The women's health doctors: Why menopause changes the rules

1. 0:00 – 2:50

   Intro

   1. SBSteven Bartlett0:00

      So in this part of the conversation, I wanna talk about exercise, nutrition, fasting, lifestyle, sleep, environmental factors, and the first question is, why does muscle matter as a woman, in particular?

   2. VWDr Vonda Wright0:09

      Muscle matters because it helps your brain produce more neurons.

   3. SSDr Stacy Sims0:13

      And that's super important for brain health.

   4. MHDr Mary Claire Haver0:16

      As far as protection as we age, it's directly correlative to the amount of muscle that we have.

   5. NCDr Natalie Crawford0:21

      And if you have something like PCOS or endometriosis, it's even more important for you, because building muscle is gonna fight insulin resistance and inflammation.

   6. SBSteven Bartlett0:30

      I've got two questions to ask. Should women exercise differently across the menstrual cycle, and what is the reason why women hear what you guys say and they don't do it?

   7. MHDr Mary Claire Haver0:38

      I'm so glad we're having this conversation.

   8. NANarrator0:40

      We're back with the leading voices in women's health.

   9. SSDr Stacy Sims0:42

      To unlock the specific insights, data and tools...

   10. NANarrator0:46

       Needed to combat the growing challenges women face throughout their lives.

   11. MHDr Mary Claire Haver0:50

       For women, forever it was all about aesthetics. I'm healthy, I'm thin.

   12. SSDr Stacy Sims0:53

       Because they are under the assumption through sociocultural ideas that a woman is coming to the gym to lose weight, not to get strong, not to gain muscle.

   13. MHDr Mary Claire Haver1:00

       But what we've ended up with is an epidemic of osteoporosis and frailty, and really dementia.

   14. VWDr Vonda Wright1:05

       Where 40 to 50% of women will have low bone density. 70% of all hip fractures happen in women. And when you have that, 30% of the time, you have a chance of dying in one year.

   15. SSDr Stacy Sims1:15

       'Cause most of it is based on male data.

   16. NCDr Natalie Crawford1:16

       And I see a large number of women trying their hardest to be healthy, but what they are choosing to do is actually having a negative impact on their hormonal health.

   17. SSDr Stacy Sims1:26

       And it's not your fault, and this is where we have to educate.

   18. VWDr Vonda Wright1:29

       And it starts now.

   19. SBSteven Bartlett1:30

       Which brings me to questions from the audience, like, what's the best and healthiest way to lose weight? Is there a diet for fertility? Should women fast? Is there a link between environmental toxins and early menopause?

   20. MHDr Mary Claire Haver1:39

       We think so.

   21. SBSteven Bartlett1:40

       But also, if you were to design perfect workout regimes for menopause and perimenopause, what would you... Oh, Stacey's clapping. (laughs) Go ahead. This is part two of my conversation with four of the world's leading experts in women's health. And in this episode, we go even deeper into actionable, practical things you can do to improve your health. And by the way, if you're a man and you've been sent this episode by a girlfriend, a wife, a daughter, uh, whoever it might be, I know you might not think this conversation's for you, but more than 50% of this planet are women. You have a tremendous advantage in your relationships, at work, and just being a human being going through life if you understand the majority of the population. And for so long, women's health, women's bodies, women's anatomy, their psychology and physiology has been a mystery because there hasn't been the same amount of scientific research done to understand them. So in this conversation, we're gonna demystify all of that so that you can understand your wife, your partner, your daughter, your colleague, your mother, your grandmother even better.

2. 2:50 – 5:07

   We've Got Women's Health Wrong

   1. SBSteven Bartlett2:50

      So in this part of the conversation, I wanna talk about exercise, nutrition, fasting, lifestyle, sleep, environmental factors, and all of the things that we kind of alluded to when we were referencing hormones and menopause, but in a more actionable sense. And I guess the first question is similar to the first question in part one, which is, why does it matter for us to have a conversation about women in this context versus fitness generally or nutrition generally?

   2. SSDr Stacy Sims3:14

      Sport and exercise science in itself is a small subset of, like, sports medicine and medical research. And most of the research has been done on men. So if we look inherently at most of the recommendations of exercise, recovery, nutrition, it's based on male data. And we established earlier that that's not generalizable. So when we really want to get into the nuances of how do we create an adaptive stress for women, we have to look at it differently. We have to look through the female lens to understand the female physiology, and acutely how hormones can affect adaptations and how women respond to different environmental cues than men.

   3. NCDr Natalie Crawford3:54

      Yeah, our hormones distinctly control a lot of our environment and the bo- our other cells that are not what we think of as our hormone cells work with our hormones. So if we think about the gut, we think about the liver, our immune system, a lot of this is so hormonally derived, but it's a two-way street, meaning your hormones influence what is happening in your gut, but your gut influences what is happening in your hormones. And because women have different hormones than men, as far as what's predominant and when they are, we have to come at this and approach it a different way.

   4. MHDr Mary Claire Haver4:25

      There's so much to do with messaging that women receive as far as their health goes, and this, you know, s- be small at any cost, you know, you know, get to that number on the scale. And I see it on social media that the conversation is changing, hopefully, you know, GLP-1s is tampering this a little bit.

   5. NCDr Natalie Crawford4:44

      Mm-hmm.

   6. MHDr Mary Claire Haver4:44

      But strong over skinny, nutrition over calories, like, we are trying to build bigger, stronger bodies and take up more space is the message that needs to have. I mean, forever it was all about aesthetics. You have to look young, feel young, be young, anti-age, you know, all those things. And what we've ended up with now is an epidemic of osteoporosis and frailty and, and really dementia.

3. 5:07 – 11:40

   Should Women Exercise Differently During Menstruation?

   1. MHDr Mary Claire Haver5:07

   2. SBSteven Bartlett5:07

      Should women exercise differently across the menstrual cycle?

   3. SSDr Stacy Sims5:11

      So this is the nuance, and this is something if you'd asked me maybe five years ago, I would've said sure. From a molecular level, we see that there are certain things that happen with estrogen being in isolation for the most part, and then when you have estrogen-progesterone, we see there are metabolic shifts, we see there are temperature shifts. But the caveat is we don't know if a woman ovulates or not. And I'm sure that Natalie can, you know, give some stats about the anovulatory incidences in most women. If we were to understand and know when a woman ovulates in addition to how she feels across her cycle, then she can individually tailor her menstrual cycle to her training. But for a general plan, we can't do that.

   4. NCDr Natalie Crawford5:57

      I think it's important that, you know, building muscle, using muscle, consistency is a huge part of effectiveness when it comes to exercise or to building strength. And so one fear we have when we say, "Do this in one phase of your cycle and do that in another phase," is that if, you know, 15% of patients are not ovulating or they have no idea when their follicular and luteal phases are, are they then doing overall less because they're waiting on this directive to tell them what?

   5. SSDr Stacy Sims6:24

      Yeah.

   6. NCDr Natalie Crawford6:24

      What is not untrue though, and how I frame this to patients, is that strength and resistance training should be the core of what you're doing regardless of the phase of the cycle you're in, regardless if you're pregnant, n- regardless if we're doing fertility treatments, building muscle, using your muscle. Now, what you do on other days is where you should allow yourself to say, "How do I feel this day? What do I need this day?" And be okay with giving yourself the grace that that may look different on your period, in your follicular phase, in your luteal phase-

   7. SSDr Stacy Sims6:54

      Mm-hmm.

   8. NCDr Natalie Crawford6:55

      ... and saying doing something and moving your body is still ultimately, we're all gonna agree, better than sitting on the couch.

   9. SSDr Stacy Sims7:02

      Nothing, right.

   10. NCDr Natalie Crawford7:02

       Exactly. Many women will say they have more energy in that late follicular phase. And so if you were looking at your workout structure-

   11. SSDr Stacy Sims7:09

       Yeah.

   12. NCDr Natalie Crawford7:09

       ... this is a day I wanna try heavier weights or more reps-

   13. SSDr Stacy Sims7:12

       Mm-hmm.

   14. NCDr Natalie Crawford7:12

       ... it can be smart to put that in a time where you have a higher chance of being successful.

   15. SSDr Stacy Sims7:16

       That's how I explain it, I'm like, "If you have your own data and you know-"

   16. NCDr Natalie Crawford7:20

       Yeah.

   17. SSDr Stacy Sims7:20

       ... "which days you feel really fantastic, that's where you wanna put your higher intensity, your heavier lifting 'cause you know that you're gonna hit those training metrics."

