to jump, how to land How do to work in this new biomechanical orientation that you have So one of the first steps that we'd want to do is put that into physical education, right? All kids will benefit from functional training and learning how to do squats and lunges and jumps and all that kind of stuff. But reteaching in this new mechanics is one step closer to getting girls confidence back Because if we get that confidence back, then it holds through all the way through post menopause. R right? So I see that early development and puberty so essential For taxing into, let's get some more type two fibers working, right? So let's get more lactate production. Let's work on that pure strength development. Let's work on how we are moving through all the planes of motion Not only is that building confidence for what we're doing for sport, but it just builds confidence for overall movement, which is good because that's what we want, right? We see that people who boys and girls that are moving more have better mental health. If you have better mental health, that's more confidence, more confidence is better learning, better learning, and all these subsequent outcomes When We talk about perimenopause and menopause, the conversation often focuses on hormones. And let me be clear, hormones absolutely matter But one thing I think we don't speak enough about is muscle Women can lose significant muscle mass and strength during the perimenopause to menopause transition, and that loss impacts far more than just our appearance Muscle influences metabolic health insulin sensitivity, mobility, healthy aging and more And the good news is there's so much we can do about it. Strength training and adequate protein intake are critically important. And increasingly, we're learning about the role mitochondrial health plays in maintaining muscle quality as we age That's why I've been paying attention to the science behind M Aure from Teline Mitopure contains realithin A, a clinically studied nutrient that supports mitochondrial renewal through a process called mitophagy Think of it as supporting the energy systems that help keep your muscles functioning at their best For women who want to remain strong, capable and resilient for decades to come, this is an essential area of research worth knowing about. Visit timeline. com and use code Cynthia for twenty percent off your order Again, that's timeline d. com and use code Cynthia for twenty percent off your order This is one of my foundational supplements that I never miss I think it's so important because I think back to when I was growing up, I think if your parents talk to you about the changes that you were going to experience, you were probably fortunate in the seventies and eighties versus now, I think it's probably a bit more proactive. points about helping young women and young men understand physiologically what's happening in their bodies so that they can optimize training. And I really think about this, you don't necessarily have to be a full fledged soccer player, lacrosse player, but just being physically active is so critically important You know, we we're looking at escalating rates of diabetes and metabolic disease in young kids. You know, when I finished My medical training, it was so unusual to see children dealing Type two diabetes, That was a lifestyle issue And now you're seeing itng and younger individuals Now when we're talking to young women about menstrual cycles, and I think again, this goes back to You know, some schools are talking about this proactively. some people are getting information from home I know you're a proponent of helping young women understand their physiology, their menstrual cycle, and actually training for their cycle. So let's talk a little bit about the phases of the menstrual cycle and how young women can actually optimize their training. And when I say training, you don't necessarily have to be an athlete. You could just be someone who's an avid exercis or someone who's prioritizing physical movement into their lifestyle But I don't think we talk enough about menstrual cycles. I think, know, it's sad to admit this that You know, I'm now in menopause, but I think I understand more now than I ever did. And yet I think about it like I'm as a clinician We do such a poor job in many ways of talking to women about the physiology of their bodies and what it all represents. Yeah, I mean child of the seventies eighties, so I completely get that right. I got some information from my sister, others from friends My daughter doesn't stand a chance having me as a mom But yeah, it's still a little bit of a taboo thing because I'll go and I'll give talks to high school students and they all still are kind of like, oh, you're talking about menstrual psycho But when we talk about it, it's a natural thing, right? And we see that there's a whole socio cultural construct around it as well as a physiological. So when we talk about the physiological Just you know, the brief outline of day one is the first day of your bleeding around a twelve or thirteen is Ovulation, which is you'll have a surge of estrogen and then after ovulation is what we call the high hormone or the luteial phase when you're building that endometrial lining. So you have an elevation of progesterone that is more of our catabolic hormone. so that's what's providing all the building blocks for the endometrial lining We also see that there's a lot of carbohydrate that gets put into that endometrial lining. So our glycogen storage is affected, so that goes more look into that endometrial lining And then around a twenty eight to thirty, you have an inflammatory response that causes a shedding, which lead you to the next bleed happens a lot in those menstrual cycle conversations is that When you're first starting, the first few years are going to be very irregular. We know that, right? And no one tells ids like you're twelve, you start your period. and I mean, a lot of girls think in health class, oh, it's going be a bleed phase for five to seven days and then it's gonna be over. But you know, it's really irregular. They don't know how long the whole cycle is going be. so they