Female-Specific Exercise & Nutrition for Health, Performance & Longevity | Dr. Stacy Sims

1. 0:00 – 2:24

   Dr. Stacy Sims

   1. AHAndrew Huberman0:00

      (uptempo music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Staci Sims. Dr. Staci Sims is an exercise physiologist, and a nutrition scientist, and a world expert in all things training and nutrition, specifically for women. In addition to working at Stanford and with numerous professional athletic teams, Dr. Sims has authored more than 100 peer-reviewed studies on exercise physiology. She has not only evaluated existing protocols for nutrition and fitness that are specific to women versus men, but she has also developed many new protocols that are now in practice with professional sports teams, but that can also serve people who are generally interested in fitness and longevity, and in doing so, the general public. The tools that Dr. Sims shares with us today are applicable to fitness, to changing your body composition, and to overall health. Today, we discuss how hormones and hormone cycles impact nutrition and fitness needs, specifically in women of different ages. We, of course, discuss the menstrual cycle, perimenopause, and menopause, but also female-specific nutrition and training as it relates to things independent of hormones. For instance, we evaluate the evidence that women may not want to train fasted and the reasons for that. We talk about how training might vary according to different phases of the menstrual cycle, and we discuss how women can design nutrition and training programs that are optimized for their specific needs, not just because they are women, but because they are women of a particular stage of life and women with particular goals. As you'll soon see, Dr. Sims is exquisitely skilled at explaining the human universals of nutrition and training, that is, the things that do not differ between men and women and their needs in terms of nutrition and training. But she is also exquisitely skilled at highlighting the data showing that there are specific areas of nutrition and fitness for which women and men differ and women have specific needs. So today you will learn what those are, and you will learn how to apply those specific protocols such that by the end of today's episode, you will be armed with a tremendous amount of new knowledge about the biological mechanisms and the specific dos and do nots that can guide you towards your female-specific health and fitness goals.

2. 2:24 – 7:03

   Sponsors: Maui Nui, Eight Sleep & Waking Up

   1. AHAndrew Huberman2:24

      Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Maui Nui Venison. Maui Nui Venison is the most nutrient-dense and delicious red meat available. Now, I've spoken many times before on this and other podcasts, and with several expert guests on this podcast, about the fact that most of us should be seeking to get about one gram of high-quality protein per pound of body weight every day. Not only does that protein provide critical building blocks for things like muscle repair and synthesis, but also for overall metabolism and health. Maui Nui Venison has an extremely high-quality protein-per-calorie ratio so that you can get that one gram of protein per pound of body weight easily and without ingesting an excess of calories. Also, Maui Nui Venison is absolutely delicious. I love their venison steaks, their ground venison. I love their bone broths, and I love their jerky, which is extremely convenient when you're traveling. Those Maui Nui Venison jerky sticks have 10 grams of high-quality protein per stick, at just 55 calories. While Maui Nui offers the highest quality meat available, their supplies are limited. Responsible management of the axis deer population on the island of Maui means that they will not go beyond harvest capacity. So signing up for a membership is the best way to ensure access to their high-quality meat. If you'd like to try Maui Nui Venison, you can go to mauinuivenison.com/huberman to get 20% off your membership or first order. Again, that's mauinuivenison.com/huberman. Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. Now, I've spoken many times before on this podcast about the critical need for us to get adequate amounts of quality sleep each night. One of the best ways to ensure a great night's sleep is to control the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees, and in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees. Eight Sleep makes it incredibly easy to control the temperature of your sleeping environment by allowing you to program the temperature of your mattress cover at the beginning, middle, and end of the night. I've been sleeping on an Eight Sleep mattress cover for well over three years now, and it has completely transformed my sleep for the better. Eight Sleep recently launched their newest generation pod cover, the Pod 4 Ultra. The Pod 4 Ultra has improved cooling and heating capacity, higher fidelity sleep tracking technology, and it also has snoring detection that, remarkably, will automatically lift your head a few degrees to improve your airflow and stop your snoring. If you'd like to try an Eight Sleep mattress cover, you can go to eightsleep.com/huberman to save $350 off their Pod 4 Ultra. Eight Sleep currently ships to the USA, Canada, UK, select countries in the EU, and Australia. Again, that's eightsleep.com/huberman. Today's episode is also brought to us by Waking Up. Waking Up is a meditation app that offers hundreds of guided meditation programs, mindfulness trainings, yoga nidra sessions, and more. I started practicing meditation when I was about 15 years old, and it made a profound impact on my life. And by now, there are thousands of quality peer-reviewed studies that emphasize how useful mindfulness meditation can be for improving our focus, managing stress and anxiety, improving our mood, and much more. In recent years, I started using the Waking Up app for my meditations because I find it to be a terrific resource for allowing me to really be consistent with my meditation practice. Many people start a meditation practice and experience some benefits. But many people also have challenges keeping up with that practice. What I and so many other people love about the Waking Up app is that it has a lot of different meditations to choose from, and those meditations are of different durations. So it makes it very easy to keep up with your meditation practice.... both from the perspective of novelty, you never get tired of those meditations, there's always something new to explore and to learn about yourself and about the effectiveness of meditation. And, you can always fit meditation into your schedule even if you only have two or three minutes per day in which to meditate. I also really like doing Yoga Nidra, or what is sometimes called non-sleep deep rest, for about 10 or 20 minutes, because it is a great way to restore mental and physical vigor without the tiredness that some people experience when they wake up from a conventional nap. If you'd like to try the Waking Up app, please go to wakingup.com/huberman where you can access a free 30-day trial. Again, that's wakingup.com/huberman to access a free 30-day trial. And now for my discussion with Dr. Stacey Sims.

3. 7:03 – 12:50

   Intermittent Fasting, Exercise & Women

   1. AHAndrew Huberman7:03

      Dr. Stacey Sims, welcome.

   2. SSDr. Stacy Sims7:05

      Thanks.

   3. AHAndrew Huberman7:07

      Our podcast and I put out a lot of content about nutrition, fitness, cold exposure, heat exposure, hydration, topics that are very near and dear to your heart and for which you have a ton of expertise, but for which you have an extra degree of expertise as it relates to females specifically.

   4. SSDr. Stacy Sims7:30

      Yeah.

   5. AHAndrew Huberman7:31

      So, I'm excited to talk to you today because very often I will get questions in the comment section on social media or on YouTube, "Was this study done in both men and women? How does it differ for men versus women?" And on and on. And I rarely, if ever, have answers. But you have answers.

   6. SSDr. Stacy Sims7:48

      I have answers for you.

   7. AHAndrew Huberman7:49

      Great.

   8. SSDr. Stacy Sims7:50

      (laughs)

   9. AHAndrew Huberman7:50

      So, just to kick things off, because this is a question I get really often, fasting.

   10. SSDr. Stacy Sims7:58

       Oh, yeah.

   11. AHAndrew Huberman7:59

       Intermittent fasting.

   12. SSDr. Stacy Sims8:00

       Yep.

   13. AHAndrew Huberman8:00

       We need to distinguish between the two, of course.

   14. SSDr. Stacy Sims8:03

       Yeah.

   15. AHAndrew Huberman8:04

       Perhaps the most common question I get as it relates to males versus females is, is intermittent fasting, or time-restricted feeding as it's sometimes called, an eight-hour feeding window, a six-hour feeding window, a 10-hour feeding window, is that something that perhaps differs in terms of its impact and how well it works for men versus women?

   16. SSDr. Stacy Sims8:31

       Yeah. That's the short answer (laughs) .

   17. AHAndrew Huberman8:33

       Mm-hmm. Great. I'm-

   18. SSDr. Stacy Sims8:34

       Yeah, yeah. Um, so I'll put some parameters around it, right? So if we talk about intermittent fasting, that's where you have, like, the 20-hour non-feeding window, or you're holding a fast until noon or after. Um, and then we have time-restricted eating, and that's the fancy way of saying normal eating, where you're having breakfast and then you stop eating after, or you don't have anything after dinner, right? So you're eating with your circadian rhythm during the day. If we look at intermittent fasting where you're holding the fast up 'til noon or you're having days of really low calorie restriction, we see in active women it's very detrimental, unless you have PCOS or you have some other subclinical issue. And the reason for that is we as women have more oxidative fibers. So we hear about all the things about fasting to be, to improve our metabolic flexibility, to improve telomere length, to improve parasympathetic activation. But by the nature of women having more oxidative fibers, we are already metabolically more flexible than men. We have-

   19. AHAndrew Huberman9:40

       Interesting.

   20. SSDr. Stacy Sims9:41

       Yeah.

   21. AHAndrew Huberman9:41

       I didn't know that. Um, could you elaborate on more oxidative fibers, what that is, and-

   22. SSDr. Stacy Sims9:46

       Yeah.

   23. AHAndrew Huberman9:46

       ... how it relates to metabolic flexibility?

   24. SSDr. Stacy Sims9:48

       Sure, sure.

   25. AHAndrew Huberman9:48

       Yeah.

   26. SSDr. Stacy Sims9:48

       So oxidative fibers are, are muscle fibers that are more aerobic capacity. So those are the ones that, you know, you can go long and slow for a very long period of time because it uses a lot of free fatty acids. You need a little bit of glucose in order to activate those free fatty acids. So when we look when a woman starts to exercise, she goes through blood glucose first and then gets into free fatty acid use. She doesn't tap so much into liver and muscle glycogen, which is I think another misconception that happens. So when we're talking about fasting or fasted workouts, trying to improve that metabolic flexibility, it increases stress on a woman. And so when we're talking about overall stress, we're talking about cortisol increase, and they can't hit intensities high enough with no fuel to be able to invoke the post-exercise responses of growth hormone and testosterone, which then drop cortisol.

   27. AHAndrew Huberman10:38

       Mm-hmm.