   18. NCDr Natalie Crawford7:28

       Mm-hmm.

   19. SSDr Stacy Sims7:28

       What we don't want is for someone to go in to do a high intensity session on days they feel flat-

   20. NCDr Natalie Crawford7:33

       Mm-hmm.

   21. SSDr Stacy Sims7:33

       ... 'cause then they won't hit the metrics that they need to to get the stimulus we're after.

   22. SBSteven Bartlett7:37

       Can you explain this to me like I'm a 10-year-old?

   23. SSDr Stacy Sims7:39

       Mm-hmm.

   24. SBSteven Bartlett7:39

       In terms of where in the cycle typically women f- will have more energy and really be able to push themselves?

   25. SSDr Stacy Sims7:47

       Right here, five to seven days before ovulation. Some women feel really great around ovulation, some have a transient where they'll feel really awful on and around ovulation and maybe 24 hours later they feel really fantastic. Most women are variable through the early luteal phase. So if we think about day six to 14, that's when we see women feel really robust and strong and feel like they can take on the world.

   26. MHDr Mary Claire Haver8:17

       Because estrogen is rising.

   27. SSDr Stacy Sims8:18

       Yeah, exactly.

   28. NCDr Natalie Crawford8:19

       And you see the physiologic changes, heart rate variability-

   29. MHDr Mary Claire Haver8:21

       Yeah.

   30. NCDr Natalie Crawford8:22

       ... resting heart rate.
4. 11:40 – 16:58

   Low vs High-Intensity Training: When?

   1. SBSteven Bartlett11:40

      some people think moderate training is better for women. Some people think high intensity training is better throughout the cycle and sort of also considering what goals you might have in fertility, what would you say there? Is- is, should I be doing high intensity interval training if I'm a- a woman all throughout this cycle and throughout my life?

   2. SSDr Stacy Sims11:59

      So, this is where we have to think about periodization. First, lifestyle, but also how a woman is feeling. We don't want people to do high intensity interval training every day, 'cause that's just not going to create an adaptive response. We have to think about the reason why we're exercising is to create a, a stress that the body's gonna respond to. We don't get fitter during exercise. We get fitter from the stimulus of exercise and the recovery from it. So, if someone's doing high intensity interval training every day or five days a week, they're not ever going to get that subsequent recovery to be able to hit those high intensities and that stress that we want. We talk about high intensity during our reproductive years. You can pretty much get away with whatever you want to do during your repro- reproductive years, because you have the benefit of our hormones working for us. We start getting into perimenopause and we start getting into menopause, this is where we have to really carefully look at volume versus intensity. So that means, if we're doing lots of stuff, or are we doing really purposeful, high intensity versus low intensity? 'Cause we're trying to create what we call a polarization of the training so that when we hit high intensities, we're actually hitting the intensities we need to create change. But on the other side of it, we wanna hit really low intensity so that we can have recovery. It gets harder to recover as we get older, regardless if you're male or female. But in perimenopause, we don't have the benefit of estrogen supporting anti-inflammatory responses. So we have to be very cognizant that we need more recovery.

   3. VWDr Vonda Wright13:31

      So I'll give you an example. So my office, my orthopedic office is in a fabulous performance center. Outside my windows, I have floor-to-ceiling windows, there's a football field inside. That field is filled seven days a week with people taking a class I, called Ignite. Ignite has a lot of midlife women in it who are never exercising at low enough intensity to recover, and never exercising at peak intensity to change their body. So what happens five or seven days a week, they're out doing moderate, mid-range intensity training, but they're not seeing body changes.

   4. SSDr Stacy Sims14:16

      Mm-hmm.

   5. VWDr Vonda Wright14:17

      They're not seeing recomposition. They're hurt every three weeks, and in my office wondering why they're hurt because they're doing a lot of reps of medium intensity. So they're not really recovering, and they're not intense enough to really change their physiology. But that's really common. There are whole brands built around mid-intensity, and-

   6. SSDr Stacy Sims14:39

      And that falls into the whole sociocultural thing where-

   7. VWDr Vonda Wright14:42

      Yeah.

   8. SSDr Stacy Sims14:42

      ... we've grown up that if you don't have a good sweat sesh and feel completely smashed when you leave, it wasn't a good workout. But that's a misconception.

   9. VWDr Vonda Wright14:51

      Right. So they are smashed, they're dripping as sweat-

   10. SSDr Stacy Sims14:54

       Mm-hmm.

   11. VWDr Vonda Wright14:55

       ... but it's not at peak heart rate ranges for short bursts of time, right? So it's, I know, look, it's very confusing because, I don't know, 20 years people have, as they've switched from only cardio, they're like, "Now we're gonna do high intensity." Which is fine, I'm not opposed to that word. It's just that, how do you define that?

   12. SSDr Stacy Sims15:16

       Mm-hmm.

   13. VWDr Vonda Wright15:16

       What is high intensity? And so like you, because I've read your books, that we're, we're exercising people at pretty low heart rate where they're about to flip from burning fat to carbohydrates, 'cause that's really metabolically healthy, but not so intense that people are gonna get hurt. And I also prescribe really peak sprint interval training, and I did that myself in la- midlife, you know, to recompose my body, sprint interval training, 'cause it's intense and lifting, right?

   14. SBSteven Bartlett15:49

       Is the advice different for different women at different stages of life here?

   15. VWDr Vonda Wright15:52

       Mm-hmm.

   16. SBSteven Bartlett15:52

       So if I'm, if I'm before perimenopause...

   17. SSDr Stacy Sims15:54

       You get away with most stuff.

   18. NCDr Natalie Crawford15:56

       Assuming-

   19. SSDr Stacy Sims15:57

       We didn't-

   20. NCDr Natalie Crawford15:57

       ... you have a n- regular menstrual cycle.

   21. SSDr Stacy Sims15:59

       Right.

   22. NCDr Natalie Crawford16:00

       I think there, there's different time periods, which we've mentioned before, PCOS, hypothalamic amenorrhea, time periods where you're not making estrogen or making it reliably, you can get away with less.

   23. SSDr Stacy Sims16:11

       Mm-hmm.

   24. NCDr Natalie Crawford16:11

       And so we wanna protect a little bit of that. But when it comes to exercise, variety's name of the game.

   25. VWDr Vonda Wright16:17

       Absolutely.

   26. NCDr Natalie Crawford16:17

       You wanna adapt, so you shouldn't be doing the same thing every day. That doesn't mean you can't have a plan. There's seven days in a week, you don't have to move every single one. But you should pick these different activities based on your life, your schedule, what you wanna accomplish. And it, it will vary some in different phases of your life, because your goals are going to be different. And so when it comes to exercise, we always have to think about what needs to happen. Are you somebody who is overweight and needs to lose weight? Are you somebody who's underweight and is trying to gain weight? Are you trying to get pregnant or going through fertility treatments or in menopause? So there's nuance to it-

   27. VWDr Vonda Wright16:51

       Absolutely.

   28. NCDr Natalie Crawford16:51

       ... which always makes it hard. But there's not a one, do this one exercise every single day. That's pretty much

5. 16:58 – 19:56

   Pilates Is Not Good for Strength Training

   1. NCDr Natalie Crawford16:58

      not the answer.

   2. SSDr Stacy Sims16:58

      So the most popular class for females right now, I just saw this statistic somewhere, is Pilates. And my daughter loves her Legree and gets on that machine, it's like, you know... Where does that fall in all of this? I know I have a lot of, um, Pilates people.

   3. VWDr Vonda Wright17:14

      There's a social aspect to it.

   4. SSDr Stacy Sims17:16

      Yeah.

   5. VWDr Vonda Wright17:16

      You know, there's-

   6. SBSteven Bartlett17:17

      Pilates people hate you.

   7. SSDr Stacy Sims17:17

      (laughs) Yeah.

   8. VWDr Vonda Wright17:18

      Oh.

   9. SSDr Stacy Sims17:18

      Because, um, we did this reel talking about how Pilates was not appropriate as strength training, especially as rehab. When we look at Pilates, it's a complement to true strength training. What I mean by true strength training is you're lifting a load that's heavy in multiple planes. With Pilates, it's really good for isometric control, core strength, balance, proprioception, but it isn't a stress that's going to create adequate muscle gain and strength of the bone, which is what we want from strength training. So just like yoga, Pilates has a place. It does definitely fit in the scheme of things, especially from the social, and the fact that it does give you control and proprioception, but it isn't the be-all, end-all for strength.

