Women’s Fitness Expert: What You NEED To Know About Dieting & Exercise | Dr. Stephanie Estima

Dr. Stephanie Estima 0:00 I want women to stop being losers. And so I'm on a mission to really undo the genuinely [laughs] terrible advice that most women have been given as it concerns their health and their fitness. So we're gonna talk through some actionable strategies on how to build a body that has curves, more of an hourglass figure. But Steven, if I can be very honest with you, I am pissed off because we've been sold a lie that our worth is the number on the scale, and I've seen tens of thousands of patients over my 20-year tenure, and right now, a lot of online dialogue is, "I wanna be toned. I wanna have the Pilates body, be as small as possible." So this is where I get a little fired up, because I also have personal experience struggling with my own weight and my own worth. I was trying to become what I thought was the right thing, and I had massive problems afterwards. So I am gonna be very transparent and honest with you. The pursuit of skinny is a bad thing with devastating consequences. Like, you're gonna end up with bone disease like osteoporosis. [bones cracking]

Steven Bartlett 0:59 So there's lots of things on the desk here in front of us that I'd love to go through.

Dr. Stephanie Estima 1:02 Yeah.

Steven Bartlett 1:02 We've got these five fitness myths.

Dr. Stephanie Estima 1:06 Yes. So one of them, for example, is a lot of women are scared to consume more carbohydrates because they think it's gonna make them fat. But we need carbohydrates for our mood, our sleep, even performance at the gym. And then there's also women are scared that if they're lifting heavy weights, that they're gonna start looking like a bodybuilder, but that's almost impossible. 97 to 98% of women don't have the hormonal environment to bulk.

Steven Bartlett 1:30 And then we've also got these archetypes here.

Dr. Stephanie Estima 1:32 So there's four archetypes that women identify themselves in their fitness journey, and the most common woman that I see, Skinny Fat Sophie, and we'll talk about what this means.

Steven Bartlett 1:41 So let's talk about what the women listening should understand about hormones. How do you think about fasting and your menstrual cycle? What are the specific issues that mothers face as it relates to fitness? I mean, there's lots of things that I'd love to talk about.

Dr. Stephanie Estima 1:51 100%. That makes me so excited.

Steven Bartlett 1:56 This is super interesting to me. My team give me this report to show me how many of you that watch this show subscribe, and some of you have told us, according to this, that you are unsubscribed from the channel randomly. So favor to ask all of you, please could you check right now if you've hit the subscribe button if you are a regular viewer of the show and you like what we do here. We're approaching quite a significant landmark on this show in terms of a subscriber number, so if there was one simple free thing that you could do to help us, my team, everyone here, to keep this show free, to keep it improving year over year and week over week, it is just to hit that subscribe button and to double-check if you've hit it. Only thing I'll ever ask of you. Do we have a deal? If you do it, I'll tell you what I'll do. I'll make sure every single week, every single month, we fight harder and harder and harder and harder to bring you the guests and conversations that you wanna hear. I've stayed true to that promise since the very beginning of The Diary of a CEO, and I will not let you down. Please help us. Really appreciate it. Let's get on with the show. [upbeat music]

Steven Bartlett 2:51 Dr. Stephanie Estima, why is it you do what you do? Like, ultimately, what is it you're trying to change in the world, or what impact are you trying to have, and who are you trying to have it for?

Dr. Stephanie Estima 3:01 Well, [sighs] I am on a mission [laughs] to really undo the genuinely [laughs] terrible advice that most women have been given as it concerns their health and their fitness. And what I mean by that is, for the vast majority of health and fitness goals for women, it's all about becoming smaller. It's about becoming skinnier. It's about losing weight. It's about dropping a dress size. Steven, if I can be v- very honest with you, I want women to stop being losers. I want them to stop trying to lose all the time, and instead, what I would love for them to do is to shift their focus from losing, and focusing more on what they have to gain. So how much muscle can they gain? How much bone density can they gain? How much connective tissue capacity from their joints, their tendons, their ligaments can they gain? Can they work towards building a body that they love and trust and enjoy living in?

Steven Bartlett 4:01 Why do you want that for women?

Dr. Stephanie Estima 4:02 Because-

Steven Bartlett 4:03 Specifically this l- losing, gaining thing.

Dr. Stephanie Estima 4:06 We've been sold a lie that our worth is the number on the scale, which is, by the way, you know, when you, when you're weighing yourself, this is really just a reflection of your relationship with gravity. No more, no less, right? But we are told that when we fit into a certain dress size, that we are now worthy, that we will h- somehow have arrived. That is not the full experience of being women. Women can be strong. Women can be capable. Women can be competent, and you can't do that when you're starving yourself, when you're over-exercising, and you're not prioritizing your recovery or treating recovery like it is something that you have to earn.

Steven Bartlett 4:47 So are you saying being skinny is a bad thing, or?...

Dr. Stephanie Estima 4:50 I'm saying that the pursuit of skinny at all costs is a bad thing. So right now, a lot of online dialogue is, you know, strong is the new skinny. I don't want to pit those two things against each other, but I do want to... Like, if you are obese, you are much better not being obese, right?

Steven Bartlett 5:10 Mm.

Dr. Stephanie Estima 5:10 But it is the pursuit of skinny at the sacrificial altar of everything else. So if you are somebody who values being slim, the likelihood that you are gonna pick up heavy weights or weights that challenge you with enough effort and intensity is going to be lower. The likelihood that your bone density is gonna be sufficient over the arc of your life is gonna be lower. You are going to likely underconsume calories. If you are someone who thinks that they've won because they can fit into... You know, you're 40, and you can fit into a size whatever dress, but when you're 65, you have osteoporosis. You haven't won. You've been, you've been tricked.

Steven Bartlett 5:53 Tricked by who?

Dr. Stephanie Estima 5:54 A society that tells us that our worth is solely based on how small we are

Steven Bartlett 6:02 Hmm. And who are you? Like, in terms of why this matters so much to you as Dr. Stephanie-

Dr. Stephanie Estima 6:09 Yeah

Steven Bartlett 6:10 ... what do I, what context do I need to know there? 'Cause I can see you're a little bit pissed off.

Dr. Stephanie Estima 6:14 [laughs] Yeah, I am pissed off in a loving way.

Steven Bartlett 6:17 Yes.

Dr. Stephanie Estima 6:17 So I'll say it that way. I have professional experience in this, and I also have personal experience in it as well. I have an undergrad in neuroscience and psychology from the University of Toronto. When I was pursuing that, I became a fitness instructor, a personal trainer, so this is, you know, very young I started having, uh, my first exposure to seeing firsthand how people were setting goals for themselves and having a difficult time achieving it. Went on to the Canadian Memorial Chiropractic College in Toronto, Canada, and then I was in pr- I've been in practice for 20 years. So I've seen tens of thousands of, of patients over my 20-year tenure, and the same pattern kept showing up over and over

Dr. Stephanie Estima 7:02 and over. And then personally, I also, you know, just being a woman living in this society, grew up also struggling with my weight, trying to control my, what I ate, trying to do lots and lots of cardio to keep my weight down into what I thought was the ideal body type. I competed in a figure competition, which was really the first moment for me where I really felt like the science failed me, because I had followed everything to a T. Do lots of cardio, restrict your calories, you have to earn your recovery. The day that I got up on stage, I was 11% body fat. So just, just for context, you know, women have about 10 to, call it, 13% essential body fat, and if you go beneath that, then you start to get into a lot of trouble, so I was right at the bottom range of that. Most women, a healthy body fat percentage is something like, call it 18 to 25%. I had lost my period for two months before... I think it was two or three months before I stepped on stage. I ended up, um, with hormonal issues. My period ha- I had, it took a long time for that to regulate again. I gained all the weight back that I had lost, and I felt like a total failure, and I felt like the science had failed me.

Steven Bartlett 8:22 And it caused you a lot of pain.

Dr. Stephanie Estima 8:24 I hated myself. Like, full stop. I looked in the mirror, I hated what I saw. I would pinch, I would pick. It was like, "I wish this, I wish that, I wish, I wish." The other thing I'll say is w- the weeks before I stepped up on that stage, people were coming up to me and showering me with compliments. People were like, "Oh my God, you look, you look amazing. What are you doing? What's your program?" And so it's, I think it's so confusing for women. Maybe we lose the weight or we t- we go on this health journey, which is often just code word for getting smaller, and we, we get showered with these external compliments. And at the time, I was starving, because I was not eating, I was completely overworked, I wasn't sleeping, and I didn't have my period. Like, I was not the picture of health, but everybody was telling me how amazing I was, how amazing I looked. So I think that's where we get it... We, we, we hitch our worth to what the outside world tells us rather than thinking about who we need to be and how we need to show up for ourselves first in order to be able to give to everybody else, but also just unhitch ourselves from other people's expectations of us.

Steven Bartlett 9:39 And for the women, and for all the people, I guess, that have clicked to listen to this conversation right now, what are they gonna leave this conversation with specifically, and how is that gonna impact their life?

Dr. Stephanie Estima 9:49 Yeah. So this is for women and the men who love them, so this is for everyone.

Steven Bartlett 9:54 Okay.

Dr. Stephanie Estima 9:54 Um, I think for women, maybe you have been doing, like, the good girl thing like I was doing, you're doing the things that you thought you should've been doing, but you still don't have the dream body or the body composition that you want. We're gonna talk through some actionable strategies on how to do that. I think if you're in midlife, so you're in your 40s, your 50s, and maybe you're finding that you used to do those strategies and now they're not working for you as well or as much as they once did, we're gonna maybe break a little bit of your paradigm in the way that you think, you're thinking about health.

Steven Bartlett 10:30 And how old are you?

Dr. Stephanie Estima 10:31 I'm 48.

Steven Bartlett 10:32 Hmm.

Dr. Stephanie Estima 10:33 Mm-hmm.

Steven Bartlett 10:34 I think it's important context.

Dr. Stephanie Estima 10:35 Yeah.

Steven Bartlett 10:35 Are you also a mother?

Dr. Stephanie Estima 10:36 I'm a mother of two, yeah.

Steven Bartlett 10:37 Of two.

Dr. Stephanie Estima 10:38 Mm-hmm.

Steven Bartlett 10:38 Um-

Dr. Stephanie Estima 10:38 Mother of two, and then I have a, I have a stepson as well.

Steven Bartlett 10:41 Okay.

Dr. Stephanie Estima 10:41 Mm-hmm.

Steven Bartlett 10:42 So, um, there's lots of things on the desk here in front of us that I'd love to go through. They're all things that really, really interest me.

Dr. Stephanie Estima 10:47 Yeah.

Steven Bartlett 10:47 We've also got these five fitness myths-

Dr. Stephanie Estima 10:51 Hmm

Steven Bartlett 10:51 ... in this envelope here that we'll reveal at some point, and these archetypes here.

Dr. Stephanie Estima 10:55 Yes.

Steven Bartlett 10:55 Where do you believe the best place to start this conversation is?

Dr. Stephanie Estima 10:59 I think that maybe we can talk about the archetypes.

Steven Bartlett 11:02 Mm-hmm.

Dr. Stephanie Estima 11:02 Because I think that it sets the stage for allowing women to identify themselves in their fitness journey, however that is.

Dr. Stephanie Estima 11:12 Okay, my first, Overwhelmed Olivia. This woman wants to do the right thing, okay? So she is on social media, and within a couple of minutes of going on social media she sees someone saying, "Plants are trying to kill you, Olivia."

Steven Bartlett 11:30 [laughs]

Dr. Stephanie Estima 11:30 "You should never have plants. They're terrible for you." And she keeps scrolling, [laughs] and then she comes upon someone else who says, "Actually, plants are great for you. They have lots of fiber, they have lots of phytonutrients," et cetera. So she's like, "Oh. Okay, that's weird. Let me look up some fitness stuff." And then same thing with the fitness. Some people say, "You don't wanna get bulky, Olivia, so you need to do light weights, high reps." And then there's other people that are like, "That's not true. [laughs] You can... As long as you're bringing the muscle close to failure, you will build muscle." So she's getting the, I like to call it info-besity. It's, like, so much information, it's too much information, that she ends up getting, like, you know, it's like analysis paralysis. And this woman, I have a soft spot for her because she just is so scared to start something else and fail at it, because she doesn't want That to reinforce her own schema, her own perception of her being a failure.

Steven Bartlett 12:25 Mm-hmm.

Dr. Stephanie Estima 12:25 Right? So she doesn't do anything. When we think about, uh, Overwhelmed Olivia, we don't wanna get her A to Z. We don't wanna get her all the way to her goal. We just wanna give her a couple of quick wins to start, right? Get her just A to B. We're just gonna get her walking. She's just gonna have a goal of racking up 5 to 7,000 steps in a day, so she feels like she's a winner in some vertical of her life. And then you start to layer in more things with her as she goes along.

Steven Bartlett 12:52 Mm.

Dr. Stephanie Estima 12:53 The second one is probably my favorite, the m- the most common woman that I see, Skinny Fat Sophia. So the technical term for skinny fat is TOFI, thin on the outside, fat on the inside. This is a woman who doesn't present as obese, but her body composition, she's starting to see a loss of maybe bone loss, a loss of muscle, because she is not... She's very afraid of heavy weights. So maybe I'll do some Pilates, some yoga-

Steven Bartlett 13:23 Surfing

Dr. Stephanie Estima 13:23 ... maybe a walk, [laughs] right? She also calorically restricts as well, right? So this woman is my f- is... Like, personally, she's my favorite woman-

Steven Bartlett 13:32 Mm

Dr. Stephanie Estima 13:32 ... because when we start giving her a little bit more food-

Steven Bartlett 13:36 Mm-hmm

Dr. Stephanie Estima 13:37 ... and we start giving her just a little bit heavier weights than the two-pound weights that she's been lifting, you know, in her Pilates class. And by the way, I don't want Pilates people to come for me. I love Pilates-

Steven Bartlett 13:47 Mm

Dr. Stephanie Estima 13:47 ... but it's just not the main strategy for muscle building. So just-

Steven Bartlett 13:50 Fira also loves Pilates.

