The Exercise & Nutrition Scientist: The Truth About Exercising On Your Period! Women Were Right About Menopause! These 4 Supplements Give Women Optimal Health!

A lot of women come with their partners to see me and say, I don't understand. We're both doing the same training. He's leaning up and getting fitter. I'm putting weight on and getting slower. And that is because we have puberty. We have our reproductive years. We don't have pregnancy in there. We have perimenopause. We have postmenopause.

menstrual cycle each one of those is a different hormone profile that can affect the way we eat and the way we train but no one told us this or what we can do until right now dr stacy sims is an exercise physiologist and nutrition scientist who's best-selling books and over 100 peer-reviewed studies is revolutionizing how women can optimize their health, fitness, and longevity by working with their unique physiology.

We're looking at sports science research. Everything from training to eating, recovery, it's based on male data. And women have been generalized to that data. Things like we see men do really well on calorie restriction and fasting. But for women, it doesn't happen that way. And we'll talk about that. And we also know that during puberty,

for you girls, hips widen, shoulders widen, which changes our angle of the knee to hip, what we call the cue angle, so they don't feel comfortable running or swimming or jumping. And because they're not taught this stuff, we see that by the age of 14, girls who previously were sporty, over 60% of them drop out.

of sport the problem is it's never about how we can empower women to use their physiology to their advantage so let's change that let's go as it relates to nutrition and exercise how do i need to adapt across the menstrual cycle what's your view on cold plunges and supplements like creatine and what's the barrier between men and women as it relates to sleep and then let's talk about menopause starting with perimenopause i'm excited

The diary of a CEO is independently fact-checked. For any studies or science mentioned in this episode, please check the show notes. I find it incredibly fascinating that when we look at the back end of Spotify and Apple and our audio channels, the majority of people that watch this podcast haven't yet hit the follow button or the subscribe button wherever you're listening to this. I would like to make a deal with you.

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and continue to doing this thing we love if you could do me that small favor and hit the follow button wherever you're listening to this that would mean the world to me that is the only favor i will ever ask you thank you so much for your time Dr. Stacey Sims, what is the work that you do and why is it so important that you do it? I look at sex differences in exercise and nutrition.

Because when we think about everything that we know for protocols from training to eating, recovery, it's based on male data. And as a female athlete and working with women across. all ages just trying to maximize their potential you have to lean into different data but people aren't aware of it

So as I'm looking at what I do and trying to empower women to understand their own bodies, realize that there's a lot of research that still needs to be done. So if we think about something like caffeine and caffeine intake, right? And people are talking about how it either boosts them or not. Yeah. If we look at all the data on performance, about caffeine enhancing performance, there isn't anything that's been done on women. So if we're looking at...

How does that work for a woman? We have to look and say, okay, how much... exercise have you done? Where are you using the caffeine? When are you using it? Because we fuel differently during exercise. So we go through blood sugar quickly. Caffeine clears blood sugar. So a woman is going to have to eat when she uses caffeine, whereas a man doesn't have to.

You said it's based on male data. How can you quantify that? Like paint the picture for me that proves this is the case to someone that might not understand the significance of what you just said. So if we're looking at sports science research. And I'll just bring it down to sports science because that's the exercise nutrition research. If we're looking at who's around the room when we're recruiting for studies, for the most part, the language around recruitment is geared for getting men.

because we're using a lot of aggressive language in sport, so it's off-putting to a lot of women. The other aspect about sports science research is there's limited funding. So then we're looking at, okay, how can we get people in that can come in for day after day or week to week? Most often it's men.

When we look at what we're doing, we might be doing muscle biopsies, we might be doing blood draws, and if that's not explained in advance, it's a little off-putting to people. So when we're looking at the major recruitment... strategies and the people that will say, yes, I'll come and do this study. It's 18 to 22 year old college age men. And that's just been the norm.

And when we look at how studies are designed, and we're looking again at who's in the room who's designing studies, primarily it's men. Why? Because we see that most of the PIs on the studies and most of the... I guess, scientists that are coming up in academia are primarily men. When did you realize this? The first time I realized it from an academic standpoint was when I was a second year at university. And I was...

a participant in a metabolism lab, and I was one of the only women. And I standardized properly. I did all the things I was supposed to do because I come from a military family. I know how to follow rules. And at the end of the two weeks of experiments, they threw my results out. Why? Exactly. So I asked why. And they're like, well, your results don't jive with what we thought.

We were going to see they don't mesh with the results that we got from the men. So they're an anomaly. So we're not going to put them in for the context of talking about how carbohydrate metabolism was going. And I thought that was very strange. I was like, well, I've done everything properly. How come mine are the anomaly and those guys aren't the anomaly? How do you know that?

And they didn't have an answer for it. So that was like the sticking point for me to understand why would my results be an anomaly when I've done exactly the same thing as what the men had done. And it came down to menstrual cycle. came down to understanding that one week I was in a low hormone state and then the next week I wasn't. So when I started talking about that, this is where the...

professor who was in charge of the metabolism lab was like, well, we don't study women because they have a menstrual cycle. And we just study men because they're easier and we don't have to worry about hormone fluctuations interfering with our results. And at that point, I was like, excuse me? What? What are you talking about? So that was a defining point from an academic standpoint. But the seed had been planted two years prior when...

My dad, who was a colonel in the Army, was like, so what do you want to do when you graduate from high school? And I said I wanted to be an Army Ranger or a Navy SEAL. And he said, well, you can't. And I said, well, why can't I? And he said, because you're a girl.

I was like, what does that mean? And he said, well, they don't accept women in the SEALs or the Rangers. It's a special ops and they don't accept women. And that was the first time in my life I've ever heard that I was limited because I was. a female and I didn't match what the norm was. So my whole life I'd been playing with boys, competing against boys. I mean...

It was just a normal. It didn't matter if you were a boy or a girl. It just was what you wanted to do. And then when my dad said, well, you can't because you're a girl. That was the first seed that had been planted and really made me upset and said, well, this doesn't make sense. And then when I got to university and that happened, that was the definitive seed that just really pushed me into

the whole academic and sporting career that I've led over the past 20 some years. Give me an overview of that career, the sort of significant milestones in the research that you've done that's fed into everything that you know today. I've been a competitive athlete most of my life. So I would, I raced bikes professionally. I did Ironman. I did Xterra. And I would have teammates who would ask me questions of...

How am I fueling? How am I going to perform my best? So we take those questions into the lab. So we were looking at how do we optimally fuel or how do we optimally... acclimatize the heat when we're at a point in our menstrual cycle where we don't have as much heat tolerance. So that we see when progesterone comes up after ovulation, our core temperature comes up, we don't have as much heat tolerance. So how do we adjust for that?

So there are a lot of questions that would come through just by the nature of being surrounded by competitive athletes and being a competitive athlete. So we look at things like we know now that when you want to do... acclimatization to the heat. And I bring this up because if I live in New Zealand in the wintertime and I'm trying to train for something like Kona, that happens in Hawaii, and we max out at, you know, 10 degrees Celsius.

in the winter, but we have to face 40 degrees Celsius to race Ironman. And we get into a sauna and we want to accommodate for that heat. We know that men can go seven days in a row. and be fine to then race in the heat. But for women, depends on which phase of the menstrual cycle. And if you are going in the high hormone phase, then we say, okay, well, you don't need a primer. You can just go in and do nine days in a row.

But if you start in the low hormone phase, you actually have to go into the sauna for five minutes, come back out, and then go back in and do that during the low hormone phase for nine days in a row. So there are different nuances in the way that your body responds to the heat and is able to accommodate for those heat shifts versus a man can just go in and accommodate for that and be ready for the race.

Give me your CV. Oh, gosh. That's a whole thing. It's pretty varied. What did you study? Exercise physiology and metabolism. Okay. And then got into... ultra running when I was doing my master's at Springfield. And then I started getting into more Ironman distance stuff before I started my PhD. And you went to Springfield College as well?

Yeah. So that was my master's. Your master's. What did you study in your master's? That again was exercise, phys and metabolism. And then you did a PhD. Yep. What was your PhD on as well? So my PhD was looking at... Differences between men and women in heat performance and how you acclimatize to it and how you hydrate for it. As well as looking between menstrual cycle phases and oral contraceptive pill use in women.

And again, all of these topics were designed because of questions I had for myself or teammates had. And then from PhD, I went to Stanford and was working. in the high-performance lab and then moved over to do a postdoc with Marcia Stefanik, who was the PI for the Women's Health Initiative, so looking at hormone replacement therapy in menopausal women.

but also looking at exercise as a cohort to that. And I had another hand in the high performance research in human biology. So I would mesh human performance with public health. And then that transcends into a lot of the stuff that I do now, looking at what can we do, taking some of the ideas from high performance and apply it to the general population.

And how does that improve people's longevity, well-being, but also for those who are trying to be parents, who have a high-performing job, who want to do well in their age group race, whatever it is. How can we maximize some of the things we know from high performance with regards to sleep, heat, cold?

And apply that to a person who's just trying to get everything done and what small things they can tweak to improve their own training and performance. And you've authored more than 100 peer-reviewed studies on exercise physiology. Yeah. And you're a research scientist at the University of New Zealand? I am a research scientist at AUT. It's where most of my PhD students are, and we have a women's health program.

And then I also have an adjunct with the lifestyle medicine at Stanford. So that's where a lot of the public health research comes in. When we talk about the differences between men and women.

What exactly are those differences? Is it just the menstrual cycle that causes these differences? Or is there other physiological differences that we need to understand in order to understand the subjects we're going to talk about today around exercise, nutrition, and the variances between men and women there? There are sex differences in utero. I mean, when we look at... What does that mean? So sex differences when the baby's developing. Okay. So we look at stress and the mom under stress.

we see that there's a higher incidence of a miscarriage if it's a developing boy fetus than a girl fetus, and it has to do with XX versus XY. Then after birth, we see that there's relatively little sex difference. that is apparent until the onset of puberty. But when we're looking at those sex differences that aren't that apparent, there are there. We see that there's a sex difference in what we call muscle morphology. So that means that...

Men are born with more fast-switch fibers, so they have more anaerobic capacity as they get older. They have more ability to produce power. We see that girls are born with more endurance-type fibers. So this means they have more mitochondria for oxygen consumption and oxidative stress and being able to go long and slow. Then when we get to the onset of puberty, we see an expansion of these sex differences with the exposure of the sex hormones. So what we're seeing is now...

The boys are getting leaner. They're getting faster. They're getting more aggressive. But girls' bodies completely change. because center of gravity drops from the chest down to the lower abdomen area because their hips widen. And their hips widen because... You know, being XX, they have to then accommodate for getting pregnant and eventually having a baby from a biological standpoint. Hips widen, shoulders widen. This changes the angle of the knee to hip.

So we then have a, yep. So for anyone listening, there's an image I have here, which I'll put on the screen and I'll also link below. And it's called the Q angle. The Q angle, yes. Which is like the angle of my meter hip. Yep. And it's showing that women's Q angle, basically like the shape of the gap between your leg, is, is it roughly 15 degrees? What is it? Do you know? Yeah, yeah. And so when we're looking at girls whose bodies are changing.

We see that by the age of 14, girls who previously were sporty, over 60% of them drop out of sport because they're not taught that their bodies are changing, so they don't feel comfortable running or swimming or jumping or landing because they have a new...