   10. SBSteven Bartlett18:03

       People that do Pilates frequently will be shouting-

   11. SSDr Stacy Sims18:07

       But I'm-

   12. SBSteven Bartlett18:07

       So you see, it's so... It hurts so much and...

   13. SSDr Stacy Sims18:11

       I know. I hear that all day.

   14. VWDr Vonda Wright18:11

       Well, I'm sure it's hard. The times I've done it, it's not easy.

   15. SSDr Stacy Sims18:15

       It isn't easy.

   16. VWDr Vonda Wright18:15

       But the r-... But it doesn't, uh, set you up not to be frail.

   17. SSDr Stacy Sims18:21

       Mm-hmm.

   18. VWDr Vonda Wright18:22

       It is not building strength and power. And I have women who have done so many Pilates, 1,500, it's like a badge of... They count their classes.

   19. SSDr Stacy Sims18:31

       Mm-hmm.

   20. VWDr Vonda Wright18:32

       1,500, at the deficit of anything else. It's all that goes on. And, and I think that is another... You know, you gotta mix it up, number one. Number two, I say this same thing, so I'm not very popular in those crowds, but it's great for the, for the standard that I ask people do of, uh, flexibility and joint range of motion so that you don't become really stiff and hunched over and shuffling old person. But it will never give you strength and power in the way to protect yourself from falling down.

   21. SBSteven Bartlett19:05

       Because there's not enough weight?

   22. SSDr Stacy Sims19:07

       For the most part, yes. And we also have to think about when you're doing strength training, you are in, uh, you're creating a multi-directional force through the muscle and the tendons and the bones. With Pilates, especially if you're looking at the Reformer, it's not multi-directional in the movements. It... Each movement is one plane.

   23. VWDr Vonda Wright19:24

       Mm-hmm.

   24. SBSteven Bartlett19:25

       Up, down.

   25. SSDr Stacy Sims19:25

       And you can be... Yeah. You can be in, in different planes, but each motion isn't multi-planar. So, if we think about what are we trying to get out of, out of Pilates, we're getting neuromuscular control.

   26. VWDr Vonda Wright19:37

       Mm-hmm.

   27. SSDr Stacy Sims19:37

       We're getting core strength. We're getting some breath work, and all of that is beneficial. But again, if we're trying to-

   28. VWDr Vonda Wright19:43

       Yeah.

   29. SSDr Stacy Sims19:43

       ... grow muscle and bone, take up space, be strong, it doesn't quite hit the points that we need to in order to create this new strength to bring us to that health span that women

6. 19:56 – 27:28

   Perfect Exercise Routine in Your 30s

   1. SSDr Stacy Sims19:56

      are looking for.

   2. VWDr Vonda Wright19:56

      So do it a couple times a week.

   3. SSDr Stacy Sims19:58

      Yeah.

   4. VWDr Vonda Wright19:59

      Not seven days a week.

   5. SSDr Stacy Sims20:00

      Correct.

   6. SBSteven Bartlett20:00

      So if my, my partner, she's 33 years old, so she's not quite at perimenopause yet. If you were to design a perfect workout regime for her at that phase of her life, what would you... Oh, you... Stacy's clapping.

   7. SSDr Stacy Sims20:14

      (laughs)

   8. VWDr Vonda Wright20:14

      (laughs)

   9. SBSteven Bartlett20:15

      You know, go ahead.

   10. SSDr Stacy Sims20:16

       So, if she has three days that she can go to the gym, and has... Or I should say, three one-hour sessions that she could have at the gym in a week, over a seven days. Each one would start with mobilization, so using resistance bands, or maybe you're doing a Pilates Reformer warmup, so you're getting through the range of motion.

   11. SBSteven Bartlett20:36

       Why?

   12. SSDr Stacy Sims20:37

       Just to open up the joint capsules, make sure you don't have any restrictions, so that you can get really good range of motion for the movements you're gonna do next.

   13. VWDr Vonda Wright20:45

       Mm-hmm.

   14. SSDr Stacy Sims20:45

       The next movements would be-

   15. SBSteven Bartlett20:47

       Does that stuff actually work? I do wonder this. So many of my friends are getting injured at this age because th- they're my age and a bit older, because they walk into the gym and they start picking weights up.

   16. SSDr Stacy Sims20:54

       Oh, yeah. No, you need-

   17. VWDr Vonda Wright20:56

       Yes.

   18. SSDr Stacy Sims20:56

       I spend more time mobilizing, I think, than I do actually training now, just to keep range of motion going and keep the joint capsules open. And so, that's using the heavy resistance bands to distend and distract all the joint capsules to increase range of motion.

   19. VWDr Vonda Wright21:10

       Mm-hmm.

   20. SSDr Stacy Sims21:11

       Stretching doesn't do that. Stretching will get to an end point of the muscle to allow you to have more flex in the muscle, but it's not actually stretching in the joint capsule to give you range of motion. So, when we talk about mobility work, we want to get into that full range of motion. So if you have a stiffening, so as I was saying earlier about the guy and my voodoo flossing, well, voodoo floss is a way where you're creating some blood flow restriction, then you go in a range of motion in that blood flow restriction, you take the voodoo band off, and the blood flow comes back, and you go in the range of motion, you get deeper in that range of motion. So it's all about accessing the tissues and making those tissues more viable for increased range of motion so that when you go do the lifting, when you go put on a heavier load, you have better control, better range of motion, and avoid the small little sticky points that cause injuries. Tears, the micro-tears.

   21. SBSteven Bartlett21:59

       Ah, so it's the micro-tears that are going to lead to indus- in- inj- injury, and the micro-tears come when I haven't warmed up-

   22. SSDr Stacy Sims22:09

       Warmed up properly, yeah. So here's why it's important-

   23. VWDr Vonda Wright22:11

       And like for your shoulder, what would that look like? If you were-

   24. SSDr Stacy Sims22:13

       For your shoulder?

   25. VWDr Vonda Wright22:13

       Mm-hmm.

   26. SSDr Stacy Sims22:14

       Uh, I wish I had a rig. So, you could take one of those thick, um-

   27. VWDr Vonda Wright22:18

       Big bands? Yeah.

   28. SSDr Stacy Sims22:19

       ... re- the big, and wrap it around a rig or, or something, and you can pull and distend. So you're actually pulling the shoulder out-

   29. VWDr Vonda Wright22:27

       Okay.

   30. SSDr Stacy Sims22:27

       ... in different ranges, so you can rotate, roll, pull, extend, pull, extend.
7. 27:28 – 30:29

   Why Women Should Exercise to Gain Upper Body Muscle

   1. SSDr Stacy Sims27:28

      me. (laughs)

   2. VWDr Vonda Wright27:28

      (laughs) It takes a minute. Yeah.

   3. SBSteven Bartlett27:30

      So Mel's 33.

   4. SSDr Stacy Sims27:31

      Yeah.

   5. SBSteven Bartlett27:32

      Y- mobility work when she gets to the gym-

   6. SSDr Stacy Sims27:33

      Yeah.

   7. SBSteven Bartlett27:33

      ... first and foremost.

   8. SSDr Stacy Sims27:35

      Yeah.

   9. SBSteven Bartlett27:35

      On day one or every day?

   10. SSDr Stacy Sims27:37

       Every day.

   11. VWDr Vonda Wright27:37

       Every day.

   12. SBSteven Bartlett27:38

       Every day.

   13. SSDr Stacy Sims27:38

       So I'm assuming, and I could be wrong, that she already has a strength training history.

   14. SBSteven Bartlett27:43

       Yeah. She does, yeah.

   15. SSDr Stacy Sims27:43

       Okay. So we do the mo- mo- mobility work for about 10 minutes, really warm up well. Then we pick one compound movement we're gonna work on. So could be squats-

   16. SBSteven Bartlett27:55

       Mm-hmm.

   17. SSDr Stacy Sims27:55

       ... on a Monday. So we're gonna work on loading in a squat pattern. So that's your knee forward, you know, w- uh, quad dominant type squat motion.

   18. NANarrator28:03

       Back squat? Does it matter?

   19. SSDr Stacy Sims28:04

       Back squat, front squat. You could do Bulgarian split squats. So we're adding load. And we have a periodized program, so this is just a snippet of one day in a periodized program.

   20. SBSteven Bartlett28:13

       What if she didn't have that strength training history?

   21. SSDr Stacy Sims28:16

       Well, then we work on adding load through our w- I want to see how she moves first, and we wanna make sure that you're moving well before you add loads. So this is where we work with lighter loads and more reps.