get very confused. their parents don't know or their mom doesn't know, so they get confused Th then unfortunately, they'll go to a GP. The GP doesn't have a lot of time. they get told to put on an oral contraceptive pill. So there's a lot of, you know things that go with it where we're like, hold on Take a step back For the first three years of your menstrual cycle, it's going be irregular. We know there's a lot of anobvulatory phases. And so you're going to have short and long and that's normal As we get older, as we get into our late teens, early twenties, you should have a regular cycle, which means it's between twenty one for days. If you start seeing changes in the bleed pattern, or you start seeing changes in the length of the cycle, we need to take a step back because we know that there's some undue stress that's causing some menstrual cycle irregularities We also know that there are four to six an ovulatory cycles a year in the normal woman, which is increasing a lot from the seventies where we'd see maybe two or three. So there's an environmental influence that's being researched into why we're having more and more of these kind of an obvulatory fertility issues You'll still have a bleed If you have an ambulatory cycle, but the actual bleed pattern is different So you'll see it shortens, it's not as heavy. When we're talking about how do we train according to menstrual cycle, The first thing that I tell women to do is track their cycle. so they can understand what their own patterns are so then they can see, is there a change in the bleed pattern? Is there a change in the length? Is there a change somewhere along the way when I'm talking about what does my psychle mean to me alsoso finding your own pattern of how you feel across your cycle because women will say, oh, yeah, I feel bulletproof the day before my cycle starts or maybe I feel absolute shit. right? So you know what your own nuances are. thenen when you lay that over how you were life goes and times where you can train hard and when you should train easy, you can use your own menstrual cycle to pattern that out We know from a molecular level, the low hormone phase or that follicular phase from day one up to ovulation We see there's a change in the immune system where we have more capacity for fighting off virus and bacteria. Our body is more stress resilient. We have better capacity for recovery. We also have more motivation and aggression, which is, a way that we can really feed forward into our training And then after ovulation, there's a metabolic switch where we have more of that catabolism because progesterone comes up if you ovulate. So that's the key thing. If you ovulate, then you know that you can modify your training to be more aerobic, endurance based, maybe more technique oriented and really see how you feel But because we're having more and more an amomulatory cycles, we can't really dictate what's happening there That's why I tell woman, let's go back to the basics and I want you to track your own cycle. So when you start seeing your own patterns, that's how you can dial in your training. Because when we're talking about what is training, you want to get the most amount of training stress so that your body can respond to it adaptting get to fitter. So if you wake up and it's day eighteen of your cycle and you're like, day eighteen, I always feel fantastic then you're probably going to prioritize really good hard workout because you have that advanced notice, you know that you can go hit it hard, you're going to get a high training stress. Your body's going to adapt to that, recover from it, and you're going to get fitter But say you wake up on day twenty and you're like, o, I feel awful and you know you always feel awful. You're not going to do day eighteen workout on day twenty So it's a way of being able to manipulate your training and your life around how your hormones make you feel And this is a big subjective area of research that people are somewhat bringing in, but a lot of the voices in menstrual cycle research are ignoring because they're like, yeah We don't care. We just want to look at the physiological. And then there's a group of us are like You can't tell a woman to go hard if she's like, I feel like physically I feel a two, mentally I feel a one and you want me to be on a scale at ten. It's not going to happen Well, and I think it really takes into account this bioindividuality. That's why you know, stress tracking your cycle to get a sense. What do you think the increased frequency of an ovulatory cycles is attributable to. because I know you mentioned initially it used to be two to three a year. Now we're seeing four to six. That's quite significant when you have individuals that are trying to conceive or considering trying to conceive in the near future because that could potentially mean two thirds of the year someomeone may not be able to actually become pregnant Right. We see there's a lot of, well, not a lot. There's Rise in FIMech Wh we're seeing some at home tracking ks. so Prove PROOV has just been FDA approved. and it is a way of monitoring fertility, specifically looking at the progesterone metabolite, right? So if we're looking on day twenty two to twenty four using a urine stick test to determine if you've ovulated or not veryy, very helpful We're seeing this increase in an ovulatory cycles from high stress because we have a globalization of increased stress and poor Mental health as we talked about earlier, the food system We're seeing an increase in ultra processed and very overly farmed foods that are generally available And it's really interesting to me as a nutrition scientist to see that across the world, there's malnutrition We have malnutrition with Obesity and we have malnutrition from scarcity But there is a significant amount of malnutrition that is occurring that is contributing to infertility And it's kind of scary. It is very scary. You know, especially I have all boys, but you know, starting to think about the ramifications. There's also escalating issues related to, you know, male sperm counts being low and dealing with male factor infertility. So these are definitely