Dr. Stephanie Estima 13:51 I love Pilates. I do it twice a week. It's fantastic. But this woman, when she starts eating a little bit, I al- this is what she always says to me, "I can't believe I'm losing fat. I can't believe I'm losing weight by eating more. What is this trickery? What is this magic?" So I love this woman because when we get her to see the light, it's actually just... It's just a beautiful thing to have all her schema sort of rearranged in terms of what she thought was possible for her.

Steven Bartlett 14:16 Mm-hmm.

Dr. Stephanie Estima 14:16 Okay?

Steven Bartlett 14:17 This subject of fat.

Dr. Stephanie Estima 14:18 Yes.

Steven Bartlett 14:19 If someone comes to you and they say, "Stephanie, I would love to lose some, some belly fat-

Dr. Stephanie Estima 14:23 Mm-hmm

Steven Bartlett 14:23 ... because I'm skinny fat, or maybe I'm just... You know, I just have a bit too much weight on me," what is it you say to them?

Dr. Stephanie Estima 14:29 You can't actually spot reduce.

Steven Bartlett 14:31 What does spot reduce mean?

Dr. Stephanie Estima 14:33 So someone wants to reduce their belly fat, you can't just target belly fat.

Steven Bartlett 14:38 Mm.

Dr. Stephanie Estima 14:38 And so the way that you're gonna reduce overall adiposity in the body is you're gonna be strength training, which we've talked about, but you will probably also need some kind of caloric deficit.

Steven Bartlett 14:51 Mm-hmm.

Dr. Stephanie Estima 14:51 So when we think about that very famous, somewhat s- oversimplified calories in, calories out, so you wanna be thinking about, how am I going to create a deficit? So I'm consu- either consuming less calories on the calories inside, or I'm eating the same, but I have more output. So I'm doing more cardio, or I'm doing more weightlifting, or I'm doing more walking, or I'm doing something where my calories out surpass my calories in.

Steven Bartlett 15:18 Is there an easiest way to do that? 'Cause hear- hearing that, you know, just eat less, is, is quite-

Dr. Stephanie Estima 15:23 I hate it

Steven Bartlett 15:23 ... it's, it's-

Dr. Stephanie Estima 15:24 Yeah

Steven Bartlett 15:24 ... yeah, not great.

Dr. Stephanie Estima 15:25 Yeah. And it doesn't, it doesn't work in the long term either.

Steven Bartlett 15:27 Yeah.

Dr. Stephanie Estima 15:28 You can temporarily reduce your food, but at some point, your hunger hormones and your body is just gonna drive you to consume more calories. I often find when women are like, "Hey, I just wanna, I wanna build muscle and lose fat," or if it's just, "Hey, I wanna lose fat," I personally find it easier for women specifically to do more on the calories outside. So not to-

Steven Bartlett 15:49 Exercise.

Dr. Stephanie Estima 15:50 Yeah, so doing more exercise, more daily movement. I think that the calories in is totally doable. People do it all the time. I just find it's hard for most women to stick to long term 'cause then they have to... You know, they gotta measure, they gotta do all the things. So if you can figure out what your maintenance calories are, and then you can surpass that with maybe more walking or something that's not gonna ratchet up your hunger hormones or your cortisol levels, let's say, I think that that's often... I think it's a healthier option, personally, um, because you're also making sure that you're getting in sufficient substrate, sufficient calories, so that you can actually build, you know, you can build muscle, bone density, collagen, et cetera.

Dr. Stephanie Estima 16:28 So that's our Skinny Fat Sophia. Up next, I was this woman, I sometimes still am this woman, Exorcist Emily. [laughs] So this is, uh, just a funny word, um, to really describe the intensity that this woman puts out at the gym, right? So this woman, you have no problem getting her to the gym. She is the woman at the squat rack. There's no problem getting her to the gym and getting her to work very diff- like, very hard. What her issue is, and this was me for years, is that she still has some of the Skinny Fat Sophia attitude towards food. So there's a mismatch with her between how much effort she's putting out with her, uh, exercise program and how much energy is coming in with her food. She's still undereating because she's scared of gaining weight.

Steven Bartlett 17:19 Mm-hmm.

Dr. Stephanie Estima 17:20 I was Exorcist Emily. I was, you know, had the hoodie on, wearing the earpho- like I- nobody talked to me with my big earphones on. Uh, this was for me after I was going through, um, a divorce with my... I had very young children at the time. They were five and three, so I was, I was grieving that, and I was still adhering to this idea that I had to punish myself, that I was gonna go to the gym and crush it, and then follow that with insufficient calories afterwards because I still had that, "Well, I can't eat a lot, I'm gonna gain weight," kind of mentality.

Dr. Stephanie Estima 17:51 So Exorcist Emily, we love her. Um, and then the pinnacle, if you will, is the Dialed-In Diana. So this is the woman who has maybe made peace with some of her demons, [laughs] um, enjoys movement, knows that it's a way for her to tend to herself. You know, food is not a punishment. It's not, she doesn't restrict calories because she ate too much. She fuels to nourish her lifts, to nourish her recovery, and for pleasure. 'Cause I think a lot of us, a lot of women have forgotten that food is, is pleasure. It gives us joy and happiness. My sourdough bread in the morning gives me lots and lots of pleasure [laughs] and I will not give it up for anything. So this is sort of the, this is where we want every woman to be able to get to. We want her to dial in both her exercise program, her nutrition program, and to give herself some effing grace with her recovery. Yeah.

Steven Bartlett 18:45 You can swear.

Dr. Stephanie Estima 18:46 Yeah. Her fucking, her fucking... So give herself some fucking grace with her, with her recovery.

Steven Bartlett 18:51 We just got demonetized. [laughs]

Dr. Stephanie Estima 18:53 [laughs]

Steven Bartlett 18:55 Okay. But I get it. So we're trying-

Dr. Stephanie Estima 18:56 Big Es, yeah

Steven Bartlett 18:57 ... we're trying to get everybody to become Dialed-In Diana.

Dr. Stephanie Estima 18:59 Yeah. And also just know, so if you've been listening to these descriptions, you're like, "Oh, I got a little bit of the Exorcist Emily. I got a little bit of that rage or grief or something. But then I also sometimes have Analysis Paralysis." Like, you will also oscillate through them, and that's completely normal as well. Yeah.

Steven Bartlett 19:14 When you were talking about Exorcist Emily, that was not a, uh, it wasn't a light season of your life, was it?

Dr. Stephanie Estima 19:19 No, it was very dark. And it was the, it was the lifting that got me through it, truthfully. Yeah. It's, you know, sometimes when we think about resistance training, it's literally training your resistance. It's not a question for, you know, if something bad is gonna happen. It's just a, it's a matter of when. So I think something, you know, voluntarily putting yourself in a situation where you are making yourself uncomfortable. You know, going to the gym and moving your muscles to failure is not, you know, it's not fun. Uh, it can be quite intense, but it does train your resistance, your grit, your mental capacity to withstand, you know, terrible things.

Steven Bartlett 20:01 So by the end of this conversation, everybody listening is gonna be a Dialed-In Diana.

Dr. Stephanie Estima 20:04 I... That is my dream.

Steven Bartlett 20:06 Okay. Let's do that.

Dr. Stephanie Estima 20:06 That is my dream.

Dr. Stephanie Estima 20:07 Yeah.

Steven Bartlett 20:07 First, we should start with debunking some of the myths.

Dr. Stephanie Estima 20:09 Yes.

Steven Bartlett 20:09 I've got six myths in this, um, little envelope here.

Dr. Stephanie Estima 20:13 Okay. So the first one is carbs.

Steven Bartlett 20:17 Mm-hmm.

Dr. Stephanie Estima 20:19 And so the l- [laughs] so all the ladies who are listening, we have to heal our relationship with carbohydrates. You can restrict carbs temporarily, and for certain populations, that's a wonderful idea. Uh, if you're a woman that has type 2 diabetes or PMOS, something like that, a temporary clawback of carbohydrates is fantastic for improving insulin insensitivity, glucose disposal. Um, but diets like a low carb diet or a ketogenic diet, which I am a big fan of for certain populations, and even for a temporary amount of time, I think what a lot of women did with the carbs is once they started losing weight on a keto diet or a low carb diet, they said, "Oh, you know what the problem is? It's the carbs. I'm never gonna go back." And the problem with that is that if you were sick, you had a bacterial infection, you went to your doctor, they did a swab, came by pot, and they're like, "You know what? You have a bacterial infection. I'm gonna give you a script for antibiotics." Right? "You're gonna take it for the next 10 days, and then, you know, you'll come back for a checkup and we'll see how you're doing." You do that. You follow the protocol. You take the medication. I don't think anybody listening, or at least I hope anybody who's listening, is not gonna come to the conclusion at the end of those 10 days, "Do you know what I need to do to never get sick again? I need to continue [laughs] taking antibiotics for the rest of my life." No one is gonna do that. But somehow for carbohydrates, people made the illogical conclusion that you should never have carbohydrates ever again. And for women, what I noticed -- So I'm sure we'll talk about, um, my first book, The Betty Body. I advocate for a lo- lower carbohydrate, a higher protein diet in there, but for a transient amount of time, right? Until you achieve the goal of, you know, reversing metabolic issues or losing some weight, et cetera, improving your period. That's another thing that we actually see is menstrual cycle, um, regulation. But if you stay here too long, your thyroid,

Dr. Stephanie Estima 22:25 like so many women-

Steven Bartlett 22:26 What's the symptom or the consequence of your thyroid being malfunctioning?

Dr. Stephanie Estima 22:30 Yeah. I would say you're always cold, so your hands are cold. You're always cold. You might have very, very heavy bleeding, so your menstrual cycle during your bleed week, so that first three to seven days, let's say, when you're on your period. Hair shedding, so hair starts to actually fall out. Hair is not necessary at all for survival. So [laughs] when you don't have sufficient calories or sufficient balance of macros, your body is going to sacrifice the things that don't matter at all to your survival. And a lot of women will start to say hair st- uh, shedding comes out. The classic sign is the lateral third of the eyebrow. We start to see the lateral third of the eyebrow start to fall out as well.

Steven Bartlett 23:09 What do you mean the lateral third?

Dr. Stephanie Estima 23:10 The outside, the outside third of the eyebrow.

Steven Bartlett 23:12 Okay.

Dr. Stephanie Estima 23:12 So the tail for most people of their eyebrows starts to get really sparse and thin as well. So there's lots of common signs and symptoms, but we need carbohydrates, if not for the thyroid, but for our mood, our sleep, even performance, performance at the gym. In the vein of transparency and honesty, I don't always get to eat before I train, but on the weekends when I do, and I have some bread, and I have some omelets, or I have what my breakfast and I go and train, fantastic performance enhancer. A lot of women are scared to consume more carbohydrates because they think it's gonna make them fat, and this is really comes down to this CIM or carbohydrate insulin model of obesity, which has kind of largely been, like, disbanded. There's not a lot of evidence to support it anymore, but there's a lot of people online that will scare you and think, "Well, if you have carbs, your glucose levels might spike." And that, you know, the way that it's often presented is that is the worst thing that ever could happen to you.

Steven Bartlett 24:13 But there's such a thing as too many carbs.

Dr. Stephanie Estima 24:15 Correct. Yes. I think that the problem is not that the carbs were the problem. It's the overconsumption of carbs, the overconsumption of fat, the overconsumption of, of total calories.

Steven Bartlett 24:26 So it's defined by calories here.

Dr. Stephanie Estima 24:28 Yes.

Steven Bartlett 24:28 Okay.

Dr. Stephanie Estima 24:29 Yeah.

Steven Bartlett 24:30 There should be a button just down below here, and if it says subscribed, you're already subscribed. If it says subscriber, that means you're not yet. And if you're not subscribed, please could you do us a favor and hit that button? It helps the show more than you know, and according to the algorithm, you're someone that watches our show, but you haven't yet hit that button. Thank you so much.

Steven Bartlett 24:48 What's the next one? What's the next myth in your folder?

Dr. Stephanie Estima 24:51 Oh, this one. I love this one. Uh, this one is women getting bulky. Women are still scared that if they engage in a program of progressive overload, which is to say that you are... Maybe you are lifting heavy weights, maybe you are doing more volume, meaning you're doing more sets or more repetitions, that somehow you are going to bulk up as if to say that they're gonna start looking like a, you know, some- a physique competitor, a bodybuilder. It is the equivalent of saying, "Well, if you drive to the store to get some groceries, that you are gonna be on par with Lewis Hamilton, and you're gonna be a Formula 1 driver," right? It's just almost impossible for, I'm gonna say 97 to 98% of women don't have the hormonal environment to bulk. There are a few genetically gifted outliers that absolutely can, but for the most part, women cannot bulk. We do not have as mu- I don't have as much testosterone than, as you do. You have, like, 10 to 20X more than I do. So even if we train the same way, I'm never gonna be able to put on as much muscle mass as you. But a gal can continue to dream, right?

Steven Bartlett 26:12 [laughs]

Dr. Stephanie Estima 26:12 I can continue to hope. [laughs]

Steven Bartlett 26:14 Mm-hmm.

Dr. Stephanie Estima 26:15 So bulking up, it's not a thing. Um, what I, what I will say though, actually, what I will say is some people, when they do start lifting weights initially, they will start to feel a little thicker, right? 'Cause the muscle's a little bit more swollen. There's also a layer of fat that usually sits on top of the muscle. So as you begin to lose body fat, your muscles will begin to, uh, poke through, let's say. Um, but sometimes that's why people will feel bulk. They'll say, "Oh, I'm, I'm getting... I started, and I stopped because I was getting bulky." It's just a sort of a, a swelling or an inflammation, let's say, of the muscle underneath.

Steven Bartlett 26:48 Okay.