   22. SBSteven Bartlett28:29

       What if she's, doesn't have you there?

   23. SSDr Stacy Sims28:32

       Yeah.

   24. SBSteven Bartlett28:32

       (laughs)

   25. NANarrator28:32

       That was my question.

   26. SSDr Stacy Sims28:33

       Yeah.

   27. NANarrator28:33

       Like, what if you're not there?

   28. SSDr Stacy Sims28:34

       Yeah. So if I'm not-

   29. NANarrator28:35

       What is she doing around?

   30. SSDr Stacy Sims28:35

       Yeah, so this is still like, how do you squat? Uh, where are your sticking points? So you can assess, self-assess. If you've done your mobility, then you'll know like, "Oh, my hip's really tight, so I need to work on that. So let me do some air squats, uh, to see how I move." Then the next time you go in to do squats, maybe you're picking up, um, two 10-pound dumbbells and you're holding them and doing air squats with your dumbbells, and eventually you're gonna g- move to the barbell. So it's all about small progression under load to get to a point where you feel more confident to use a barbell back squat, to get into more of those compound movements.
8. 30:29 – 35:40

   Building Muscle Helps Reduce Inflammation

   1. SBSteven Bartlett30:29

      Vonda, why does it matter? You know, 'cause there's a big social pressure on women to look a certain way.

   2. MHDr Mary Claire Haver30:36

      Mm-hmm.

   3. SBSteven Bartlett30:36

      And it doesn't typically involve muscles in the... especially in the upper body.

   4. MHDr Mary Claire Haver30:40

      No.

   5. VWDr Vonda Wright30:41

      So, you know, we're still living under the times of be as small as you can.

   6. MHDr Mary Claire Haver30:46

      Mm-hmm.

   7. VWDr Vonda Wright30:47

      But small doesn't mean lean. There's a concept of skinny fat, which, you know, it's you can be as tiny as tiny, but you can be 50 pre-... You can have a body fat of 50%, which means you're neither strong, you're not metabolically healthy, you're just little, right?

   8. SBSteven Bartlett31:03

      Mm-hmm.

   9. VWDr Vonda Wright31:04

      So it's... There is a... also a misconception that lifting heavy is going to automatically turn you into a physique model or a bodybuilder shape. If that's your goal, that's probably gonna take you five years or a decade. It's a lot of hard work for a long period of time with proper nutrition.

   10. MHDr Mary Claire Haver31:24

       Mm-hmm.

   11. VWDr Vonda Wright31:24

       So for a woman who's... wants to feel better, the goal is to build muscle to be lean, to recompose, not lose weight, right? I'm not really interested in somebody's weight. I'm interested in their body fat percentage and their lean muscle mass.

   12. MHDr Mary Claire Haver31:43

       Mm-hmm.

   13. VWDr Vonda Wright31:44

       Um, because it's what you're made of that matters, right? Not the size of the shell.

   14. SBSteven Bartlett31:50

       And why does muscle matter as I age, as a woman in particular?

   15. VWDr Vonda Wright31:54

       It matters for everyone, but for, uh... Muscle matters because it's not just part of locomotion. It's not just part of moving you around. It is a metabolic organ. It is critical for glucose metabolism. It's critical for, uh, insulin sensitivity. It, uh, talks to the bone. Bone and... Bone and muscle are endocrine organs which cross-communicate all the time. So both bone and muscle have access to the brain, right? Uh, muscle will produce a hormone called irisin, which has multiple functions in the body. The, the axis between muscle and brain helps your brain produce more neurons, right?

   16. SBSteven Bartlett32:40

       Mm-hmm.

   17. VWDr Vonda Wright32:40

       Bone's access to the brain has a role in satiety. Isn't that amazing? Which means not hungry anymore. Why would you think these locomotive structures, if that's what you limit them to, would, would even have those functions? It's because we put organs in a box. So to answer your question, muscle in men and women, but women in particular for this conversation, we need as much muscle as possible to fight the insulin resistance that we get when estrogen walks out the door. We need, uh, muscle for glucose metabolism. We need muscle for the pure strength of it, because we do not wanna become frail and be one of the two thirds of nursing home residents who are women because we can't do something as simple as get up out of a chair.

   18. SBSteven Bartlett33:33

       But I could just get muscle when I'm 70.

   19. VWDr Vonda Wright33:36

       You can, actually.

   20. NCDr Natalie Crawford33:37

       It's a lot harder.

   21. SBSteven Bartlett33:37

       So why does it matter for Mel to be thinking about it when she's 33?

   22. VWDr Vonda Wright33:40

       Well, here's the great part for Mel, is she still has all her estrogen.

   23. MHDr Mary Claire Haver33:44

       Mm-hmm.

   24. VWDr Vonda Wright33:44

       Estrogen has a profound effect on muscle protein synthesis. Um, it is a significant anti-inflammatory. So high inflammation, chronic inflammation of, we've t-... talked about decreases muscle synthesis, it decreases bone synthesis because inflammation with its high cytokine level, I've mentioned them before, IL-6, tumor necrosis factor, those are all detrimental to these normal metabolic pathways. So the wonderful thing for Mel, who is entering what I call the critical decade, which is 35 to 45 estimated, it's the prime time to set your physical activity standards-

   25. MHDr Mary Claire Haver34:29

       Mm-hmm.

   26. VWDr Vonda Wright34:30

       ... and to build as much as you can while you still got all your estrogen.

   27. NCDr Natalie Crawford34:34

       In addition to the fact that for proper hormonal health, if... Think about inflammation-

   28. VWDr Vonda Wright34:40

       Mm-hmm.

   29. NCDr Natalie Crawford34:40

       ... coming in and... It's like static on a walkie-talkie. The brain's trying to interpret your hormones. And when inflammation's coming in, it's making the signals really hard to hear. So we need to make sure that we're actively fighting that. And building muscle is one great way, because it's gonna use up glucose and fight insulin resistance, which means makes your cells more sensitive to when it sees glucose and able to use it better. If you have another thing that is proinflammatory, such as PCOS or endometriosis, it's even more important for you-

   30. MHDr Mary Claire Haver35:10

       Mm-hmm.
9. 35:40 – 41:53

   70% of Hip Fractures Happen in Women — 30% May Die

   1. NCDr Natalie Crawford35:40

      you the most.

   2. MHDr Mary Claire Haver35:41

      There's a term called geroprotective... geroprotection. So gero is, is the term we use for aging. So gerontology is the, you know, the part of medicine that focuses on the elderly patients. And so when we look on... in females and the organs that are, you know, are the most geroprotective, it is the muscle and the ovary. And the ovaries go away. We have a shelf life on our ovaries. So then we're just really left with our muscle as far as protecting us in those elderly years as we age. And it's directly correlative to the amount of muscle that we have, 'cause if you have a lot of muscle, you're gonna have stronger bones.

   3. SSDr Stacy Sims36:17

      And this, this is where the intensity part, where, um, Dr. Rai's talking about seeing the ignite class, and everyone's in that moderate intensity all the time. With moderate intensity, you don't have the post-exercise anti-inflammatory response. So if we're trying to build muscle and we're trying to dampen inflammation, if we're always doing this moderate intensity cardio, then we're not, one, going to be building the muscle we want, and two, we're gonna have this baseline elevation of total body inflammation. So we need to mix it up, and have that precedence on being muscle-centric-

   4. NANarrator36:50

      Mm-hmm.

   5. SSDr Stacy Sims36:50

      ... and building that muscle. One, to help with aesthetics. I mean, that's the byproduct of lifting weights-

   6. NANarrator36:56

      Mm-hmm.

   7. SSDr Stacy Sims36:56

      You tend to look better. But it's more than that. We see it improves brain health because of the neuro connections and the neuroplasticity of the brain. And I told-

   8. NANarrator37:05

      Sleep, mood.

   9. SSDr Stacy Sims37:06

      Yeah, all of those things.

   10. NANarrator37:07

       All the things.

   11. SSDr Stacy Sims37:08

       Yep. You get an incredible parasympathetic response when you've done a, a significant heavy lifting session or a sprint interval session, which you don't get with that moderate intensity cardiovascular work.

   12. SBSteven Bartlett37:19

       Two questions to add to what you, your brother said here is, um, am I right in thinking that at the end of that golden decade that you referenced, 45 years old-

   13. SSDr Stacy Sims37:28

       Mm-hmm.

   14. SBSteven Bartlett37:29

       ... because you have changes in estrogen, one will expect to see a decl- a natural decline-

   15. SSDr Stacy Sims37:34

       Yes.