Q angle, they become quad dominant. Their center of gravity is different. Their shoulders are wider. So they don't feel comfortable running because their whole running mechanics change. So when we're looking at girls who are eight, they can keep up with the boys. right their bodies haven't quite started changing it by the time they're 10.

they're starting to see a discrepancy. And I say that because my daughter's now 12, and I've seen it over the course of the elementary school years, where they used to be on par with the boys playing soccer and rugby and stuff on the field. And then you start seeing a morph where... The boys are becoming more aggressive and they're kicking the balls faster and running faster. And the girls are starting to.

develop a little bit more, getting a little bit more body fat, feeling a little bit more comfortable running. They can't do the monkey bars anymore because their center of gravity is lower, so they can't get up. do the monkey bars as well. But no one explains this to them. So then we see this discrepancy of being sporty, not sporty. We see these changes in body composition.

And all of this is in those early stages of the teen years, which is another knock because we also have brain changes where girls become more self-aware and boys. They're like, okay, you know what? You pissed me off. I'm going to beat you up and we're going to get on with it. But girls are very self-aware and they hold things to themselves in a more negative fashion.

And this creates a lot of mood changes. And this also creates a feeling of... negative body positivity so they don't feel that comfortable with how they look or who they are and society doesn't help that either so this all perpetuates in a socio-cultural as well as a biological change with regards to

exercise. And as it relates to, we'll talk about the Q angle a little bit more in a second when we talk about exercise, but as it relates to the other changes, fat differences in men and women. Yeah. So if we see essential fat for men is around... four to eight percent so that means what we need for our nerves and just survival yeah for women essential fat is around 12 okay so this is for nerves and and

looking around our central organs to survive. We look at body composition itself, we see that women tend to sit around 20% as a normal healthy individual. Although the data has changed over the years and men sit around 15%. And what about the heart? How is the heart different in men and women? So women have smaller heart and lungs relative to relative body size to men.

We also have less hemoglobin. So that means our oxygen carrying capacity is lower because if we are looking at our red cells and we have four different what we call heme molecules in a red cell and each one carries oxygen. our red cell count is lower as compared to men because the red cell count is driven by testosterone. So men have around 100% more.

aromatized testosterone as compared to women so this increases the carrying capacity of oxygen which means it goes to the muscles can deliver more fuel to the muscles to be able to contract better have more power and more strength. Does that mean women breathe more when they're exercising the same? Not that they breathe more. When we're talking about oxygen carrying capacity, this is...

The amount that you're taking into the lungs, how it transfers to the red cells to then be able to go to the working muscles to give the muscles the available fuel. to do a contraction. So it's not a respiratory rate. It's the ability for you to breathe in and how fast that can be conducted to the muscle. So there's going to be an impact on endurance then?

It's more of a power and speed factor. Okay, okay, okay. Because the speed in which the oxygen can get to the muscles is what's being impacted and the volume of oxygen that can get to the muscles. Yep. Okay, fine. And then you said the lungs are... sort of i read 25 to 30 smaller than a man's lungs typically yeah and what's the impact of that as it relates to exercise so when we're looking at

I guess, world records, right, that have been kept. And we see there's a gender gap there. And this is slowly closing in the endurance world, but that has to do with muscle morphology with regards to being able to go long and slow. We're looking at the sprint capacity where we have to have a quick transference of oxygen and quick muscle contraction, that gap isn't closing. And that is because we have smaller lungs, smaller heart.

We have less blood volume. We have less red cells. So the overall capacity for quickly developing power and speed is at a smaller, I guess it's a limited capacity in women versus men. And in your book, Raw, on page four, in the opening of the book, you talk about how women are 52% as strong as men in their upper bodies and 66% as strong as they are in their lower bodies. But when women train, they can become 70 to 80% as strong as men.

So when we're looking at resistance training itself, we see that women relative to men can accommodate and develop muscle just as well as men in the lower body, but upper body not so much. Okay. We talked about this Q angle thing. One of the things that I'm really fascinated by is there's been a big conversation recently around ACL injuries in sport.

Yeah. And from reading your work, it seems that, and just doing some research online, it seems that this increase in women getting ACL injuries links somewhat to this Q angle situation, which again is the, I don't know how to explain it for someone that is listening on audio and can't see. But I will link it in the description. So I highly recommend you look at this picture because the minute you see it, it makes a ton of sense. But it's essentially like, and this is me probably butchering it.

As a man, because my hips don't widen, my legs are effectively quite straight. So from my hip down to my toes, it's quite straight, which means that I'm going to be more sturdy. Say if I jump up in the air, when I land... I know this because my dad's an engineer. The center of gravity being straight means that I'm less likely to get injured. But if you're, is that right? Yeah, because your forces are going to be in a more linear fashion. So you have more.

even distribution of the force through the knee. But for women, as you're going to describe, our hips are wider, so we have more of an angle to the knee, and the forces aren't distributed evenly when we land. So when we look at that, as well as the quad dominance that develops for women, so that means that we use our... with front muscles of our legs, our quads, a lot more than our hamstrings, our posterior chain. So we don't use our glutes and our hamstrings by default as well as men do.

We're being pulled forward more and we put more emphasis on the front of our body because the quads tend to take the bulk of the muscle work that we're trying to do. unless we're really trying to train hamstrings and glutes to fire, which isn't the default for women's bodies because center of gravity, again, is lower and you tend to lean forward. So when we're looking at ACL injury, again, it comes down to...

One, training stress. Two, mechanics. And if we're not taught again how to land, how to run, how to jump with the new angles, it predisposes people to severe ACL injury. And how much more likely is a woman to have an ACL injury than a man? It is a higher rate, but the thing about the research is that there hasn't been a direct comparison. because we hear incidentally that women tear their ACL. And so we see a lot of observational studies that women have torn their ACL.

And we have lots of retrospective studies that are going back to, oh, where are we in our menstrual cycle when we chore ACL? But there hasn't been a definitive comparison between men and women. If we were to look at the current research, we see a three to four to one ratio of ACL tears of women versus men. Three to four. So either three to one or four to one, depending on the research that you look. So three women for every one man or four women for every one man. Okay. So 300% difference. Yeah.

Okay. So interesting. I absolutely never knew that. And in fact, it wasn't until I was looking through your work that I'd seen, I went and did some research and there's a big conversation online. A lot of sort of news coverage around women's football because I think it's the fastest growing sport in the world. But I read that the probability that a woman tears her ACL muscle is significantly, like hundreds of percent more likely than a man because of this.

in part because of this cue angle? In professional sport, it's not as much as when we're looking at recreational sport. Because when we get into professional sport, we have specific warm-ups, especially for football, put out by FIFA. to prevent ACL tear, to make sure that you are actually properly warmed up and engaging the right muscles and learning how to stop pivot because it's a...

The mechanism in action usually is a twisting angle. But if we're looking at more age group or grassroots sports, because people aren't aware of this cue angle, they aren't aware of the quad dominance. women haven't been taught again how to work with these new mechanics. Then we're seeing a greater incidence of ACL tear. 30 female football players missed Women's World Cup in 2023 due to ACL injuries, including...

In the UK, Lioness, Beth Mead and Leah Williamson, which is staggering to me. Yeah, it's very high incidence. So is there something that can be done if you're a woman that's exercising, that's doing... Things like jumping and running and sprinting and fast sort of twitch sports. Is there something you can do to avoid having an ACL injury? It's all about being strong.

So if we're looking at how, what is the biggest thing for ACL prevention? And I'll bring in one of my PhD students that's graduated, looked at ACL rehab after surgery. And it comes down to the definitive difference between quad and hamstring strength. So if we're looking at improving the strength capacity of the hamstrings, then it offsets some of the default.

strength that the quads are taking. So if we're able to balance it from being front loaded to being more even loaded, it comes down to, you know, how we were talking about. distribution of forces through the knee with men being more linear and women having an angle well if we're able to take that angle and we can evenly distribute the load between the muscles of the hamstring and the quads of the front and the back then it pulls the forces more

which reduces the stress of one point of contact. Got you. So if we're developing the strength through the whole posterior chain, we're looking at... glutes, we're looking at hamstrings, we're doing a lot of calf work, and we can develop that whole posterior part. It reduces the incidence of being pulled in one direction and the misalignment of forces. The other is the cutting motion. The more we're looking at

lateral movement. So a lot of times when we're looking at warm-ups and you're observing on like kids' sports, there's not a lot of lateral development. So if we're looking at prevent... prevention of ACL tear, we have to work a lot of the explosive lateral movements as well as jumping and single leg jumping. And these are things that aren't really done in grassroots. But as we start to get more into professional sport, it's becoming more and more apparent that we have to do specific.

mechanism of injury prevention. So they're looking at the sport. We're a football player. We have a high incidence of ACL potential. So we have to really develop our posterior chain. We have to work on our power for our lateral movements, our step and our jump. So this is part of what FIFA's put in for the warmup because there is such a draw. And as you're saying, that 33 women in the World Cup.

toward their ACL. Part of it is loading, part of it is a little bit maybe over-trained before they go into the World Cup, but a lot of it has to do with this imbalance between the muscles and now having to address it. Did science just look at women as a different version of men? Sorry, did they just look at women as like a... Smaller version of men? Is that how they looked? Yeah, for the most part. Because, I mean, a lot of the stuff...

when I was going through school and even now textbooks. So I was standing in the metro in DC a few months ago and there was a young girl who has just gotten into exercise physiology and I overheard her conversation. And she was talking about some of the experiments that they were doing, but it never, she never talked about like, we have to make, you know, we're doing women specific, we're doing men specific. And I asked her, I was like, has anyone talked to you about?

how women's bodies are different than men's from angles and muscle morphology. And she's like, no, what are you talking about? I was like, this is the second year in ex-phys now. And if you look at the textbooks, it's still a representation of men in the textbook with regards to images. You have him or they, you never have her. They might have a very small section in there about the female athlete, but usually it's about the female athlete.

anemia or relative energy deficiency in sport. It's never about how we can empower women to use their bodies and their physiology to their advantage. And it's what, almost 2025 now. Is there any element of it of people being too scared to talk about differences in physiology amongst men and women? I don't think so. I mean, I always explain it from historical perspective when we're looking at the history and...

when we started seeing the modernization of medicine. Prior to the modernization of medicine, it used to be women who were the caretakers. If you're thinking about, you get sick, you go, and someone has an herbal remedy for you. But when we started medicalizing and becoming...

more nuance in the medical education, women were excluded. So when we start looking at the origins of medicine and who was in the room, it was men. When we start looking at the origins of science and science development, it was men. So all the scientific experiments and everything have always been a default to men. We look at AI now, and they're learning from algorithms based on male data. So even now, healthcare is still heavily male-oriented.

So when we start looking at why women haven't been included or why women have been generalized to male data, it's just been the nature of how things have developed. Now that we're aware of it, and now we have more research money coming into women's health. starting to see a change. And part of the two definitive moments in healthcare research that really invoked this change, one was when we started seeing a lot of incidences with Ambien.

and the dosage of medicines where women were getting into a lot of accidents, car accidents, after they'd taken Ambien because it was still in their system the next morning. It's Ambien. It's a sleep aid. Okay. a prescription-strength sleep aid. So then people are like, whoa, what's going on here? Oh, the dosage for 180-pound man is the same as 120-pound woman.