   28. SSDr. Stacy Sims10:39

       So from an overall stress perspective, that fasted workout and holding that fast for a long period of time increases cortisol. But then when we look from, like, a hypothalamic point of view and we're looking at how the brain reads it, so we know that there's one area of kisspeptin neurons in the brain for men, but there are two for women. So the two areas are distinct where one controls appetite and luteinizing hormone and the other one is looking at estrogen and thyroid. So if you start having an exercise stress or a daily stress of getting up and going on with your day without fuel, you perturb those kisspeptin neurons and downregulate them. And so when you start downregulating them, we see that after four days you have a, a dysregulation of thyroid, we have a change in our luteinizing hormone pulse, which is really important to maintain endocrine function. And we'll hear this, "Oh, I've been fasting for so many years and it does great for me," but the other side of the question is, well, how much better would you be if you were to actually pay attention to your circadian rhythm and fuel according to the stress at hand and knowing that you're gonna garner less stress that way? And if we're really tying in nutrition according to that profile instead of following a fast, we see better brain improvements as well, we see more cognitive function, we see less thyroid dysfunction, and overall a woman does much better when we're not in that fasted state. Then when you look at population research that's coming out now, they're showing in both men and women who hold their fast 'til noon and then have an eating window from noon to maybe 6:00 PM have more obesogenic outcomes than people who break their fast at 8:00 and finished.... their eating window by 4:00 or 5:00 PM. So it's coming back to the chronobiology of we need to eat when our body is under stress and needs it. Unless we have a specific issue like obesity, inactivity, PCOS, or other metabolic conditions, then we can look at using fasting as a strategic intervention to help with those modalities.

4. 12:50 – 17:25

   Cortisol & Circadian Rhythm, Caffeine & Training

   1. AHAndrew Huberman12:50

      Super interesting. Two questions. Is there a protective effect of starting the eating window, and here I'm asking for both men and women-

   2. SSDr. Stacy Sims12:59

      Mm-hmm.

   3. AHAndrew Huberman12:59

      ... starting the eating window at, say, 11:00 AM or noon and ending it a little bit later? So not a six-hour eating window or seven-hour eating window, but extending that to 8:00 or 9:00 PM. Under those conditions, do you still see the obesogenic effect?

   4. SSDr. Stacy Sims13:15

      Yes, because we're looking at the way cortisol responds. We know cortisol has lots of fluctuations throughout the day and it peaks about half an hour after you wake up, right? So if you're having that cortisol peak half an hour after you wake up, but you're not eating, then that is that higher baseline sympathetic drive for women. For men, it's not the same.

   5. AHAndrew Huberman13:36

      Mm-hmm.

   6. SSDr. Stacy Sims13:36

      So when we're looking at that obesogenic outcome, the actual timing hasn't been tested yet to see how can we ex- expand or contract that eating window for men. But for women, because of that cortisol peak that right after waking up, women tend to be already sympathetically driven, so then they walk around more tired, but wired, and have a really, really difficult time ac- accessing any kind of parasympathetic responses down the way. Where if you have something really small where you're bringing blood sugar up, then it's signaling to the hypothalamus, "Hey, yeah, there's some nutrition on board, then we can start our day." So again, it has to look at that circadian rhythm and those hormone fluxes, which people don't really e- either understand or talk about-

   7. AHAndrew Huberman14:20

      Mm-hmm.

   8. SSDr. Stacy Sims14:21

      ... 'cause all of our hormones flux through the day. And so you have to look at where's the peak of cortisol? How does estrogen flux? How does luteinizing hormone flux, progesterone? All of these things that have this tight interplay. And the more we're doing the hormone research and the more we're understanding these perturbations and how important it is to fuel for it to stay out of any kind of low energy availability stance.

   9. AHAndrew Huberman14:43

      Regular listeners of this podcast will know this, but just to remind everybody, a sympathetic state has nothing to do with emotional sympathy. It's the sympathetic arm of the autonomic nervous system, which drives more arousal and alertness and at higher levels, stress, sometimes called the fight or flight response. Parasympathetic being the other arm of the autonomic nervous system, sometimes called the rest and digest arm of the autonomic nervous system. They work sort of like a seesaw or a push-pull, pick your analogy. In any case, it sounds like intermittent fasting or time-restricted feeding, unless it's very well aligned to the circadian rhythm, is not going to be advantageous for women. That's what I'm hearing. I'm also hearing that if a woman trains while fasted, so in the non-feeding window, so wakes up, maybe has some, uh, hydration and trains, that's going to further exacerbate the stress response in a way that's not going to be good.

   10. SSDr. Stacy Sims15:39

       Exactly.

   11. AHAndrew Huberman15:40

       And I have to imagine that if she also is drinking caffeine in order to do that training, because caffeine is a stimulant of the sympathetic arm of the autonomic nervous system-

   12. SSDr. Stacy Sims15:52

       (laughs)

   13. AHAndrew Huberman15:52

       ... that it will further exacerbate all these issues. So this is a eye-opener for me because I've had female training partners for years. I don't eat until 11:00 AM. I like to hydrate and caffeinate before I train in the morning, and then I like to eat starting around noon. Several of them have hopped on that schedule with me. Some of them eat breakfast first, some of them don't. They do as they choose, of course. But now I'm thinking th- that's probably the worst way to go.

   14. SSDr. Stacy Sims16:24

       And it gets worse as you get older, because if we're seeing as women are getting into perimenopause, which is in their 40s, and we have more fluctuation of those hormones and an increase in baseline cortisol anyway, then when you look at fasted training, it increases that cortisol drive and that sympathetic drive.

   15. AHAndrew Huberman16:44

       Mm-hmm.

   16. SSDr. Stacy Sims16:44

       And because it's at a point where you really need to polarize your training to get any kind of body composition change, not having any fuel before high-intensity workout puts them in moderate intensity. They just can't hit the intensities they need to. Same with resistance training. Like, you go in-

   17. AHAndrew Huberman17:01

       Mm-hmm.

   18. SSDr. Stacy Sims17:01

       ... and a lot of women are now working on sessional RPE, or rating perceived exertion, where you go in and say, "Okay, we need you to hit an eight on the squat." So you have two reps in reserve and a sessional RPE of an eight. Well, if they're not fueled, then we are seeing trends that they're missing around 2 to 5% of that top load. So they're not really lifting in that zone that they need to be in.

5. 17:25 – 21:06

   Reps in Reserve, Rate of Perceived Exertion (RPE); Age & Women

   1. AHAndrew Huberman17:25

      Let's get, um, people... Sorry to interrupt. Let's get people up to speed on RPE, 'cause this is a term that's starting to, um, circulate more outside the physical, um-

   2. SSDr. Stacy Sims17:33

      Yeah.

   3. AHAndrew Huberman17:33

      ... training community-

   4. SSDr. Stacy Sims17:34

      Yeah.

   5. AHAndrew Huberman17:35

      ... into the broader kind of, you know, recreational exerciser community, which I consider myself part of. Um-

   6. SSDr. Stacy Sims17:40

      Me too now.

   7. AHAndrew Huberman17:40

      I mean, I train regularly and have-

   8. SSDr. Stacy Sims17:42

      Yeah.

   9. AHAndrew Huberman17:42

      ... for years, but I'm not an a- I'm not an athlete. I don't get paid to train and I, you know, and so forth. So rep- reps in reserve perceived effort, maybe just, um, explain this. I think probably 95% of our listenership has never heard these terms.

   10. SSDr. Stacy Sims17:57

       Okay. So if we're talking about reps in reserve, this is when you go in and if you say eight means you have two reps in reserve. So you finish your eight and you should be able to complete two more with a really good form, and then you hit failure.

   11. AHAndrew Huberman18:12

       So eight repetitions in good form and-The person doing the exercise could, in theory, if they really dug in there and grit their teeth, could complete two more repetitions in good form before hitting failure, the inability to move the weight any more in good form.

   12. SSDr. Stacy Sims18:31

       Exactly.

   13. AHAndrew Huberman18:31

       Okay. But they're stopping at eight, so they have two reps in reserve.

   14. SSDr. Stacy Sims18:34

       Exactly. And so we can correspond that with your rating perceived exertion. So if we're saying, "We need you to hit an eight on our scale of one to ten of rating perceived exertion," we see it correlates with, um, that eight with two reps in reserve. So it's a way of quantifying what you're doing in the moment for a squat, or a deadlift, or some other really heavy lift that you're trying to accomplish.

   15. AHAndrew Huberman18:57

       Mm-hmm. As opposed to looking at, um, say, percentage of one repetition maximum-

   16. SSDr. Stacy Sims19:02

       Yeah.

   17. AHAndrew Huberman19:02

       ... saying you're gonna move 70% of your one repetition maximum for six repetitions. Seems like that's a great thing as well, but it's a little bit more complicated because you need to know your one repetition maximum. Doing one repetition maximums can be dangerous if you're not skilled in that, especially with compound movements like squats and deadlifts.

   18. SSDr. Stacy Sims19:19

       Yep.

   19. AHAndrew Huberman19:20

       Okay, so is there an across the board recommendation for most people that they should generally train their sets in good form to failure, to leave a couple reps in reserve? What do you suggest for, let's say women, but this could also pertain to men?

   20. SSDr. Stacy Sims19:38

       Uh, and then that also depends on the age of the woman.

   21. AHAndrew Huberman19:41

       Mm-hmm.

   22. SSDr. Stacy Sims19:41

       So if we're looking at the reproductive years, so you know, 20 to 40, then it doesn't matter so much. You can periodize pretty much how normal periodization works with your mesocycles and your microcycles. So you're looking at what you're doing across a few months, what are you doing in the week? Are you lifting heavy, power-based training? But when we start to get to perimenopause and we're losing all the flux of estrogen, and estrogen is a woman's testosterone, the key driver for strength and power, we have to look at lifting heavy. So this is where we really turn women on to, "We want you to do something that is two reps in reserve, three reps in reserve." Because your one rep max also changes depending on what kind of training block you're doing. So we're finding that when you're talking about reps in reserve, then it allows people to lift more on the day. So we can get women to get into that strength and power-based type training rather than going, "Let's lift to fatigue," 'cause then it might be 20 reps. And that 20 reps doesn't invoke a big central nervous system response, which is what we want. It's more of that hypertrophy and muscle tearing. You will gain some lean mass, but not as much strength as if you were to invoke that central nervous system response. And that becomes really critical as women get older, because we need to find that external response that's gonna cause the same kind of strength and power adaptation that estrogen used to support.