concerns that everyone should embrace. I feel like we would be remiss if we didn't at least touch on contraception because I'm thinking about the young women that have irregular cycles who are told by their provider, hey, we've got a fix for this. They put them on oral contraceptives for ten, fifteen, twenty years. What they don't realize is they' being kept in that low estradial state that low sex hormone state, they're missing out on the peak opportunities to build bone and muscle. in their twenties and thirties, I speak from personal experience. So I would imagine that when you're talking to clients or dealing with your research subjects, do you have preferences of How to address contraception because I want to respect a woman's right to choose. and I am a believer and, you know we have to find the solution that works best for us. What's interesting to me and I was asking several girlfriends, how many of us were on oral contraceptives in our twenties, te, late teens, twenties and early thirties? how many of us felt terrible? You know, we didn't realize we didn't actually have bad PMS It was a byproduct of being on these synthetic endocrine disrupting chemicals, So help us kind of understand the net impact of contrption on training and how you know, what can we do to optimize? if we need to find a good option for contraception, but also beinging cognizant of what's going on behind the scenes with regard to some of these medications What I get really frustrated when GPs will say We'll put you on an OCO jet, period. because withdrawal bleed is not a perod,? And so many people are like, oh, yeah, I have a regular cycle. I'm on the oral contraceptop fillld. It's like, Well, first and foremost, we know that the OC down regulates your natural oarant function So it's not representative of your intocrine system. We can't tell if you're over traraining, we can't tell if you're adapting because your intocrine system is so important When I'm talking to my athletes or I'm creating a research study I want to know not only if they're on an oral contraceptive pill But what generation of the progestin and how much Eestrdio becausecause those all affect people differently and outcomes differently So I tell people that OC is experimental in its own right because there's so many different formulations and variations. And it was just last year that a study was released looking at the amygdala and some of the brain volume of young girls who were put on OC and how it shrunk it and increased the capacity for anxiety and fear And for adults who went off it, that was reversible, but they don't know if that is true in younger girls who are still developing. That's a question that still needs to be answered, right? And we're looking at it' twenty twenty four, we're just getting these answers. So it is a little bit of a misstep because there's so many girls who don't understand, right? Because they get put on it and they don't understand what are the ramifications. So when I give a talk about this, I'm like, look It's your right to choose, but I want you to know that you want to know what amount of estrodol is in there. You want to know what progestin is in there becausecause there are different generations, they all have a different function. If you are put on an oral contraceptive pill for irregularity, when you get off, you're still going to have irregularity If you are within the first three years of your menstrual cycle and you're having irregularity, you should not go on an OC If you have bad skin, you don't go on a OC. We have really, really good dermatologists and really advanced science to understand and help with skin issues. If you have heavy menstrual bleeding or maharia and you have other issues that might require you to be on it, well let's take a look We know that you can use transmenic acid or You can use passion fllower extract for heavy menstrual bleeding. We also see an IUD is really effective for that IUD is very effective for endometriosis And you will still have your own natural ovarian function if you're using an IUD If you are some of my tactical athletes who are out in the field and they have to go on mission, they don't know what's going to happen, IUD is where they go because they won't want to worry about taking a pill the same time every day IUD after maybe two to three cycles Almost completely ameneric from ovarian dysregulation, but from aophagy So the nometrial lining becomes so thin, the uptake can be through autophagy instead of a bleed So I get frustrated with the lack of education that the medical field has becausecause they've been around since the sixties. Well, actually earlier than that, right? And then we have the other side of the coin where now people are talking about menopause hormone therapy and comparing those two. And they're completely different R? So we see Contraceptive formulations are completely different from hormonal therapies for menopause and other low ovarian function. And people don't understand that either because there's that lack of commommunication and lack of education Yeah, it's so interesting to me because I think that there's this lack of fully informed consent, not done for any other reason other than for the most part, for the traditional allopathic medical model We're looking for a solution to a problem at full stop. and that is really what we are focused on versus understanding that a lot of the women that are started on oral contraceptives as one example probably have Polycystic ovarian syndrome is the number one anocrine disorder not hypothyroidism, like many people believe you put someone on oral contraceptives who has PCOS, you're not fixing the problem. You're actually putting a little blanket over it. And I think many, many people don't understand that the withdrawal bleed they get on oral contraceptives is not actual real perod bleeding The other thing I wanted to mention is that doses of estrogen in oral contraceptives have tremendous range anywhere from twenty to fifty micrograms. What I found interesting as I was preparing for this is that progestins, which is that synthetic form of progesterone first and second generations like you