And we also know that there's differences in body composition and metabolism. So a 180-pound man can take this dose and be fine in the morning, but a 120-pound woman can't take that same dose and be fine in the morning. And then we have COVID and the outcomes. of long COVID and the differences between the sexes with regards to women ended up with more long COVID, men ended up dying. So then during the COVID time period.

People were like, whoa, there's sex differences in the outcomes of this disease. We have to really start looking at that. So there's slow things that are... really impactful on society that now people are starting to step and say wait we have to really look at women as women we have to look at men as men. And is there an element of hormones impacting injury?

There's always an impact of hormones. When we're looking at the overlay of hormones and sex hormones and then the protocols that have been developed, they don't take into account. estrogen, progesterone, and to some extent testosterone. So if we're looking at injury and the way that estrogen makes more laxative ligaments, so that means that...

our ligaments become more lax when estrogen comes up, which is why people assume that around ovulation is when people will have more ACL tears. It's not because we also see that progesterone comes in and can have... a different effect on the tendons. But that isn't accounted for in a lot of the protocols that are out there for training and prevention of overtraining.

We see that when we're looking at male and testosterone, there tends to be the more testosterone, the better for developing muscle and recovery. But that's not necessarily true either. So there's nuances in the sociocultural idea around sex hormones that also impact on our actual guidelines and protocols. If a man and a woman came to you and said, I want to lose weight, they said, I'm...

200 pounds and I'd like to lose some weight. Would you give them different advice on what to do? Absolutely. Absolutely would. And it comes down to a lot of... We see this on social media all the time, calories in, calories out, right? So when we're looking at calories in, calories out, that idea of that algorithm can work well in men.

And the reason for that is the hypothalamus. So if we're looking at the hypothalamus, which is an area in the brain that controls appetite, it also controls our endocrine system. So for men... they don't have as many of what we call our kispeptin neurons activated. So this is neurons that are responsible for when we have nutrients coming in.

They fire, they're like, yeah, okay, we got enough nutrition coming in that we can now accommodate for developing muscle and losing body fat. For women, we have more areas that are very sensitive. Sensitive to... to nutrient density. So when I say this, when we're talking about four grams of carbohydrate that come in.

and say they're a carbohydrate from fruit and veg, not from ultra-processed stuff, those four grams of carb will affect the bodies differently between being a man and a woman. For a man, those four grams of carb coming in... primarily will go blood sugar and then be stored as liver or muscle glycogen. For women, it's blood sugar. It doesn't get stored because for women, in order to store muscle and liver glycogen...

you have to have an activation of some enzymes from the liver as well as some enzymes within the skeletal muscle itself to say, yeah, okay, we want to store this. We don't want to circulate it. So then we start looking at how the brain is perceiving that. So the brain is saying, yeah, we can store this because there's still enough muscle tissue around. There's still enough blood glucose that we can keep going and we can survive the day. But for women...

It sits there. The blood glucose sits there. And when it starts being used, the hypothalamus is like, okay, where's the extra food that's coming in so we can keep going and countering the stress that's coming in. And the best way from a numbers perspective to look at it is when we are looking at baseline calorie intake. just to exist and not get into any kind of endocrine hormone dysfunction and appetite dysfunction. For men, it's 15 calories per kilogram of fat-free mass. For women, it's 30.

So we start to see men do really well on things like fasted training. We see men do really well on calorie restriction because the hypothalamus is not as sensitive to lower calorie intake. or to low carb intake, or to high protein and high fat intake. But for women...

because the hypothalamus has more areas that are sensitive to nutrient density. What does that mean? Sorry, I'm not even sure what the hypothalamus is. So the hypothalamus is an area in the brain. Yeah. And it's sensing. So you have blood that... circulates through the brain it senses temperature how hot your your blood is like the thermostat or something of the body yeah okay so it's yeah it is a thermostat it's the appetite control center it's how your body responds to salt

how your body responds to protein, carbohydrate. Do I need more? Do I need less? So it's like the control center for the most part. So for women who come in and they're doing fasted training, the hypothalamus is like, wait a second. We don't have any blood sugar. We don't have enough carbohydrate to actually do this kind of training. So what I'm going to do is I'm going to create a little bit of a dysfunction here and I'm going to start.

down turning all the other systems that need the same kind of fuel because I don't have enough just to do these muscle contractions. So that means you could end up losing muscle. Absolutely. So if a woman comes to me and is like, I want to lose weight. And I've been doing fasted training. I get up, I have a black coffee, I go to the gym, I do my lifting, I do some of my cardio. My girlfriend does exactly that.

And then I'm not that hungry because I did a hard workout at the gym. I might have a protein recovery shake and then I'll hold off eating my first meal until noon. I always turn to them and go, well, why did you go to the gym? Because all you've effectively done is burn through your lean mass. So your body needs to have some fuel. And the first thing that goes is lean mass because it's a very active component of the body.

So it would be better for you as a woman to have maybe 15 grams of protein if you're going to do strength or 15 grams of protein with 30 grams of carb, which isn't a lot. before you go do cardio and strength, because this is just enough to raise your blood sugar, to circulate to the hypothalamus that, yes, there's some nutrition coming in. I'm able to...

get that blood sugar working. I'm able to get that blood sugar into the muscle. I'm able to stimulate the mitochondria in the muscle to actually use some more free fatty acids. I'm able to tell the liver that I can... You actually get through this and use these three fatty acids instead of storing them. It only takes a little bit of food to then have benefit for what you're doing. For a man...

If he's like, comes in, I have a black coffee. I go to the gym. I do my strength. I might do a little cardio, have my protein afterwards. And then I might delay my meal. That's all right. Because you have a longer window for recovery. The hypothalamus isn't as sensitive. You're not burning through lean mass. You're developing a stress on the body. And we know that...

it's really good that you have that protein post-exercise because that's going to create some muscle protein synthesis and hold you over until you have your meal. Okay, so I'm going to try and explain this to you. Like I'm a 10-year-old, which is the exact level of IQ I have on this subject matter. So you've got this hypothalamus in the brain, which is basically this sensor. It's trying to figure out, make sure everything is in... I'm trying to think of that big word that someone taught me.

Homeostasis. Homeostasis. Everything is level, right? And a woman's hypothalamus is more sensitive. So if my partner wakes up, goes to the gym, has her black coffee, goes to the gym, does a big workout, she always does. her body, her hypothalamus, is going to panic a little bit more because it's going to assume that there's stress on the body now and...

It's going to look around to see if it has sufficient blood glucose levels. And it's not going to, because she's not had anything for a while, she's not going to have the sufficient blood glucose levels. So it's going to start burning her lean muscle mass. Exactly. Which means that she's... she's essentially going to, it's like one step forward, one step back, right? Super simplified. For a guy, has his black coffee in the morning, goes to the gym, does the workout, the body looks and...

Because the hypothalamus is less sensitive, it's less requiring of there to be higher blood sugar levels, doesn't care as much. So it's going to... It can also tap more into our liver and muscle glycogen stores. Okay, so it's going to say... Okay, well, we have...

A little bit of blood glucose. We need a little bit more. So let's tap into the stores and pull them out. So it's less reluctant to go straight for my lean muscle mass. Exactly. Because it has an alternative fuel source. That's interesting. And what's the evolutionary story of this? Why does this make sense? When we look tribally, I might get hit by some sociologists who are like, wait, this isn't completely true. But for...

The exception, there are some tribes that didn't fit into this, but for the general idea from a biological evolutionary standpoint, when we had times of low calorie intake. So we had to go find the beast or we had to go out and find calories. It was at a disadvantage for the woman to be pregnant or to have a baby, an extra amount to feed. So in times of low food intake...

The reproductive system or the endocrine system of a woman would wind down. So she would become amenorrheic or lose her menstrual cycle for a while. But it didn't affect men in that same way because they had to lean up. and get fitter and faster because they had to go fight the beast or they had to go find the calories and bring it back.

So when we're looking from that evolutionary standpoint, in times of low calorie intake or low food intake, a woman's body will start to conserve and wind down because it thinks there's a famine coming. But for men... They're not as sensitive and the body's like, oh, not a lot of calories coming in. That must mean there's a fight that I have to prepare for. So I'm going to lean up.

I'm going to address all of my fuel systems so that I can tap into all these alternative fuel systems so that I will have the energy to be able to go and fight the beast to bring the calories back. So when there's adequate calories available, we see that women will lean up. They'll become more acutely aware. Cognitive function comes up.

Carbohydrates are really important. So we see that there is a development of egg maturation. We have better endocrine pulse. So that means that our hormones that pulse on a daily basis, they actually have the full pulse. and return to baseline. to encourage the body to have a really robust endocrine system. So that's thyroid, that's our menstrual cycle, it's all of the things. But when we start pulling the calories back, all that stuff winds down. So what does that say about fasting?

So this is the big debate, right? So we look at fasting and where it first came out and it's like, okay, we see that. Obese, sedentary individuals who had to lose weight rapidly for surgery, they're put on a fasting-type program to lose weight quickly in order to survive surgery. And unfortunately, a lot of those times we look at clinical research and it gets transposed over to health and fitness without actually asking if it's viable. So then we look at...

the lower end of the fitness population. People are just learning to move and wanting to move. And like, I also want to lose more body fat so that I can move better. Oh, I'll start fasting. And when we see a lot of the, like... push on it it comes from male data again so when we start looking at women and a lot of women

used to come with their partners to see me and say, I don't understand. We're both doing the same kind of fasted training. He's leaning up and getting fitter. I'm putting weight on and getting slower. I'm like, okay, well, we have to separate it out. If you're a woman, you want to fast for all the health reasons that we hear about with regards to telomere length, improving longevity, improving our body's metabolic control. Then we work with our circadian rhythm.

where we stop eating at dinner. So we have dinner and we don't eat two to three hours before bed. We have the overnight fast. And then you want to have food within a half an hour of waking up to blunt that cortisol peak that's natural upon waking. For men. you can have variations of fasting. You can do intermittent fasting, you can do warrior fasting, and you can still have benefit. But for women, when we look at the data,

And if we were to do a warrior fast, which is a 20-hour fast, four-hour eating window, for men, we see more parasympathetic drive, so they get that more focus. They have better blood glucose control. acceleration of body fat loss. They become more metabolically flexible, meaning their body's able to transfer between carbohydrate and fat utilization. For women, it doesn't happen that way. For women who do a warrior fast, so that's it. 20-hour fasting and four-hour eating window. They end up...

with less blood sugar control. We have higher resting blood glucose. We have more fat storage. We have more sympathetic drive. So that means the body's under stress and you're not going to be able to sleep or recover well. And we see a downturn of the thyroid within four days of doing this. So when we're looking at the data of fasting, again, it's pulling from the men and generalizing to the women. But when we start really looking and narrowing it down and looking at female-specific...

data, the type of fasting that's out there in the health and fitness world is not appropriate for women. But you would say that the sort of overnight fast, eating dinner at a... Earlier time. At six, seven. Six, six o'clock. And then eating breakfast when you wake up at, say, eight in the morning or nine or something. Six or seven. What about the, like, three-day fast you hear about to get into, like, autophagy or whatever it is?