Dr. Stephanie Estima 26:49 Yeah. Ooh, long fasts. So I will call myself out here as well. I used to believe that this was the key, and this was when I was in my Skinny Fat Sophia era, when I was in my Exorcist Emily era, where I thought that the more you could fast, the m- less calories you could take in, and you could lose weight. You wanna make sure that you have total sufficient calories. You don't wanna overconsume calories, but you also don't wanna underconsume them either. But fasting doesn't actually teach you how to eat when you are not fasting, right? So I think that a lot of people overly rely on long fasts. So when I say long, I would say 20 hours, 24 hours, 36, 72, like these really multi-day fasts. If I start eating a lot less calories than, let's say, you do, I'm gonna have, over the long term, more detrimental effects than you might.

Steven Bartlett 27:47 Why?

Dr. Stephanie Estima 27:48 The female body is just more sensitive to whether nutrients are coming in or not, so that we can figure out whether or not we wanna direct our energy to, you know, being able to get pregnant that month. Our ovaries, when we sort of look at the density of the mitochondria in them, it's something like 100,000 mitochondria per oocyte, like per cell. So they're constantly scanning the environment to see whether it's safe for, uh, a woman to get pregnant. And so if you are fasting all the time, you run the risk of sending a signal that it's not safe, that these are famine conditions, and that you should not be producing an egg because that would be terrible, because if you got pregnant, there's not enough food to feed you or the baby.

Steven Bartlett 28:33 So it shuts off the, your, your menstrual cycle as a way to stop you having a baby.

Dr. Stephanie Estima 28:37 Yes. So you can still fast, but the way that I like to fast is sort of pull the food, you know, call it two to three hours before you go to sleep. That's when you cut off the food. You sleep for eight or nine hours. That's like a 10-hour, 11-ish hour fast, and then you wake up in the morning, and you eat. What often happens is women try to push th- They'll have a cup of coffee in the morning, and then they try to push their eating window, let's say, to 11 o'clock or noon, and that ends up... Well, it becomes more difficult, I'll say it that way. It becomes more difficult for you to get in sufficient calories, sufficient protein, sufficient carbohydrates and fats in a restricted eating window.

Steven Bartlett 29:16 Hmm.

Dr. Stephanie Estima 29:16 Yeah.

Dr. Stephanie Estima 29:17 Okay, so this is related to the bulky myth. I think a lot of women are scared of lifting heavy, partially because they've never done it, so it's foreign. And I think that the other reason that women are scared of lifting heavy is they're scared of getting injured, which, to be fair, is a valid concern. I think that in the era of, you know, again, social media can be a blessing, it can be the greatest thing ever, and sometimes it can be a, um, a vehicle for misinformation. And I think now we hear muscle mommies and lifting heavy, and I think that for women, at least in my cohort, you know, 40s and 50s who grew up in the, you know, the '90s, the Kate Mosses and the... Asking a woman who is very comfortable with a cardio machine as her vehicle for exercise to now move into the, you know, the free weight section of the gym, the deadlifting platforms, even the machines, can feel really intimidating. So there are lots of different ways that you can build muscle. It doesn't have to just be heavy. There are other ways that you can progressively overload the muscle, which is to say that you are applying sufficient intensity and effort every single time, whether it's heavy weight or it's more volume, or you're increasing the density of your workout, meaning that you take less rest, so you're a little bit more tired. Like, you can... There's a lot of different ways that you can make a workout harder. It doesn't always have to be heavy.

Steven Bartlett 30:39 Okay.

Dr. Stephanie Estima 30:40 Yeah.

Steven Bartlett 30:41 Heavy

Dr. Stephanie Estima 30:41 Oh, this one, this one's good. This is post-workout fueling. We used to think that you only had 15 minutes to, like, knock back a protein shake, right?

Steven Bartlett 30:50 After you've done a workout.

Dr. Stephanie Estima 30:51 After you've done a workout because you need to replenish the glycogen, and you have to start muscle protein synthesis, and I would say that this is largely false. Your muscle protein synthesis is not just limited to the 15 or 30 minutes that are immediately after the workout, right? Your muscles are building little protein factories over the next, you know, depending on how trained you are, 10 to 72 hours in some cases.

Steven Bartlett 31:13 Mm-hmm.

Dr. Stephanie Estima 31:14 As long as you are getting sufficient, again, total protein over the course of the day, total calories over a 24-hour period, totally fine.

Steven Bartlett 31:23 Okay.

Dr. Stephanie Estima 31:24 Yeah. Oh, pre-workout fueling. Okay. I would say in an ideal world, everyone would have some food before they train. So a little bit of protein, a little bit of carbs just to start raising some blood sugar to have some available substrate, um, for the workout. I don't do this, um, most of the week. So when I work out during the week, I'm typically at the gym around six-ish in the morning, and I don't, I don't like the way that it feels when I eat that early in the morning. And it sort of feels like I have a brick in my stomach. So what I typically do is I will fuel with ketones. I have ketones, uh, for my workout, and then when I get home, that's when I have my big,

Dr. Stephanie Estima 32:08 uh, meal.

Steven Bartlett 32:09 So you have ketones before you do a workout?

Dr. Stephanie Estima 32:10 Yeah. Mm-hmm.

Steven Bartlett 32:11 Why?

Dr. Stephanie Estima 32:12 In the absence of food, I would say that ketones are fuel that your body already kn- you, your body produces ketones, right? It's a fuel that your body already knows what to do with, especially when it's a big muscle gr- so if you're doing a leg day, let's say, or a back day, it provides you with the neural drive to continue going. So you get into that sort of sympathetic state.

Steven Bartlett 32:35 Mm-hmm.

Dr. Stephanie Estima 32:36 That's my favorite, um, flavor too, is the green apple. My kids have the green apple before their soccer, too. [laughs]

Steven Bartlett 32:41 I am a co-owner of this company, hashtag ad.

Dr. Stephanie Estima 32:43 Yes. [laughs]

Steven Bartlett 32:44 So I have to, I have to disclaimer that-

Dr. Stephanie Estima 32:46 Yeah

Steven Bartlett 32:46 ... someone's gonna come for me.

Dr. Stephanie Estima 32:47 Yeah.

Steven Bartlett 32:48 Mm.

Dr. Stephanie Estima 32:48 So in an ideal world, we would fuel before we work out, but my, the constraints that I have in my life is that I just can't. In the weekend, different story. I can wake up later. I can have a long coffee with my boys, you know, have breakfast, head to the gym, and then, you know, I always know that when I do have food, my performance is mwah.

Steven Bartlett 33:08 Better in the gym.

Dr. Stephanie Estima 33:09 Better, always,

Dr. Stephanie Estima 33:10 100% of the time.

Steven Bartlett 33:11 So let's talk about what you do in the gym and why you do it, 'cause you-

Dr. Stephanie Estima 33:14 Yeah

Steven Bartlett 33:14 ... you've clearly got a big focus on muscle being important.

Dr. Stephanie Estima 33:17 Yeah.

Steven Bartlett 33:17 I train with lots of women. I actually trained with a colleague of mine this morning called, uh, George. She often goes off into, like, the cardio section.

Dr. Stephanie Estima 33:24 Mm.

Steven Bartlett 33:24 And she does muscles as well as some, some resistance training as well, and I go off in the other direction to, like, the, you know, pecs.

Dr. Stephanie Estima 33:30 The platform and all that. Yeah.

Steven Bartlett 33:32 Yeah, like the men, the stuff that men typically-

Dr. Stephanie Estima 33:33 Mm

Steven Bartlett 33:33 ... gravitate towards.

Dr. Stephanie Estima 33:34 Yeah.

Steven Bartlett 33:35 And I'm wondering what you think all women should be doing in the gym. Like, is there, if you think about a seven-day workout regime-

Dr. Stephanie Estima 33:40 Mm-hmm

Steven Bartlett 33:41 ... what do you think is optimal in those seven days?

Dr. Stephanie Estima 33:43 Yeah. There is, uh, I do wanna, I do wanna call out something that you just said, and then I'll answer your question.

Steven Bartlett 33:47 Mm-hmm.

Dr. Stephanie Estima 33:48 Um, you just said, "I go to the area that typically men go to, and I do the exercises that men typically do." So just because squats and deadlifts and presses and pull-ups are typically done by men doesn't mean that those are ma- male exercises.

Steven Bartlett 34:00 Mm.

Dr. Stephanie Estima 34:00 Those are fundamental human, you know, motor patterns that both men and women can benefit from. Um, but to your point, there is typically more men doing those things that are more comfortable doing those things-

Steven Bartlett 34:11 Mm-hmm

Dr. Stephanie Estima 34:12 ... versus someone who's like, "Hey, I can figure out how a StairMaster works. I'll just get on this thing, and I'll be on here for the next 35 or 40 minutes," right?

Steven Bartlett 34:18 I love the StairMaster.

Dr. Stephanie Estima 34:19 I love the StairMaster, too. It's, uh, a special kind of torture. It's great. Okay, so in terms of what I think people should be doing, if she can aim something like three or four days a week of strength training-

Steven Bartlett 34:31 Yeah

Dr. Stephanie Estima 34:31 ... it would be alternating upper body and lower body.

Steven Bartlett 34:34 Okay.

Dr. Stephanie Estima 34:34 And then we would be thinking about what muscle groups are we gonna be working together. Is it a pull or push? Yeah. So this is, um, I think that-

Steven Bartlett 34:41 What is this?

Dr. Stephanie Estima 34:43 This is from, um, my book, uh, my upcoming book, uh, called Nothing to Lose, actually, because we shouldn't be losing. We should be try to, try to be gaining. And these are the, these are the muscle groups that I want women to be thinking about if their goal is body composition and they are trying to build a body that has curves. You can't spot reduce, but you can definitely spot build. Like, you can put curves where, uh, you know, they weren't before. So what I've done in the book is I've outlined muscle groups that I think women should be focusing on in order to help develop a more of an hourglass figure. So we have, starting at the top, we have the deltoid muscle group, which your, these are your shoulder. I like to call these your bread buns. So they're sitting on the side of your shoulder, the lateral delts. Below that, we'll have the back muscles and the lats in particular. I like to call the lats our angel wings because we have, you know, it helps sort of create that V. As the back widens, you have a, the appearance of a slender or slimmer waist. Moving posteriorly, we have glutes. So there's three, uh, muscles that make up the glutes. It's max, med, and min, glute maximus, glute medius, glute minimus. And then we have the adductor group, uh-

Steven Bartlett 35:53 Which is the insides of the legs

Dr. Stephanie Estima 35:55 Just the inner thigh muscles, yeah. And then the last, the last one is the, the pelvic floor, or may- more broadly, we'll say the, the core muscles.

Steven Bartlett 36:05 So what do I need to know? If I'm a woman and I, I'm thinking about building this, uh, these five muscles that you've highlighted here-

Dr. Stephanie Estima 36:11 Yeah

Steven Bartlett 36:11 ... are there, as it relates to how I should be training-

Dr. Stephanie Estima 36:14 Mm-hmm

Steven Bartlett 36:14 ... and the big misconceptions about how to train to build this-

Dr. Stephanie Estima 36:18 Yeah

Steven Bartlett 36:18 ... what do I need to know?

Dr. Stephanie Estima 36:20 For these muscle groups, you probably should be hitting something like 10 sets of, um, exercises per week per muscle group.

Steven Bartlett 36:29 Okay, so if I do four hip thrusts-

Dr. Stephanie Estima 36:31 Mm-hmm

Steven Bartlett 36:32 ... um, that is one set of four.

Dr. Stephanie Estima 36:35 Correct.

Steven Bartlett 36:35 And that's gonna help my glutes.

Dr. Stephanie Estima 36:36 Correct.

Steven Bartlett 36:37 So you're saying that I should be doing 10 sets a week.

Dr. Stephanie Estima 36:40 Per muscle group per week, yeah.

Steven Bartlett 36:42 That's not actually that much.

Dr. Stephanie Estima 36:43 It's not that much, no. And this is why I was saying before the two times a week that the ladies that are like, "I just have, I just have two. That's all I, uh, that's all I can give you," you can still have incredible results as long as you are taking the muscle close to Muscle failure, which is to say that you can no longer perform the repetition anymore. You don't have to take it to failure, but as long as it's one to three repetitions from failure. That's all you need to do. And now, I, you know, it's simple to say, "That's all you need to do." It's gonna be very difficult for you to do that because you are going to start noticing your, uh, range of motion, like your ability to do your range of motion is gonna be limited. You're gonna start noticing the velocity of the repetition is starting to slow down, so your ability to sort of move the, the weight through space is gonna start slowing down. You're gonna subjectively, even though you can see that you're holding like a 15 pound or 10 pound, you know, weight, it's gonna start feeling like 20 or 25, like your subjective perception of the weight is gonna be, um, increasing. You know, if you were to rate it out of 10, you would rate your effort like eight or nine out of

Dr. Stephanie Estima 37:52 10.

Steven Bartlett 37:53 And, and men and women, because they have different anatomies, should be doing slightly different exercises?

Dr. Stephanie Estima 37:59 I think that that's more a matter of preference and goals.

Steven Bartlett 38:02 But is my anatomy and your anatomy the same?

Dr. Stephanie Estima 38:05 Our anatomy is not the same, no. So when we think about the way that we move through, let's say if you and I were to squat together, or you and I were to lunge together-

Steven Bartlett 38:13 Mm-hmm

Dr. Stephanie Estima 38:14 ... there's gonna be some differences in terms of how we look. And so we'll pull up some props here if we can. So this is a female pelvis, and this is, this little guy who doesn't wanna s- stand up today, is a, is a male pelvis. So when we sort of look at the difference between them, the female pelvis is wider and it's more shallow. The male pelvis is more narrow. And the reason that we have more of this sort of, if you sort of look at the two, this looks like a little bit more like a heart shape.

Steven Bartlett 38:43 Mm-hmm.