know, Depo Pvera, Marinna IUD tend to be more Androgenic. I know you know this. I'm just kind of including this into the conversation tend to be more androgenic And so it's interesting when we're looking at contontraception is just one piece of the puzzle. There's so much more to it than we actually give credit for. And nothing is more frustrating to me as a clinician and middle aged woman is to have a patient say to me He, I finally got put on HRT. I'm like, great, what are you taking? And then they tap them like That's the pill That's not actually menopausal hormone replacement therapy, that's actually quite different. And I'm sure you probably find that to be baffling as well that you're like they're not synonymous. They're quite different. Different dosage, different purposes Are you sometimes surprised when you either see people talking about this or there's this lack of information? patients don't realize they're assuming that they're getting what they're asking for. And then they find out after the fact, oh no That's actually a contraceptive. Thank me. first at Stanford and I was working with Marcia Stefank, who was the PI for the Women's Health in Initiative So I've been into that data and It didn't dant on me that the peopleeople who are outside of that data didn't realize that that whole study was designed to look at late post menopausal women. who were ten or or more years post menopause to see if then taking hormones would help with some of these risk factors that came up with menopause. So when all the scaremongering came out about menopause hormone therapy No one identified the fact that it was a late population that should never have been put on hormone therapy anyway So now we have the penulum swinging the other way where now we're hearing the rhetoric that everyone needs to be on menopause hormone therapy for brain health, for cardiovascular health or bone health to prevent body composition change none of that's true. So I get very frustrated when people are like, o I'm going to have to be on menopause hormone therapy for my bones. I'm like, oh, wait a second. You are forty one and you have the opportunity to do some jump training, some resistance training, build your bones, get some good health factors in there. You don't have to go on menopause hormone therapy. Oh I need to because I need to also look after my brain. like there is no evidence. to show that going on menopause hormone therapy helps with cognition and demention or dementia We know that exercise does We see high intensity resistance training, high intensity exercise, both of those types of exercise significantly help attenuate cognitive decline. And so there's that whole like like I said, the whole pendulum shifting, right? And again, it's a lack of education because everyone is looking at that pharmaceutical fix. Let's just take a pill and make it easy So when we're looking at oral contraceptive pill That's a blanket like you were saying And one of the scary things when you mention the depot, is if you're on the depot for more than a year, then you can kind of say goodbye to your bow mineral density because we see that it significantly drops your bone mineral density. It just attenuates the responses for building bone And the longer you're on it, the worse it becomes On the other side of things, for women who have a diagnosis for osteopenure osteoporosis goingoing on menopause hormone therapy because it's transermal estradile can help So there is treatment effect of using menopause hormone therapy for helping with bone at that end of things So you do have to understand what the two different ends of the spectrum are and why you want to use it instead of listening to everybody saying All teenage girls should be on oral contraceptive pills. I'll get shot for saying that. But yeah, that's how I feel now menopause hormone therapies. when there's like all women who are in their mid forties and onwards need to be on menopause hormone therapy. It's like, no, no, no, no We have to unpack each individual and see what the needs are so that we can say, yes, you are a candidate for this or no you're not, or let's try all these other things first. because Both OCs and contraception for things other than contraception, can have a time and a place, depending on health needs Same with menopause hormine therapy. But there are lots of other interventions in between that we can try because those are just tools in the toolbox Yeah, I love that that you're kind of bringing up that point because I think that Lifestyle as medicine needs to be at the forefront because to your point, If I put a patient on HRT, And technically, it's appropriate because they're menopausal and they're having symptoms, but we haven't addressed the sleep, the stress management, the training And let me be clear, I think most women are still training like they would at eighteen at fifty and they're wondering why it's no longer working. So let's take a couple of minutes just to kind of talk about the different types of training that are beneficial for women in perimenopause and menopause, which is a different focus than an eighteen, nineteen, twenty year old athlete or you know, someone who can as the parent of a child who plays college level lacros, like what his body can handle right now is very different than where he will be in thirty years, and that's okay So let's talk about training needs for women and in middle agge Yeah. so I like to tell women that Our hormones are really good because they affect every system of the body and help us adapt to stress because the idea of having a menstrual cycle, you have ebbs and flows And we see there are changes in the brain across the inital cycle, which is why we see changes in our cognition ability, our aggression, our motivation, depression, anxiety, because our hormones flx our brain as well We also see that there are times where we can recover better and there are times where we don't. And so we see that our hormones affect everything So when we start to get to perimenopause And we're having more and more an avulatory cycles, so we're not having as much progesterone. We're having changes in our ratio of estrogen