Exercise is a stronger stimulus for autophagy than fasting. So if we look at exercise in itself as a fasting state, what happens during exercise? You start exercising, your body is trying to provide fuel. So it's breaking down. Fat is breaking down glucose. It's breaking down amino acids. It's also creating, in a recovery standpoint, a boost of growth hormone, a boost of testosterone in both men and women that creates the cell cleanup, which is autophagy.

So if we're looking at the difference between fasting and exercise, exercise is a stronger stress. All the things that we hear about fasting and longevity, exercise does the same. It's a stronger stimulus board. But the problem is we've become a lazy society and people think exercise is too hard. As an exercise physiologist, it breaks my heart to see people who are struggling to walk down the street because we are so used to...

being conditioned to a certain temperature in a room to having a car automatic opener or Uber come so we don't have to walk down the road. And I bring up that movie WALL-E from the early 2000s. with the little robot who's like wandering around society. And you see all these people on these floating beds watching a screen. And one of the guys gets kicked off by Wally, accidentally falls down. He can't get up.

And he's looking around going, well, why can't I get up? What's going on? I'm like, that's today's society where people are not able to actually. pull their own body weight around for a significant amount of time because it feels too difficult. Whereas we look at all the stuff that comes out with nutrition and all the trends that come out with nutrition from fasting to carnivorous diet to... you know, the old-fashioned paleo, all of these things that people are trying to do.

We turn to exercise and we change the modalities of exercise. Are we doing intense exercise? Are we doing low intensity? Are we doing resistance training? Are we doing cardio? What are we doing? All of these things in exercise are significantly stronger stress on the body. that create more adaptive changes than all these crazy diets. But people find exercise too hard or they don't have time. So if I, in that example where a man and woman come to you.

You wouldn't recommend the woman to fast in the same way that you'd recommend a man to fast. Is there any differences that you'd recommend in training if their goal was to lose weight? Yep. Absolutely. So when we're looking at regardless of age for women, because we see that women don't age in a linear fashion like men.

definitive points we have puberty we have our reproductive years we don't have pregnancy in there we have perimenopause we have postmenopause each one of those is a different hormone profile that it can affect the way we train for men you know you just kind of go and we start a decline of testosterone when we get into our late 50s. So we're talking about women and training.

someone is coming in and they're in their mid thirties and they're like, I want to lose weight. Okay. Resistance training. If someone comes in and they're in their mid forties and perimenopause resistance training, it doesn't matter. Resistance training. is key for mobilizing abdominal fat and for creating more lean mass and also increasing the amount of crosstalk between their skeletal muscle and our stored fat.

through little things called myokines, which are hormone signals that are released during exercise and released from the skeletal muscle. So if we say, okay, let's do resistance training to really recomp the body. We also want to increase our protein intake. because we see if you're doing resistance training with a higher protein intake, then we have complete recomp over the course of 12 weeks.

And it's a very powerful, motivating tool for women because for the most part, women have been excommunicated from the strength world until recently. It wasn't kosher for women to have a lot of muscles. We see, like I grew up in the 90s. with the supermodels that were super skinny, right? And it wasn't kosher for women to be in the gym lifting weights.

But we see this evolution change. And so we're starting to see more research come out in women in resistance training. And it's so imperative for body composition change to invoke that resistance training. What about a Zempec? A Zempec, yeah. So I find it interesting because of all the impact it's having on society. And it is a very powerful tool. The problem with it is no one is being...

necessarily taught how to come off it. So if we look at Ozempec and how powerful the GPL-1 is, we see it does invoke an appetite switch where it mutes the appetite. dampens cravings. So we see rapid weight loss, but that rapid weight loss is lean mass. So that comes back to the WALL-E. picture where you can't get up because you don't have lean mass i fear for society who doesn't have the opportunity to learn how to come off it through proper strength training

exercise modalities and nutrition to support the weight loss that comes with those MPEC use. It's absolutely brilliant tool. It's absolutely a brilliant tool, but we're falling on the behavior change. If we were to really teach people how to create that behavior change while they're using the tool, then they can come off it and not be afraid of putting weight back on.

Okay. So would you recommend it for your, for people that come to see you or ask you for advice? No, because most of the people that come to see me have this 10 vanity pounds they want to lose. I call them vanity pounds because they're the ones that creep up and you can instigate little changes within the daily life to actually lose them and keep them off.

For people who are struggling, who have severe obesity, they're pre-diabetic, they have other medical conditions, and exercise is definitely in the too hard basket because they get breathless just getting up out of their chair. We need to lose some weight first.

so that we can then implement some of the adaptive changes of exercise. And do you think women should be eating immediately after they exercise, and men? Or is there a variance there at all? There is a variance, because when we look at... what we call metabolism coming back down to baseline. So that's your overall body coming back down to its resting state. For women, it happens within 30 to 40 minutes after exercise.

For men, it's 2 to 18 hours, depending on the intensity. So in that, we see that if we want to maximize our body's... resistance training, muscle building capacity, we need to give it some food. We need to give it some really good hit of protein. For women who are in their reproductive years, we see 35 grams of protein post-exercise within 45 minutes.

will tip the muscle into muscle protein synthesis. For men, it's 20 grams, and it can be two for whatever hours later. We're looking at returning our... Muscle glycogen back to normal. We don't need as much carbohydrate post-exercise as a woman. as men need more because they tap more into their stores. So the window of opportunity for women post-exercise is around that 45-minute mark, but for men, it's open a lot wider. What about the keto diet for women? I...

am kind of anti-keto for both sexes. And I say this because when we look at the gut microbiome, that is so important. We see a decrease in diversity as we become more and more. I guess, city dwelling, and we are having less and less of variety in our food chain, we have to take care of the gut microbiome. If we look at the ketogenic diet.

And the high fat intake that comes with it significantly decreases that gut microbiome diversity, which reduces the body's ability to synthesize vitamins, to produce serotonin, to have this conversation between the gut and the brain. And for women, we're already metabolically flexible by the nature of being born with more of those endurance fibers, that there's no reason to try to do a ketogenic diet. Could I not take a prebiotic or something or just eat more?

Fruits and veggies and stuff. So if you're eating a lot of fruit and veggies... Sorry, not fruit and veggies. No. If you're eating a lot of fibrous fruit and veg, then that's how we increase the diversity. Taking a probiotic pill... It just affects the upper intestines, but even that is a little bit suspect because there's only two to three companies that are making all the probiotics that are B2B, so that means business to business.

And we don't really know the long-term outcome. And we can have the overgrowth of some probiotics that, again, can cause some dysbiosis. Could I be on the keto diet and still protect my gut microbiome? I don't think so. Not from what I've seen. Because I thought the gut microbiome was predominantly about plants. It is, but you also need some protein.

that comes from a wide variety of different sources. And the amount of fat that is taken in through a true ketogenic diet is 70% to 80% of your total intake coming from fat. And then that will cause the overgrowth of the bacteria that relies primarily on fatty acids, which downregulates all the good bacteria that relies on our fibrous fruit and veg.

Because you're not going to be able to consume as much fiber as you need on a ketogenic diet to really invoke this diversity. If we're thinking about invoking diversity, you want 30 different plants across the week. And on a ketogenic diet, you're just not. capable of being able to eat as much to create that diversity. And the reason why it's really important for women to have that diversity is because we have some gut bugs that are responsible for sex hormone metabolism.

So we think about estrogen, progesterone, people think, oh yeah, well, it's released from the ovaries and the adrenals and it goes and it hits our target tissues. But we have this thing called the second pass where our sex hormones will be taken up by the liver, bound by...

sex hormone binding globulin shot into the intestines through bile, unconjugated or unpacked by these little gut bugs, and then shot back out in the circulation to work. If we have a lower diversity of the gut microbiome, we don't have those bugs that will help with our sex hormone. I guess, reactivation and the ability for the sex hormones to work optimally. What about things like saunas and cold plunges? Yeah. Is there a difference, a variance there between men and women?

Absolutely. So if we're looking at cold plunge, and it's all the rage, right? So we're saying, let's get into ice water. It's going to invoke this massive parasympathetic. parasympathetic response i'm going to have lots of cognition and focus it's going to create a hormonal response that improves my blood glucose

is going to invoke a lot of autophagy and all the things that we see with fasting as well. And it gives me this incredible sense of being in control, male data. We look at women who were in ice bath. it's too cold to invoke those responses. And the reason for that is we have differences in our skin sensation between men and women.

with regards to thermoregulation. So women have more subcutaneous fats and more fat under the skin. And we tend to vasoconstrict and vasodilate first. So that means that blood vessels will... constrict tightly and then we'll start to have some internal changes. Or if we're too hot, we'll vasodilate first and then we'll have internal changes to create sweating. So we look at a cold plunge, there's too much constriction.

and it becomes too much of a threat to women. And their bodies don't have the same response to ice water. We see that 15 to 16 degrees C are around 55 degrees Fahrenheit. is optimal temperature for women to experience the same effect that men have with ice. So there's a sex difference in the temperature to invoke the same response between cold water immersion responses.

In the sauna, everyone responds. And we see that the adaptation for sauna is different again for men and women. Because for women, with the difference of... the vasodilation in the heat before they start sweating. It takes a longer time for core temperature to come up. So women can spend more time in the heat before they start to get changes in their hormone responses.

and blood volume adaptations. For men, they can go in and I kind of laugh. My husband will come in with me in the sauna and I'll sit there for like 10 minutes. I'm not sweating yet. And he's like pouring. He's like, I got to get out. And it takes me like 20 or 30 minutes. in order to get the same response. So when we look at the actual research and data that looks at acclimatization and looks at sauna invoking changes, we see again that women need more time, both long...

longer time for an acute bout and longer time across the weeks in order to get the same cardiovascular adaptations as men. Interesting. I didn't realize that. A typical ice bath is what temperature? It's what minus? 1 or something? I think it's 0 to 4 degrees C. Oh, okay. 0 to 4. Okay. So you're saying that a woman should be near a 15 for the same benefits. Yep.

At my company, Flight Studio, which is part of my bigger company, Flight Group, we're constantly looking for ways to build deeper connections with our audiences. Whether that's a new show, a product, or a project, it's why I launched the Conversation Cards. I've relied on Shopify before, who's a sponsor.

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for listening to my show we're giving you a trial which is just one dollar a month you can sign up by going to shopify.com slash bartlett that's shopify.com slash bartlett or find the link in the description below One of the conversations I had with my partner last year at New Year's Eve was about creatine.

I had some with me on the counter in our home, and we were away from home. And I said to her, I said, oh, you should take some. And her response was, no, that's not for women. And she went on to explain.

that she felt it was for effectively like bodybuilders. Yeah. And that it would like put on weight. And I was like, I don't think that's true. Some people on my podcast have told me that everyone should be taking it. Yeah. And so we sat there and Googled it. And after Googling it for a couple of...

she was like scooping it into her drink as fast as she possibly could. But there is a prevailing narrative here. Actually, before you came, I asked AI a couple of questions about women's perceptions on creatine. And the number one thing was... women thought that it would gain muscle and gain weight. And they thought it was for bodybuilders. Yep. That is the prevailing myths around creatine. And what's the expression people use? The dose or the poisons in the dose?