   16. SBSteven Bartlett37:34

       ... in muscle?

   17. NANarrator37:35

       Yes.

   18. SBSteven Bartlett37:35

       Um, and an increased chance of osteoporosis, osteopenia, bone issues later in life. Do women ... Uh, this is m- several questions, and I apologize, but do women then also tend to have more frail bones in later life, and is that linked to the, the muscle loss?

   19. VWDr Vonda Wright37:49

       So this is how it works. So both men and women build bone and peak about up to 25, somet- sometimes 30, and then bone loss plateaus for a little while. Men continue to lose about one percent a year. So men do not arrive with hip fractures or devastating fractures until their 70s or 80s, or older. Women also decline slowly until we lose our estrogen, and then the rate of decline, and I'll tell you why it happens for bone, doubles or triples, such that you will lose 15 to 20 percent of your bone density during your perimenopausal period, just from loss of estrogen alone, because estrogen plays many roles. I've already talked about estrogen being a huge anti-inflammatory. Bones are very sensitive to inflammatory chemicals in your body. Estrogen also directly affects the balance of the two main cells that subtract minerals from bone, the osteoclast, and the cell that builds the bone, the osteoblast. And in well-hormoned times, there is a balance. The body loves balance. We take what we need, we build it back. But because estrogen has such a profound effect on the osteoclast, the Pac-Man, bone-eating cell, there's a dis- there's an unbalance, and we take more bone than we're capable of building. We're still building bone, but the rate cannot keep up with this. So with the inflammation, with the direct effects on the osteoclast, women will lose bone density if they do nothing ab- Well, number one, they're gonna lose bone density, but they must do something about it. The reason it's so critical, uh, a- for a 33-year-old is because you still have your estrogen. So let's learn how to lift heavy. Let's take advantage of the estrogen circulating. Let's learn to have a jumping practice-

   20. NANarrator39:52

       Yes.

   21. VWDr Vonda Wright39:52

       ... and impact our bones, right? So the, the way our body tells our bones to build more is, um ... There's another little cell called the osteocyte. It sits encased in bone, but it's connected to these other, uh, cells by little tunnels that contain fluid. When you jump, the biomechanical impulse of that fluid shifting in the little tunnels is translated into a biochemical stimulation that tells the bone, "Oh my God, she's jumping around. I need to build more bone." So we need that impact to stimulate the laying down of more bone.

   22. SBSteven Bartlett40:32

       I was looking at this graph, which is what you were describing.

   23. SSDr Stacy Sims40:34

       Yeah.

   24. VWDr Vonda Wright40:35

       Yeah.

   25. SBSteven Bartlett40:35

       Um, uh, men and women aren't that far away in terms of bone mass?

   26. VWDr Vonda Wright40:42

       So this is showing the fact that because of the way testosterone interacts with a man's bones, he will peak at a higher bone mass than a woman will.

   27. SBSteven Bartlett40:51

       Yeah.

   28. SSDr Stacy Sims40:51

       Mm-hmm.

   29. VWDr Vonda Wright40:51

       So he's starting at a higher level.

   30. SBSteven Bartlett40:53

       Yeah.
10. 41:53 – 47:45

    Hormone Treatment and Bone Growth

    1. NANarrator41:53

       Can't carry a muscle around if you have weak bones.

    2. VWDr Vonda Wright41:55

       So without bone, muscle is just a heaping pile of steaming metabolic tissue sitting there.

    3. NANarrator42:01

       (laughs) Yeah.

    4. VWDr Vonda Wright42:02

       Right? There would be no bicep to complement, right? Because it has to be connected to a bone. So they're important for locomotion and giving support to the muscle, but bone is an endocrine organ that secretes hormones that go to your brain to help build neurons, to your pancreas to be active in insulin, uh, release, to the muscle-... for glucose metabolism, in men, to the testes to build testosterone. And that's only one of the many hormones that the bone produces. The bone is no- not only structural, not only hormonal, I've already talked about it being a storehouse, but it's an incubator. In our pelvis is where we build all of our blood cells.

    5. SSDr Stacy Sims42:46

       Mm-hmm.

    6. VWDr Vonda Wright42:46

       And so it has these multi-functions. But to Mary Claire's point, for women, 40 to 50% of women will have low bone density, and when you have that, 50% of the time you'll break a bone. So if we're looking around at this table, if we all have osteoporosis, which we don't, uh, one in... Two of us will fracture. When that fracture is a hip fracture, which is very common, 70% of all hip fractures happen in women, 30% of the time when you hit the floor and something breaks, you have a chance of dying in one year. This quick, your life changes. 50% of the time, even if you survive, you will never return to pre-fall function, meaning you can't go home. And that puts your family in this situation of having to figure out 24-hour care-

    7. SSDr Stacy Sims43:42

       Mm-hmm.

    8. VWDr Vonda Wright43:43

       ... or you move in with your eldest daughter, or you go into a facility where you use your life savings until you have no more, and then you have to apply for Medicaid and the government will pay for it. These are terrible situations to get at something that we could've prevented had we started early enough.

    9. SBSteven Bartlett44:04

       So you wanna start early. So I have Mel. So Mel's gonna be doing strength training, not just for the muscle benefits but also because it's gonna help her bi- build strong, healthy bones in that critical decade.

    10. SSDr Stacy Sims44:14

        Yep. And then we finish it with some jump training.

    11. SBSteven Bartlett44:18

        Jump training?

    12. VWDr Vonda Wright44:18

        Yep.

    13. SSDr Stacy Sims44:18

        Yeah. So plyometric type work, or if we're looking at not having the robustness of doing straight plyos, then you can do band-assisted pogos, you can do low depth jumps so you're getting some impact to the bone, 'cause as, um, Doctor Rai's talking about, it's a multi-directional stress. N- 'Cause people think, "Oh, I run, I'm gonna have s- strong bones." But running doesn't do it, you need multi-directional stress. So if you think about it, when you land, your body has to move, the ground doesn't, so it's, uh, called the ground reaction force that comes up through the bone-

    14. VWDr Vonda Wright44:49

        Mm-hmm.

    15. SSDr Stacy Sims44:49

        ... to create that strength. So that ideal situation in a workout for her would be some mobility, some heavy lifting. If we're doing plyo, that's also strength, or a sprint-

    16. VWDr Vonda Wright45:01

        Mm-hmm.

    17. SSDr Stacy Sims45:01

        ... type training so you're getting a metabolic stress. So you're hitting all the major factors in one one-hour workout.

    18. SBSteven Bartlett45:07

        I read that, um, that there was a study done with some Australian elderly ladies on bone growth?

    19. VWDr Vonda Wright45:15

        On lifting and bone growth?

    20. SBSteven Bartlett45:16

        Yes.

    21. SSDr Stacy Sims45:17

        Yeah, lift more. Lift more.

    22. VWDr Vonda Wright45:18

        In the Lift-More study-

    23. SSDr Stacy Sims45:19

        Yeah.

    24. VWDr Vonda Wright45:19

        ... by Dr. Beck.

    25. SSDr Stacy Sims45:20

        Yes.

    26. VWDr Vonda Wright45:21

        She was trying to dispel the myth, which I hear every day, that you've got osteoporosis, you can't lift weights.

    27. SSDr Stacy Sims45:26

        Yes.

    28. VWDr Vonda Wright45:27

        And so her study... Because we're big proponents of teaching people to progressively lift heavier and heavier-

    29. SSDr Stacy Sims45:35

        Mm-hmm.

    30. VWDr Vonda Wright45:35

        ... and that scares people-
11. 47:45 – 52:59

    Best Exercises to Avoid Injuries

    1. SSDr Stacy Sims47:45

    2. MHDr Mary Claire Haver47:45

       So when my patients come in and they are looking to prevent osteoporosis or they've gotten a diagnosis of low bone density, you know, what can they do? I'll discuss the Lift-More trial. The n- new study just came out May of this year, of 2025, and they looked at very similar to the protocol used in Lift-More. So there was a control group where they just did nothing, then a group that did the... They did three days a week and they did resistance training and jump training-

    3. VWDr Vonda Wright48:11

       Mm-hmm.