progesterone, changes in our estrogen receptors or progesterone receptors. Everything's all over the show So we have to think Remember when we were talking about puberty, how everything's all over the show? We need to re teach our girls how to run and land and jump and all those things When we get to this end of things, kind of the same thing. We have to look at training as a way to mitigate the changes that are happening And we have to look for an external stress that is going to create an adaptive response the way estrogen progesterone used to So when we're looking at those factors, we know that estrodiol or E two at our powerful estrogen as reproductive women. is responsible for things like the satellite cell stimulation for lean mass development alsoso for bone turnover and bone density Also for metabolic control are blood glucosin or uptake in insulin We see that progesterone is helpful for Things like bone mineral density and our bone uptake. we also see that it is responsible for a lot of our vagal tone So when we're looking at what's happening in perimenopause and we're starting to see a loss in strength and power, we're starting to see more of the cal fat, we're starting to see more inflammation and oxidative stress. We're seeing a misstep in our brain metabolism because it's becoming hyp metabolic, meaning that it's not using blood glucose very well We going to take a pause and say, o, what kinds of external stresses can we put on the body to change all of us for the better. So we see that heavy resistance training is really essential across the board first step and this comes from someone who is a long term endurance athlete. like I did twenty marathons before I was twenty. I've done Ironman. I was on the crew team, so all that stuff, right? So as we get older, we look and see how important resistance training is. And I don't mean booty bands, I don't mean the five pound dumbbells likeike lifting heavy loads Because when we lift heavy loads We have a nervous response Brain is stimulating muscle contraction in the fact that we have to lift this heavy load So now we have faster nerve conduction, which creates more acetylcholine, which is our neurotransmitter that's responsible for how fast nerve conduction happens We see that there's a signal for our two muscle binding proteins, Mycin and actin to actually bond and hold together more tightly And we also see that there is a stimulation for developing lean mass from the nerves saying, hey, wait, we have to be able to have the ability to lift this load because it's going to happen again So that's our adaptive response to our external stress, where estrogen used to be responsible for those three things. When we're looking at our metabolic control We need to do high intensity exercise. So we're looking at intensities that are eighty percent or more Preferably sprint interval training, which is thirty seconds or less, as hard as you can possibly go. becausecause now we're looking at creating some epigenetic changes. So we're looking at increasing the muscle, skeletal muscle ability to open up and allow carbohydrate to come in without using insulin We're seeing more myokines, which are a little signals that get released from the skeletal muscle during this high intensity exercise that then tells the liver, you know what? this estrified fat that's circulating? We don't want it to be stored as veral fat. We want it to be converted into usable free fatty acid for the muscle in the mitochondria So then we're reducing that the cereial fat storage and gain We're also producing lactate at those high intensity exercises. When we're producing lactate, we're improving brain metabolism. Why it's so important is one, if you remember at the beginning I was saying that women are born with less glycolytic fibers than men So we have to work on our lactate production Date is not a negative byproduct of exercise It is a preferred fuel for the brain and the heart the more lactate reproduce The more we're providing fuel for the brain so that we have more neurons that are able to talk to each other. We're having better nutrition for that couctivity. And we're also increasing the amount of brain neurotrophic factor that's being produced, which improves brain volume So when we're talking about using exercise and different modes and different intensities to improve overall responses as our hormones drop We also see that these different modes and intensities also address those problems that people are talking about why they should be going on menopause hormone therapy For're looking for brain health Resistance training. and high intensity work Those are the two key things for having faculties around you when you're one hundred years old We also see that strength straining improves the amount of muscle that you have. muscle is very metabolically active. It helps increase our body's ability to control blood glucose and our metabolic responses. we also see that high intensity and resistance training again helps with the crossstalk of the skeletal muscle to the liver and fat storage to say we don't need it And the other thing about resistance training and high intensity work like plyometrics, jump training, is it's all signaling for developing bone and maintaining bone density. So when we're looking at what do perimenopausal women need to do, they need to polarize their training and making resistance training the bedrock And then you pepper it with high intensity work, that one hundred and fifty minutes of modern intensity activity that all the guidelines put out That's Fine if you don't move it off likeike work up to that But for someone who's already moving and someone who's already living a fitness lifestyle not appropriate at all It puts people in moderate intensity that doesn't do anything It doesn't challenge the body enough to create that adaptive stress does create more of a cortisol response. And when we have elevations in cortisol, then we don't get the positive outcomes that we want from exercise. And I see it all the time because when I'm like, I don't understand, I'm exercising, but I'm not getting any change. I'm getting tired, I'm getting slow, I'm