Right. So that's part of the creatine. So if we're looking at the bodybuilding set and how it increases muscle capacity and training status. So if we're using a lot of creatine, the dosing for bodybuilding is five grams, four times a day. with one gram of carbohydrate. And we see that creatine helps store water within the muscle with glycogen. And we want that for muscle performance because the idea of being able to...

train harder with creatine is to enhance the amount of enzymes that are available for muscle contraction. And creatine is part of the buffering system of that. If we're looking at creatine for health and for women... The dose is three to five grams only once a day without carbohydrate. And the reason for that is women have around 70% of the stores that men have.

by the nature for the most part, don't eat as much creatine filled food as men. And we see that we use it for a lot of our fast energetics. So like for our gut health, for our brain health. And then also for muscle performance. So if we're having women take three to five grams once a day, it does not have the same side effects as the bodybuilding set of taking five grams four times a day.

Yeah, because on the label it tells me to take it a few times a day. Yeah, you don't have to. And it says about loading. So this is all the bodybuilding stuff, right? So if you want to load, we see a loading protocols over the course of two weeks and you're starting to really saturate the body with those five grams, four times a day.

But for women, we see that three to five grams will fully saturate the body over the course of three weeks. So that means that all of our fast energetics, like I said, our gut. the intestines. And we're looking at the integrity of the intestinal cells and the mucosal lining. And we see that there is a greater incidence of GI distress in women. I think it's something like a five to one ratio of women to men having GI distress.

running. And it has to do with estrogen, but also has to do with what we call the mucosal lining of the intestines. So we want to maintain the integrity of the mucosal lining and creatine is really important for that. So if we're looking at saturating the body over three weeks with three to five grams, we improve that integrity. So we have less GI distress. We also see that there have been randomized control trials looking at mood.

specifically with regards to depression and anxiety. And women who are taking three to five grams of creatine... will come out of a depressive episode more so than women who are just using an SSRI. So it's really important for brain metabolism. And when we're looking at that whole loading strategy for men, that's all about muscle performance. It's not about gut health. It's not about brain health. It's about muscle performance. Just looking at some studies creating supplication.

Creatine supplementation for both men and women enhances muscle strength, increases lean muscle mass, improves high intensity exercise performance, improves recovery, has potential cognitive benefits and supports in neurodegenerative diseases. Yes. So Abby Smith-Ryan is a colleague out of UNC, and she's done a lot of work in creatine for women. And yes, we see that there is an improvement in muscle capacity because you're increasing the amount of...

buffer that's available for muscle contractions, but it doesn't have to be the same loading dose as men. If you are looking for performance enhancement because you want to improve a training block or you're in physique building, or you're going to do something like high rocks. and you need to have greater muscle capacity, you might want to try the loading strategy. Yes, you will gain water weight because you're also storing more within the muscle.

But for the general woman who's looking for health and performance benefits, you don't have to do a loading strategy. You just have to do that three to five grams a day. That loading strategy for anyone that doesn't know is basically some of the creatine boxes will tell you the labels will say for the first.

week or two weeks whatever have a huge dosage of it and then thereafter you can kind of ease down the dosage but i think that's kind of been debunked to something that we all need to do in all cases yeah are there any other supplements that you recommend women to take based on the way that we live our lives and the food that we eat? Vitamin D. Okay. And why? And what does that do? So if we're looking at vitamin D, especially vitamin D3. What's the difference?

So you have vitamin D2 and vitamin D3. Vitamin D2 is more of a storage form. It's not converted to being a functional form. So if you take D3, it's already a functional form. So that means your body's going to take it in and use it as it should be. So we're looking at a vitamin D3 supplement. Then we are able to boost circulating levels of vitamin D3 or vitamin D that's usable. And it's used for every system in the body.

And it's really important now, especially I'm coming from the Southern Hemisphere just out of winter. You're in the upper parts of the Northern Hemisphere in the middle of winter, and we don't get enough sun. And when we're looking at now all the worries for skin cancer, people are...

Slip, slap, slop, you know, sunscreen, hat, clothes, and we don't get enough. And then if we're looking at our food supply, there's not a lot of proper vitamin D rich foods. You're looking at mushrooms or fortified dairy products. And those tend not to be consumed a lot nowadays. So if we're improving the amount of vitamin G3 that we're taking in and...

The amount of vitamin D that's circulating, we have better recovery. We have better muscle function. We have better brain health. We have pretty much every system is affected in a positive way. Omega-3. Yeah, omega-3s are good, especially as we get into peri and postmenopause. We want to look at how inflammation affects the cells. So we look at using a really good vitamin, or sorry, a really good omega-3.

And omega, I guess we're looking at the types of omega-3s that are in there. Then we're enhancing cellular integrity that our estrogen used to help with anti-inflammatory properties. It's not something that everyone needs to take. It's something that we have to consider when we start getting into our late 30s, early 40s, maybe get a blood test for it, see how your omega-3 levels are, and then consider dosing with a really good fish oil.

What about iron levels? Because I've had a friend of mine who is a woman tell me that their iron levels were low. This is common. And we see that there's the incidence of... A change in the norms when we're looking at the reference ranges. And I find it really interesting that the reference ranges that we have for all of our blood markers are shifting to a sicker population. What's that mean? So if we're looking at the bell curve and we're taking population data.

Overall, our society has become sicker. So now we're seeing that the norms for iron used to be a ferritin of 50 or lower was considered low ferritin. Now it's 26 for women. We look at testosterone. Lower testosterone now for men is normal. And it is because that is just what a sedentary population now presents. But if someone is active... and comes to me and says, you know, I had my iron tested and it's sitting at 26. And they say that it's normal, but I feel awful.

It's like, that is not normal. If you were part of my high-performance athletic crew, we want to see minimum 50, preferably 100. So we have to supplement you to bring it up. And it's a really specific area of how we supplement. It's supplementing every other day with a very high bioavailable iron. when we start looking at how we are supplementing every other day with either a carbonyl or a glyconate.

then we're really able to boost that ferritin and people start to feel better. What does iron do and how does someone who's iron deficient feel? So iron is responsible for... Those heme groups that I was talking about with oxygen carrying capacity. Hemoglobin, the blood cells. Yeah, their blood cells. So iron is responsible for allowing those heme.

groups to carry oxygen if we have low iron then we don't have enough oxygen circulating throughout the body or being used by the body so you feel very flat very tired you start to get really dark circles under your eyes It's a mission to do anything. So it's like a dead-end fatigue. And people were like, this...

This isn't stress-oriented fatigue or jet lag-oriented fatigue. This is fatigue where I can't even walk up the stairs without getting winded. What foods have iron in them or iron-rich? So... Primarily red meat is where a lot of people turn to. But if you are more plant-based, then we look at leafy greens, we look at nuts and seeds, but using a lot of vitamin C with that.

Preferably adding a little bit of olive oil on our salads. Maybe cooking in an iron skillet to improve the amount of iron that comes into the food. And we also know that... We have to time it with what we call hepcidin or hepcidin, depending on where you come from in the world. It's an enzyme that decreases the body's availability of iron absorption. It increases with inflammation, so it's higher after training.

for about five hours in men and in reproductive women. And it can be elevated for up to 24 hours in late peri and early postmenopausal women. So basically, how do I supplement? Supplement before training. or at night away from training. When you think about men's and women's diets, is there anything to be aware of when we're thinking about, because, you know, me and my partner will sit down for dinner and we share the food. Yeah. So we, you know, food comes out, we...

Even when we go to a restaurant, sometimes we'll order the exact same thing and we'll both finish it. Yeah. Is that okay? Is it working for you guys? I think part of the reason I ask is when I did some... blood glucose tests. I think, if I recall this correctly, my partner was more glucose sensitive than me. And I recall them telling me that women have a greater blood sugar sensitivity than men.

So this is the interesting part. So when we're looking at blood glucose and insulin sensitivity, it changes across the menstrual cycle. So it depends on is she in the high hormone phase or not. If she's in the high hormone phase, which is after ovulation, we have more insulin resistance. And the reason for that is when progesterone comes up.

It's trying to take in everything as a building block for the uterine lining. Insulin resistance, what does that mean? So insulin is the hormone that is a signal for your muscles to uptake. glucose to store it. Okay, so it sends a signal to grab the glucose out my blood, store it, which brings my glucose levels down? Exactly. Okay. Exactly. When progesterone's in the picture, insulin doesn't do its job very well.

Okay. Because progesterone wants to have more carbohydrate available to be able to then send it to the developing uterine lining, the endometriosis. Because the endometriosis becomes a really thick layer of tissue that is really rich in glycogen. So progesterone increases lean mass breakdown or... You increase your protein intake to have more circulating amino acids. It also makes your body less apt to store glucose because it wants both amino acids and glucose to build this lush uterine lining.

When we get into perimenopause, we have more insulin resistance because there's confusion across all systems of the body. And the body is like, I don't know if I'm going to need this glucose or not. So I'm not going to store it. And there's a misstep in the liver and a misstep in the mitochondria, which is responsible for... tapping into using free fatty acids with carbohydrate. So the body's having a higher level of blood glucose because the body doesn't know if it should store it or not.

So when your partner gets tested, it depends on how old she is and what phase of the menstrual cycle or if she's well beyond that. So the part of the menstrual cycle where her... progesterone is highest is when she's going to be most sensitive to sugar. Exactly. And that is typically between day 19 and 23 if she has a normal cycle, a regular cycle. Well, the caveat there is ovulation.

Is she ovulating or not? Okay. And unfortunately, we're seeing in the modern fertility literature that women are having more and more anovulatory cycles, but you won't necessarily know that because you'll still have a bleed. What's an anovulatory cycle? You don't ovulate. Why? They're looking at a lot of the stress that's coming on today's society, the food system, a lot of the...

I guess, trendy diets that are out there. A lot of women aren't eating enough to support their menstrual cycle function to allow the egg to actually develop to then instigate ovulation. And it's not just an act of women, it's across the board. So as it relates to this menstrual cycle, 28 days, I'm going to put it on the screen for anyone that doesn't understand it.

or doesn't know what I'm referencing right now, but I'll also link it below in the comments, in the description, sorry. 28 days long. There's the early follicular stage, the late follicular stage, the mid... luteo. That's exactly what I said. And the late luteo phase. As it relates to nutrition and exercise, how do I need to adapt across these 28 days? And why do I need to adapt?

So again, it comes down to the ovulation, right? So if we're looking at the low hormone phase, so that's your follicular phase. So day one to six, roughly. Yep. And even up to ovulation. Which is where? So around day 12 or 13 on a 28-day cycle. So right at that peak. 12 to 13. Oh, yeah. Yeah, yeah. There. So this is where the immune system is.

really robust and we're really resilient to stress and we can have a lot of carbohydrate and protein intake and we're not going to be that affected. We're more sensitive to glucose. It's going to be pulled into places it needs to be. If we ovulate, after ovulation, like I said, progesterone comes up. It's only produced if we ovulate because progesterone is produced from the breakdown of the housing of the egg. Progesterone...

like I said earlier, will hold everything in the blood. It will tell the body we need more blood glucose and we need that glucose to come to the... endometrial lining. We also need more amino acids. So we're going to break down lean mass or I'm going to make this person crave more protein-oriented foods so that I can have amino acids to come in. So we're looking at adapting. right the only real thing that we need to be aware of is after ovulation if we're going to do a high intensity workout

we need to make sure that we have some more carbohydrate. So we're actually eating before and after having some good carbohydrate that comes in. Which is from day 14 onwards? Yep. So from day 14 onwards, if we are going to do... a lot of high intensity workout or high um a big workout yeah then we need to just make sure we're having more carbs yeah

And then we have around a 12% increase in our protein needs because we have a higher amount of amino acids that are needed. One, because we're developing tissue, but two, we also have skeletal muscle turnover that we need to keep up with. Interesting. So is there any day in the cycle where we shouldn't be working out hard? That's individual. So it used to be...