    4. MHDr Mary Claire Haver48:12

       ... and then the third group did all the same exercises and added HRT, and, uh, depending if they had a uterus, they got estrogen or estrogen plus a progestogen. And so, of course, as expected, the do-nothing group lost bone. You gained bone, as expected, in the resistance group, but it seemed to be synergistic when we added hormone therapy and the resistance training together, they grew even more bone. They had even better results. So when my patients are like, "I wanna hedge my bets. My mother fell and fractured. She's broken her hip, in a nursing home, whatever, and I'm trying to avoid this."... I'm, we're hitting all the points. And the only medication of it... Now, we either have other medicines that will help slow down resorption of bone, the bisphosphonates and stuff, but they, you know, there's, they can be hard to take and they have a lot of side effects. So to me-

    5. NCDr Natalie Crawford48:56

       And it's not

    6. SSDr Stacy Sims48:56

       Yeah.

    7. MHDr Mary Claire Haver48:56

       ... prevention is always better than cure.

    8. NCDr Natalie Crawford48:59

       Exactly.

    9. MHDr Mary Claire Haver48:59

       Right? So I'm trying to get them in, get them early. I just ignore the guidelines that say you have to wait till 65 unless you have some chronic medical condition to get a bone density. I'm telling patients, "You can find it for about $99 around Hu- Well, I, I work in Houston. And that is worth the investment-"

    10. NCDr Natalie Crawford49:16

        Absolutely.

    11. MHDr Mary Claire Haver49:16

        "... for you to go get your baseline bone density." I don't know a single orthopedic surgeon, you know, a synchro exercise physiologist, or anybody who deals with, with osteoporosis who thinks 65 is a good idea. So if your listeners are like, "Oh, well, you know, my insurance won't pay for it," I'm like, "There are centers popping up now where you can go and get a DEXA scan-"

    12. NCDr Natalie Crawford49:34

        Mm-hmm.

    13. MHDr Mary Claire Haver49:34

        "... and just pay out of pocket and get a great re-, you know, and figure out where your starting base is."

    14. SBSteven Bartlett49:39

        A DEXA scan is?

    15. NCDr Natalie Crawford49:41

        A bone scan to see your bone density, is the easiest way to describe it.

    16. SBSteven Bartlett49:44

        And your muscle mass.

    17. NCDr Natalie Crawford49:45

        Yeah. They can do that as well.

    18. MHDr Mary Claire Haver49:46

        Yes, you can do that.

    19. NCDr Natalie Crawford49:47

        This conversation is really important though to extend besides just menopause or perimenopause, that there are women of reproductive age years who have profound periods of low estrogen-

    20. MHDr Mary Claire Haver49:57

        Yeah.

    21. NCDr Natalie Crawford49:58

        ... who are also at risk for serious problems with their bone density, both now and down the road. And so if you come to me and you say, "Oh, I haven't had a period for seven years, no big deal." Well, that is a big deal. And depending on the reason why, many of the causes will result that you had low estrogen and you were not ovulating and you have hit that graph you showed of while you're building your bone, that person's on a different trajectory. And those women do need bone scans much earlier-

    22. MHDr Mary Claire Haver50:28

        Mm-hmm.

    23. NCDr Natalie Crawford50:28

        ... so that we can see where they are and see what treatment we need. But it's one of the biggest reasons, bone health is one of the most acceptable medical reasons for why we should put younger women who are, have low estrogen time periods onto estrogen treatment, because it can so profoundly change their bone health long term.

    24. SSDr Stacy Sims50:47

        So in my, uh, niche of active women, we see there's a very, very high incidence of recreational active women and low energy availability. Meaning they're not eating enough to support daily life as well as their training. So the sub-clinical aspect of not eating enough creates a myriad of, of issues that does create lower bone density, menstrual cycle dysfunction, greater inflammatory responses. So, you know, the end result would be hypothalamic amenorrhea, so their periods have stopped, which is that low estrogen standpoint.

    25. MHDr Mary Claire Haver51:24

        Estrogen.

    26. NCDr Natalie Crawford51:24

        Mm-hmm.

    27. SSDr Stacy Sims51:25

        So, uh, you know, keeping track of, of your period, making sure you're eating enough is one of the first stop gaps that we have in the athletic realm. It's like we want you to eat enough and if you're looking at bookending our calories on either end of the day, that's not appropriate. We have to look at how your circadian rhythm works because the circadian rhythm, like we talked about in the first, um, half was about the pulses of our hormones. So if we're holding our calories on either end of the day, then there's this big space in the middle of the day where your body thinks it's under a starvation threat. So you start to have this down, downturn of all of our metabolic functions. We see after four days of low energy availability, there's a direct impact on thyroid function. So we have to be very cognizant that women who are saying, "I haven't had a period in seven years." Or, "My periods are really irregular." We have to bring it back to the energy function as well. So I know, unfortunately, we're still in this environment of aesthetics-

    28. NCDr Natalie Crawford52:20

        Mm-hmm.

    29. SSDr Stacy Sims52:20

        ... and I'm always like, "We need to eat." And if you eat in and around your training and fueling appropriately for what you're doing, it has a positive impact on body composition. You're not going to gain body fat. You're going to gain lean mass, you're gonna gain bone.

    30. NCDr Natalie Crawford52:36

        Mm-hmm.
12. 52:59 – 54:04

    When to Work on Your VO₂ Max

    1. SBSteven Bartlett52:59

    2. SSDr Stacy Sims52:59

       So if you were to do three days a week in the gym-

    3. SBSteven Bartlett53:01

       Yeah.

    4. SSDr Stacy Sims53:01

       ... that would be p- pretty similar except for the compound movement. What are we doing for each of those compound movements, right?

    5. SBSteven Bartlett53:06

       A different muscle.

    6. MHDr Mary Claire Haver53:07

       Mm-hmm.

    7. SSDr Stacy Sims53:07

       So it would be the knee forward squat motion one day, push/pull upper body next, and then, uh, posterior. So your hip thrusts, your deadlifts, that kinda stuff, 'cause women are quad dominant. To prevent injury, we really need to build the posterior chain, and this is your glutes, your hamstrings, uh-

    8. NCDr Natalie Crawford53:27

       Your deadlifts.

    9. SSDr Stacy Sims53:27

       Your, yeah, so you're getting really, uh, strong around the knee joints, the hip joints, because again, that feeds forward to better movement, movement economy, and prevention of a misstep for a hip fracture later down.

    10. SBSteven Bartlett53:40

        What about cardio and...

    11. SSDr Stacy Sims53:42

        So that's where, like, if we're looking at those three days a week and we're finishing with plyos or some sprint work, then the other days just walking, low level intensity walking, or maybe you have sole food, you wanna go for a bike ride, you wanna go for a run. If you're not training specifically for something, then those three strength training days are your key workouts. And then you can pepper in all the other things

13. 54:04 – 58:00

    Is It Okay to Be Super Skinny When Running Marathons?

    1. SSDr Stacy Sims54:04

       that you like to do.

    2. SBSteven Bartlett54:04

       I hear a lot about VO2 maxes, so I thought that we should all be driving our cardiovascular performance up to get a high VO2 max.

    3. SSDr Stacy Sims54:11

       Well, that's where the intensity is-

    4. NCDr Natalie Crawford54:12

       Once a week.

    5. SSDr Stacy Sims54:12

       Yeah. I think it's-

    6. NCDr Natalie Crawford54:13

       That's only once a week.

    7. MHDr Mary Claire Haver54:14

       I mean, f- and correct me if I'm wrong, but my understanding after reading and watching everything is it doesn't take that much to build VO2 max.

    8. SSDr Stacy Sims54:20

       No, it doesn't. It's that high intensity that's a little bit uncomfortable where you're pushing at that max for, uh, you know, about four minutes to build that VO2, uh, um... In the sport science world, it's always been the four by four, the Norwegian four by four.

    9. NCDr Natalie Crawford54:35

       Yeah, the Norwegian.

    10. SSDr Stacy Sims54:36

        Four minutes on, four minutes off. Four minutes on, four minutes off.

    11. NCDr Natalie Crawford54:39

        But that's not three days a week.

    12. SSDr Stacy Sims54:40

        No, not at all.

    13. NCDr Natalie Crawford54:41

        The Norwegian protocol is once a week.

    14. SSDr Stacy Sims54:42

        Once a week at the most, right.And the other sprints, just to give you ... I tend to give my examples-

    15. NCDr Natalie Crawford54:48

        Yes.

    16. SSDr Stacy Sims54:48

        ... 'cause it makes it more real. But when I'm doing sprint intervals, um, I do it the 30 seconds on and then complete recovery, meaning I'm, for 30 seconds, I'm taking my heart rate as high as I can get it, and then I'll completely recover, which takes me two to three minutes. I just happen to do it on a treadmill, but the reality is, you can do it on anything.