Dr. Stephanie Estima 38:44 And this looks a little bit more like an oval shape. And the reason for that is to allow a baby to pass through. Why this is so important is this is going to shape the stressors that happen in our knees and our ankles. So in particular, we have something called the Q angle, which I believe, I believe I have a... Yeah, I have something. Yeah, yeah. So here is the Q angle. So what a Q angle is, is basically you take a measurement from the hip and you draw it all the way down to the kneecap or the patella, and then you take like another little line from the tibial tubercle and, and draw it upwards. So that's just for all the nerds that are listening, if you wanna measure this, it's the anterior superior iliac spine all the way down to the, uh, to the patella, and then the tibial tubercle. And what you'll see for women here in pink, because the pelvis is wider, the femur has to more aggressively come in medially. It has to come more to the center. So this makes women, when we compare women and men, um, it makes us more knock-kneed, which just means that the knees are coming more together. So this is gonna impact literally every s- uh, how we move. So it's gonna affect how we walk, how we jump, how we squat, how we lunge, how we run. And so it's important to, for women to understand how we're different because often the cuing and the instruction that women get are sort of very, they're based off of a male pelvis, let's say. And so we can run into feeling like squats are not comfortable, that lunges are not comfortable, or we start to even, uh, shy away from some of these motions because we don't think that they're meant for us. You just need to know how to adapt your training so that you can support some of those sheer motions as you, as you're moving. Because what ends up happening for women is as we are, let's say, lunging or squatting, as the knee comes down, we will start to see more sheer forces being placed through the medial or through the inside part of the knee, right?

Steven Bartlett 40:49 Mm-hmm.

Dr. Stephanie Estima 40:49 So that puts us at a greater risk for, uh, ligamentous injuries, so in the knee, the big one is the ACL that we often worry about. So as you're getting tired, you need to be aware that you're gonna have a tendency for that knee to come in, and there's nothing wrong with the knee coming in as long as you have muscles that can kind of support it. If I were to grab this back here so we can sort of think about superimposing it. If we were to look at the, the leg here, the muscles that are gonna be helping to control the way that the hip moves i- are the glutes. So you have the glute max, but in particular the glute medius, which is often called like the upper shelf, uh, muscle. That's actually gonna help the femur or counteract the femur being pulled inwardly.

Steven Bartlett 41:36 Mm-hmm.

Dr. Stephanie Estima 41:37 Yeah.

Steven Bartlett 41:37 Yeah.

Dr. Stephanie Estima 41:38 So we do have different anatomical differences that women need to be aware of so that we can bias training that will provide mobility and stability for us. So that's another reason why, I mean, yes, glutes look amazing in jeans, but it's also because they are providing such a driving force of stability for the spine, for the knees, for the ankles, literally for the entire body.

Steven Bartlett 42:00 And so with squatting, men and women should squat differently?

Dr. Stephanie Estima 42:03 Yeah, not all women and men should squat differently. There are women that can squat in the sort of traditional cuing.

Steven Bartlett 42:09 Can you show me this?

Dr. Stephanie Estima 42:10 I can, yeah. I'll have to take my heels off, but I'm happy to. Yes. Do you wanna do it now?

Steven Bartlett 42:15 Sure.

Dr. Stephanie Estima 42:15 Yeah, okay.

Dr. Stephanie Estima 42:16 Let's do it.

Steven Bartlett 42:16 So tell me how the anatomy of a woman and a man determines how we should be squatting.

Dr. Stephanie Estima 42:21 So I'll say first that you have to play and see what feels good for you.

Steven Bartlett 42:25 Mm-hmm.

Dr. Stephanie Estima 42:25 So there's gonna be some women that are gonna be able to squat just like the traditional cues that I'm about to give you. Most women prefer a little bit of a wider squat, and I'll show that. So the typical squat f- that w- the way that we're often cued is feet are hip-width apart-

Steven Bartlett 42:39 Yeah

Dr. Stephanie Estima 42:39 ... toes facing forward, and then we're gonna come down, and then I'm just like, I can't actually get... I'm trying. I'm collapsing my chest at this point. So for women, what a lot of women find is more comfortable, and they can actually get the range of motion that you just demonstrated, is taking your feet a little bit wider, and then you're gonna turn the feet out. So because the female femur tends to sit a little bit more spun inwards or in- internally rotated, now with this external rotation, we can actually just get by all of that and we can come all the way down into a squat.

Steven Bartlett 43:13 Mm-hmm.

Dr. Stephanie Estima 43:14 So, and we can hang out here, like I can, we can probably do the rest of the podcast like this if you'd like.

Steven Bartlett 43:20 I'd rather not.

Dr. Stephanie Estima 43:21 [laughs]

Steven Bartlett 43:21 I'd rather not.

Dr. Stephanie Estima 43:23 Yeah.

Steven Bartlett 43:23 So, so that's the squat. Is there anything else I need to know about the squat, the, the variance between man- men and women with squatting?

Dr. Stephanie Estima 43:28 The other thing that you can think about, whether it's a squat with two feet or a lunge or a split squat with one, is with a woman, when she's coming down, when she's decelerating, like she's coming down into the, into the lunge or into the split squat, everything, and your-- This is true for you as well. Everything is gonna be internally rotating, so the femur, the leg bone is coming in, the tibia is coming in, the foot on the inside, you're actually rolling onto the... You're flattening out the arch. It's called pronation, which everybody says is a bad thing, by the way, but it's, you need it to be able to load the spring. And then for women, like, if you and I were to squat with the same leg forward, you'll probably be able to see that as I'm coming down, like, my knee come, my knee tracks a little bit inward versus yours stays a little bit more straight. There's nothing wrong with that. It's just a matter of whether or not I have sufficient control with my hip stabilizer muscles to, in order to make sure that I'm not putting excess shearing forces on the, on the knee.

Steven Bartlett 44:27 So you need to strengthen your hip stabilizer.

Dr. Stephanie Estima 44:29 Yep.

Steven Bartlett 44:30 Okay.

Dr. Stephanie Estima 44:30 The peach.

Steven Bartlett 44:30 'Cause I, I read something about, I think it was about the World Cup, the Women's World Cup, where they said that it was something like 12 women had got-

Dr. Stephanie Estima 44:36 Yeah

Steven Bartlett 44:36 ... ACL inj- injury, injuries-

Dr. Stephanie Estima 44:38 Yeah

Steven Bartlett 44:38 ... in the lead-up to the World Cup.

Dr. Stephanie Estima 44:39 Yeah. So when we're thinking about why that happens, it usually happens when the athlete is tired. So if it's leading up to the World cup, they've probably over-trained, they're not recovering, uh, and then it can be just the- they're training one day and she takes a weird step. The shearing forces happen just before her ligaments and her tendons are able to stabilize it, and, and you,

Dr. Stephanie Estima 45:01 and you damage it.

Steven Bartlett 45:01 And is that, is that true that there's a connection between, like, your brain and your mechanics that often result in injury? Like, so I can't remember what it was, but I think someone, it was a sleep doctor telling me that when you're underslept, one of the reasons why you get so many injuries is because when you do, like, jump, your brain and your-

Dr. Stephanie Estima 45:18 The reaction time is slow. Yeah.

Steven Bartlett 45:20 A- and you see a lot of athletes doing, doing this before games-

Dr. Stephanie Estima 45:24 Mm-hmm

Steven Bartlett 45:24 ... because they're almost, like, practicing landing.

Dr. Stephanie Estima 45:26 That's actually a little bit of deceleration.

Steven Bartlett 45:28 Oh, okay.

Dr. Stephanie Estima 45:29 So what that is is basically a stick and land, right? So they're jumping and they're holding it so that the forces are not dumped into the joints, but rather absorbed into the connective tissue, so the, the ligaments and the tendons.

Steven Bartlett 45:40 And why is deceleration, why is it important, even for everybody, even non-athletes, to do that?

Dr. Stephanie Estima 45:45 Well, if you are not an athlete and you're just somebody who doesn't wanna fall and break a hip [laughs] , you know, I think that that's really important. You know, if you're thinking about falling, what you need to be able to do is get the hip flexor up in front of you, right, and then stop the fall. So there's a couple muscles. So we have the hip flexor muscle that has to come up quickly in order to m- get ahead of the fall. We have the tibialis anterior, which is just-

Steven Bartlett 46:10 Mm-hmm

Dr. Stephanie Estima 46:10 ... this muscle in the front of the tibia that is involved in what's called, uh, dorsiflexion, which is just nerd speak for toes come up, right?

Steven Bartlett 46:19 Mm-hmm.

Dr. Stephanie Estima 46:19 So you need to be able to clear the floor, and then you need to have glutes to sort of absorb and break, right? And then we were talking a little bit about the hourglass figure before when we were talking about the adductors or the inner thigh muscles. One of the things that the inner thigh muscles will do is they'll actually pull the leg back underneath you, right? So they'll also help to stabilize that fall. And the adductors, or the outside muscle gr- like the side of the glutes, they're also gonna help break. So there's a couple-- Like, when you're falling, it's like you gotta get the leg up. You gotta have the toe clear the floor. And then if you're falling off to the side, you need the adductors and the abductors to be able to, um, to stabilize so that you don't trip over

Dr. Stephanie Estima 47:02 it. [paper flips]

Steven Bartlett 47:03 One of the smartest things a business can do is build like a bigger company without actually hiring like one. But the problem we all face is that most companies don't have every skill in-house. So when I look at the businesses seeing real success today, the consistent pattern with all of them is how quickly they move. They bring in specialists with skills in emerging areas to keep themselves ahead. Even in our company, we've spent the last year pulling in talent across areas like AI-native strategy, no code builds, and product workflows, and we find this talent through our longtime partner, Fiverr Pro. Their premium service only shows you vetted talent, so you've always got the safeguard that anyone you pull in to help you with a complex project has the skills that you're after and will deliver to the same high standards as your internal team. And most importantly, they'll keep up with the pace. It's a simple strategy, but it lets us stay agile without compromising on quality. So if you need these kind of skills in your business, head to pro.fiverr.com to find pioneering talent to fill your business' gaps. That's pro.fiverr.com. [paper flips] You guys know that I only drink one type of coffee these days, and it's called Cometeer. If you don't know the brand, they flash freeze coffee at the perfect moment to lock in all of the amazing flavor. They've done something incredible. They've gone all around the world and they found the most delicious coffees from all of these places, and they've created a world mug competition box that you can buy. So if you wanna try coffee from Honduras or Panama or England or the USA or Italy or France, you can then order that particular coffee on subscription to come to your house. No machines necessary. Not only are they our sponsor and a company I have invested in, it is the only coffee I drink now. Actually, this morning when I came to work, I put Cometeer, one of these red ones, which is another one of my favorites from France. If you wanna try your own Cometeer, they've reserved a certain amount for Diary of a CEO listeners. Just go to cometeer.com/doac and you can get $20 off if you use the code DOAC at checkout.

Steven Bartlett 49:01 [paper flips] So let's talk about, um, let's talk about supplementation.

Dr. Stephanie Estima 49:04 Mm-hmm.

Steven Bartlett 49:04 Do you take supplements?

Dr. Stephanie Estima 49:06 I do. I'll pre-frame this by saying that I am a special category of nerd. So I take a lot of the foundational supplements, and then there are other ones that I take because I'm just very, very interested in the research and the research excites me. But for, I would say for the general population, for women that are listening, if they're thinking, "Oh, I gotta supplement," there's a couple of sort of tier one, we'll say, supplements that we wanna be thinking about. So I will find my magnesium first. This is our tried and true bestie, okay? So I love a magnesium, uh, glycinate. There's lots of different kinds, uh, but glycinate's just the easiest to absorb for most people. Tends to help with relaxation, helps with sleep, helps with muscle recovery. So this is something that I love. I'll usually take one, like 250 mgs at lunchtime, and then another one in the evening. So-

Steven Bartlett 49:55 Mm-hmm

Dr. Stephanie Estima 49:55 ... magnesium for everyone.

Steven Bartlett 49:57 How do you remember to take them?

Dr. Stephanie Estima 49:59 I tend to habit stack them. So I always know that when I'm preparing my lunch, I actually keep my magnesium right beside my salt and my pepper.

Steven Bartlett 50:08 Oh, okay.

Dr. Stephanie Estima 50:08 So as I'm, like, salting my food, I'm like, "Oh yeah, there's the magnesium. I'm gonna take it." And I have another bottle upstairs in my bathroom.

Steven Bartlett 50:14 Mm-hmm.

Dr. Stephanie Estima 50:14 So as I'm getting ready for bed, I'm putting up my hair, I'm doing my skin, whatever, I will- I'll take one there, too.

Steven Bartlett 50:20 So you put it in the way-

Dr. Stephanie Estima 50:21 Yeah. Yeah

Steven Bartlett 50:22 ... of, of other habits.

Dr. Stephanie Estima 50:23 'Cause otherwise, if I put it in a really beautiful supplement closet, it's just going to-

Steven Bartlett 50:28 Yeah, same

Dr. Stephanie Estima 50:28 ... stay there. Yeah.

Steven Bartlett 50:29 I have to put it on my desk, and also when I travel, it's on the hotel desk.

Dr. Stephanie Estima 50:32 Yeah. You're already doing something else.

Steven Bartlett 50:34 Mm-hmm.

Dr. Stephanie Estima 50:34 So just put the thing next to the thing you're already doing, and your compliance and your adherence is gonna go up.

Steven Bartlett 50:39 Mm-hmm.

Dr. Stephanie Estima 50:40 Right? Um, what else do we got in here? Ooh, omega-3s. Okay. These are so well established in literature. They reduce inflammation. They help with cognition. Something like two to four grams a day.

Steven Bartlett 50:52 I didn't know you needed to keep it in the fridge. I've been keeping it in a hot cupboard for the longest time.