   23. AHAndrew Huberman21:05

       Interesting.

6. 21:06 – 26:45

   Pre-Training Meal & Brain, Kisspeptin

   1. AHAndrew Huberman21:07

      Lots to talk about in terms of exercise, but before we move on, if the bad situation is a woman fasting, drinking caffeine, and training intensely, but as you told us, not as intensely as she would be able to otherwise, what's the solution? I imagine that solution involves ingesting some fuel.

   2. SSDr. Stacy Sims21:27

      Mm-hmm.

   3. AHAndrew Huberman21:28

      What is a good example of a, you know, a, a pre-training, um, meal, if you will? And we could put some variation on that for people with different, you know, tendencies towards omnivore, vegan, or whatever.

   4. SSDr. Stacy Sims21:43

      Yeah, yeah.

   5. AHAndrew Huberman21:43

      Uh, but what is the timing of that meal relative to training that works best? Or, and, and I'm assuming there's some flexibility there.

   6. SSDr. Stacy Sims21:52

      Yeah, I mean, like, I'm the kind of person that gets up and is out the door within a half an hour to go do whatever I'm gonna do, so it's not like I'm gonna have-

   7. AHAndrew Huberman21:59

      Bless you.

   8. SSDr. Stacy Sims21:59

      ... a full meal.

   9. AHAndrew Huberman21:59

      I've heard of people-

   10. SSDr. Stacy Sims22:00

       Right?

   11. AHAndrew Huberman22:01

       ... like you. Yeah. (laughs)

   12. SSDr. Stacy Sims22:02

       Um, like-

   13. AHAndrew Huberman22:02

       Meaning, meaning I tend to move slowly in the morning, so...

   14. SSDr. Stacy Sims22:04

       (laughs) I wish I could, but the way my life is, it doesn't work that way. Um, so the, but I'm also one of the people that never really has an appetite till 11 o'clock.

   15. AHAndrew Huberman22:11

       Okay, so we're-

   16. SSDr. Stacy Sims22:12

       Right?

   17. AHAndrew Huberman22:12

       ... similar in that way.

   18. SSDr. Stacy Sims22:13

       Yeah.

   19. AHAndrew Huberman22:13

       So how do you, how do you square that?

   20. SSDr. Stacy Sims22:15

       So, I make a double espresso at night and I put some almond milk and a scoop of protein powder in there. So, uh, the almond milk is sweetened, and usually it's unsweetened, but sweetened for the carb, and then the protein powder for the protein, because if I'm gonna go do an ocean swim, then I need some carbohydrate and protein on board. If I'm gonna just go to the gym, then I'll probably just have the protein powder in the coffee. Yes, I'm caffeinating, but I'm also getting the calories for the hypothalamus and getting some more circulating amino acids. Abby Smith Ryan out of UNC did some specific work looking at carbohydrate protein before and, you know, strength or cardio, and found that if you're gonna do a true strength training session, you only need around 15 grams of protein before you go to really help you get into the idea that, yes, you have some fuel on board, and also increases your post-exercise oxygen consumption, or your EPOC, so your resting metabolism stays elevated, um, giving you a better chance for recovery post-exercise as well. If you're going to do any kind of cardiovascular type work up to an hour, then you're adding 30 grams of carb to that. So it's not a lot of food and it's not a full meal. Um, other people are like, "I'm starving right before I go training," then yes, you can have your meal, giving yourself about a half an hour before. Um, but it doesn't have to be major food that we're talking about. Um, but that's just enough to bring blood sugar up and s- and stimulate the hypothalamus to say, "Yeah, there's some nutrition coming in," and then you have your real food afterwards. You have your breakfast afterwards within 45 minutes.

   21. AHAndrew Huberman23:52

       As a neuroscientist, I find it so interesting that at least some of what you're talking about with this pre-workout meal, and perhaps most of it, relates to how ingesting those calories impacts the brain, protects those kisspeptin neurons.

   22. SSDr. Stacy Sims24:08

       Mm-hmm.

   23. AHAndrew Huberman24:08

       And we'll talk more about kisspeptin, very interesting peptide. As opposed to saying, "Okay, you need X number of calories because you're going to burn X number of calories."

   24. SSDr. Stacy Sims24:18

       I hate that conversation.

   25. AHAndrew Huberman24:18

       Right? Which is a very different conversation. Um, here what we're talking about is the neural aspects-

   26. SSDr. Stacy Sims24:24

       Yeah.

   27. AHAndrew Huberman24:24

       ... of being able to generate intensity, also blunt cortisol.

   28. SSDr. Stacy Sims24:28

       Yeah.

   29. AHAndrew Huberman24:28

       ... and get the most out of training without putting the body into kind of a, an emergency state.

   30. SSDr. Stacy Sims24:34

       Yeah.
7. 26:45 – 29:59

   Post-Training Meal & Recovery Window

   1. AHAndrew Huberman26:45

      as long as we're talking about food and food intake relative to training, what is the suggested post-training, um, window, um, in which one should either avoid or make sure they get nutrition? Um, meaning how long does one have after, let's say, a resistance training session of about an hour?

   2. SSDr. Stacy Sims27:06

      Mm-hmm.

   3. AHAndrew Huberman27:07

      Seems to me that's what most people are doing if they're investing in resistance training, maybe plus or minus a, what, 20 minutes?

   4. SSDr. Stacy Sims27:14

      Yeah.

   5. AHAndrew Huberman27:14

      Um, and they're hitting those, um, high intensity sets where they have maybe just one or two repetitions in reserve, maybe going to failure on a few of those sets. What do you recommend women eat after they train?

   6. SSDr. Stacy Sims27:26

      So we know that women who are in their reproductive years need around 35 grams of good protein, high quality leucine-oriented protein within 45 minutes. And we see that women who are perimenopausal onwards are 40 to 60 grams, because we become more anabolically resistant to food and exercise as we get older. Um, when we look at, like the recovery window for food, there are definitely sex differences, 'cause we hear all the conversation of, "There's no recovery window, it's, you know, it, it's old science." But we look at the research of when women's metabolisms come back down to baseline, meaning that they have constant straight blood sugar levels versus men, women it's within, uh, 60 minutes, and for men it's up to three hours. So when we're looking at the data that says there's no window per se for getting food in, it's based on male data. So when we're looking at wom- women, we have this tighter window to stop that breakdown effect and start the reparation.

   7. AHAndrew Huberman28:27

      Mm-hmm.

   8. SSDr. Stacy Sims28:28

      Um, so yeah, it's like when we're talking about the protein intake, it's really important not only to get that leucine content up in the muscle to start the reparation and repair, but also again, to signal that yeah, we're in a building state, we're not holding that catabolic state and increasing all the repercussions that come with it.

   9. AHAndrew Huberman28:49

      So, women should try and get 30 or as ma- much as 40, maybe 50 grams of protein depending on their age-

   10. SSDr. Stacy Sims28:57

       Mm-hmm.

   11. AHAndrew Huberman28:58

       ... post-training within an hour of training?

   12. SSDr. Stacy Sims29:00

       Yeah.

   13. AHAndrew Huberman29:02

       Men seem to have a longer window.

   14. SSDr. Stacy Sims29:04

       They do.

   15. AHAndrew Huberman29:04

       They could wait an hour, two hours, maybe even three hours-

   16. SSDr. Stacy Sims29:08

       Yeah.

   17. AHAndrew Huberman29:08

       ... uh, before ingesting protein. What about carbohydrate?

   18. SSDr. Stacy Sims29:10

       We look at mixed, but for men it's more important because they go through their liver and muscle glycogen so much faster than women.

   19. AHAndrew Huberman29:18

       Mm-hmm.

   20. SSDr. Stacy Sims29:18

       So when we look at women, we wanna get around 0.3 grams per kilo, um, of carbohydrate within two hours of finishing. So we look at protein and people are like, "Whoa, that's a big dose of protein. How do I get it all in?" It's like, yeah, well, you can look at how we mix all of these things and you're also getting carbohydrate in with that. So that's why I say you could have your next meal after your training session. Um, yeah, there's a time and a place for protein supplementation, but if you're getting that real food in, then you're also getting, you know, your magnesium and your potassium and your sodium and all the things that people supposedly lose, and you're able to also repair a lot better.

8. 29:59 – 31:48

   Sponsor: AG1

   1. AHAndrew Huberman29:59

      As many of you know, I've been taking AG1 for more than 10 years now. So I'm delighted that they're sponsoring this podcast. To be clear, I don't take AG1 because they're a sponsor. Rather, they are a sponsor because I take AG1. In fact, I take AG1 once and often twice every single day, and I've done that since starting way back in 2012. There is so much conflicting information out there nowadays about what proper nutrition is. But here's where there seems to be a general consensus on. Whether you're an omnivore, a carnivore, a vegetarian, or a vegan, I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough but not overeat...... get plenty of vitamins and minerals, probiotics and micronutrients that we all need for physical and mental health. Now, I personally am an omnivore, and I strive to get most of my food from unprocessed or minimally processed sources. But the reason I still take AG1 once and often twice every day is that it ensures I get all of those vitamins, minerals, probiotics, et cetera, but it also has adaptogens to help me cope with stress. It's basically a nutritional insurance policy meant to augment, not replace, quality food. So by drinking a serving of AG1 in the morning and again in the afternoon or evening, I cover all of my foundational nutritional needs, and I, like so many other people that take AG1, report feeling much better in a number of important ways, such as energy levels, digestion, sleep, and more. So while many supplements out there are really directed towards obtaining one specific outcome, AG1 is foundational nutrition designed to support all aspects of wellbeing related to mental health and physical health. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs with your order, plus a year supply of vitamin D3 K2. Again, that's drinkag1.com/huberman.

9. 31:48 – 34:24

   Hormones, Calories & Women

   1. AHAndrew Huberman31:48

      At some point, there was a lot of discussion about training fasted burns more body fat.