    17. NCDr Natalie Crawford55:12

        Mm-hmm.

    18. SSDr Stacy Sims55:12

        It's a heart rate function-

    19. NCDr Natalie Crawford55:14

        Mm-hmm.

    20. SSDr Stacy Sims55:14

        ... not an apparatus function. So for me, on a treadmill, after I'm done warming up, you can't do it cold or you'll hurt something.

    21. NCDr Natalie Crawford55:24

        Exactly.

    22. SSDr Stacy Sims55:25

        After I'm done warming up, 'cause I'm a really short person, I punch the treadmill up to 11 and I am just working so hard I don't fly off the back. But that gets my heart rate up really high, about 186. Everybody's top heart rate is different.

    23. NCDr Natalie Crawford55:42

        Mm-hmm.

    24. SSDr Stacy Sims55:42

        And then I completely recover, and I do that four times.

    25. NCDr Natalie Crawford55:47

        And that's all you need.

    26. SSDr Stacy Sims55:47

        It doesn't take that long, and you feel so good when you're done.

    27. NCDr Natalie Crawford55:51

        Yeah. So I can't run at the moment, so this morning, I did explosive kettlebell swings.

    28. SBSteven Bartlett55:55

        Why can't you run at the moment?

    29. NCDr Natalie Crawford55:56

        Uh, I've a torn hamstring and meniscus, so I can't run at the moment.

    30. SBSteven Bartlett56:00

        Running is in.
14. 58:00 – 1:04:56

    Your Body Composition Isn't Your Fault

    1. NCDr Natalie Crawford58:00

       welcome to my world of DEXAs.

    2. SBSteven Bartlett58:02

       Yeah, d- d- ... Is that healthy? I'm not even sure if that's, that's the right question, or one can judge from just looking, but ex- ex- being extremely skinny in that regard, being that sort of marathon runner physique, you could have an-

    3. SSDr Stacy Sims58:13

       There are some that are naturally predisposed to that.

    4. SBSteven Bartlett58:16

       Oh yeah.

    5. SSDr Stacy Sims58:16

       So naturally predisposed, having really good running economy, running biomechanics, having a leaner body, and this is what, when you were talking about the Olympics earlier-

    6. SBSteven Bartlett58:25

       Mm-hmm.

    7. SSDr Stacy Sims58:25

       ... where you can see the ideal body type for that particular sport. And then there are those like me who build muscle naturally, and it's pretty easy, so I'd never be a skinny little runner. And my running economy's a little bit off because of where I build muscle versus not. So not everyone is meant to be a long distance runner, and there are some that are meant to be long distance runners. So if we're talking about your friends who are, like, super skinny, are they i- i- economically viable for being a long distance runner? Possibly, but we also have to look, are they male or female? What is their injury rate? What is their fueling? And then for me, I'd want to see the DEXAs of the women that are just training long distance and super skinny, because most of the time we see a higher visceral fat in, um, in and around the organs as we were talking about. Even though on the outside they look super lean-

    8. SBSteven Bartlett59:17

       Super.

    9. SSDr Stacy Sims59:17

       ... but they have a really high percentage of visceral fat because of the inflammation, the low energy intake, and most likely estradiol suppression.

    10. SBSteven Bartlett59:27

        And that's the skinny fat thing you were, you were t-

    11. SSDr Stacy Sims59:29

        Mm-hmm.

    12. SBSteven Bartlett59:29

        ... talking about earlier.

    13. SSDr Stacy Sims59:30

        Yeah.

    14. SBSteven Bartlett59:30

        Is, is there an evolutionary lens on this? I always think about this when we're having these conversations, like, well, what used to happen thousands of years ago?

    15. SSDr Stacy Sims59:36

        We talk about the evolutionary biological theories, and there are a lot of sociologists that will counter what I'm getting ready to say, so I'll apologize in advance. When we look at original hunter-gatherer type communities, the male body was designed to go out to find the calories. The women body was designed to stay and take care of the offspring and make sure that home was set. If it was low calorie, menstrual cycle would stop 'cause you didn't want to reproduce in a time of low calories. Body fat would come on because there weren't a lot of calories.

    16. SBSteven Bartlett1:00:07

        And so the equivocal in the time now is that I'm not eating enough-

    17. SSDr Stacy Sims1:00:11

        Mm-hmm.

    18. SBSteven Bartlett1:00:11

        ... or I'm burning more than I'm consuming?

    19. SSDr Stacy Sims1:00:13

        Exactly.

    20. SBSteven Bartlett1:00:13

        So I'm in a calo- calorie deficit in some way.

    21. SSDr Stacy Sims1:00:15

        Exactly.

    22. SBSteven Bartlett1:00:16

        Okay. Th-

    23. SSDr Stacy Sims1:00:16

        In an energy deficit. So with the male body, and we see this, their brain and hypothalamus is not as sensitive to those nutrient deficits as m- much as a woman's body because we have menstrual cycle and menstrual cycle function. A man will lean up and get more cognitively focused in times of low calorie intake, so this is what we see with fasting data and we see with restrictive diets. Mm-hmm. And that was, we need to bring it back to that biological lens, low calorie, I have to go find the calories, I have to be fit to go find the calories. Low calories, I need to not have to eat as much, so I need to store fat, and I can't have a baby because we don't have enough calories.

    24. SBSteven Bartlett1:00:57

        And then stress?

    25. SSDr Stacy Sims1:00:59

        ... when we add modern stress onto that, that's a comprehensive addition of cortisol and addition of inflammation, and that also perpetuates body fat.

    26. SBSteven Bartlett1:01:08

        I mean, like, uh, stress 10,000 years ago would have been like a lion.

    27. SSDr Stacy Sims1:01:12

        Oh.

    28. NCDr Natalie Crawford1:01:12

        Right, well it's episodic.

    29. SSDr Stacy Sims1:01:12

        Oh, yeah. It's a lion. Yeah.

    30. NCDr Natalie Crawford1:01:14

        Right? We had stress.
15. 1:04:56 – 1:13:41

    The Must-Do in Your 50s and 60s

    1. SSDr Stacy Sims1:04:56

       to all the voices on social media that are just yelling at mostly women and telling them, "It's just a matter of willpower-"

    2. SBSteven Bartlett1:05:04

       Right.

    3. SSDr Stacy Sims1:05:04

       ... "and you don't have the body composition you deserve?" (laughs)

    4. VWDr Vonda Wright1:05:07

       Well, you swipe left and don't talk to those people.

    5. NCDr Natalie Crawford1:05:09

       (laughs) Yeah.

    6. SBSteven Bartlett1:05:09

       (laughs)

    7. SSDr Stacy Sims1:05:10

       But that's me, right?

    8. NCDr Natalie Crawford1:05:11

       Right.

    9. SSDr Stacy Sims1:05:11

       But I'm, I'm talking to the woman in Ohio who's feeling defeated-

    10. NCDr Natalie Crawford1:05:14

        I know.

    11. SSDr Stacy Sims1:05:14

        ... and, uh, stumbles across someone screaming at her on the internet that her body composition that she's not happy with is her fault. I hate that because it's a construct of society, right? Especially Western society. This is where we have to educate. It's not your fault. These are the things that have come into play and lined up to create this situation, but now we have tools to offer you to take one step out of that situation. And let's see how many more steps we can get you away from this situation to improve your health.

    12. NCDr Natalie Crawford1:05:46

        Yeah.

    13. SBSteven Bartlett1:05:48

        And are the rules of exercise slightly different o- once you've entered perimenopause?

    14. SSDr Stacy Sims1:05:53

        So this is where we really need to look at how we can use exercise and some environmental stress to create a really strong adaptive stress and a really strong recovery stress.

    15. NCDr Natalie Crawford1:06:04

        Stacey, can you explain adaptive stress?

    16. SSDr Stacy Sims1:06:06

        Yes.

    17. NCDr Natalie Crawford1:06:06

        'Cause I'm thinking of the 10,000 people who follow me who will be like-

    18. SSDr Stacy Sims1:06:09

        Who have no idea what adaptive stress is.

    19. NCDr Natalie Crawford1:06:11

        Mm-hmm.

    20. SSDr Stacy Sims1:06:11

        So if I go and I, uh, d- do some resistance training, some heavy lifting, I want to create a stress on my body that's gonna then have a signaling cascade to repair the muscle in a stronger way than when I first went in.

    21. NCDr Natalie Crawford1:06:28

        Because lifting the muscle damages the muscle?