Dr. Stephanie Estima 50:56 Yeah, I mean-

Steven Bartlett 50:57 Apparently it spoils

Dr. Stephanie Estima 50:58 ... it just... Yeah. It just helps with, with spoilage, so you can pop them in the fridge. And then same kind of thing, like habit stacking. So as you're opening up the fridge, put it in front of, you know, the thing that, the thing that you would most commonly reach for. If you go for fruits in the morning, you put them right beside your fruits.

Steven Bartlett 51:12 Okay.

Dr. Stephanie Estima 51:12 Yeah. Uh, what other goodies do we have in here? Vitamin D for sure. Uh, D3 with a K2. Uh, 4,000 IUs minimum, uh, per day I would say. Most people should be taking that. They call it a vitamin. It's not really a vitamin. It's more of like a pro hormone or a pre hormone. So this is really important for sex hormone, reproductive hormone, uh, production. Uh, again, inflammation, cognition.

Steven Bartlett 51:36 Every day?

Dr. Stephanie Estima 51:37 Every day.

Steven Bartlett 51:37 Every day.

Dr. Stephanie Estima 51:37 Yeah, every day.

Steven Bartlett 51:38 I went to the doctor and he said I was deficient in vitamin D and omega-3. So those much.

Dr. Stephanie Estima 51:42 Do you know how many p- even if you live in a sunny... I can't tell you. I, I've had patients who live in, you know, Florida, let's say, where it's, you think that you're getting a lot of sun exposure because the temperature is, uh, amicable to that, and you run their vitamin D and...

Steven Bartlett 51:57 It's crazy.

Dr. Stephanie Estima 51:58 Yeah.

Steven Bartlett 51:58 Crazy.

Dr. Stephanie Estima 51:59 Ooh, I'm so happy you have this one here. Creatine. Uh, I know you just had Dr. Darren Candow-

Steven Bartlett 52:04 Mm

Dr. Stephanie Estima 52:04 ... on the show. He was actually on my podcast as well. For women,

Dr. Stephanie Estima 52:08 you know, I think creatine used to be this, um, like bro supplement, you know? It was like these, the bodybuilders with the scary, you know, noises and the, you know, weird T-shirts and stuff. But the creatine is really, really important for women. The way that Dr. Candow, uh, described it to me was he said, you know, lifting weights builds the cake, and this is like the icing on top of it, right?

Steven Bartlett 52:29 Mm.

Dr. Stephanie Estima 52:29 So you're not gonna, you know, enhance performance, you're not gonna build strength if you're just doing the creatine. You have to be pairing it with the mechanical signal of resistance training, but I think every woman can be taking five grams, three to five grams of this every single day.

Steven Bartlett 52:45 How much are you taking?

Dr. Stephanie Estima 52:45 I

Dr. Stephanie Estima 52:46 take five.

Steven Bartlett 52:46 Sometimes you take a bit more than five.

Dr. Stephanie Estima 52:48 Sometimes I take a little bit more than five. So when you have been... And this is, this is the little perimenopausal hack, because I am in, fully in the throes of it right now. There are nights where I don't sleep well. So taking a higher dose of creatine that day will help with your cognition, your awareness, and your alertness. So something like a 10 gram dose, uh, because it's a little bit harder to get f- my understanding of it is it's harder to get across the blood brain barrier, so you need a higher dose in order to facilitate that. But yeah, 10 grams.

Steven Bartlett 53:21 And what impact has it had on you? Have you noticed an impact?

Dr. Stephanie Estima 53:24 When I haven't slept well, yeah, definitely. If I take it in the morning, it definitely wakes me up. I would say that when I am not taking regular cr- like, I'm not taking the three to five grams, or f- you know, for some reason I start forgetting, um, muscles look a little less swole. You know, they look a little less full. Um, don't have as much energy in the tank when I'm doing, like, a really intense, uh, workout.

Steven Bartlett 53:46 Mm-hmm.

Dr. Stephanie Estima 53:47 There's a performance degradation when I am, when I'm not

Dr. Stephanie Estima 53:51 on it. And then collagen. I love this one because it gets so much hate online, so we're going to go against the grain and talk about how great collagen is. A lot of the criticism for collagen often comes from this idea that, well, it's terrible. It doesn't have any leucine or it has less than 3% of leucine, which is an amino acid that stimulates muscle protein synthesis. And yes, that's true. It is a terrible driver for muscle protein, but this, that's not, like, the whole goal for women is not just muscle, right? We have other tissues that go to the gym alongside our muscle that train, like our tendons, our ligaments, our joints. Um, and so collagen is just like muscle, is a very expensive process. So it's very expensive, you know, you know, from a, a mechanistic point of view to create collagen. So taking collagen is great for what I like to call the JTL, your joints, your tendons, and your ligaments. So I will typically take something like 10 to 15 grams of this a day. People will probably come at me. I put this in my coffee sometimes, which I know the heat, I get it, but if I don't, I won't take it.

Steven Bartlett 54:59 There's so many collagen products out there at the moment, isn't there?

Dr. Stephanie Estima 55:01 Yeah, yeah, yeah.

Steven Bartlett 55:02 Collagen drinks, collagen, collagen's in everything.

Dr. Stephanie Estima 55:04 Mm-hmm. Mm-hmm.

Steven Bartlett 55:05 Someone's gonna figure out how to, like, put it in the air or something.

Dr. Stephanie Estima 55:07 Yeah, right. Yeah.

Steven Bartlett 55:08 Is that all a fad? C- uh, they're saying it's good for skin, it's good for nails, it's good for hair.

Dr. Stephanie Estima 55:13 Yeah.

Steven Bartlett 55:13 It's good for everything.

Dr. Stephanie Estima 55:13 It's good for fascia. It's good f- I mean, collagen is the primary compound in joints, tendons, ligaments, fascia, skin, hair, and nails.

Steven Bartlett 55:21 Do you take a particular type of collagen?

Dr. Stephanie Estima 55:23 Hydrolyzed. Hydrolyzed type one, two, and three. Yeah.

Steven Bartlett 55:26 Okay.

Dr. Stephanie Estima 55:26 Yeah.

Steven Bartlett 55:26 Fine. What else?

Dr. Stephanie Estima 55:28 Electrolytes. I take electrolytes not as consistently. Again, in the vein of transparency and honesty, I typically will take this on a very heavy cardio day. So- I have recently taken up tennis. I'm terrible at it, but being outside, tennis, you're in the heat, you're running left and right, and you're doing it for hours on end, you know, you can s- when you're sweating a lot, electrolytes are really great.

Steven Bartlett 55:51 Okay.

Dr. Stephanie Estima 55:52 Yeah, so like electrolytes, don't take them all the time. And what's our last puppy here? Oh, vitamin C. Vitamin C I actually like to take with the, um, the collagen because it can enhance its absorption, and then this is just a general antioxidant that I think, you know, there's no harm in taking vitamin C, right? It's water-soluble. You take too much, you pee it out.

Steven Bartlett 56:12 Mm.

Dr. Stephanie Estima 56:12 Um, but good as an antioxidant, good as an anti-inflammatory. Helps with the absorption, um, of collagen as well.

Steven Bartlett 56:19 What about protein? How do you think about protein? Do you, do you take protein shakes or anything?

Dr. Stephanie Estima 56:23 I do when I'm traveling, so I typically in my day-to-day, um, diet, I typically don't. I will if I'm falling a bit short, but for me, my, most of my protein is coming from

Dr. Stephanie Estima 56:37 whole foods.

Steven Bartlett 56:38 What about cardio? Because we, we've talked a lot about doing resistance training and the importance of building muscle.

Dr. Stephanie Estima 56:43 Yeah. Mm-hmm.

Steven Bartlett 56:43 Um, what, where does cardiovascular exercises, running, sprinting, StairMaster, fit into all of this?

Dr. Stephanie Estima 56:49 It's life. It's everything. Cardio is, is fantastic as well. Um, I think that again, you know, when I think about my overwhelmed Ophelia, us- you know, she's online, and she has people that are saying things like, "You should only lift weights and walk," and then there's other people that are doing, you know, the chronic cardio and the people who are kind of overdoing it that and not doing enough weights. I sort of think about her as we start this discussion. So we wanna be thinking about cardio not as a punishment for what you ate and not because you're trying to get skinny, but because we want to have other goals around our health span and our lifespan, so living a longer life and spending more of those years healthy.

Steven Bartlett 57:26 A lot of women have PCOS, including my partner.

Dr. Stephanie Estima 57:28 Yeah.

Steven Bartlett 57:29 Um, and I was looking at the, the comments on your, one of your interviews you did, and one of the top comments from a woman was, "For women with PCOS or insulin resistance-

Dr. Stephanie Estima 57:38 Yeah

Steven Bartlett 57:38 ... sprint training, HIIT, um, often backs- backfires because it spikes cortisol and insulin.

Dr. Stephanie Estima 57:43 Mm.

Steven Bartlett 57:43 Many of us do better with strength training plus Zone 2 until hormones stabilize.

Dr. Stephanie Estima 57:47 Mm-hmm.

Steven Bartlett 57:48 I would love to hear more tailored guidance for PCOS.

Dr. Stephanie Estima 57:51 Yeah. So the first thing I wanna dismantle in that comment is that cortisol spikes are bad. It really, context really matters. So without, so I'll just say it this way. Without cortisol, you won't wake up in the morning [laughs] you know? Like we need cortisol. There's something called the cortisol awakening response where it tends to peak, you know, somewhere, you know, right, right around the time that you wake up, and then it sort of looks like a ski slope, and it, you know, gradually exits the chat, right? So cortisol is a normal process. A cortisol spike is a normal process, just like when you train. So when she was saying like, "I train when I do resistance training," if she were to be monitoring her hormones, she would see both a glucose spike and a cortisol spike when she's training because tho- to, to be able to train with enough intensity and effort, you need to be, you need to get into something called sympathetic drive. You need to be in like stress physiology. So her cortisol is spiking when she's training as well. So I wanna really caution women away from being scared of normal and predicted, you know, um-

Steven Bartlett 58:54 Spikes

Dr. Stephanie Estima 58:55 ... spikes, right?

Steven Bartlett 58:56 Yeah.

Dr. Stephanie Estima 58:56 Like glucose spikes, cortisol spikes, so that, that's what I would say f- uh, just to start off that conversation.

Dr. Stephanie Estima 59:01 Women with PMOS, it used to be known as PCOS, now it's polyendocrine metabolic ovarian syndrome, her body typically behaves more like someone who is diabetic, like a Type 2 diabetic, where she has issues with glucose disposal. She has issues with insulin sensitivity. So specific recommendations for someone who has PCOS is absolutely she should be training 'cause every time she's contracting her muscles, she's actually helping whether insulin is present, is present or not, for her to pull that glucose into the muscle cell and to be able to make energy, so that's really fantastic. I also think that whether you have PCOS or you're, you know, Type 2 diabetic, I think that Zone 2 cardio is fantastic, again, for endurance, but you can also benefit from the very high-intensity cardio that, you know, might be categorized as high-intensity interval training or HIIT or sprint interval training, sometimes called SIT. This is, like SIT is basically like 10 to 20 seconds all out, ovaries to the wall, 100% effort, uh, and then you recover, and then you do that, you know, four, five, six times if you're feeling, you know, particularly [laughs] you know, energetic. Uh, and that can also, that stress, that cortisol spike and the, all the, you know, the physiological cascade that happens from that is going to make you stronger and a better glucose disposal agent, right, which is what she wants if she has PCOS, over the long term.

Steven Bartlett 1:00:40 Are there any particular exercises that women and people generally tend to stop doing as they age because it's kinda like it becomes harder as you age-

Dr. Stephanie Estima 1:00:49 Yeah

Steven Bartlett 1:00:49 ... but they should definitely n- not stop doing?

Dr. Stephanie Estima 1:00:52 Oh my gosh.

Steven Bartlett 1:00:53 Like what are the ones where we all kinda stop doing it, but it's, it leads to a downwards spiral?

Dr. Stephanie Estima 1:00:57 Sprinting 100%.

Dr. Stephanie Estima 1:00:58 I think that everybody should be sprinting.

Steven Bartlett 1:01:00 Why?

Dr. Stephanie Estima 1:01:01 You are gonna be increasing something called your VO2 max, which is, uh, just again nerd speak for how much oxygen can you take into the lungs and distribute to the cells, right? That along with, we've all heard the stat, muscle declines 1% per year if you're not doing anything. VO2 max is the same, so you will decline your VO2 max capacity 10% per decade if you're not actively working on it.

Steven Bartlett 1:01:24 I'll, I'll put some graphs on the screen that show that decline over time.

Dr. Stephanie Estima 1:01:27 Yeah. Great. I c- I can think of family members, you know, going up the stairs or down the stairs or trying to get groceries and bringing them into the house that are huffed and puffed, right? That they're, they've lost their breath from going up a flight or two of stairs.

Steven Bartlett 1:01:42 But they think, you know, they say that that's just getting older.

Dr. Stephanie Estima 1:01:44 Absolutely not. [laughs] It's absolutely not a function of aging. It's just a loss of capacity. There was, um-

Steven Bartlett 1:01:50 Can you sprint?

Dr. Stephanie Estima 1:01:52 I sprint all the time. Yeah. But there's d- so I wanted, what I wanted to say was there's a couple of different ways that we can sprint.

Steven Bartlett 1:01:57 Okay.

Dr. Stephanie Estima 1:01:57 So you can sprint in a, on a track. So I used to be a track sprinter, so that's like my love. Um, but you can also sprint on a cardio machine in, in the gym. So in the wintertime, so I live, uh, on the East Coast where I can't always sprint on the track, so I will take my sprinting indoors, um, and I will do something called the Norwegian 4x4 on a bike. Have you ever heard of a Norwegian 4x4?

Steven Bartlett 1:02:19 I have heard of it, but please do explain.