Early days when menstrual cycle research was coming out, we saw on a molecular level that the low hormone phase was where we could really push it and we could really get really good adaptations because our body was really responsive. to stress. Then after ovulation, we see a fuel shift. Like I said, progesterone is really conserving or pulling glucose away. Estrogen is also sparing it.

and saying, you know, you need to go to the uterine lining. So with the change of hormones, we have a change in our fueling system. We also have a change in our core temperature where it goes up by about 0.5 or 0. five degrees Celsius or around one degrees Fahrenheit, so our heat tolerance isn't as great. But because we're seeing more and more anovulatory cycles, we have to rely on the woman to track her own cycle. Which is hard.

Well, it doesn't have to be as hard as what people think. It's the nuance of how do I feel today? So I tell women, instead of really dialing it in and saying, oh, well, I think I ovulated today, so that means I should back it down. When you go to the gym, use what we call sessional rating of perceived exertion. So I tell people, most of the time you're going to go in, you can have a physical and a mental, right?

Physical, how are you on a 1 to 10? Mental, how are you on a 1 to 10? If physically you're an 8 and mentally you're a 2, warm up really well and see if that mental capacity comes back up. If not... then we're not going to push too hard. We're not going to work on technique because mentally you're just not there. Physically, maybe you are. If you go in and you're low on both of them, then it's going to be a technique and recovery day. You're not.

wasting time at the gym, you're going to make it work for you by really working slow under the bar, nailing technique, not getting the heart rate up so much. And as we're going through and tracking how we feel, we're going to start to see patterns. across our cycle. And we can anticipate those patterns and say, okay, well, I know on day 21, I always feel flat. So I'm not going to schedule a high intensity workout that day.

I'm going to sleep in, maybe do some mobility, recover, and really know that I'm not going to nail it that day. I'm not going to go push myself because I don't want to beat myself up mentally. Because women do this. They're like, I suck. I don't know why. But it comes down to that physiological variability. And for a woman to track her own cycle, understand her own nuances.

really onto it and you know when you ovulate, then you can take those molecular structures into play where you know you can hit your PR and you can really push it in the low hormone phase. After ovulation, you're going to switch it to more. endurance, maybe not so high intensity, but more tempo type work. And then about the four or five days before your period starts where your immune system's more compromised, you just kind of want to dial it down and use it as deload.

So we can take the strength and conditioning ideas of building up macro, micro cycles and deload across the menstrual cycle. So where in this cycle am I going to be strongest if I'm a woman? So if we're looking from a cognitive and a physicality aspect, it's right around where that estrogen starts to come up. So around day six. Day six? To about day 13. Day 13? Yeah. Okay.

And where am I going to be least strong, theoretically? From about day 23? Yeah, yeah. Yep, as this hormone starts to come down. Yeah. To 28. Oh, okay. To the very end. Yeah, the very end. And the variation of those hormones coming down is what instigates a total inflammatory response. So if we're looking at inflammation, which drives the menstrual cycle to start the bleeding phase, we have a change in our immune system.

Bleeding happens at 28. Around day 28. So we say bleeding is day one in a cycle is day 28. Of course, yeah. Day one to day six, typically. Okay, fine. Yeah. Well, I guess the question is, what questions should I be asking about the menstrual cycle? Well, you know, the questions that are never asked is like, what is a typical menstrual cycle? Yes, we have a textbook from 1 to 28. That's very, very rare.

Most women have a cycle that might be 21 to 40 days. The bleed cycle is something that's never talked about. What does a bleed cycle look like? Is it really six days? No, every woman has a different one. And if you're tracking what that bleed is, maybe you have two heavy days, a light day, and another couple of days of spotting, and then a heavy day, that's your norm. When you start having changes in the norm, that's when you want to look and say,

Am I getting into low energy availability? Am I not recovering well enough? Or am I in my late 30s, early 40s, and I started getting into perimenopause? The bleed pattern is so important for people to understand because that's how we have a true inherent... identification of stress. So we see changes in the bleed pattern.

as well as the length of the menstrual cycle itself, when the body's not adapting to stress. And stress isn't just our daily life stress, it's exercise stress. And that disruption could also be just not having a bleed. Yes. Because a lot of women talk about that. They talk about having irregular periods or just the period didn't come this month. Is that often an indicator of...

the body being under stress. Yes. And that stress can be not just bad emails at work, but it could be you're working out too much or something. Yeah, working out too much, not eating enough is the big one. We've done some really interesting research. looking at recreational female athletes. So people who go to the gym three or four times a week, right? They're not training specifically for anything but life. And they tend to fall into...

some of these trendy diets like fasted training or maybe they're eating too low carbohydrate because they're on a low carb, high fat or high protein diet and they're missing on the carbs. And again, that interrupts the hypothalamus. So we call it low energy availability. When someone isn't eating enough for the hypothalamus to say, yeah, all of our systems can work and we can adapt to exercise.

So we see on the upwards of 55% of recreational female athletes in a low energy state or subclinical low energy site. And it comes out as changes in the bleed cycle or a missed period. That's why I tell women, look, if you're tracking, you can do sessional RP, but really track that bleed pattern and the length of the cycle. Because if you start to see changes in the length and changes in the bleed pattern or just changes in the bleed pattern, it's an opportunity.

for you to take a pause. Say, what have I done from a training perspective or a sleep perspective or somehow increased my stress that my body's not adapting well? Because if we do that first, then we don't get into a clinical position of amenorrhea, which is no menstrual cycle, and poor bone health and psychological issues and things that all come with endocrine dysfunction. Why is bone health so important?

for women in particular? When we see bone, it is driven by estrogen and progesterone, an interplay between estrogen and progesterone. We see a peak. velocity or peak bone mass hitting around the time we're 20-ish, and then we'll start to degrade it if we're not creating multi. directional stress on the bone through jumping through resistance training and if we start to lose bone density and we become osteopenic or osteoporitic meaning we have very thin bones they break easily

And it's really, really difficult for someone who is in their reproductive years to be able to do all the things they want to do if they don't have a really strong, robust skeletal system. And this is why vitamin D is also so important. Yes. Okay. And men and women have different bone density. Yep. Men have thicker bones and tend to not have as much degradation of the bone because they don't have estrogen, progesterone perturbations that are changing the signaling to.

increasing bone density or stopping the growth of bone. Right. So women have this perturbation throughout their menstrual cycle that will change how their bones are responding. And then when we don't have a menstrual cycle or we get put on an oral contraceptive pill, we have changes in that signaling, which changes our bones.

density. And you mentioned sleep a second ago. Yeah. How is sleep relevant and what's the variant between men and women as it relates to sleep? Sleep's really important because that's where we have our parasympathetic drive and our ability to recover. So the whole...

I shouldn't say the whole reason because nobody really knows why we need to sleep other than the fact this is where our physical and our mental capacities become solidified. So that means that our body fully repairs while we're sleeping. Our memories get solidified. Our brain becomes...

a little bit relaxed and can repair itself while we're sleeping. For women, we see changes across the menstrual cycle in our sleep phases. So when we are slow sleep phases, meaning our deep sleep versus our late sleep. versus our dream sleep. And we need to get in that really super deep sleep in order to have optimal reparation. When we are getting close to the bleed phase, then we see more interruption in the sleep.

And it's really really apparent for women who have really bad PMS or other conditions that happen to affect estrogen and progesterone. We have an increase in our core temperature from progesterone. We have changes in melatonin pulse because of estrogen. So when women are talking about having really poor sleep right before their menstrual cycle...

it is because we have these sex hormones that are interfering with our sleep phases. For men, they don't have that perturbation. For men, we see that chronologically, they tend to have a melatonin peak that's later. So they tend to want to stay up later and they can sleep in, but they can also have shorter sleeps. So there's a chronobiology aspect that comes to it with regards to how our body actually falls asleep and wakes up.

And there's a sex difference in that chronobiology. Do men or women suffer more with jet lag? Women suffer more with jet lag. And if so, why is that? Because if we're looking at our circadian rhythms and how long they are. Like I said, melatonin peaks earlier for women than men. And we have a slightly different... What does that mean, sorry, melatonin? So melatonin is what allows our body to actually get into sleep. And our wind down...

for that is melatonin production. So a lot of people will start to feel really sleepy at like four in the afternoon, right? It's just a natural occurrence. Our core temperature comes up. We start to have melatonin production. And for women, melatonin peak for sleep. for sleep onset hits around 9pm on average. For men, it's about 10 or 11pm because our circadian rhythms are different.

So women are on a shorter side than men. So we're talking about jet lag. For women going east, it's a little bit easier because it's a shorter. For women going west, it's a little bit harder because it's longer.

so there's a difference men will do better going west and worse going east women go better east than going west when it comes to food i trust my gut and i trust zoe a business i'm an investor in and today's sponsor of this podcast all the nutritionists i've spoken to have highlighted just how misleading information is out there when it comes to food take healthy halos the claims you see on packaging

say things like low sugar and nothing artificial, are often a sign of foods to avoid. Have you ever noticed a health claim on fresh fruit? You probably get my point. Understandably, there's loads of distrust out there. Who should you turn to for accurate information? I use Zoe, which is backed by one of the world's largest microbiome databases and most scientifically advanced at-home gut health tests. Zoe gives you proven science whenever you need it. As a Zoe member...

You'll get an at-home test kit and personalized nutrition program to help you make smarter food choices that support your gut. To sign up, visit zoe.com and use my code BARTLET10 for 10% off your membership. That's zoe.com. Code Bartlett10. Trust your gut. Trust Zoe. Use this term chronobiology. I have no idea what that word means, but that's the biology of our circadian rhythm? Yeah. Okay. Yeah, yeah.

And is there anything else that men and women should understand about our chronobiology that's pertinent to making sure that we're high performing and healthy? Yeah, so this comes down to our hormone and... pulses throughout the day so we see that cortisol which everyone talks about as being a bad thing it's not a bad thing we have a peak

about a half an hour after you wake up. And for women, we need to eat in order to dampen that peak. For men, it just naturally dampens. So you don't need the food to instigate dampening of that peak. We see a luteinizing hormone pulse in both men and women, but the... The amplitude of that pulse is greater in women because it's responsible for how our body responds to developing an egg so that it can be fertilized. We also see estrogen pulses again.

to pulse throughout the day and then throughout the week before we can come to one of those estrogen peaks. So our body is... is a line for these pulses, and we have a 24-ish hour clock, and within that we have cellular clocks. So we have a cellular clock that's telling us to pulse. luteinizing hormone every so often. We have an internal cellular clock that's telling estrogen to pulse every so often. And we can change that through differences in sleep.

change that through our light wake time and through food intake. How important is it to time our meals and be intentional about what we eat? It's pretty important if we're looking about... how our clock is aligned and how we are repairing while we're sleeping. Because if we're eating late and we've shifted everything late because people eat late, they go to bed, they wake up, they're not hungry, they don't dampen that cortisol peak for women.