   2. SSDr. Stacy Sims31:55

      (laughs) Yeah.

   3. AHAndrew Huberman31:55

      Um, I think now most people accept that that's not the case, that perhaps the percentage of fat as fuel is increased when one trains fasted, but that overall, in terms of loss of body fat, it doesn't matter if you train fasted or you train fed.

   4. SSDr. Stacy Sims32:14

      Correct.

   5. AHAndrew Huberman32:15

      Okay, I think, um, that can't be stated enough-

   6. SSDr. Stacy Sims32:17

      Right, exactly.

   7. AHAndrew Huberman32:18

      ... um, by experts like you.

   8. SSDr. Stacy Sims32:21

      Yes.

   9. AHAndrew Huberman32:21

      Um, that doesn't mean that if one prefers to train fasted or with a minimum of food in their gut that they can't do that.

   10. SSDr. Stacy Sims32:27

       Right.

   11. AHAndrew Huberman32:28

       Like, I like to train fasted, but I, what I'm hearing is that, uh, women should probably ingest at least some protein, high-quality protein and maybe drink the protein in a protein shake-

   12. SSDr. Stacy Sims32:37

       Yeah.

   13. AHAndrew Huberman32:38

       ... um, form if they don't want to ingest solid food.

   14. SSDr. Stacy Sims32:40

       Yeah. I think the easiest way for people to understand the basic idea of what low energy is and how this affects men and women is when we're looking at, um, a tipping point for endocrine dysfunction. For men, we're seeing that tipping point at 15 calories per kilogram of fat-free mass. For women, it's 30. So when we're looking at baseline calorie needs before you really get into that endocrine dysfunction, when you're looking at those parameters, you can see why men do better in a fasted state or a low-calorie state. But for women, our intake, and especially our carbohydrate needs, are so much higher because we have so many other functions that are reliant on that kisspeptin upregulation or down regulation, preferably upregulation. Um, so when we're just talking the basic calorie needs and what we're seeing, it's that dichotomy right there of 15 to 30. And when you start telling people that, they're like, "Oh, okay, I get it. Is that a biological aspect?" It's like, well, you could trace it all the way back where, you know, men went out to get the calories in most tribes and the women were home, and it wasn't advantageous to be pregnant under a low calorie intake. That's why you have dysfunction when the calories are too low. But, you know, you can also feed forward to modern day now, and you're seeing that all this perturbance of hormone and the way we regulate hormone across the circadian rhythm requires more calories for women than it does for men.

   15. AHAndrew Huberman34:13

       I know some men that basically don't eat all day and then eat one meal in the evening and they'll train in the morning, that's inconceivable to me, because-

   16. SSDr. Stacy Sims34:20

       (laughs) Yeah.

   17. AHAndrew Huberman34:20

       ... within an hour or so of training, I'm hungry.

   18. SSDr. Stacy Sims34:22

       Yeah (laughs) .

   19. AHAndrew Huberman34:23

       Uh, which brings

10. 34:24 – 39:10

    Women, Strength Improvements & Resistance Training

    1. AHAndrew Huberman34:24

       to mind what we mean when we say training. Uh, I'm a big believer in people, everybody getting ideally two or three resistance training sessions in per week, and two, maybe three cardiovascular training sessions per week.

    2. SSDr. Stacy Sims34:40

       Mm-hmm.

    3. AHAndrew Huberman34:40

       That would be ideal.

    4. SSDr. Stacy Sims34:41

       Yep.

    5. AHAndrew Huberman34:41

       Um, one could potentially do more, probably not a whole lot less before you run into long-term health issues that you could offset. But I think most people can fit those in, and I'm very, frankly, delighted that nowadays there's such a push for women and men to resistance train. That wasn't the case when I was growing up.

    6. SSDr. Stacy Sims35:00

       Yes, wasn't for me.

    7. AHAndrew Huberman35:01

       You know, I recall taking my sister to the gym for the first time, and it's like, I think she was the only woman in the gym when we were in high school-

    8. SSDr. Stacy Sims35:08

       Yeah.

    9. AHAndrew Huberman35:08

       ... except for a few female bodybuilders. And she said, "Well, I don't want to look like that." And I said, "Well, don't worry, you're not going to look like that." Um, but now you go to a gym and women are lifting weights, men are lifting weights.

    10. SSDr. Stacy Sims35:19

        Yeah, it's great.

    11. AHAndrew Huberman35:20

        It's terrific.

    12. SSDr. Stacy Sims35:20

        I've seen the evolution, right? When I was 16, one of my friend's brothers was a bodybuilder, and he took us to the gym, kind of like what you did with your sister. And so both of us were like, "Oh, we want to beat those guys." So we got into weight training with him, not to be a bodybuilder, but it's been, like, the paramount throughout all of my athletic career. Used to be I'd be the only woman on the lifting platform, and now it's like you have to wait because there's so many women on the lifting platforms. I love it. It's great.

    13. AHAndrew Huberman35:48

        Yeah, it's awesome.

    14. SSDr. Stacy Sims35:48

        Yeah, yeah.

    15. AHAndrew Huberman35:49

        As I mentioned before, I've had female training partners and they, they kill it.

    16. SSDr. Stacy Sims35:51

        Yeah.

    17. AHAndrew Huberman35:52

        They, they, um, it's a lot of fun to have a, um, female training partner also because, um, n- not only is it cool to see the progress they can make really quickly, which surprises them often. You know, I think a lot of women think that, okay, it's going to require external androgens or it's going y- you know, and, and what you pointed out that there are some barriers to women putting on mass quickly.

    18. SSDr. Stacy Sims36:17

        Mm-hmm.

    19. AHAndrew Huberman36:17

        I think I've noticed that strength increases can come really quickly.

    20. SSDr. Stacy Sims36:20

        Really quickly, yeah.

    21. AHAndrew Huberman36:21

        Why is that?

    22. SSDr. Stacy Sims36:22

        It's a central nervous system aspect.

    23. AHAndrew Huberman36:24

        Mm-hmm.

    24. SSDr. Stacy Sims36:24

        There's a lot of, like, if we look at the culture of how a lot of us grew up, and I'm saying us like 45 plus, right? The women were all the 90s supermodels, don't show muscle, that kind of stuff. So always been gravitated to cardio.Even now, if you go to a gym and you're a new member, you're signing up for a new member, and you're a woman, they'll say, "Hey, great. Here's all of our spin classes and our box fit classes."

    25. AHAndrew Huberman36:49

        Still- they're still doing that?

    26. SSDr. Stacy Sims36:50

        Yeah.

    27. AHAndrew Huberman36:50

        Okay.

    28. SSDr. Stacy Sims36:50

        And there's the cardiovascular machines. A guy comes in, they're like, "All right. How much do you want to put on? Here are the lifting platforms." All the, you know, the weight training's at the back. Starting to see a shift with boutique-type gyms, but that's still the commonality there. So it's still that little bit of taboo. So when women start strength training, they haven't been exposed to that kind of central nervous system stress before. And the whole aspect of getting the nerve and acetylcholine, which are, are little vesicles that, you know, hold the ability for the nerve to actually stimulate the muscle fiber, all that gets trained really quickly. So the more that you train it and the more muscle fibers that are recruited for contraction, you see an increase in strength really rapidly. And slowly building on that for increased muscle bulk, because it takes a long time for women to put bulk on, uh, because the driver for strength training is that central nervous system. Um, so it's great when we see higher doses, more volume. We aren't seeing huge hypertrophy, we're just seeing really good increases in strength.

    29. AHAndrew Huberman38:04

        Whenever somebody, male or female, is concerned about growing too big, too fast, um, I always remind them that resistance training is unique among different types of exercise in that, because of the blood flow to the muscle during the exercise session, the so-called pump.

    30. SSDr. Stacy Sims38:21

        Mm-hmm. Yeah.
11. 39:10 – 44:16

    Tool: Women & Training Goals by Age Range

    1. SSDr. Stacy Sims39:10

    2. AHAndrew Huberman39:10

       So we've been talking about training, but we haven't really spelled out what you would suggest a novice, perhaps an intermediate, um, resistance training, cardiovascular training, um, program would look like, in- in broad terms. I realize we don't have time here to get into all the-

    3. SSDr. Stacy Sims39:27

       All the details, yeah, yeah.

    4. AHAndrew Huberman39:28

       ... nitty-gritty details. You've written about this elsewhere, and we'll refer people, um, to those terrific resources in the show note captions. But, um, what would you like to see women doing? And maybe we can break up the- the age brackets because it sounds like this is something that, um, is resurfacing again and again here. Um, women, let's say, 30 and younger, women 31 to, let's say, 40?

    5. SSDr. Stacy Sims39:51

       40?

    6. AHAndrew Huberman39:51

       And then, let's say, 41 to 60, and then maybe 61 and on. In terms of how many sessions of resistance training per week, is it whole body training, how many sessions of cardiovascular training, and- and what sorts of examples could- could you give?

    7. SSDr. Stacy Sims40:06

       Yeah. So if we're looking at that 20- 20 to 30-year-old, a lot of times, I really try to get them to focus on the whole movement aspect first. So we phase them in. Same with older women. Phase them in, learn how to move, learn complex movements, so that when you are going in to do resistance training, preferably three to four times a week, you can look at moving well. And it doesn't have to be a long period of time. If you're doing to failure, which works really well when you're younger to increase strength and a little bit of hypertrophy, you're gonna have to spend a little bit more time in the gym. So it might be 45 to 60 minutes. When we're looking at doing that four times a week, you can add in a sprint interval training at the end of one of those to get that super high intensity. Or you can look at putting in, at the most, two HIIT sessions from- on separate days. If you're training specifically for something, so if- I work with a lot of endurance athletes still, and they're like, "Well, how do I fit it in?" It's like, "Okay. Well, we look at the quality and how that fits into your training." So if you're training for a marathon, or you're training for a triathlon, or other endurance stuff, you can take that high intensity work and put it into your training program. So ideally, we look at three to four resistance training with really good movement when we're in the younger set with two high intensities. When we start getting into our 30s, we start having an eye to how are we actually doing that resistance training? Instead of just going and doing a circuit, we're really focusing on let's do some compound movements. Let's look at doing some heavier work. Let's look at how we are periodizing, so we're having, you know, six-week blocks and we're building on those blocks. Because we want that base foundation, so when we get to be 40 plus, we can actually go and do our power-based training.