Dr. Stephanie Estima 1:02:21 Yeah. It's a special, uh, it's a special kind of torture. I hate it up until the moment I get on the bike, and then when I'm doing it, I'm like, "Okay, I'm gonna do this," and then when I'm finished, I'm like, "I'm so proud of myself." So a Norwegian 4x4 is basically four minutes. You're s- you're... In my case, I do it on the bike, but it can be done on a treadmill or any cardio machine. 85 to 95% of your heart rate max. So you need to know what your maximum c- like the maximum heart rate that you have ever achieved, 85 to 95% of that for four minutes.

Steven Bartlett 1:02:52 Mm-hmm.

Dr. Stephanie Estima 1:02:52 It's a long four minutes.

Steven Bartlett 1:02:54 Mm-hmm.

Dr. Stephanie Estima 1:02:54 And then you take a, uh, you take a three-minute break, and then you do that again four times, hence the name four minutes, four times.

Steven Bartlett 1:03:01 Mm-hmm.

Dr. Stephanie Estima 1:03:02 Lots of really cool studies on looking at VO2 max capacity. There's one that I'm thinking of where they looked at women. The average age of the women were 58, so they were, a lot of them were n- in like post-menopausal, let's say, and they put them on a sprinting protocol. What they s- found was that in a period of eight weeks, they were able to increase their VO2 max by 10% in two months, which is wild when you think about how quickly you can lose it, and you can get 10% back in two months, which is, which is phenomenal. And the other really cool thing about that study was they actually took that cohort. So that was the, um, we'll call them like the, the well-lived or the older cohort, let's say, and they compared it to 18 to 30-year-olds, and they found that the gains that happened in the older cohort were s- they had mitochondrial efficiency improvements of 69%.

Steven Bartlett 1:04:03 Mm-hmm.

Dr. Stephanie Estima 1:04:04 Whereas the younger cohort, their mitochondrial gains were 49%. So all that to say, a lot of people will frame aging as this, like, well, now you're getting wrinkles, now you're getting old, and now you're just pa- you're over the hill. It's past your prime. These women had, maybe the gap was bigger for them, but they had so much more upside to gain, right? Which is so, I mean, that makes me so excited because it's never, ever, ever too late. Like, you can... Like, the best time to start was 10 years ago, fine, but the second best time is today. Like, you're not behind. You can totally

Dr. Stephanie Estima 1:04:35 do it now.

Steven Bartlett 1:04:36 One of the top comments in your recent video as well was someone saying jumping or hopping is a good way to strengthen your bones and knees.

Dr. Stephanie Estima 1:04:41 Yeah.

Steven Bartlett 1:04:41 We should not stop doing that as we age.

Dr. Stephanie Estima 1:04:44 True.

Steven Bartlett 1:04:45 Is it? 'Cause a lot of people start thinking, "Oh, I sh- I can't run anymore because it's not good for my hips and my knees, and I've-"

Dr. Stephanie Estima 1:04:50 Mm.

Steven Bartlett 1:04:50 "... you know, I've had injuries and stuff like that." So running is one of those things that people stop doing 'cause they're scared of joint issues.

Dr. Stephanie Estima 1:04:55 Yeah. I think the old adage of use it or lose it is really, really key here.

Steven Bartlett 1:05:01 Mm.

Dr. Stephanie Estima 1:05:01 Like, if you stop doing it, you're gonna definitely stop your ability to, like, you're not gonna be able to do it, right?

Steven Bartlett 1:05:06 Mm-hmm.

Dr. Stephanie Estima 1:05:06 Your body is going to prioritize the things that it does. So if you want to be able to jump, you want to be able to sprint, you want to be able to squat, age is, is absolutely inconsequential to that. So in that, in that particular comment, if somebody wanted to improve their bone density, yeah, for sure, you can strap on a weighted vest,

Dr. Stephanie Estima 1:05:26 do some plyometrics, add some weight to your jump. Like, that's gonna, you know, increase that strain magnitude and strain rate on the bone, which is gonna drive that positive bone reformation. That's awesome. But yeah, it's, if you don't jump, you're gonna lose your ability to jump.

Steven Bartlett 1:05:40 Do you jump?

Dr. Stephanie Estima 1:05:41 I do it all the time. Well, sprinting

Dr. Stephanie Estima 1:05:43 is jumping, right?

Steven Bartlett 1:05:44 Do you do like, is there such a thing as jump training though?

Dr. Stephanie Estima 1:05:46 Like plyos, plyometrics? Yes.

Steven Bartlett 1:05:48 Oh, is that what, okay.

Dr. Stephanie Estima 1:05:48 100%.

Steven Bartlett 1:05:49 And you do that?

Dr. Stephanie Estima 1:05:50 Yes. Even if it's just isometric holds, let's say.

Steven Bartlett 1:05:53 Mm-hmm.

Dr. Stephanie Estima 1:05:53 Like maybe somebody can't jump, but they can stand with their e- with their heels elevated so that the Achilles tendon and the calf, like the gastrocnemius, is contracting. Just to give you a little bit of a, a visual here, so what I'm talking about. Maybe one of the most famous tendons in the body is the Achilles. It is the extension of the calf muscles here, and then it sort of wraps around the heel and attaches into the, um, into the, uh, inferior part of the calcaneus, which is just, uh, your heel bone.

Steven Bartlett 1:06:20 Mm-hmm.

Dr. Stephanie Estima 1:06:20 So maybe you can't quite jump yet, but you can... Actually, this, um, mannequin is doing a really good job. They're just coming up on their toes, contracting the gastrocnemius, and this is called an isometric hold. So that tension in the muscles and in the tendon, we have these little mechanoreceptors that sort of detect stretch. So they will detect that w- whether something's being contracted or where s- whe- whether something's stretching, and they will say, "Oh, we need to remodel in order to meet the demand of this, this activity." And then you can progress to doing little hops. You can progress to doing jumps, et cetera.

Steven Bartlett 1:06:54 Very easy to do. You don't need to, you don't need a gym or anything like that.

Dr. Stephanie Estima 1:06:58 Not at all.

Steven Bartlett 1:06:59 I've heard you say that, um, deceleration is important-

Dr. Stephanie Estima 1:07:01 Mm.

Steven Bartlett 1:07:02 .. for mobility?

Dr. Stephanie Estima 1:07:02 Yeah. Deceleration is the opposite of acceleration. So we think of acceleration, it's speeding up and getting fast. Deceleration is coming to a stop. So in order to come to a stop without dumping all of the forces in your joints, again, the tendons and the ligaments need to be able to absorb that kinetic energy. And from a sport perspective, your ability to decelerate, so coming to a complete stop, and then changing direction, so change of direction training, is actually more predictive of whether you'll go pro than your vertical jump, your acceleration speed, or if you're doing things like beep tests or whatever. Um, it's also really important for us as we age. You might trip on, you know, something on the floor or, you know, the corner of a rug, or you might lose your footing on the stairs. You need to be able to get your foot in front of you and then- Be able to stop the motion before

Dr. Stephanie Estima 1:07:57 you fall

Steven Bartlett 1:07:58 Are there any other exercises that are, like, really, really simple and underrated-

Dr. Stephanie Estima 1:08:01 Oh

Steven Bartlett 1:08:01 ... that one can do without equipment?

Dr. Stephanie Estima 1:08:02 I have so many to show you, yes

Steven Bartlett 1:08:04 Okay

Dr. Stephanie Estima 1:08:04 [laughs] So the one that I love, this is almost like a diagnosis, but then it, you know, the diagnosis almost becomes the plan, like, the, the care plan. Uh, something that, um, I just call the X plank. It's very difficult to do, but it is a test for stability and mobility of the hip. So we were talking about the Q angle before. This is directly challenging the muscles on the side of the hip and whether or not you can stay stable. So, uh, this is a great exercise. Yeah, I can show it to you. So this is, again, like I was saying, it's the prescri- it's the test, but then it also becomes the care plan. So, um, maybe what we'll do, so I'll show it to you, and then maybe we'll have you try it.

Steven Bartlett 1:08:44 Yeah, you show me.

Dr. Stephanie Estima 1:08:45 Yeah.

Steven Bartlett 1:08:45 I'll, I'm gonna be over here.

Dr. Stephanie Estima 1:08:45 Yeah. [laughs] Okay. So you're basically gonna come into a side plank, so where your wrist and your shoulders are all aligned.

Steven Bartlett 1:08:54 Mm-hmm

Dr. Stephanie Estima 1:08:54 Toes are facing forward, hand comes up, and then you're going to lift the arm up, and you're gonna try and see if you can hold this for 30 seconds. It is not easy, and so this is really testing the stability and the mobility of your hips. It's also testing the integrity of your ability to stay abducted, which is what my leg is doing right now. So if someone has a timer, hopefully I'm close to 30 seconds, but we'll call it maybe now. [laughs] Probably about 30 seconds there.

Steven Bartlett 1:09:26 Yep

Dr. Stephanie Estima 1:09:27 Uh, so that's a, that's a really great test for anybody to do, and it's also, there's core work. There's shoulder work. It's a really whole body workout.

Steven Bartlett 1:09:33 Okay. Yeah, my, my turn.

Dr. Stephanie Estima 1:09:35 Why don't you try?

Steven Bartlett 1:09:36 Okay.

Dr. Stephanie Estima 1:09:36 Yeah, same.

Steven Bartlett 1:09:38 Okay.

Dr. Stephanie Estima 1:09:39 So on your side, toes stacked on top of each other. Wrist is kinda tucked under the shoulder. Yeah, hand is waving hello, and now try to lift your top leg.

Steven Bartlett 1:09:48 Oh, gosh, okay.

Dr. Stephanie Estima 1:09:50 [laughs]

Steven Bartlett 1:09:50 Let me just call somebody. I'm just [laughs]

Dr. Stephanie Estima 1:09:53 Yeah [laughs] let me phone a friend.

Steven Bartlett 1:09:55 Okay, I'm gonna tuck my... It hu- my, my feet hurt

Dr. Stephanie Estima 1:09:59 So in this case, if you're not able to do it, this becomes the thing that you train, right?

Steven Bartlett 1:10:04 I mean, the, the pressure of putting my foot on my other foot and putting all the weight on this foot here.

Dr. Stephanie Estima 1:10:08 Okay

Steven Bartlett 1:10:08 Oh, maybe I'll put my foot on the mat. Foot.

Dr. Stephanie Estima 1:10:10 Yeah, yeah, like, maybe you need a little bit of grip. Yeah.

Steven Bartlett 1:10:13 Here we go. [grunts] That's no better. I think it's actually just me being weak. Okay, so like this?

Dr. Stephanie Estima 1:10:22 Yeah

Steven Bartlett 1:10:23 And then lifting this leg up

Dr. Stephanie Estima 1:10:25 Lifting the leg up. There you go

Steven Bartlett 1:10:26 Okay

Dr. Stephanie Estima 1:10:27 Yeah

Steven Bartlett 1:10:28 Okay, I get it

Dr. Stephanie Estima 1:10:29 Yeah. Yeah, so now you're just gonna work yourse- yourself up to 10 seconds, 15 seconds-

Steven Bartlett 1:10:34 Do I do up the right arm?

Dr. Stephanie Estima 1:10:34 ... 20 seconds, and over time you'll just be doing this at the airport.

Steven Bartlett 1:10:37 Where does this arm go?

Dr. Stephanie Estima 1:10:38 Just, um, just on top

Steven Bartlett 1:10:39 Anywhere?

Dr. Stephanie Estima 1:10:39 Yeah, just on top. Yeah

Steven Bartlett 1:10:41 I think I've got more of a balancing issue, it seems

Dr. Stephanie Estima 1:10:43 Yeah, it's also, it's a really strong balance test, yeah.

Steven Bartlett 1:10:45 [exhales]

Dr. Stephanie Estima 1:10:46 This is a, this is one of those exercises that literally tests almost every system in the body, so I love it as a diagnostic.

Steven Bartlett 1:10:51 Okay. Is there, like, a, an entry to this exercise-

Dr. Stephanie Estima 1:10:53 Yeah

Steven Bartlett 1:10:54 ... that's a little bit more amateur?

Dr. Stephanie Estima 1:10:54 For sure. Yeah, and-

Steven Bartlett 1:10:56 What's that?

Dr. Stephanie Estima 1:10:56 Well, oh, if there's, m- you can maybe instead of doing it on both feet-

Steven Bartlett 1:10:59 [laughs]

Dr. Stephanie Estima 1:10:59 ... you can maybe do it on your knees.

Steven Bartlett 1:11:01 Okay

Dr. Stephanie Estima 1:11:01 So, um, I'll demo that real quick. So if you wanna just come here, so you're stacking the knees on top of each other, and then you can do it this way.

Steven Bartlett 1:11:09 Okay

Dr. Stephanie Estima 1:11:09 So there's still, you're still having to recruit the glute med, um, here, but it's just less, less stress.

Steven Bartlett 1:11:16 Okay.

Dr. Stephanie Estima 1:11:17 You wanna try that? See how that one feels.

Steven Bartlett 1:11:20 I got it

Dr. Stephanie Estima 1:11:20 Yeah, you got it. Okay.

Steven Bartlett 1:11:21 I got it

Dr. Stephanie Estima 1:11:21 Take a rest now

Steven Bartlett 1:11:21 Is there anything else that you can show me that you think's pertinent to the conversation we just had?

Dr. Stephanie Estima 1:11:25 You know what? Well, yeah. This one actually relates to, um, mobility a little bit, which we did talk about. So in cultures where people sit on the floor, they eat on the floor, um, you know, they toilet on the floor, they, their fall risk is literally almost zero. So I think as North Americans or Western, we can do more sitting on the floor. So one of the big tests, um, I'll u- I usually won't start on the floor, but I'll have, if it's an elderly person, maybe they're sitting on a chair, can they stand up unassisted, like, without using their hands? And this is the hardest part of the test. So what you'll do is your feet crossed, and we'll do it with both feet to see. Without using your hands, you can use a little bit of momentum if you want, um, but you're gonna see if you can get up without using your hands. There you go.

Steven Bartlett 1:12:14 Ooh, that clicks.