And then they don't sleep very well because if you are eating right before bed, your body is using parasympathetic response to digest instead of... Invoke really good sleep. So we see a lot of this circadian misalignment that's occurring. We see it a lot in shift workers. We see it a lot in our global society of staying up late and working and having screens.

And the impact on metabolism is that it changes appetite hormones for women, where it will increase the craving for carbohydrates and the desire to eat more, and they don't ever feel full. For men, it's just a craving aspect. And so they'll eat according to cravings. It's called hedonistic eating rather than a true change in appetite hormones. So people who are having difficulty sleeping and difficulty changing body composition for overall health, we shift it.

We're like, okay, we want to shift to be able to eat during the day and to have regular food at regular intervals so that our body has fuel to do what it needs during the day. We stop eating. at dinner time, which is around six or seven, have a good two to three hours before we go to bed so that when we do go to bed, all our parasympathetic responses can go into getting really good sleep architecture. So that means that we get really good.

phases of sleep for optimal physical mental recovery. Because if we have that, then we have better blood glucose control. So better insulin responses. We're able to have more energy during the day and all of our systems work better. I had noticed something intriguing about me, which is when I wake up early to go to the airport. So say I have to wake up at like...

4 a.m. to go to the airport. I am so hungry. Yeah. And I've never understood why. Because if I wake up at, say, 9 a.m., I don't wake up as hungry. Yep. Why? Your brain is perceiving a stress. And this is that hedonistic. Where you're like, my brain is like, I'm under stress and I need fuel. I need glucose. So it thinks like a lion has woken me up. Yeah. Fucking hell, that makes so much sense. Honestly, it's always confused me because...

And sometimes I have to wake up super early, so 2, 3 a.m. to go get a plane or something. And when I get to the airport, I'm so hungry. But like a day-to-day, what time is it? It's 1 p.m. And I haven't eaten yet.

I know you're mad at me. But I haven't eaten yet because I don't want to eat before I do a podcast because then it's going to like, it like messes with my articulation. So I can't get the words out of my mouth. Okay. Maybe that's bullshit. I'm saying this to someone that knows what they're talking about.

Maybe there's something else I could eat. But I just find that if I eat something heavy or generally if I eat, the way that I've always rationalized it is all the oxygen's like going to my digestive system. Is that nonsense? That's nonsense. Is it actually? Yeah.

So can I eat before I do a podcast? Yes, you can. And it won't impact my ability to articulate myself. If you're really worried, then you can have like a protein shake or protein water. You can sip protein water while you're having a podcast. So then you're getting amino acids circulating. Your hypothalamus is like, sweet, okay.

We're all good to go. But I hear you because I don't like to have a lot of food in my stomach when I'm going to be concentrating a lot or trying to articulate. So I eat things that are high in protein but easy to digest. Okay. So like protein water, protein shake would be a good idea before. Or hard boiled eggs. Hard boiled eggs. Okay. Okay. Let's talk about menopause then. Yeah. Starting with perimenopause. Yeah. You got a smile on your face. Oh.

It's something that I'm really excited is coming into conversations now because three years ago, no one would say the word. I knew we had made it as women in society when the nightly news was talking about menopause. So let's go. I'm excited. One thing I saw, which is quite an interesting observation, is in the UK this year on Apple, the most shared podcast episode in the whole country of all podcasts was a conversation I had about menopause.

Nice. And. Congratulations. That's awesome. It gets even better. And in the US, the most shared podcast episode of all podcasts in the US on Apple was the same guest. on Mel Robbins' podcast talking about menopause. I go, that's incredible. And also crazy that in both countries, the number one most shared podcast episode was the same guest talking about the same topic. Yep.

That doesn't surprise you? Nope. Why? Well, I know this guest and she's very good at articulating, but also we have seen this upsurge of women like myself, my age group. Put myself out there. We all grew up on the understanding that we were women. We were a little bit different from men. But no one told us about menopause. And now all of a sudden.

There are these extreme changes that are going on and people are like, what's going on? And if I were to take a typical case scenario of a woman who's in her 40s and goes to a doctor. and goes, you know what? I can't sleep. I am trying to exercise, but I'm so tired. I can't do it. My body is changing, and I just don't know what's going on. The general response... to her three years ago would have been, well, look, you're a woman in her 40s who's highly stressed. You have...

Kids on one side. You have older parents on another. You're trying to, you're right in the middle of your career. You have a really busy life. Here's an SSRI for anxiety and depression is going to help you sleep. But now, with all the conversations that have been going on. A woman in her 40s will go to a GP and for the most part will be told, well, you're in your 40s, it might be perimenopause. And this is such a relief to so many women because they're not being gaslit anymore.

They're not being told that what they're feeling isn't true. It's just something to do with stress. Now they're being told, you know what? All your systems in your body are being affected because your sex hormones are changing. So remember puberty? When everything was changing and no one wants to live through puberty anymore? You're on the other side of that. You're in reverse puberty, where all of your hormones...

are starting to downregulate. So every system in your body is being affected. Let's unpack it. Let's see what's going on. So when Mary Claire comes on and talks about menopause as an MD and talks about... All the things that she's seeing in her clinic, women are like, that's me. Now I understand I'm not alone.

And that's the power that's coming through all of these conversations and all of these groups like Naomi Watts Swell Group, right? They're talking about menopause. So now women are listening and keying in and going, wait a second. There actually are things that are occurring to me and I can get information, which is why these podcasts are taking off because now women are like, I'm not just crazy.

There are actually things happening to me, and people understand that. Now what can I do to help myself? Because it isn't being taught in med school. A lot of the doctors that are out there are getting information because they are seeking it out themselves. And looking to people like Mary Claire and other, like Louise Newsome in the UK, who are actually talking about it and saying, these are the things that are happening and these are the things that we know that we can do.

Gosh, it's a shame, isn't it? It's a shame that there must have been so many women over the years that went to their doctor and got really bad advice and were given antidepressant medications and stuff like that. Well, the other side is women who are in their reproductive years who have something like PCOS or endometriosis.

or they're having irregular periods and they're put on an oral contraceptive pill because the doctors don't understand that there are other things that are going on that will cause a misstep in menstrual cycle. So I get frustrated when teenage girls go to a doctor with irregular cycles and they're handed OCs like Skittles.

That's not appropriate either. We have to actually understand what's going on. We know that there's irregularity in a menstrual cycle until people are around three years post the onset of their first menstrual cycle. It's not unusual. An OC is not the answer. If someone's still having irregularity, we have to look at lifestyle and say, hey, what's going on? They're having really heavy menstrual bleeding. It's not about using an OC to control it. Let's look and see why is that happening.

Maybe we use an IUD or maybe we use some other medication to help. But there's a lot of things that are not taught in med school that women are having to find out for themselves. And so when we listen to podcasts and we're hearing information from medical doctors who now have a...

like a vocal aspect of being able to touch so many people, it resonates. So now doctors are trying to find that information if they have the time. But we know the healthcare systems in most countries, doctors are so pressed for time, they don't have that opportunity. So let's talk about perimenopause. What do I need to be thinking about? And what age group typically is perimenopause?

I guess it can be a wide spectrum, but when does that typically start and how do I need to be thinking about my nutrition and exercise in that phase? So around age 35 up to, I think they say now the average age of menopause is 52 years old. So what's happening in that 15 to 17 year span is you're having such a change in the ratio of estrogen and progesterone. Early days, a lot of it...

appears as I'm not adapting to my training. It's not working well. I'm putting on more body fat. I'm becoming squishy, not sleeping well. I'm having lots of mood changes. It must be, this is why a lot of doctors say, oh, it's because you're busy and stressed out. Here's a serotonin reuptake inhibitor. But no, it's changes in the ratios. How can we dial it in? We look at menstrual cycles.

Is it becoming shorter or longer? What's our bleed phase? When we get into our mid to late 40s, it's very apparent because there are a lot of different changes that are occurring. We're seeing a change in our blood lipids. There's an increase in our low density lipoprotein. which is the quote, bad cholesterol. Even if a woman's never had an issue with it, now all of a sudden she's having issues with her cholesterol.

We see A1C coming up, which is a marker for diabetes, prediabetes, without any real change in what they're doing, other than the fact that their exercise isn't working, their sleep is a little bit disrupted. their body composition is completely changing. And when we're looking at what's happening, we see... that decrease in gut microbiome diversity because we don't have as many sex hormones. So that impacts serotonin, that impacts vitamin production, that impacts parasympathetic drive.

And we're also seeing a misstep in the way liver is reading fat and fat circulation. So we're seeing free fatty acids that are coming around. And because we don't have as much estrogen, we don't have as much anti-inflammatory responses. So we can't pull as many free fatty acids into the mitochondria and the skeletal muscle to be used as fuel. So they circulate. And the liver has a signal that goes, we're going to change that.

free fatty acid into what we call esterified fatty acid, which then gets stored as visceral fat. And visceral fat is that dangerous fat that gets stored around the organs, which is why women start to get like a minnow pot or develop a lot of... abdominal adiposity. So people will start seeing this and going, I don't understand what's going on. Over the past six months, I put on 10 pounds or I put on four stone, right? What's going on? My training is not working. I've become very despondent.

And if they don't know they're in perimenopause, then they don't know that that's what's happening. And how can they find out if they are? Well, it's... really symptomatic because we can't use blood tests. There isn't a definitive blood test to say, hey, you're a perimenopausal. You have to have a history of everything of getting blood tests like every week and no one does that.

So we have to go on symptomology. It's really using the sociocultural aspect of how a woman is experiencing life with her symptoms and really listen and say, okay, well, here are the things that are going on. And we try to instigate non-hormonal options. There's exercise, there's lifestyle. And then...

If all else is really going to shit, then we can look at using some menopause hormone therapy. Just like we were talking about Ozimpec being a tool, so hormone therapy can also be a tool. Does it matter? my pre-existing health when I approach menopause, if I've got more weight on my body, is that going to impact the amount of symptoms that I experience of menopause? It can, yeah.

We see that there is a greater incidence of vasomotor symptoms or hot flashes for women who have a greater amount of body fat. We also see that if you have more lean mass, then you're going to have less of an incidence of insulin resistance. So body composition has a huge play in symptomology. And then you also have to look at what your mom went through. Because if your mom had a really, really horrible time with lots of vasomotor symptoms and body composition change, there's a genetic link.

Doesn't necessarily mean that you're going to experience the same thing, but you have a greater predisposition to having more severe symptomology. How should I be thinking about exercise as I'm going through my menopause journey? So we look at... As I said earlier, exercise is a really good stress for adaptive change. So when we start getting into all these ratio shifts of estrogen and progesterone, we can't rely on our hormones to create those adaptive changes.

And so what I mean by that is like estrogen is responsible for muscle protein synthesis and strength and power for women. Progesterone and estrogen are responsible for bone, bone growth, bone density. We can't rely on our hormones for that anymore. We have to look for an external stress. So this is where exercise comes in. So we're looking specifically at how to invoke a stress to change our insulin sensitivity.

In other words, improve our blood glucose control. We need to do proper high-intensity work. So that's sprint interval or it's true high-intensity work to create a stress that's high enough. To have the brain say, hey, this is a really, really, really strong stress. I need to invoke changes within the skeletal muscle to be able to store more. I also need to invoke more changes in the mitochondria so that it can use and store more free fatty acids.