    8. AHAndrew Huberman41:59

       Mm-hmm.

    9. SSDr. Stacy Sims41:59

       If you're in your 40s, you've never done resistance training at all, then we take between, mm, two weeks to four months to really learn how to move well, because there's a higher incidence of soft tissue injury and overall injury as we get into our 40s because of perturbations of estrogen. And ideally, when we get there, we're looking at that around three, minimum, three resistance training with compound movements, and either one sprint interval or two sprint intervals and one HIIT in a week.

    10. AHAndrew Huberman42:34

        And just to remind people, compound movements, multi-joint movements-

    11. SSDr. Stacy Sims42:36

        Yeah.

    12. AHAndrew Huberman42:36

        ... squats, deadlifts, uh, chin-ups, rows, overhead presses, bench presses, et cetera, as opposed to isolation movements where only one joint is- is moving.

    13. SSDr. Stacy Sims42:46

        Yeah, yeah.

    14. AHAndrew Huberman42:46

        Yeah. And-... for everybody in all those age ranges that you describe, are you suggesting they train the same muscle groups three or four times per week or they do some sort of split where it's upper body, lower body, take a day off, or upper body, take a day off, lower body, take a day off? Whatever that, what might work for them.

    15. SSDr. Stacy Sims43:04

        Yeah, what works for them. If you're looking for short amount of time in the gym because of busy lives, then you can split it. If you're looking at, okay, well, I can allocate an hour to an hour and a half in the gym, then you can do total body with adequate rest. Um, the key when you're younger is working to failure. The key when you're older is working heavy.

    16. AHAndrew Huberman43:27

        Interesting.

    17. SSDr. Stacy Sims43:27

        Yeah.

    18. AHAndrew Huberman43:28

        For sure-

    19. SSDr. Stacy Sims43:28

        So when we're looking at working to failure, we're trying to get more of that lean mass growth with strength. When we get older, because it's so difficult to put on lean mass, we really wanna focus on the strength component because that becomes more important when we're talking about longevity. 'Cause if you're looking at the strength component from a central nervous system standpoint, we see it feeds forward into better proprioception, uh, attenuation of cognitive decline. And this is the other thing that you in neurosciences would understand, the sex differences in things like dementia and Alzheimer's. There's some really interesting research looking at strength training and that power-based stuff when we're getting into our older ages because we get more neural growth patterns and more neural pathways.

12. 44:16 – 47:14

    Women, Perimenopause, Training & Longevity

    1. SSDr. Stacy Sims44:16

       Yeah.

    2. AHAndrew Huberman44:16

       Even some interesting literature about emphasizing some unilateral movements as people get older-

    3. SSDr. Stacy Sims44:21

       Mm-hmm.

    4. AHAndrew Huberman44:21

       ... not just, um, dual limb movements or-

    5. SSDr. Stacy Sims44:23

       Exactly.

    6. AHAndrew Huberman44:23

       ... dual limb simultaneous movements. You always wanna train both sides of your body, folks.

    7. SSDr. Stacy Sims44:27

       Yeah, yeah, yeah, yeah, yeah.

    8. AHAndrew Huberman44:28

       But, um, so if I understand correctly, younger women should train to failure, try and generate strength and hypertrophy.

    9. SSDr. Stacy Sims44:36

       Mm-hmm.

    10. AHAndrew Huberman44:36

        As women get older, they should emphasize more strength training, leave some repetitions in reserve-

    11. SSDr. Stacy Sims44:41

        Yeah.

    12. AHAndrew Huberman44:41

        ... but train heavier.

    13. SSDr. Stacy Sims44:42

        Yes.

    14. AHAndrew Huberman44:43

        It makes so much sense what you're saying-

    15. SSDr. Stacy Sims44:45

        Yeah.

    16. AHAndrew Huberman44:45

        ... um, because what we know about the nervous system as we age is that there's some atrophy or at least some weakening of neuromuscular connections-

    17. SSDr. Stacy Sims44:55

        Mm-hmm.

    18. AHAndrew Huberman44:55

        ... and the upper motor neurons in the brain that control the neuromuscular connections in the spinal cord out to the muscle.

    19. SSDr. Stacy Sims45:00

        Yeah.

    20. AHAndrew Huberman45:01

        Um, there's something really sticky about this idea-

    21. SSDr. Stacy Sims45:04

        Yeah.

    22. AHAndrew Huberman45:04

        ... in terms of longevity that I don't think anyone else has ever-

    23. SSDr. Stacy Sims45:07

        S- no.

    24. AHAndrew Huberman45:07

        ... said.

    25. SSDr. Stacy Sims45:08

        No. The thing about it is men age more in a linear fashion. Whereas women, we have a definitive point in our late 40s, early 50s, where all of a sudden things go to shit, where it's that perimenopausal state. And I can't tell you how many emails and DMs I get in a day from women who are like, "I'm 46," or, "I'm 47, I'm putting on body fat. I don't know what's going on. I can't sleep." And then when you say, "It's perimenopause," they're like, "What is that?" And so when we're looking at perimenopause, it is a huge change in the body because you're having less and less of your sex hormones circulating. More and more anovulatory cycles means no progesterone or very low progesterone. You're having a difference in the pulse of your estradiol to those flat line aspects, and because every system in the body's affected by it, this is why you see more soft tissue injuries. Like two of the biggest things that women who are in their 40s are going to PTs about are frozen shoulder and plantar fascia. Those are two really indicative issues that are happening in perimenopause. So that whole section of mid to mid-40s to early 50s is a definitive aging point where I really try to get women to get into the heavy lifting and get into the patterns of polarizing their training, not putting an emphasis on zone two, just really looking at how am I polarizing, how am I affecting my central nervous system, so that when they get into that one point in time of that perimenopause, their body is already conditioned for the stress that's coming. Whereas men, we see that kind of stuff happens in their late 50s, early 60s. So the soft tissue injuries, the change in body comp comes at a later time, so yes, looking at how we're scoping our strength training, definitely something to think about in a longevity factor. But for women it's, uh, there's a better indication of the timing across the ages of when you should start implementing. For men, I think you have a better bandwidth of when you should start implementing.

13. 47:14 – 51:42

    Women & Training for Longevity, Cardio, Zone 2

    1. SSDr. Stacy Sims47:14

    2. AHAndrew Huberman47:15

       For women who are not on hormone replacement therapy-

    3. SSDr. Stacy Sims47:18

       Mm-hmm.

    4. AHAndrew Huberman47:19

       ... and we did a previous episode about perimenopause, menopause, and hormone replacement therapy, but if it comes up again and again today, that would be wonderful-

    5. SSDr. Stacy Sims47:26

       Yeah.

    6. AHAndrew Huberman47:26

       ... because these are important under-discussed topics.

    7. SSDr. Stacy Sims47:29

       Absolutely.

    8. AHAndrew Huberman47:31

       For women that are not on hormone replacement therapy who decide to train heavier, maybe do a bit more training volume, not train to failure, they're making sure to not let their cortisol spike too much by making sure they have some pre-workout nutrition, some post-workout nutrition, would they be wise to be very careful in how much cardiovascular exercise they add to that? Meaning, there seems to always be this risk of overtraining.

    9. SSDr. Stacy Sims48:01

       Mm-hmm.

    10. AHAndrew Huberman48:01

        And as you pointed out, for various reasons, cultural reasons, historical reasons, um, around exercise, I, my observation is that most women sort of, unless they know better, default to cardiovascular exercise as opposed to resistance training.

    11. SSDr. Stacy Sims48:17

        Yeah.

    12. AHAndrew Huberman48:18

        So if a woman in her 40s, l- late 30s to, let's say, 50, is doing two to four sessions of resistance training workouts per week and they also really like cardio or they feel they want to or should do cardio, should they be careful about how much cardio they're doing and is there a best form of cardio? Should they really emphasize the high intensity interval training? Should they avoid zone two? We should probably also define for people what zone two is if they-

    13. SSDr. Stacy Sims48:46

        Yeah.

    14. AHAndrew Huberman48:46

        ... if they don't already know.

    15. SSDr. Stacy Sims48:48

        Um, so I am notorious for slamming things like Orangetheory and F45 because they market specifically to that age group of women, and it's not appropriate because it's not true high-intensity work. When we're looking at women who are really trying to maximize body composition change and longevity and, unfortunately, default to cardio 'cause they think, "Oh, that's gonna help change my body composition, it's gonna help me lose body fat," it doesn't.

    16. AHAndrew Huberman49:16

        Is this things like SoulCycle as well?

    17. SSDr. Stacy Sims49:18

        Yeah. Yeah.

    18. AHAndrew Huberman49:18

        Okay. I've never done any of these-

    19. SSDr. Stacy Sims49:20

        Yeah.

    20. AHAndrew Huberman49:20

        ... um, but I imagine there's a lot of spinning, a lot of moving, a lot of sweating, and a lot of quote unquote calories burned emphasis.