    22. SSDr Stacy Sims1:06:30

        Yes, and it creates a series of feedback mechanisms that make it repair stronger than when you first went in. So that's an adaptive stress. And we're looking at what levels of stress we can put, so it's a training stress, or what levels of stress we can use through exercise to really, really create an environment that improves our health.

    23. NCDr Natalie Crawford1:06:53

        Okay.

    24. SSDr Stacy Sims1:06:54

        So if we talk about sprint interval training, the 30 seconds on and the two to three-minute recovery, the reason why we want that super high-end stress of our heart rate is it then creates a...... eventual epigenetic change. So it's that environment that's gonna create a change within the muscle that's going to allow that GLUT4 protein that I mentioned earlier to open up and have glucose come in, reducing insulin resistance. Also, with that really high, high heart rate, we're having a lot of stress on the muscle that's going to release, uh, myokines, which are little hormone signals that then will go to the liver and say, "Wait a second. We don't need to store visceral fat. We need to create non-esterified fatty acids," which can then go into our skeletal muscle to be used in the mitochondria as fuel. So we want to have the stress that's strong enough to create these cascades of feedback mechanisms to improve our overall health. If we stay in that moderate intensity zone-

    25. NANarrator1:07:53

        Mm-hmm.

    26. SSDr Stacy Sims1:07:53

        ... we aren't creating a strong enough stress to create that signaling.

    27. NANarrator1:07:57

        What are we doing?

    28. SSDr Stacy Sims1:07:58

        We are exacerbating inflammation. We're exacerbating cortisol. Now, cortisol isn't the demon, but when we have an elevation of it, and especially in perimenopause when we're sympathetically driven and we already have a higher level of baseline cortisol, if we are continuously in this modern intensity zone, we never get a signal to allow that to drop. So if we're looking at polarizing, which is top, top end and low recovery end, then with the top end, we get the signal cascade of improving body comp, improving, uh, insulin sensitivity, as well as getting growth hormone and testosterone responses, which then feed back to drop cortisol.

    29. SBSteven Bartlett1:08:40

        So am I right in thinking the solution if I'm perimenopausal is to do high intensity interval training for short periods of time?

    30. SSDr Stacy Sims1:08:48

        So we look at the quality of the training, not the volume of the training. So if we're in our reproductive years, then yes, you can do the modern intensity stuff because you have estrogen-
16. 1:13:41 – 1:18:30

    Metabolism and Alzheimer’s Link

    1. MHDr Mary Claire Haver1:13:41

       a new book out, um, coming out, called Joy Span. I don't know if you've spoken with her.

    2. SSDr Stacy Sims1:13:45

       Mm-hmm.

    3. MHDr Mary Claire Haver1:13:45

       So she's a gerontologist and works with the very elderly and she has a very specific, you know, what determines who's gonna kill it in that last decade of life.

    4. SSDr Stacy Sims1:13:55

       Mm-hmm.

    5. MHDr Mary Claire Haver1:13:55

       And that community part, using your brain, you know, having interactions with human beings seems to be the key, and if you don't keep that going through this 40s, 50s, 60s, when you get to 70 and 80, you're not gonna have a great end of your life.

    6. SBSteven Bartlett1:14:13

       And what about the last phase then? So if someone's post-menopausal-

    7. SSDr Stacy Sims1:14:16

       Mm-hmm.

    8. SBSteven Bartlett1:14:16

       ... does their exercise recommendations change at all?

    9. SSDr Stacy Sims1:14:20

       We like to start the habits early and continue them through. If you haven't started, it's not too late. As we're seeing, like, with Lift Mor and some other of the older age research that's coming out, it's never too late to start. We just have to be very careful how you start to have support and phase you into these different-

    10. MHDr Mary Claire Haver1:14:37

        When.

    11. SSDr Stacy Sims1:14:37

        ... exercise mo- modalities.

    12. SBSteven Bartlett1:14:39

        Is it the same exercises though?

    13. SSDr Stacy Sims1:14:42

        Meaning?

    14. SBSteven Bartlett1:14:43

        You know, the three days a week, the mobility, the strength, the-

    15. MHDr Mary Claire Haver1:14:46

        I am firmly post-menopausal and I am doing all these things.

    16. VWDr Vonda Wright1:14:50

        But it's different, different... People always ask me, "What does heavy lifting mean?"

    17. SSDr Stacy Sims1:14:54

        Right.

    18. VWDr Vonda Wright1:14:54

        And-

    19. SSDr Stacy Sims1:14:54

        It's relative.

    20. VWDr Vonda Wright1:14:55

        It's relative. My heavy is not gonna be Stacy's heavy. Or I should say it the other way, Stacy's very heavy is not gonna be my heavy.

    21. MHDr Mary Claire Haver1:15:03

        In Lift Mor, they just, the authors describe the one, the one-rep max. And so one-rep max is, like, safely, h- what is the heaviest you can do one rep, you know? So for a bicep curl, what is the heaviest weight I can do one to fail, you know, t- I'm gonna fail after this one. And for me, that was about 20 pounds.

    22. SSDr Stacy Sims1:15:21

        With good form.

    23. MHDr Mary Claire Haver1:15:22

        Exactly. Safely, with good form. And so I could nail 20. And so then they took them down to about 70, 80% of that, um, which for me was about 15, 16 pounds, so that you can usually do about five reps before you hit failure, and that is what they consider lifting heavy and that seemed to really resonate with my followers to understand what that meant.

    24. SSDr Stacy Sims1:15:45

        Mm-hmm. And there's so many women that underestimate their strength.

    25. VWDr Vonda Wright1:15:48

        Mm-hmm.

    26. MHDr Mary Claire Haver1:15:49

        Yeah.

    27. SSDr Stacy Sims1:15:49

        See them and they gravitate towards the 10-pound dumbbells. It's like, put that away. Go to the next one, do a couple of lifts with that, and then ideally I want you to put that away and pick up the next one, 'cause that's gonna challenge you. Because women have been so conditioned to do 10 to 15 reps to get, quote, toned, and not really put in the work they need to to build muscle and to get the benefit out of strength training, and I'm always telling women, "You're underestimating yourself in so many facets. Don't cheat yourself with the strength training as well."

    28. VWDr Vonda Wright1:16:21

        Because people have to remember what we're, what we're training for now, it's different than... I had a woman recently say, "I was taught to do biceps curls, five pounds 30 times." Well, after 30 times, not only are you bored, but you'll probably g- be f- at failure 30 times.

    29. SSDr Stacy Sims1:16:37

        Mm-hmm.

    30. VWDr Vonda Wright1:16:38

        That will build endurance. I am training to be as strong as possible and when I'm est- when I have strength down, then I start playing with tempo-
17. 1:18:30 – 1:23:42

    Ads

    1. SSDr Stacy Sims1:18:30

       The other thing I want to bring in is the brain health component, right? We talk about Alzheimer's and dementia and one of the reasons I really preface doing high intensity work is the lactate production 'cause we're finding more and more research coming out s- um, showing that part of the development of dementia and Alzheimer's and the plaque is a misstep in brain metabolism. So when we're looking at brain metabolism and the brain uses a lot of glucose, it also uses lactate. Now for women, we have less of the glycolytic or lactate-producing fibers and we tend to lose those with age. Men are born with more, tend to hold onto them more, so it's not necessarily...... as big an issue for lactate production. Men need to spend more time in the low intensity being able to produce more of our fat burning capacity. But for women doing that high intensity work and being able to produce lactate to then allow the heart and the brain to use that preferential fuel feeds forward to reducing the misstep in this brain metabolism component that occurs, and it's such a sex difference. We're seeing a- a change in glucose metabolism in and around perimenopause into menopause.

    2. MHDr Mary Claire Haver1:19:42

       Mm-hmm.

    3. SSDr Stacy Sims1:19:42

       So it's that lactate production that I, is kind of the offshoot of the high intensity work that's super important for brain health as well as-

    4. MHDr Mary Claire Haver1:19:51

       When you look at glucose metabolism in the brain, I'm talking specifically coming out of Arizona and- and from Lisa Mosconi's work.

    5. SSDr Stacy Sims1:19:59

       Mm-hmm.

    6. MHDr Mary Claire Haver1:19:59

       And they looked at glucose utilization in the brain, especially the forebrain, through the transition. It's w- wildly different based on what phase of perimenopause, menopause, and post-menopause that they're in, and it's- it's absolutely astounding and- and they're seeing patterns that can give clues that maybe the women who are headed towards the dementia route versus those who aren't.

Episode duration: 2:36:23