And I'm going to have more myokine released from the skeletal muscle to tell the liver, don't esterify those fatty acids. I want to use them at rest so we don't get baserial fat gain. So hit workouts? Yeah. Plyometrics? Yeah. Which is what jumping and stuff is. Resistance training? Absolutely. Weights, right? Yeah. But specific to the type of weights that you're doing. What about frequency of training and how long I train for?

We want to think about less volume and more quality. So we're not going to the gym for an hour and a half every day. We're looking at doing short, sharp, high-intensity cardio, or we're looking at doing... power-based resistance training three times a week, and the cardio can be two to four times a week. Why shorter durations of training? We're looking at intensity.

So if we're doing long, slow stuff or we're doing moderate intensity zone two stuff, that's not really going to create the kind of stress that we need to invoke change. What about saunas and stuff like that? Yeah, absolutely. We see that... Women who go into the sauna get better control over things like hot flashes.

Because it's all about temperature and temperature control. So if the blood going through the brain is really hot, it understands, hey, this is what hot is. And can then have subsequent peripheral changes for... controlling heat and understanding heat, as well as central changes to understand heat. And what about food through menopause? Is there a specific diet that I should be thinking about for menopause? We want a higher protein intake.

Of course, because as we get older, we become more anabolically resistant to protein. So that means our body isn't responding as much to the amino acids. So we need a higher dose. to invoke muscle protein synthesis and bone regeneration, nerve regeneration. Also knowing that the recommended daily allowance that's out there for protein, especially for women, is based on sedentary older men.

So it's not really adequate for what we're looking for. So we want higher incidence of protein at regular intervals across the day. And again, taking care of that gut microbiome. So we want a lot of colorful fruit and veg. that also helps with blood glucose control as well as creating that diversity. so that we are able to reduce the amount of bacteria that is responsible for storing body fat. We want to have that great amount of diversity of gut microbiomes.

to or great diversity of the gut microbiome to have more of the bacteria that says hey you know what we want more lean mass we want to have less body fat i noticed earlier on when you talked about hormone therapy you referred to it as menopausal hormone therapy as opposed to hormone replacement therapy yeah most people could say hrt right right why do you say something different yeah

I got a lot of my chops and menopause work through the Women's Health Initiative, and I'm not going to apologize for that. cohort because this study was designed to look at older women going through perimenopause or going through menopause and does it work so there's a whole issue around whi and other things but when we look at specifically women who

are going through perimenopause into menopause, we're not looking to replace hormones. We're looking at a therapy to attenuate change. If we're looking at hormone replacement, that could be thyroid. That could be a premature ovarian failure that we need to have some estrogen progesterone. We're looking at menopause. and perimenopause in itself we're looking at using a hormone dose that is a very low physiologic

level so that we don't have symptomology. So the body is not going to have vasomotor symptoms and is not going to have mood changes and is not going to really have an... incredible amount of body composition change. If we're replacing hormones, people have the idea that it's going to be the same physiologic level as when we were in our reproductive years, and that's not the case.

Is there also a bit of an underlying notion that women are using these hormones as a way to stay young? And when you say replace, you're kind of implying that they're fighting against something. that we are replacing our hormones to stay young and be in our reproductive years. So we look at Western society, and I like to use the cast of friends as an example from, you know, 90s to now, right?

And we see that the cast of Friends women all have a certain look that they've had to maintain in order to be viable in Hollywood, which means that they're thin, they have good body composition, they don't have any wrinkles, they have really good lustrous hair. And that's the image that women have now of how they're supposed to age. Where men, not so much. We see the images of men who are aging, becoming more.

demure, I guess. They have gray hair, they have some wrinkles, they're very distinguished, and that's the image we have of men aging. There's a huge disconnect in society. So when women start to experience perimenopause, it's a definitive point of aging. And people are afraid to age. Everyone's afraid to age for the most part. The idea of aging gracefully or embracing it hasn't quite gotten to the mainstream. So when someone's like...

Here's some hormones to replace so you can stay young. People are like, great. But we look at the research and it's not about staying young. It's about slowing the rate of change that's so severe that creates quality of life distress. And we also see that the research isn't there for maintaining brain integrity to prevent dementia, which is the other thing that's floating around. It's not there. There's no evidence to show that taking hormone therapy is going to stop dementia.

So there's lots of things out there that's a disconnect. And trying to say it's menopause hormone therapy is one way of getting people to understand that it's not an anti-aging agent. It's something to help with this phase of life. and to help get through so that we don't have severe changes to our daily life and who we are as a person. Is there anything else that we need to talk about as it relates to menopause? Just want to make sure we've covered it all.

It gets better on the other side. I think that's something people don't talk about is perimenopause is such the conversation now with all the conversations around hormone therapy, exercise, lifestyle. But no one talks about the other side. Once you've gotten through perimenopause, do my joints stop hurting? Do I stop having all these sleep interruptions? Do I stop having to worry about my bones?

If you're putting in the right lifestyle changes to maintain bone health, yes. On the other side, everything becomes a new normal without the pain and dysfunction. Because it's the shift in hormones that's creating so many different... issues with every system of the body. So if we get through this with really good interventions for preventing or attenuating the changes that are happening, the other side is much better.

And for women with PCOS or endometriosis, is there anything that they need to be thinking about as it relates to exercise or nutrition? Yeah, so there's I guess a huge misstep in the understanding that endometriosis... is an inflammatory response. Yes and no. There's some more emerging evidence that it could be bacterial or viral.

But with regards to endometriosis, we see that if you're able to use some cold water therapy, for the most part, or a cold water plunge, around the time that you think about ovulation, where... after ovulation you have endometrial growth. It reduces the total inflammatory response so that the endometrial lining doesn't grow as much.

So you don't have as much growth of endometrial tissue outside of the uterus. So we're looking at how do we stop that extra growth? We can use environmental cues to help with that. So that's that cold therapy.

If we look at PCOS, it's all about a higher androgen count and we have more insulin resistance and how we're training for... exercise is all about how do we control that insulin resistance so we look at high intensity we look at using resistance training so women who have PCOS they have irregular cycles so we can't

use the menstrual cycle as an indication of stress. So we have to look at things like heart rate variability. We have to look at properly putting in intensity and resistance training to work with blood glucose levels to, again, attenuate. some of the symptomology that comes with PCOS. What is the most important thing we haven't talked about that we should have talked about? That this conversation isn't just for women.

I'm very grateful that you're very excited about the menstrual cycle, but I think... A lot of people kind of tune out when we start to hear conversations about women and conversations about sex differences, but it's for everybody. Because if we're going to push forward and understand how we need to do research to improve the health of women and men, then it's a combination in the conversation.

Yeah, I'm very appreciative to men who come into the conversation and men who are in the room and very appreciative of you for having these conversations because then it pushes it out and makes it normal across the board. Yeah, and the reason I have these conversations is because it's a lot of my conversations at home with my partner. We spend so long talking about her menstrual cycle and about... when she's ovulating and she talks to me a lot about how she's feeling because of that and

uh certain things we should be doing even when we're thinking about like how to spend the weekend it's often decided through the context of like her cycle and then obviously we're trying to we're in the phase of life where we're going to try and have kids now so we're thinking a lot about it there but then just more broadly you know

if something is having such a significant impact on a woman's life, which I think it does, I think it does have significant impact, things like menopause and the menstrual cycle generally, then I'm going to interface with women my whole life. If I have a daughter, I have a sister, I have a mum, I have a partner. So if I can better understand.

um them because i understand how their body is working then we're gonna have more successful relationships and frankly a year ago i didn't even know what menopause was yeah so To be fair, I didn't even know what a menstrual cycle really was a year ago. I knew that women had periods, but I kind of told you with great confidence that...

Different things happened throughout the cycle in that it was 28 days long. I really had no idea. And I'm like 32 years old. And I don't really care about admitting that. But I don't really care because I know there's a lot of people out there that feel the same way.

And we're like not allowed to admit that because then you get people attack you or whatever, but who goes? I had a PhD student who came up to me and he's like, my partner has something to tell you and it's going to come through me. I was like, okay, what is it? He said, she said to tell you that I know more about the menstrual cycle than she does. And I was like, awesome. Because he was looking at women in the heat.

versus men in the heat. So we had to understand the menstrual cycle and how all of that came. And then that upskilled her. So it came in the opposite. Instead of her trying to upskill him, he upskilled her. We don't really learn about this stuff in school. Nobody ever told me about it in school. Do women learn about it in school? Not anymore. It's been cut. All the health programs and everything have been cut. So, yeah, it's really like I give talks and the rooms get full.

of parents who want to know what's happening. Like I give talks for young kids who are, you know, surf life-saving or whatever, just explaining it all. And then I'll get questions for women. Well, what about perimenopause? What about menopause? What about... IUD, what about this, what about that? Because it's not taught. And it's, yeah, it's really scary.

All of the subjects we've discussed today are in these two excellent books. Well, there's even more in the books, but all the subjects that I touched on, pretty much all of them are in either of these two books. Next Level, which is your guide to kicking ass, feeling great and crushing goals through menopause and beyond, and your book Raw, which is...

match your food and fitness to your unique female physiology for optimal performance create health and a strong body for life i would not have been able to read that

If I had eaten today, I would not have been able to. Maybe if you had had a protein shake, you would have been able to read it. Even better, maybe. We have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're going to be leaving it for. And the question that's been left for you.

is if you have children, what is the most important message you would pass on to them? If you don't, then what is the most important message you would have passed yourself as a child? I have a daughter. And the most important messaging that I keep giving to her is to be empowered, to ask questions and to be empowered. And she'll often say, well, what does that mean, Mom? I'm like, you have a question, you ask it.

Don't be afraid to ask it because if you don't know, you don't know. So society is very changing. I want you to be empowered and be educated and have the confidence to ask questions. Stacey, thank you so much for the work that you do. It's incredibly important. And it's so wonderful that people are shining a light on some of these differences between men and women. Because yeah, like me and my partner's trained together. We work out. It's a big part of our relationship in life. And now...

having studied your work, which was absolutely fascinating to me, because it was, again, it was a first for me to understand that there was any differences in these sort of things that have been pushed on us in culture in terms of exercise, nutrition, cold plunges, fasting, et cetera. Absolutely fascinating.

But it's been a huge conversation now between me and her. We were talking before I came on air about this. And it's really turned the lights on. And it's actually made a lot of things make sense. Excellent. A lot of things make sense that we were pondering. So thank you so much for the work that you do. And I highly recommend everybody goes and checks you out.

Thanks so much. I appreciate it. Are you going to make her eat before you go training now? Well, I don't know. I actually did send her a screenshot of that particular part because we have the same routine, especially on like the weekends when we're together. We get up, we have the coffee. Then we go to the gym. Yeah. We train and then we go and try and find something to eat after. So I'll leave it up to her. She could have fresh and coffee.

Yeah, maybe that's a good idea. Maybe I'll leave it up to her. Listen, I'm never going to tell her what to do. So I just sent her the research. Okay. Encourage her. Yeah, I was like, look at this. You'll find this interesting. So we'll see. Awesome. Thank you so much, Sissy. Do you know that 80% of New Year's resolutions fail by February?

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