    21. SSDr. Stacy Sims49:27

        Yes, there is. But it's, it puts women squarely in moderate intensity where they're so used to leaving one of those classes feeling absolutely smashed that when you tell them, "Actually, that training doesn't work for you because it's putting you in a state of intensity that drives cortisol up, but it's not a strong enough stress to invoke the post-exercise growth hormone and testosterone responses that we want to dampen that cortisol." So this is why we have that hyperbole of women who are in their 40s plus shouldn't do high-intensity work. It's like, well, actually they shouldn't do moderate intensity. They need to avoid that. Polarizing, absolutely, that's what we want. We want true high-intensity work, which is one to four minutes of 80% or more, or if you're doing sprint interval, it's full gas for 30 seconds or less. And you're doing that a couple of times a week, you're not doing it every day because you need to have enough recovery to hit those intensities truly because those are the intensities that are gonna give you those post-exercise hormonal responses to drop cortisol. When we're looking at women who are like, "Oh, well, I love going out for hours and hours on my bike, and I love, you know, doing my spin classes," it's like, okay, but we need to look at the big rock here. If you are looking for longevity and body composition change and cognition and all those things, you have to polarize your training, and that has to be the focus. But soul food, like I come from a long background of endurance. I now love riding my gravel bike on the weekends for long periods of time, which is not optimal for me, my age, that kind of stuff, for all the things that I want to see improvements in. But mentally, it's great. So when we talk about going out for that long stuff, zone two's at low conversation, and that's fine for mental health and being out in nature. But for optimal health and well-being, we don't wanna do that. We want to look at resistance training as a bedrock and true high-intensity work to help with body composition change, metabolic control, insulin sensitivity, brain health, and dropping that cortisol.

14. 51:42 – 58:23

    Tools: How to Start Resistance Training, Machines; Polarized Training

    1. SSDr. Stacy Sims51:42

    2. AHAndrew Huberman51:43

       I have family members who are women who are thin because they love to walk.

    3. SSDr. Stacy Sims51:49

       Mm-hmm.

    4. AHAndrew Huberman51:50

       And they just walk a ton.

    5. SSDr. Stacy Sims51:51

       Mm-hmm.

    6. AHAndrew Huberman51:52

       Um, and they eat well, um, and enough. But they are resistant to resistance training, and if they do pick up a weight, it's usually some very light dumbbells, do a few curls, a couple tricep extensions, and aren't really, um, leaning into the higher intensity work.

    7. SSDr. Stacy Sims52:12

       Yeah.

    8. AHAndrew Huberman52:13

       I think this is pretty common, and my observation is that it's common not because they couldn't be incentivized to do the higher intensity work, but that learning the complex compound movements, like how to squat properly or even leg press properly-

    9. SSDr. Stacy Sims52:31

       Yep.

    10. AHAndrew Huberman52:31

        ... um, deadlift properly, can be a bit overwhelming, especially when one walks into a gym. This is true for men too, like all this stuff, all this equipment, all these bodies, and these people look like they know what they're doing. It's like if I were to go into an advanced, like, kitchen or, or, um, symphony and, you know, there are all these instruments I don't know how to play.

    11. SSDr. Stacy Sims52:48

        Yeah.

    12. AHAndrew Huberman52:49

        So what's the best line of attack for somebody who really wants to overcome this, uh, longevity barrier?

    13. SSDr. Stacy Sims52:56

        Mm-hmm.

    14. AHAndrew Huberman52:56

        Because clearly resistance training, proper nutrition work.

    15. SSDr. Stacy Sims53:00

        Yeah.

    16. AHAndrew Huberman53:00

        And the cardiovascular exercise piece is a little bit more intuitive. Walking, you do it faster, you're jogging, you do it faster, you're running.

    17. SSDr. Stacy Sims53:07

        Yeah, yeah.

    18. AHAndrew Huberman53:07

        Um, the bike, the SoulCycle class, et cetera, it's just, it's easier in terms of the mechanics. One can still get hurt, but it's just more straightforward. Is there a way that in the absence of a budget for a personal trainer-

    19. SSDr. Stacy Sims53:20

        Yeah.

    20. AHAndrew Huberman53:20

        ... that somebody can learn how to do these movements and, as you said, ease into them over the course of even up to four months in a way that they can be confident that they're unlikely to get hurt-

    21. SSDr. Stacy Sims53:30

        Yeah.

    22. AHAndrew Huberman53:31

        ... and really build up their capacity to do real work that can benefit them?

    23. SSDr. Stacy Sims53:35

        Yeah, this is where I love technology, for one thing, but if we're staying really basic, I look at some of my family members and I've gotten them started with just body weight stuff or loading a backpack with cans to add a little bit of resistance so they feel comfortable in their own house and they might be doing lunges or squats. Um, just keying them up of like where foot placement and knee and that kind of stuff so they're getting used to that kind of movement. Um, I love Kelly Starrett's stuff with mobility, so show them like here's how we do some of the mobility to find where the sticking points are. And then you can either direct them to some of the programs that are out there that, um, like Haley Happns has some really good ones for women who are 40 plus, so does, um, uh, Bree and then Sonny Webster down in Australia. You can send in a video of what you're doing and he can critique you and tell you things to do. There are other programs like that too. Um, so there's lots of ways of getting help if you seek it. The personal trainer is very much a stumbling block for a lot of people.And as much as I am not a fan of Planet Fitness, I am a fan of the fact that they've made it really easy for someone to walk in who's interested in resistance training, and they can go to a circuit, one of the circuit things that they have at the back, and they can start resistance training on machines, which is another level up to learning compound movements. So there's lots of ways of breaking that barrier to entry, you just have to find the motivation factor of what's gonna incentivize the person to give up their time walking every day and taking time to go to the gym or taking time to do garage-based stuff that's going to improve their lean mass.

    24. AHAndrew Huberman55:25

        I'm a big fan of machines, uh, especially plate-loaded machines, but-

    25. SSDr. Stacy Sims55:29

        Yeah.

    26. AHAndrew Huberman55:29

        ... machines just create the close to correct or correct arc of movement.

    27. SSDr. Stacy Sims55:36

        Yeah.

    28. AHAndrew Huberman55:37

        And that, um, so...

    29. SSDr. Stacy Sims55:38

        For your size.

    30. AHAndrew Huberman55:39

        Yeah.
15. 58:23 – 59:10

    Perform with Dr. Andy Galpin Podcast

    1. SSDr. Stacy Sims58:23

    2. AHAndrew Huberman58:23

       I'd like to take a quick break to let you know that the Huberman Lab team has launched a new podcast with host Doctor Andy Galpin. Andy is an expert in exercise science and human performance and has long been a fan favorite on the Huberman Lab podcast. This new podcast is called Perform with Doctor Andy Galpin, and it dives into topics such as how to build muscle and strength, how to improve your cardiovascular health, and how to optimize recovery and sleep for performance and much more. Andy is an absolutely fantastic educator and true expert on all things human performance. I know you'll thoroughly enjoy his new podcast and learn a ton of useful knowledge from it, so please check it out and give it a subscribe wherever you're watching or listening to podcasts now. Again, the podcast is called Perform with Doctor Andy Galpin.

16. 59:10 – 1:04:31

    Menstrual Cycle & Training, Tool: Tracking & Individual Variability

    1. AHAndrew Huberman59:10

       Let's talk about the menstrual cycle-

    2. SSDr. Stacy Sims59:12

       Yeah.

    3. AHAndrew Huberman59:12

       ... and how that impacts training at the level of psychology and physiology-

    4. SSDr. Stacy Sims59:17

       Mm-hmm.

    5. AHAndrew Huberman59:17

       ... meaning mo- And of course, the two are linked. They're inextricably linked. For instance, is there a particular phase of the menstrual cycle where a woman should expect that motivation and/or recovery would be more challenging?

    6. SSDr. Stacy Sims59:34

       So this is the sticky point of recent science, because we see all these research studies and meta-analyses that are coming out of the sports science literature saying that there is no effect of the menstrual cycle on anything. When you look at that population, it is specifically eumenorrheic women might have an, uh, subject pool of 10 if you're lucky, 12.

    7. AHAndrew Huberman59:55

       So this is women who have, quote-unquote, "normal menstrual cycles," eumenorrheic?

    8. SSDr. Stacy Sims59:59

       Who are-

    9. AHAndrew Huberman59:59

       Yeah.

    10. SSDr. Stacy Sims59:59

        ... supposedly ovulating. So they have a definitive low hormone and high hormone phase.

    11. AHAndrew Huberman1:00:05

        And this is probably because these studies are being done on university campuses-

    12. SSDr. Stacy Sims1:00:09

        Yes.

    13. AHAndrew Huberman1:00:09

        ... with un- with college undergraduate women?

    14. SSDr. Stacy Sims1:00:11

        Yes, exactly.

    15. AHAndrew Huberman1:00:12

        Okay.

    16. SSDr. Stacy Sims1:00:12

        Yeah.

    17. AHAndrew Huberman1:00:12

        Which is a, typically is in a given age range.

    18. SSDr. Stacy Sims1:00:14

        Right.

    19. AHAndrew Huberman1:00:15

        Okay.

    20. SSDr. Stacy Sims1:00:16

        And they look at performance, meaning that one point in time. And we know that psychologically, you can perform at any point in the menstrual cycle unless you have something like heavy menstrual bleeding. Um, when we're looking at a higher touch and looking not only from a molecular aspect but also pulling in mixed methods and looking at the qualitative, we need women to track their own cycle and find their own patterns, because we know that there are times where you feel like crap and you can't push intensity. But that might be on day eight for one woman, it might be day 18 for another.From a molecular standpoint, we know that the low hormone phase, being day one is the first day of bleeding, up through ovulation, which is midway through your cycle, you have a greater capacity for pulling in and accommodating stress, physical and mental stress. So if we're looking at doing heavier loads, we're looking at doing high intensity work, we're looking at motivation, then that low hormone phase is really optimal for trying to hit a PR or trying to hit a new speed 'cause you can take on that stress and your immune system handles it, your muscles handle it, your core temperature, everything handles it.

    21. AHAndrew Huberman1:01:30

        So, for most women, in the weeks before their period, they're going to feel more robust e- except right up until the point of, um, of menstruation, or the inverse?

    22. SSDr. Stacy Sims1:01:45

        It is day one-

    23. AHAndrew Huberman1:01:46

        Mm-hmm.

    24. SSDr. Stacy Sims1:01:46

        ... of bleeding up through mid-cycle that they're gonna feel great.

    25. AHAndrew Huberman1:01:49

        Got it. Okay. Yep.