putting on belly fat. I can't sleep very well, what's going on It's like let's polarize the training. Let's pull it all the way back and think about quality over quantity and putting a lot of push pull motion from load in there to really strengthen the muscle, create these responses and improve our bone strength. And when we start doing that, we see really good positive outcomes over the course of twelve to sixteen weeks You know when we're talking specifically about strength training Do you feel that there's a minimum necessary amount of time per training session, like do you need at least thirty minutes or can you do two sixty minute sessions per week? What's the frequency with which you recommend And again, this is like a high level recommendation. Everyone's their own bio individual what are your typical recommendations or suggestions? further you are in menopause, the more frequent doses of activity that you need. So if you're ten years or more Post menopause then smaller duration, but more frequently across the week is what we see is very effective When you're in peri and early post menopause, we say three times a week resistance training And it can be, you know, maybe twenty minutes So we're going in and maybe on Monday you're doing a squat focus. so you're doing some heavy squats and some single leg lunges and then you call in you're not super setting, you're not spending all this extra time doing ourur triceps, our biceps, all of that kind of stuff. we're not after that. We're doing compound movements Wednesday might be push pull where you're doing bent overhead stuff, you're doing you know bent over row, anything that's upper body push pull. And then Thursday or Friday, you're going in and you're doing all your posterior chain, right? And so you're hitting major compound movements three times a week twenty minutes Its not of doable. And that's why I was trying to get you to define that becausecause I think many people hear three to four times a week and they're like, oh my God, I'm gonna to be in the gym for three or four hours. And that's not what you're saying that actually those people benefit. When we're talking about bone mineral density You know, multid directional stress, jump training Where do things like weighted vests or belted, you know, you see someone wear a weighted belt, where do those factor and do you have a preference for those? Is that part of your suggestions or recommendations Um no. I look at weighted dress and I get frustrated because I see a lot of injuries that come with them because it's changing center of gravity and center of mass for women whichich alters biomechanics. So I see a lot of women who are walking up our big hill with weighted vests, right? And so they're like, oh yeah, I'm putting more resistance on to create a harder workout. It's like, well, you're changing your biomechanics and you're putting yourself in moderate intensity because you can't do a twenty minute up the stairs and hold that intensity where we need you to weighted belt Move is the center of gravity back down, but it's still kind of the same thing. I do say if you're going to be doing some sprint training, maybe you warm up with a weighted belt so that when you take it off, you can go faster I like that. See, that seems completely reasonable Let's just touch on bone health. I know we kind of talked around it the impact of osteopenia, which is not technically a real diagnosis but for women that are Maybe they were on oral contraceptives for a period of time. They missed out on those peak bone and muscle massks building times in their twenties and thirties But they get a diagn diagnosis of osteopenia I'm assuming the jump training or that degree of multidirectional stress is going to be a benefit Where do you feel like introducing HRT kind of fits into that. I'm presuming it's after we've already done all these lifestyle measures. If we're still dealing with some degree of osteopenia or even osteoporosis, that might be the time to introduce the estrogen Yeah. so ostate opinion that low normal or lower than normal bone We see if you're doing proper resistance training and maybe some impact, not jumping how we all learn with soft knee landing, but actually absorbing the impact into our bones. So you're not jumping high, you're just landing hard. You do that for twelve weeks and we see an improvement in bone If we're very consistent. consonsistency matters We're talking about osteoporosis, that takes longer. I have seen women who have been very diligent and consistent in their heavy resistance training four times a week with some ply metric work after two months of that kind of stuff Phasing in and then over the course of six to nine months, they get into normal bow mineral density range. So it's possible. takes hard work and consistency And if you're someone who's like I'm not that consistent and hit or miss on how hard I work then you might want to think about using some menopause hormone therapy as that transient as you are building that bone And then think about getting off it. once you've put in those implementations of lifestyle It's the same thing and like with the Ozimbc conversation, right where people can use it as a tool to help them get weighed off, but they have to put in the work They have to put in the work and then they can get off the drug and maintain that work. So it is that tool to improve the outcomes to get to a better starting point But that starting point doesn't mean that you rely on the drug and then start something. gives you that buffer of while you're implementing change, you are garnering benefit. to a point where once you have all of those lifestyle changes in play and you're really consistent and you're working well, then you can get off the medication and continue That's very helpful And for most middle aged women, one of the greatest pain points is weight loss resistance. And I find for many individuals, you know, theyve grown up in this know this diet culture where we count our calories and we exercise to offset what we've eaten What are your thoughts on CCO? So calories in, calories out. I probably know the answer to this, but I always like to ask