Dr. Stephanie Estima 1:12:15 That was awesome.

Steven Bartlett 1:12:15 That really clicks

Dr. Stephanie Estima 1:12:15 Nicely done. All right, let's get back down, and let's try to cross our feet the other way, the wrong way.

Steven Bartlett 1:12:20 The other way?

Dr. Stephanie Estima 1:12:20 Yeah. [laughs] I know. 'Cause you always typically cross your feet one way, right?

Steven Bartlett 1:12:25 Okay

Dr. Stephanie Estima 1:12:25 So I don't do this one as well as I do the other one, so I'm working on it as well. So again, no, um, hands. You can use a little bit of momentum if you want, and you're gonna come all the way up. That one was not as pretty.

Steven Bartlett 1:12:38 [grunts]

Dr. Stephanie Estima 1:12:38 Yeah. There you go.

Steven Bartlett 1:12:39 Okay

Dr. Stephanie Estima 1:12:39 You did really well.

Steven Bartlett 1:12:40 What is that, I, you know, what is, what, what muscles am I using there?

Dr. Stephanie Estima 1:12:43 You're using every, you're, you are recruiting mobility in your ankles. You are recruiting your quads to be able to extend your knee, your glutes to extend your hip. Like, it's the whole leg.

Steven Bartlett 1:12:52 Mm. Great.

Dr. Stephanie Estima 1:12:53 Nicely done

Steven Bartlett 1:12:53 Thank you so much. We're done.

Dr. Stephanie Estima 1:12:54 Yeah. Awesome

Steven Bartlett 1:12:54 Thank

Steven Bartlett 1:12:55 you. Any others that you love?

Dr. Stephanie Estima 1:12:56 Oh, goodness

Steven Bartlett 1:12:57 That you can do without equipment at home?

Dr. Stephanie Estima 1:12:58 Push-ups.

Steven Bartlett 1:13:00 Yeah

Dr. Stephanie Estima 1:13:00 Uh, body weight squats, which I think you should eventually progress to weights, but so many people have terrible technique, so you can actually have a fantastic workout with just your body weight. Um, glute bridges I think are fantastic. So many. You can pick up, like, a big, um, bag of cat food or dog food and, you know, do walking lunges down your, you know, wherever.

Steven Bartlett 1:13:23 If you know me, and if you've listened to this podcast before, you'll know how obsessed I am with sleep. I've been on a bit of a journey with sleep. I see it as the single most important thing that I, um, have the privilege of having control over, and that's exactly what our sponsor, Eight Sleep, are. It's a very, very intelligent piece of material to sleep on. Here's what the Eight Sleep pod does. It monitors your body while you're sleeping, and with their AI, it adjusts the temperature for you using billions and billions and billions of hours of sleep data, and members have reported up to a 34% deeper sleep and falling asleep up to 44% faster. Me and my fiancée, Melanie, sleep on different parts of the bed, and it adjusts my part of the bed to my body and her part of the bed to her body. So if you wanna learn more about this pod, go to eightsleep.com/stephen. That's code STEVEN for $500 off from now until July 12th. Big opportunity. I am not kidding. Give it a try For every founder, there comes a point in building a company where your job shifts from being the person inside your business actioning everything to the person responsible for absolutely everything. The only way I've been able to make this shift across the different companies and teams I'm responsible for is by knowing that the right systems are in place to manage everything, systems that don't need me in order for them to work. Our sponsor, Pipedrive, is one of those systems, an easy-to-use intelligent CRM tool for growing sales teams. My teams use it and have for the last decade because it's genuinely the most effective way to run a sales operation. Through one dashboard, you get every deal visible, and every stage of the sales process is clear, and what needs to happen next is all there in real time. When a system like this works, you don't need to be in every conversation to know exactly if your business is moving forward, where, and what the blockers are. Over 100,000 companies are already running their sales on it, so if you'd like to join them, sign up at pipedrive.com/ceo where you'll get an exclusive 30-day free trial instead of the usual 14 days. No credit card is needed. That's pipedrive.com/ceo.

Steven Bartlett 1:15:31 [paper rustles] One of the... I mean, I looked at lots of the comments, and a lot of them also talk about the specific issues mothers face after they have a child.

Dr. Stephanie Estima 1:15:38 Mm.

Steven Bartlett 1:15:39 Um, I saw comments about prolapse and pelvic floors, et cetera.

Dr. Stephanie Estima 1:15:43 Yeah.

Steven Bartlett 1:15:43 You've had two children.

Dr. Stephanie Estima 1:15:44 Mm-hmm.

Steven Bartlett 1:15:45 What are-- And you speak to many, many mothers.

Dr. Stephanie Estima 1:15:47 Yeah.

Steven Bartlett 1:15:47 Um, what are the specific issues that mothers face as it relates to fitness, their workout regimes, their goals-

Dr. Stephanie Estima 1:15:53 Mm-hmm

Steven Bartlett 1:15:53 ... um, resistance training, et cetera, that I wouldn't be aware of-

Dr. Stephanie Estima 1:15:57 Yeah

Steven Bartlett 1:15:58 ... as someone that's not given birth to a child?

Dr. Stephanie Estima 1:16:00 So, you know, we talked about how the, um, the hips are different for men and women. The pelvic floor is also very different for men and women as well. So just

Dr. Stephanie Estima 1:16:11 from a-

Steven Bartlett 1:16:11 What is the pelvic floor?

Dr. Stephanie Estima 1:16:13 The pelvic floor is like a hammock of muscles that goes from the pubic bone. So, um, if we were to think about, so here is the, uh, female pelvis. We have the pubic bone here.

Steven Bartlett 1:16:24 Mm-hmm.

Dr. Stephanie Estima 1:16:25 And then it's, it's like a sling of muscles that come around and then attach to the coccyx or what's known as the tailbone, and these are called the pubococcygeal, so pubic, coccyx, pubococcygeal muscles or PC muscles. And they're different than, let's say, your quadriceps or your glutes because they are literally working all the time. They are working to keep your organs in the pelvis so that they don't just fall out. And for women, this is another area where we are different because we have more... I mean, first of all, we have more openings, right? So if you think about the sling of muscles for a woman, you're gonna have a hole at the urethra, at the opening of the vulva into the vagina, and then also the anus. So there's three holes, and so already you have less surface area for that pu- for those muscles to be able to contract and support, right? Versus a male, uh, those PC muscles just have to deal with one.

Steven Bartlett 1:17:18 Mm-hmm.

Dr. Stephanie Estima 1:17:18 So it's mechanically much simple, sim-simpler for a man.

Steven Bartlett 1:17:21 Mm-hmm.

Dr. Stephanie Estima 1:17:22 And then you layer on hormonal fluctuations over the course of a, you know, woman as she's menstruating, if she becomes pregnant, under the influence of different hormones like relaxin, uh, the weight of the baby, you know, constantly pushing down, um, and then birth, as I've mentioned before. Uh, these can significantly alter the strength and the ability for the, for the PC muscles to, um, absorb load appropriately. So for women who've had babies, first you have to obviously be working with your OBGYN or your midwife or whoever is managing your care plan to be able to clear you for exercise. And once they do, you don't wanna necessarily go back to extremely heavy loads with lots of intensity right away because you haven't nec- you haven't necessarily yet completely healed, right? So this is where we get into thinking about, okay, so what are some ways that we can connect with, um, with the pelvic floor? So the famous exercise that everybody's probably heard of is Kegels. You've probably heard of Kegels.

Steven Bartlett 1:18:28 Mm-hmm.

Dr. Stephanie Estima 1:18:29 So those are wonderful if you're someone who has a weak, uh, pelvic floor. Not so much if you-

Steven Bartlett 1:18:34 Where you just sit and contract in, in your seat.

Dr. Stephanie Estima 1:18:37 Yeah. It's, it's literally like you... Uh, for men, the way that I've often, um, sort of cued men is, like, imagine you're, like, zipping up a zipper. Like, you're just kind of coming up, and you're sort of holding it, and then you're relaxing. You don't necessarily have to move and jump, but you're literally just sort of connecting as much as you can. It's hard because our, uh, neuromuscular connection to the pelvic floor sometimes is not really strong, but often just closing your eyes and just think, like, just coming up, holding, and then coming down, and you can do all-- You can do these all day long free, you know. No one's gonna know that you're doing it. Um, so that, that, if you have a weak pelvic floor, that would be something that you might explore. So pelvic floor physiotherapist would be someone who'd be able to diagnose that and give you a bit more counsel there. But weak pelvic floors, Kegels are great. They can actually... If you have, if you have a tight pelvic floor where you actually have trouble relaxing, Kegels can actually make things a little bit worse for you.

Steven Bartlett 1:19:30 Um, on your book, The Betty Body, the last word on the subtitle is the word sex.

Dr. Stephanie Estima 1:19:36 Mm.

Steven Bartlett 1:19:36 A Geeky Goddess' Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex.

Dr. Stephanie Estima 1:19:42 Yeah.

Steven Bartlett 1:19:43 Why did you include transformative sex?

Dr. Stephanie Estima 1:19:45 I included it because I think just like all of the myths that we've been talking about today about bulky and carbs, I think that the other thing that has been really, uh, taboo for women is women who enjoy their sex life. And so I was hoping in that first book to give women permission to, to want to desire it, to figure out if there wasn't, if there was low desire or low libido, what maybe some of those causes were and what are some of the ways that we can, we can learn more about ourselves. I'm thinking of this one patient that I had, um, and she actually was part of the reason why I included it in this first book. She had come into my clinic. She had come in for low back pain. It was, like, n- the most typical, like, um, have, you know, mechanical low back pain, right? And so we were giving her, uh, adjustments. We were giving her strengthening exercises. We were doing the rehab, all the things. Nothing out of the ordinary. At her reevaluation appointment She said, "Um," like, "Dr. Steph, I wanna, I wanna talk to you privately." I was like, "Okay, fine. Let's go into this room, close the door," all the things. And she said, um, "Do you know the real reason why I came in to see you?" And I said, "Yes, it was mechanical low back pain." And she said, "No. Uh, it's because when I was with my husband, you know, getting on top of him while we were being intimate was really hurting me. My back was killing me, my pelvis was killing me, my joints felt like they were rubbing on top of each other." I mean, I was lucky enough that this patient trusted me enough and we had enough rapport for her to basically say, "Yeah, I, um, I wanna ride my husband and I can't. I couldn't before, and now I can." And so I think that there is a quiet, um, taboo we'll say around women not enjoying sex, and I want to give women permission to. So whether you have low back pain and that needs to be corrected, if there's a hormonal input to that.

Steven Bartlett 1:21:42 Okay. Stephanie, what's the most, um, what's the most important thing we haven't talked about that we should've talked about?

Dr. Stephanie Estima 1:21:48 Oh my goodness.

Steven Bartlett 1:21:49 Well, we didn't talk about GLP-1s. That's all the bloody rage at the moment, isn't it? But-

Dr. Stephanie Estima 1:21:52 The G- yeah, GLP-1s are... Yeah, they're interesting for sure. I do think with all medications, and I am including hormone therapy in here as well, um, at the risk of getting shot down by some people, [laughs] is I think that we often marry ourselves to what we feel the benefits might be, and we will divorce ourselves from the possible side effects, right? Hormones are going to help with your, for sure, your sleep, your mood, uh, if you're experiencing some of the thermoregulatory problems, like the night sweats and the hot flashes and all the things. But it's not going to go to the gym and lift weights with you. It's not going to build a healthy plate. It's not gonna set boundaries with your boss. You know? Like, those things, you have to do those things, right? So there's this beautiful opportunity where we see more women taking MHT to a- or hormone replacement therapy, menopause hormone therapy, to blend that with lifestyle medicine. You can't... It's not, there's no easy button here. You know? You have to also put in the work.

Steven Bartlett 1:22:55 And lifestyle medicine meaning?

Dr. Stephanie Estima 1:22:57 Training, gr- managing your stress, recovering, doing the cardio that we've been talking about.

Steven Bartlett 1:23:02 On that recovery point you just said-

Dr. Stephanie Estima 1:23:03 Hmm

Steven Bartlett 1:23:04 ... what are the re- recovery protocols that you think all women should be doing?

Dr. Stephanie Estima 1:23:07 The best one that I can tell you is sleep. [laughs]

Steven Bartlett 1:23:10 Yeah.

Dr. Stephanie Estima 1:23:10 Which can be a challenge in perimenopause, I understand, but that is where you have things like, uh, growth hormone and IGF-1 tend to surge, muscles grow when you're sleeping, brain cleans itself out. Sleep is, sleep is the number one thing that everybody should be prioritizing. That's wonderful. That's like sort of tier one. Like, if there's like an S tier, sleep is an S tier. Um, under that, I would say if you have access to something like a sauna, that might be something that you can think of for recovery, whether that's an infrared sauna or it's a traditional Finnish sauna. I often call it lazy cardio-

Steven Bartlett 1:23:49 Mm

Dr. Stephanie Estima 1:23:49 ... so if you don't feel like doing a really intense cardio session, get yourself into a sauna if you have access to one. Not necessary, but really, really, like, there's a lot of really cool, uh, studies that have come out of Finland, which by the way, sauna is the only word in English that we've borrowed from Fin- from Finnish.

Steven Bartlett 1:24:06 Hmm.

Dr. Stephanie Estima 1:24:06 Just a little, little fun-

Steven Bartlett 1:24:07 Interesting

Dr. Stephanie Estima 1:24:07 ... little tidbit there. But, um, electrolytes we've talked about. I think that if you are really pushing, uh, yourself and you're sweating a lot, helping to recover and replenish those. As we lose estrogen in, in midlife, our ability to regulate salt also starts to decline as well.

Dr. Stephanie Estima 1:24:24 So-

Steven Bartlett 1:24:24 So what if, um, what should we have talked about that we didn't talk about as it relates to the most pressing questions you get asked by the people that consume the content you make?