    26. SSDr. Stacy Sims1:01:50

        The sticky point comes, not every woman ovulates, and this is a thing when we're looking at general pop. We have lifestyle stress, we have nutrition stress. We know that women, for the most part, have four to five anovulatory cycles a year. So this is where when you're looking at that high hormone phase, we can't say you're definitively in the high hormone phase. So this is where we need women to track their own cycles and understand their own patterns, because in an ideal world, we know that in the luteal phase, this is wh- where we have the most change, where we have a pro-inflammatory response from the immune system. We have a inability to access carbohydrate as well. We have a higher sympathetic drive. So there's lots of things in there that aren't so fantastic for accommodating stress.

    27. AHAndrew Huberman1:02:42

        So broadly speaking, the luteal phase is associated with more cortisol.

    28. SSDr. Stacy Sims1:02:46

        Mm-hmm.

    29. AHAndrew Huberman1:02:47

        More kind of baseline levels of stress. Would it make sense for a woman to try and offset some of that with a bit more nutrition during that phase, a bit more perhaps complex carbohydrate? We know that some complex-

    30. SSDr. Stacy Sims1:02:58

        Yeah.
17. 1:04:31 – 1:08:36

    Tool: 10-Minute Rule; High-Intensity Training & Menstrual Cycle

    1. AHAndrew Huberman1:04:31

       How hard should a woman push through the mental and maybe even physical resistance to train less or not train during a given phase of the cycle?

    2. SSDr. Stacy Sims1:04:41

       Again, depends on how she feels. What we can't rely on are things like heart rate variability, 'cause we know that changes with the autonomic nervous system change with progesterone. It's a good indication that you've ovulated 'cause your heart rate variability tanks, but it's not a good indication of what your body can do. If you wake up, I always say it's the 10-minute rule. You wake up and you feel awful and you're like, "Uh, I really wanna do this workout, but I don't know how it's gonna go." Give yourself 10 minutes. If after 10 minutes you can't hit those intensities or you just feel horrible, change it, drop it down, do something that's more recovery. Do something that's not gonna be so taxing because we do have a limited amount of that stress acumen of how much stress we can handle. So if you're gonna try to exert it all in a high intensity workout, what do you have left over for the rest of the day? And then that compounds because if you're always fighting it, then you're going to increase this baseline sympathetic drive because you're fighting the training, you're fighting life. So give yourself that 10-minute rule. If it happens three days in a row, that's okay 'cause it's a very short period of time. It's not gonna last forever. So a lot of women have this internal conversation of, "I have to do this." And it's really based on some kind of external... They think everyone's watching them, but internally you don't have to. If you give yourself permission, you end up training better, recovering better, and getting better gains.

    3. AHAndrew Huberman1:06:07

       On the flip side, if a woman is feeling spectacularly good, should she just really push it as hard as she can?

    4. SSDr. Stacy Sims1:06:15

       Yeah.

    5. AHAndrew Huberman1:06:15

       Or is there anything about the relationship between the hormone fluctuations of the menstrual cycle and feeling really, really great that training hard can somehow disrupt the cycle? And this is actually kind of the, uh, the old lore, um, probably myth, I would imagine, that high intensity resistance training is somehow detrimental to female hormone cycles. I don't think there's any evidence for that, but I hear that from time to time.

    6. SSDr. Stacy Sims1:06:42

       Yeah.

    7. AHAndrew Huberman1:06:43

       Um, why do you think that myth came to be? Uh, why do you think it propagates and what can we do to extinguish it if in fact it's not true?

    8. SSDr. Stacy Sims1:06:49

       It's not true. We see it comes from a misstep in food intake.And we also see that it's a cultural influence, because if we think about how sports started, it started as a way for men to demonstrate how powerful and aggressive they are. And this is the original Olympics, right? There were no women allowed. And as we feed forward into sport and how it became okay for women to be involved, at the high performance level, if a woman walks in and shows any fallibility, then she's immediately put on a lower stool, right? "Oh, you can't, you can't play with the boys because you have a menstrual cycle. You're bleeding. You're a woman. You're a delicate flower." So women would walk into that professional sports space and be excited if they were amenorrheic or didn't have periods, or they trained hard enough and their period went away, because then they were more like men and they could play with the boys. If you start bringing up menstrual cycle in professional sport now, as of the past about four or five years, it's okay to talk about, which is, you know, what? 2020. So that myth of high intensity resistance training causing issues with the menstrual cycle, one, it's a cultural nuance for pushback against women being in that space, but then the reality is, women weren't eating enough to accommodate for that stress, which then feeds forward to low energy availability, maybe relative energy deficiency in sport, perturbations in all of our menstrual cycle hormones. So it's not the act of the high intensity resistance training, it's the act of not fueling appropriately for it and then getting the okay to not have your period, because yeah, now you're, you're in with ... You're training hard enough, you've lost it, you're more like a man.

    9. AHAndrew Huberman1:08:33

       Wow. Um,

18. 1:08:36 – 1:12:22

    “Train Hard & Eat Well”; Appetite, Nutrition & Menstrual Cycle

    1. AHAndrew Huberman1:08:36

       very interesting history there. Is it true then that if a woman maintains either, um, caloric balance with her basically eating enough to support her energy output, or even a slight caloric surplus, that it's unlikely that, um, her periods will cease, even if she's training very hard and very often?

    2. SSDr. Stacy Sims1:08:57

       Correct.

    3. AHAndrew Huberman1:08:58

       So it basically boils down to calories in, calories out.

    4. SSDr. Stacy Sims1:09:02

       Fuel for the task at hand.

    5. AHAndrew Huberman1:09:03

       Mm-hmm.

    6. SSDr. Stacy Sims1:09:04

       Because some people want to have a slight calorie deficit even in high training, and if that deficit is at night away from training, maybe 150 to 200 calories, then it's gonna help perpetuate body fat loss, not lean mass loss, and it's not gonna interfere with recovery. It's the fueling in and around the stress, meaning the exercise stress, that's really important, but women have been so conditioned to not eat and not take up space, to be small, you know, all of these sociocultural things, that women are afraid to admit the fact that they want to eat and they should be eating. So this is a, a, a nuance within the fitness community that we're really trying to change and get the mindset around, you train hard, you eat well, and your body responds in kind.

    7. AHAndrew Huberman1:09:55

       Appetite, body temperature, and hormones are very tightly linked.

    8. SSDr. Stacy Sims1:10:00

       Yes, they are.

    9. AHAndrew Huberman1:10:00

       Um, far too tightly for us to, uh, disentangle all of those in a single conversation here. But as you're describing the urgent need for women to fuel enough with the proper fuels, to train hard enough to stimulate the correct adaptations that they need, I imagine that the shift in appetite and body temperature that occurs across the menstrual cycle is also gonna play into this, meaning there will be phases of the menstrual cycle where women will be just naturally less motivated to eat enough carbohydrate, enough protein-

    10. SSDr. Stacy Sims1:10:32

        Yep.

    11. AHAndrew Huberman1:10:32

        ... in order to get the most out of their training.

    12. SSDr. Stacy Sims1:10:34

        Mm-hmm.

    13. AHAndrew Huberman1:10:34

        What phases of the menstrual cycle are those, um, so that women can pay particular attention to make sure that they're fueling enough?

    14. SSDr. Stacy Sims1:10:40

        Yeah. Um, as estrogen starts to come up right before ovulation, that estrogen surge really dampens appetite. Uh, it also has a, an interplay with our appetite hormones, which is part of the reason why we don't have that great of an appetite. It holds after ovulation, estrogen dips, you get hungry, it comes up, and people are like, "I have some cravings," which are driven by progesterone, 'cause your body needs more calories, but at the same time with the elevation of estrogen, you're not hungry. You have cravings, but you're not hungry.

    15. AHAndrew Huberman1:11:13

        Interesting.

    16. SSDr. Stacy Sims1:11:13

        Yeah. So i- it's trying to disconnect those.

    17. AHAndrew Huberman1:11:16

        Mm-hmm.

    18. SSDr. Stacy Sims1:11:16

        It's like, your appetite is something that will come back, of course, once you eat, but cravings are more of a, of that psychological capacity of, "Yeah, I ... My body needs more, but I'm not quite sure what." So to get women to understand what's happening across the board, it's always coming back to, let's fuel appropriately for the exercise, and even if you're not hungry, if you are fueling appropriate- appropriately at that point in time, if you end up with less, at least you've stopped that breakdown state, that catabolic state, so we don't get those perturbations in the hypothalamus. That's my biggest concern for women, is really taking care of that signaling from the brain to the rest of the body. And if we have fuel on board, even though we have appetite perturbations, and if you go do a really hard workout in the heat, you're not gonna be hungry either. But if you're having a cold protein drink after that hot workout, you're taking care of that immediate need to shut down the signals that we need to break down things.

    19. AHAndrew Huberman1:12:21

        Let's

19. 1:12:22 – 1:20:57

    Oral Contraception, Hormones, Athletic Performance; IUD

    1. AHAndrew Huberman1:12:22

       talk about one of the many third rails of, um, discussions online, which is birth control.

    2. SSDr. Stacy Sims1:12:29

       Yeah.

    3. AHAndrew Huberman1:12:30

       And we need to define exactly what type of birth control we're talking about because there are so many different forms.

    4. SSDr. Stacy Sims1:12:35

       Yes.

    5. AHAndrew Huberman1:12:36

       There are IUDs, there are the copper IUDs, there's the ring, there's the, you know. Let's talk about oral contraceptives that are designed to prevent ovulation.

    6. SSDr. Stacy Sims1:12:47

       Mm-hmm.

    7. AHAndrew Huberman1:12:48

       So this is, quote unquote, the pill.

    8. SSDr. Stacy Sims1:12:50

       Yeah.

    9. AHAndrew Huberman1:12:50

       So we're being ... Let's, for now, limit the conversation to that so that there isn't confusion. Um, share with us, if you will, your-... thoughts on these, how they impact any of the things that we're talking about, or anything else from that, for that matter.

    10. SSDr. Stacy Sims1:13:02

        Can we have another history lesson?

    11. AHAndrew Huberman1:13:04

        Please.