this question of guests because I really want listeners to be reaffirmed and understanding that That is calories are just one of many things that impact our weight. And I think there's too much emphasis and focus on it I wait Christmas time when all the magazines come out and say, if you have four cookies and you have to run on the treadmill for thirty minutes, it's like no, you cannot out exercise a bad diet And it's not about calories and calories out because fourour calories of protein respond differently in the body than four calories of carbohydrate We see a lot of the weight loss resistance ind middle aged women occurring from gut microbiome issues, because we see a significant decrease in the diversity of the gut microbiome when we start losing our sex hormones And when we're losing that diversity, unfortunately, we're having an overgrowth of the bacteria that responds to stress because our bodies are under a lot of stress with this hormone perturbation. We're seeing an increase in our baselineg cortisol, We're having issues sleeping All of that is being perceived as stress, which feeds the gut bacteria that creates more oesogenic outcomes Then we see that really happening about the three to four years before menopause actually hits. And this is where a lot of women are like, I'm putting on Mennobelly and you know, so what do I do?s like But we also have to talk about increasing the amount of really good fibers fruit veg because that really does help with that gut markco biome diversity, which increases our ability to change our body composition. but also, because we've all grown up in the seventies and eighties in the diet culture and the calories in calories out, I see so many women who are under ereating. People are like, what what do you mean? I can't lose weight. I keep putting weight on. I don't understand. I'm training harder and I've cut my calories, but I put on five pounds in the past month It's because you're not eating enough You cannot change body composition if you're not eating en not. And we hear, oh, well, you know, your metabolism slows down when you hit menopause. It's like, no, doesn't slow down. What happens if we stop moving as much because we're so tired from all the changes that are going on. But if you're moving on a regular basis, then you also need to fuel for it And I mean, I just got through going through a cohort of ten women who were varying ages from mid thirties to their mid fifties, and they all had the same profile of under ereating, even though they were active because they were all following the fitzbow information of calories in calories out. I need to restrict, I need to do this, I need to do that And once they increased their food in around their training and they were eating according to their circadian rhythm, all their blood markers looked better. all their body composition changed and it's like, look, food is really important But it's the quality of the food that we're having Yeah, it's so important and knowing that you're touching on the gut microbiome, the changes in diversity This is the area focus of my next book. So it's completely timely. And I echo everything that you're saying as someone that for many, many years used intermittent fasting as a strategy to manage the changes that were occurring in perimenopause I still eat within a twelve hour window. I just don't intermittent fast and to be completely fair and transparent And I've said this on the podcast over the last several months multiple times In order to put on muscle, which is what I need to do at this stage of my life I have to eat three meals a day And I have to eat enough protein with each meal. And what I found interesting, and I'm going to say this for the first time publicly on the podcast You know, my goal has been to put on five pounds of muscle And I can tell you that Eating three meals a day when I've gone eating two meals a day for like eight years, I have not put on weight and I think a great deal of it has to do with the fact I probably unknowingly U ereatating and putting on some muscle is allowing me to have a bit more latitude. So I kind of enter this as a cautionary tale because I feel like many, many women point they under eat, they don't realize they're overrestricting. They don't realize they're over fasting because it just has become their norm. They're not hungry for another meal And so I think this is a really, really, really important point to make that we can course correct, we can change things. We don't have to do the same thing And to your point about, know, having women in their thirties, forties, and fifties that started eating more food and they're able to change body composition. I think that speaks volumes. So I'm so appreciative that you shared that One thing that I would love to touch on is to talk about protein because I think many women Urereat protein habitually, chronically And as we get older, we need more protein, not less. Can we speak to this? becausecause I think this is such an important point to reaffirm and reestablish so that women understand like when we talk about nourishing your body, not in your eating, we really want you to eat the protein because we need more to stimulate muscle protein synthesis at this stage of life Yeah, absolutely. I mean, protein's really interesting and I always start the protein conversations with, I want people to realize that the recommended daily allowance of protein is based on the least amount to consume per day to prevent malnutrition We also see that the recommended daily allowance for women is based on Older? Sedentary men who were assumed to have the same body composition as women who were in their twenties And we know that that's not true, differentere quality of muscle. And old nitrogen studies that don't work So when we're looking now at protein and what's happening, especially in peri menopause One, we're becoming less anabolically sensitive to resistance training and protein intake. So we need more. We need more resistance training to stimulate muscle We need more protein to build that muscle. The other thing is what we call the protein leverage theory. So what we're seeing is this loss