Dr. Stephanie Estima 1:24:33 The only other thing I would say that we didn't really go on a nerd safari on is the joints, tendons, and ligaments, so, like the connective tissue capacity.

Steven Bartlett 1:24:41 Mm-hmm.

Dr. Stephanie Estima 1:24:42 We've talked a lot about muscle. I love muscle. I train muscle. Um, muscle's like the popular girl at the party. She gets a lot of attention. You know, if you think about a, a superstar like, I don't know, like Beyoncé or something, right? She's beautiful to look at, the pump is great, all of that, but if you put Beyoncé on a rotting stage or you put her on a stage that can't handle her, she's just gonna fall right through it, and then you have no concert, right? So I think that the forgotten tendons and ligaments and joints, we have to be thinking about those as we age because you, you can't squat if you don't have good knees.

Steven Bartlett 1:25:14 How do I get great ligaments and tendons?

Dr. Stephanie Estima 1:25:16 So the way that you encourage them to become stronger over time is how you train in the gym. So there's a couple of different ways that, um, you can bias for more tendon strength and more ligament strength. One of them is when you are lifting, you can bias what's called the eccentric portion of the lift. So concentric, muscle gets shorter, bones come together. Eccentric is stretch.

Steven Bartlett 1:25:39 Mm-hmm.

Dr. Stephanie Estima 1:25:40 When you start stretching the tendon, the tendon's like, "I'm being stretched. Okay, we have to now create more tensile strength to be able to meet that demand."

Steven Bartlett 1:25:48 Okay, so stretching.

Dr. Stephanie Estima 1:25:49 So stretching under load.

Steven Bartlett 1:25:51 Okay.

Dr. Stephanie Estima 1:25:52 Not just stretching.

Steven Bartlett 1:25:53 Pilates.

Dr. Stephanie Estima 1:25:54 Not Pilates, no. So Pilates, again, love Pilates, do it twice a week.

Steven Bartlett 1:25:58 You've really got a bee in your bonnet about Pilates.

Dr. Stephanie Estima 1:26:00 [laughs]

Steven Bartlett 1:26:00 You really don't like Pilates people.

Dr. Stephanie Estima 1:26:00 Do you know what, do you know what it is? No, no, no, it's not that. It's people confuse muscle endurance. So in Pilates you often have, like, very high reps, the muscle burns. Um, it's fantastic for the pelvic floor that we were talking about before. Phenomenal for women's health, for pelvic floor health, that posture.

Steven Bartlett 1:26:18 But you're saying it, Pilates isn't enough to build sufficient muscle mass.

Dr. Stephanie Estima 1:26:22 That's the main point.

Steven Bartlett 1:26:23 Okay.

Dr. Stephanie Estima 1:26:23 And that's where I think that people are like, "How dare you talk about this?" Like, I love Pilates. I do Pilates. I'm probably in your Pilates class. However, I also am training four or five times a week. I'm also sprinting one, you know, sometimes two, but mostly one time a week. I'm, I'm doing tennis. Like, I'm doing all of these other things, and Pilates brings me a lot of joy, right? B- I feel s- I always say I feel so happy after Pilates. I don't know why. It makes me really happy.

Steven Bartlett 1:26:47 But some people are doing just Pilates. Is the-

Dr. Stephanie Estima 1:26:48 But, but yes, so if you are just doing the Pilates, that's where I fear that you're like, "Look at me, I'm slim." You know, if you, if you're, "I'm able to fit in this dress now," but then what you're not doing is you're not loading your bones appropriately, you're not building sufficient muscle, your tendons and your ligaments are weak, and you're gonna end up with bone disease or a loss of loath, uh, load capacity when you're older.

Steven Bartlett 1:27:12 What's the most popular question that women message you with on Instagram?

Dr. Stephanie Estima 1:27:17 Usually it's, "Tell me about your skincare." [laughs]

Steven Bartlett 1:27:20 Okay.

Dr. Stephanie Estima 1:27:20 "Tell me, tell me about what you do with your hair," um, or you know, "What your workout outfit is." All those little questions, but it's, "How do I gain muscle and lose fat?"

Dr. Stephanie Estima 1:27:29 That's the big one.

Steven Bartlett 1:27:30 So tell me about your skincare routine then.

Dr. Stephanie Estima 1:27:31 Yeah. [laughs] Uh, it's pretty basic. Uh, I learned this from my dermatology friends, so some vitamin C, uh, in the morning, some, uh, SPF, um, and in the evening, uh, there's some kind of vitamin A. Uh, I actually really like NAD. I use a, another company I ha- has something called Urolithin A in it, which is supposed to help get rid of senescent cells in the body.

Steven Bartlett 1:27:55 Which are like dead cells, right?

Dr. Stephanie Estima 1:27:56 Which are, yeah, they're like the zombie cells that, um, uh, that sort of hang around and just create inflammation

Dr. Stephanie Estima 1:28:02 everywhere.

Steven Bartlett 1:28:03 You're almost 50?

Dr. Stephanie Estima 1:28:04 I'm almost 50, yeah.

Steven Bartlett 1:28:05 Feeling good?

Dr. Stephanie Estima 1:28:06 I feel great. I feel like I, I inhabit my body now in a way I wish I did in my 20s. Like, I was so punitive and I was so terrible to myself. The things I would say to myself and call myself, um, when I was 20, 30, um, I would never say that out loud to anybody else. And so now I, I feel really proud of myself. You know, I got into weight training just like a lot of women who are watching, they wanna look better, build muscle, lose fat. That's why I got into it as well, but I stayed with it because of, um, you know, it, it provided me a way back home. Like, it provided me a, like, it taught me how to love myself, it taught me how to be patient with myself, right? It taught me how to, um, forgive myself when I felt like I had failed, right? Like, it reimagines, uh, your relationship with failure, which I think is, like, a really big F-word for women.

Steven Bartlett 1:29:00 Dr. Stephanie, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they're leaving it for, and the question left for you is...

Dr. Stephanie Estima 1:29:07 What's your skincare routine? No, I'm kidding. [laughs]

Steven Bartlett 1:29:09 [laughs] I should've known that was a coming.

Steven Bartlett 1:29:12 Do you believe in God, and why or why not?

Dr. Stephanie Estima 1:29:16 Oh. Hmm. I do believe in God. I believe that there is a force greater than us, greater than we will, uh, ever be able to explain, um, that protects us, that gives us the lessons that we need to learn, and it will continue to present the same lessons to us over and over and over again until we are wi- you know, until we are willing to surrender to, um, to learning the lesson.

Steven Bartlett 1:29:45 When you're on your, um, when you're on your last day and you look back at your life and you go, "Do you know I did it?"

Dr. Stephanie Estima 1:29:50 Mm.

Steven Bartlett 1:29:52 What would warrant you being able to say that?

Dr. Stephanie Estima 1:29:55 That my family is around. I see my, I've met my grandchildren, maybe even my great-grandchildren, that they're all around my bed telling me... Oh, you're gonna make me cry, Steven. That, that they're telling me, um, all the ways, all the things that they have learned from me and that they're gonna take onto future generations on my, in my lineage.

Steven Bartlett 1:30:17 Why is that so important for you?

Dr. Stephanie Estima 1:30:20 I think all, all the reasons why I do what I do, um, is it's, it's, it's for my kids. Like, I want my kids to have a better life. I want to shortcut some of the learnings for them that I had to learn the hard way, and that's not to say I wanna deny them of their own learning opportunity, but I wanna be able to pass on what I feel is important values that I think make the world a better place. Like, I just wanna leave the world better than how I found it, and the way that I wanna do that is through my family and the work that I do here.

Steven Bartlett 1:30:58 Thank you. Thank you for doing all that you do. Um, I think it's incredibly important for so many reasons. I mean, there's been, I think through, I mean, it kind of says on the back of your book here, The Betty Body. Through time, people have thought that women were little men.

Dr. Stephanie Estima 1:31:10 Mm.

Steven Bartlett 1:31:12 Um, and that's what you wrote on the back of your book. It says, "Women are not little men, but that's how we treat our bodies."

Dr. Stephanie Estima 1:31:17 Yeah.

Steven Bartlett 1:31:17 And it's great to have voices like you that are so backed by science, so eloquent, that are out there demystifying what is a incredibly, um-

Dr. Stephanie Estima 1:31:26 Yeah

Steven Bartlett 1:31:26 ... complicated world of, uh, health information and conflicting information and, you know, I know it better than anybody because my audience will often say to me that, that I, I relate to all of the personas that you highlighted there, where you've got, uh, what was it? Was it Anxious Stephanie? Which was the one with the persona? This one.

Dr. Stephanie Estima 1:31:44 Exorcist Emily. [laughs]

Steven Bartlett 1:31:46 No, it's this, uh-

Dr. Stephanie Estima 1:31:47 Skinny Fat Sophia

Steven Bartlett 1:31:48 ... I get a lot of this one.

Dr. Stephanie Estima 1:31:49 Overwhelmed Ophelia.

Steven Bartlett 1:31:50 Overwhelmed Ophelia.

Dr. Stephanie Estima 1:31:51 Where do I start?

Steven Bartlett 1:31:52 Yeah.

Dr. Stephanie Estima 1:31:52 Yeah.

Steven Bartlett 1:31:53 Where-

Dr. Stephanie Estima 1:31:53 Where do I start, 'cause I don't wanna fail again.

Steven Bartlett 1:31:55 Yes.

Dr. Stephanie Estima 1:31:55 Yeah.

Steven Bartlett 1:31:55 So many Overwhelmed Olivias, in part because one of the upsides of there being so much information out there now is that people are getting, you know, they're not having to go to some expensive doctor and they can go on an AI, they can go on a podcast, whatever.

Dr. Stephanie Estima 1:32:08 Right. Right.

Steven Bartlett 1:32:09 But with science evolving over time and with lots of different voices, people are feeling often f- I think feeling more overwhelmed than ever with what they consider to be conflicting information, and I think you do a wonderful job of demystifying that.

Dr. Stephanie Estima 1:32:21 Thank you so much.

Steven Bartlett 1:32:21 Um, because it's nuanced, it's very human, it comes from lived experience, and it comes from, as you said, you've, you've, you've sat with tens of thousands of patients through the care- your career-

Dr. Stephanie Estima 1:32:31 Yeah

Steven Bartlett 1:32:31 ... in practice.

Dr. Stephanie Estima 1:32:32 Mm.

Steven Bartlett 1:32:32 And things aren't always so simple. They're not always as simple as they are easiest to sell, and I think things that sell are often simple and reductive.

Dr. Stephanie Estima 1:32:41 Yeah.

Steven Bartlett 1:32:41 But, um, the truth is often complicated, personal.

Dr. Stephanie Estima 1:32:45 Yeah, and it doesn't exist always in a lab. [laughs]

Steven Bartlett 1:32:47 Yes.

Dr. Stephanie Estima 1:32:48 Like you can't-

Steven Bartlett 1:32:48 Yeah

Dr. Stephanie Estima 1:32:48 ... always replicate it in a lab.

Steven Bartlett 1:32:49 And one of the things I learned from your work as well is that it changes through time.

Dr. Stephanie Estima 1:32:52 Yeah.

Steven Bartlett 1:32:53 I.e., for me, what's true for me now at 33 years old as a man, this stage of my life with the hormone complexion I have and the goals that I have, one thing can be true, but maybe when I'm 55, a different set of things are gonna be true.

Dr. Stephanie Estima 1:33:04 Mm.

Steven Bartlett 1:33:04 Um, and I think that nuance is super, super important.

Dr. Stephanie Estima 1:33:06 Yeah.

Steven Bartlett 1:33:07 If people want more of your work, I know you've got a book coming out at the top of the year-

Dr. Stephanie Estima 1:33:10 Yes

Steven Bartlett 1:33:10 ... next year called Nothing to Lose: Build the Dream Body You Want Today: Gain the Strength and Mobility You'll Need Tomorrow. And you've got this current book here called The Betty Body, which I'll link below.

Dr. Stephanie Estima 1:33:21 Yeah.

Steven Bartlett 1:33:21 Subtitled A Geeky Goddess. You use the word geeky a lot.

Dr. Stephanie Estima 1:33:24 Geeky. [laughs]

Steven Bartlett 1:33:24 A nerd. A nerd safari, that's an interesting phrase.

Dr. Stephanie Estima 1:33:27 Used to be, used to be sort of a, you know, a terrible word to use. I'm like, no, I'm a total nerd. Yeah, special category of nerd.

Steven Bartlett 1:33:33 A Geeky Goddess Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex.

Dr. Stephanie Estima 1:33:38 Yeah.

Steven Bartlett 1:33:39 Where else do people find you if they wanna learn more or message you or get in touch or come see you? What, like, what do they, where do they go?

Dr. Stephanie Estima 1:33:44 My podcast.

Steven Bartlett 1:33:45 Yeah.

Dr. Stephanie Estima 1:33:45 Not quite the reach that DOAC has, uh, but we are, I have a podcast called Better With Dr Stephanie.

Steven Bartlett 1:33:52 Mm-hmm.

Dr. Stephanie Estima 1:33:53 So I do solo episodes there where I go on my little tangents about tendons and ligaments and all the things, and then I also interview what I would qualify as the world's thought leaders in science and health, and we try to distill what it means for, uh, what it means to have a well-lived life. So podcast's free, uh, probably where you're listening to this, uh, YouTube and all the places, and then you can head over to my website, drstephanieestima.com.

Steven Bartlett 1:34:21 Anything else you wanted to say?

Dr. Stephanie Estima 1:34:23 I would say for the woman listening, my Overwhelmed Olivias who are feeling like they don't know where to start, or my Skinny Fat Sophias who are scared of lifting weights and eating like a bird, uh, or my Exorcist Emilys who are still exercising their demons, um, you're not behind, you are absolutely enough, and don't be so hard on yourself.

Steven Bartlett 1:34:48 Thank you.

Dr. Stephanie Estima 1:34:49 Thank you.

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