    12. SSDr. Stacy Sims1:13:04

        All right. Erm, I just gave a talk at home to some young athletes on contraception, because someone might be on the depot, and if they're on it for more than two years, they get bone mineral density loss. So then the question of, okay, well, how does the oral contraceptive pill come up? How does that affect things? It's like, well, let's look at the history of it. Initially, came from Stanford. It was funded by, um, Katharine McCormick from McCormick family, and a feminist activist, Margaret Sanger. But because they are women, they couldn't get in the lab, so they got a guy from Stanford to develop the pill, and he's like, "You know what? We need to put in a placebo week so that women feel like they're having a bleed." So if we're looking at the three active pills and then the one sugar pill week, it was by design to make women feel like they are having control over their menstrual cycle, and they would still have a bleed. But it's not a true bleed, it's a withdrawal bleed. So this becomes the confusing point for people who are on an oral contraceptive pill. They're like, "I get my period." It's like, "No, you don't," 'cause the idea of the hormones that are in an oral contraceptive pill is to downregulate your ovarian function so that you don't ovulate. So you have a whole different hormone profile from someone who naturally cycles. So this depends on the type of oral contraceptive pill you're using. For the most part, monophasic is the one that's most prescribed, so that means the three weeks of the active pill is the same dose of estrogen, progesterone, and then you have your sugar pill week or your withdrawal week, and then you start again. When we look at the repercussions of using oral contraceptive pill in active women, there's a higher amount of inflammatory responses and oxidative responses. So from a training standpoint, no one's done the study yet, but I would be interested in doing this, of looking at how that impacts adaptation. You do end up with a new baseline of this when you start taking the pill, but we're not really sure how that impacts adaptation. We also look at the progestin component of the oral contraceptive pill, 'cause we have four generations of progesterone. First generation was really high dose and has a lot of risk factors, not really prescribed that much. Second generation is the most prescribed, and this is the one that people just take. It's in your IUD. It's in your OC. Uh, has the least amount of side effects. And then we have a third and a fourth generation. The fourth generation is primarily used for women who have really bad PMS or PMDD, which is your, um, premenstrual dysphoria disorder. So significant mood issues, because that progestin has a direct effect on a lot of the dopamine receptors in the brain as well. The third generation is very androgenic. So we see that in, in some preliminary research, that improves speed and power by the second week of intake because it's accumulated. So when we're looking directly at an oral contraceptive pill, we can't make generalizations because you have low dose, high dose estrogen. We see that a 30 microgram dose increases hypertrophy but not strength, 'cause estrogen increases the satellite cell aspect. Um, so for my power and Olympic athletes, Olympic lifting athletes, that's a detriment, because they'll put on muscle mass but no strength. So we've had to look at changing their OC or getting them off. For women who have breakthrough bleeding, that higher incidence of, or that higher intake of estrogen is, is really beneficial. So we look overall at how it impacts women from an athletic standpoint, it's so variable in the hormone profile that we can't make generalizations. We only look at the very high performance athletes and what's happening up there, because that can make or break an athlete. So from the general touch point, we don't know enough, right? The beginning of this year, 2024, there was a study that came out looking at changes in the amygdala that happens with oral contraceptive use. It's reversible in adults, but for young girls, we don't know because their brain is developing. And unfortunately, physicians will pass out OCs as if it's candy.

    13. AHAndrew Huberman1:17:23

        OCs?

    14. SSDr. Stacy Sims1:17:24

        Oral contraceptives.

    15. AHAndrew Huberman1:17:24

        Oral contraceptives. And do you recall what the direction of the effect was on the amygdala? Uh, for those that, uh, don't recall the amygdala, a bilateral brain structure, meaning one on each side of your brain, uh, literally means almond in Latin, it's almond shaped, and it's part of a larger network associated with threat detection.

    16. SSDr. Stacy Sims1:17:41

        Mm-hmm.

    17. AHAndrew Huberman1:17:42

        Um, sometimes it's described the locus of fear in the brain, but it's involved in a lot of other things too.

    18. SSDr. Stacy Sims1:17:47

        Yeah.

    19. AHAndrew Huberman1:17:47

        Both positive valence and negative valence, but nonetheless, is part of the, um, threat detection system, elevated levels of arousal, which is why it's often d- discussed in the context of fear, anxiety, et cetera, uh...

    20. SSDr. Stacy Sims1:18:02

        It increased fear in women who are on the OC, oral contraceptive pill, made them less, um, willing to take chances, and when they went off it, they're like, "Well, why couldn't I do that before?" So that's why they started looking at the amygdala. And when I say we're looking at young girls, and again, we don't know what's happening. Is it reversible in young girls that are put on it or not because of the brain structure changes that are happening? Um, so when we talk about an oral contraceptive pill, I want people to understand that it has a significant effect on the body, not just reproductive. We don't know enough about all the other effects. So I have parents who say, "My daughter wants to go on the oral contraceptive pill. She's having irregular periods. She's this athlete. We want to be able to control it." And it's like, if there's a issue with your menstrual cycle now, it's still gonna be there when you get off it. So we have to look and see what, what's going on here. If you're looking to get on it to control your menstrual cycle, why? Because we know that you can have an increase in your VO2 max and other anti-... anaerobic capacity when you are not on it. So you have a better top-in capacity when you're not being blunted by these hormones. And then the other conversation is, oh, my skin. It's like, well, they have really good dermatologists that can help you with that. You don't have to go on an oral contraceptive pill. But unfortunately, GPs don't understand all of that and if a girl comes in and says, "I'm having irregular cycles, heavy menstrual bleeding, I want to go on the OC," here you go. So it is a huge conversation still to be had. Um, I put it in the same category as menopause hormone therapy, 'cause there isn't enough research to address all the population needs, and we see these big pendulum switches. So before it was like, "Everyone be on the OC," and now it's like, "Maybe not." And then it was, "No one be on menopause hormone therapy. Everyone should be on it." But we need to land in the middle and understand more of what's happening with these exogenous hormones.

    21. AHAndrew Huberman1:20:04

        Is there any evidence that other forms of female contraception can be, let's just say, problematic for the types of things we're discussing today?

    22. SSDr. Stacy Sims1:20:12

        Like the implant and the Depo?

    23. AHAndrew Huberman1:20:14

        Or IUD, copper IUD, um...

    24. SSDr. Stacy Sims1:20:16

        Copper IUD and the Mirena or, you know, your progestin-laced IUD, those are what a lot of my tactical athletes will use, 'cause it doesn't have a systemic effect on adaptation or inflammation, mood, any of those things. Um, and it's a fit and forget, so you can put it in for up to three to five years. If you have a really heavy bleeding, it really dissipates because the whole idea of an IUD is to thin the endometrial lining and so then you have autophagy that takes care of the endometrial lining so you don't necessarily have a bleed. The copper IUD is different because you do have really heavy bleeding for the first three cycles, and then it attenuates.

20. 1:20:57 – 1:26:31

    Evaluating Menstrual Blood, PCOS; Hormones & Female Athletes

    1. SSDr. Stacy Sims1:20:57

    2. AHAndrew Huberman1:20:57

       Before we got started today, you mentioned some very interesting pioneering studies on evaluating menstrual blood itself as a window into some larger themes about what's going on physiologically, maybe even psychologically. Um, now might be a good time to-

    3. SSDr. Stacy Sims1:21:17

       A good segue?

    4. AHAndrew Huberman1:21:17

       ... to, uh, just touch into that. We can always return to it again later.

    5. SSDr. Stacy Sims1:21:21

       Yeah.

    6. AHAndrew Huberman1:21:21

       But let me just ask it, um, more directly. What are some things that can be measured directly from menstrual blood that are informative for women? And it sounds like there's a new generation of at-home tests that might be interesting and informative for them to think about.

    7. SSDr. Stacy Sims1:21:38

       Yeah. Well, if you think about menstrual fluid, everyone thinks about it as a discard product, but it's a very good indicator of what's happening from an endocrine standpoint, gives a really good indication of what's happening from an endometrial standpoint. So if you're looking at all the cytokines and the proteins and the tissue that comes from it, it's a huge indicator that's naturally discharged that we're now looking at for determining HPV, do you have it or not, what about proteins for PCOS, can we really identify PCOS or endometriosis?

    8. AHAndrew Huberman1:22:15

       Can we talk about PCOS for a moment?

    9. SSDr. Stacy Sims1:22:16

       Yeah.

    10. AHAndrew Huberman1:22:16

        Most people have heard of it by now but, uh, polycystic ovarian syndrome, it's associated with typically elevated androgens.

    11. SSDr. Stacy Sims1:22:23

        Mm-hmm.

    12. AHAndrew Huberman1:22:24

        Um, it's becoming more and more common or perhaps detected more based on better detection methods-

    13. SSDr. Stacy Sims1:22:30

        Yeah.

    14. AHAndrew Huberman1:22:30

        ... I don't know which. Um, the prevalence of PCOS seems to be very, very high.

    15. SSDr. Stacy Sims1:22:36

        It does, and I think it's a combination of both. Uh, we also see some rebound PCOS that happens when someone gets off an oral contraceptive pill. It's not necessarily true PCOS 'cause what's happening now, your ovaries are producing eggs-

    16. AHAndrew Huberman1:22:54

        Mm-hmm.

    17. SSDr. Stacy Sims1:22:54

        ... that have been downregulated for so long. So under ultrasound it might look like PCOS but it's not necessarily true indication. The other is more and more women are starting to eat more and so they're coming out of low energy availability. If you have more carbohydrate, you end up with greater follicular stimulation which also shows up as PCOS. So, the true PCOS, yes, there is a high incidence from a reporting standpoint but is it that rebound where it's not having all the androgenic changes? That's still kind of up in the air at the moment. Um, but it is a big concern for women because it is an indication that something's going on and they might have some fertility issues. Uh, we see a really high incidence of PCOS in Olympic level athletes because of the higher androgenic aspect of PCOS, so better recovery time, a little bit higher baseline testosterone. Um, so yeah, it's a population spec- specificity as well.

Episode duration: 2:28:37