of lean mass, which is creating a need for more protein. But instead of eating more protein, women are craving more carbohydrate because it's a stress on the body where we're losing this lean mass we're in a catabolic state So we need to make a conscious effort to eat more protein in order to preserve and to build lean mass and to prevent that body fat gain for women who are trying to lose weight as well in that slight calorie restriction, not full calorie restriction to slight. If you have a higher amount of protein intake, then you're preserving and building lean mass and facilitating body fat loss Whereas if you don't have a high protein intake and you're trying to restrict calories, the first thing that goes is lean mass So we need to really put that emphasis on protein. and in our generation, we haven't had that conversation around protein. It's all about carbs and fat, that's what we've heard from the seventies to now. And now it's protein coming into play. and people are like, oh, I don't know, how do I eat that much protein? It's like, it's not really that much. If you're thinking that palm size is about twenty five grams and we're thinking one gram per pound as a minimum It's not really that much protein. and you can get it from all sources. You can get it from combination of Enami and seeds and nuts and eggs and yogurt and fish and meat and just a whole bunch of different things and it doesn't take much. If you're having lots of variety of fruit and veg and grains and lean meat and dairy, then you're going to exceed your protein intake Yeah, I think people are oftentimes surprised. They forget about some of the plant based sources of protein that they can use complelmentary to kind of buffer their protein intake Now I'd love to end the conversation talking about supplements. I know that we have some shared supplements that we enjoy. When you're talking to your female subjects or talking on podcasts or publicly, what are some of your favorites that you think for women in perimenopause and menopause can be most beneficial Be your team for one. So Good nod of the head there, yeah. Creatine is the good one for all of us. so important because one For women who are eating less and or following vegetarian and vegan type diet, don't get enough creatine anyway And we also have less stores than men. We also see that creatine is so important for the fast energetics of our body we're talking about gut health, heart health, but in particular brain and brain metabolism So we really want to push creatine for health And we also can see a benefit for muscle performance It's only three to five grams.' not a lot and When we start seeing women who start using creatine, not only do they mentally feel better, they're also seeing better muscle performance. It takes about three weeks to fully saturate though. So it's not something that you just take a one off before training, It's something that you actually want to take on a daily basis The second one that's really important is omega three fatty acids especially in perimenopause for cellular integrity or having more oxidative stress, we need to really prrotect our cellves. And so mega three fatty acid is super important And the third one I often talk about is vitamin D because we see such a precedence of low vitamin D intake and low vitamin D levels. We have a lot of the slip slap slop in the sun, right? So we have a hat and sunscreen and a shirt. So we aren't getting that sun exposure U we're also looking at a lot of time inside. and the ultra processed foods aren't doing any good. So we're looking, you know If you need to supplement then vitamin D three, but also thinking about how mushrooms are your friends because mushrooms are really good sources of vitamin D So those are the three big ones that I talk about for the most part. And then they're the individuals. like if you're having sleep issues, you might think about Lthianine. If you're having stress issues, you might look at other adaptogens. And if you're having iron issues, then maybe we look at what kind of carbonyl iron and how to use that? But for the most part, most women should really be paying attention to creatine Omegaes and vitamin D I love that. And for women, if they're listening and say that Creatine prompts bloating, it makes them feel like they've you retained a great deal of water. I know quality is certainly important And what do you typically say around those kinds of concerns? So we want to make sure that you're using Krea Pure So this is a German BB a business business company That is all about how pure that creatine is so you don't have any acid leftover, which is from the cheaper versions that can cause some of the side effects and start small. Start with one and a half grams and work your way up to five Kn that there will be some water retention because creatine pulls water into the muscle cell It shouldn't be an overt bloat. If it's an overt bloat, then look at the the type of creatine monohydrate you're having, againain, look for caure. Start at a lower dose and work your way up I love that. Thank you so much for your time today. Can you let listeners know how to connect with you, how to find you on social media, how to pick up your books? Your latest book, which I have right in front of me is nextext level. It's a great resource For all the things that we're doing, it's our website, know doctacyems. com and has all the blogs, you can sign up for the newsletter, it has the courses we're doing, all the books that are coming out, the research that I'm doing But if you're like, I don't want tona go there, I just wantna be on social media. Sweet, that's good too. you can find us on Instagram, Dr. Stacy Sims and for those who still use Facebook, We're there and we're also on TikTok try to post really good Translatable and transparent science. att least four to five times a week. We do some instant lives and that kind of stuff, but it's just really trying to educate women and men Part of the conversation, too Yeah, so that's where you can find me Thank you again Thanks for having me If you love this podcast episode, please leave a rating in review, subscribe and tell a friend