The Body Reset Women Over 40 Actually Need (Fat Loss, Energy & Hormones)

1. 0:00 – 1:15

   From specialist menopause clinics to whole-person care

   1. RCDr. Rangan Chatterjee0:00

      No one size fits all. Every woman is gonna need a slightly different, uh, I guess a lifestyle prescription, if you will. But I wonder if you could just talk us through what are some of the common things that people can do that are gonna help them with their hormonal symptoms?

   2. AMDr. Annice Mukherjee0:14

      And, uh, just to give you a background, this goes back to the fact that I, I worked very much in a tertiary referral menopause service. Women who, over the last 20-odd years, who had the most severe problems, s- uh, uh, symptoms related to particularly menopause, would get referred to specialist clinics, and I worked at, at Christie Hospital, which was a cancer hospital, and I looked after many women who'd had, um, an early menopause from cancer treatment, many women who'd gone through breast cancer and developed menopause. So I was there being asked, how do we treat these symptoms? You know, how do we, how do we treat the symptoms in someone who can't safely take HRT, and how do we treat the symptoms, and this was very much, um, my, m- my later experience from when I went to Salford in about 2005, was women were coming to me on HRT already and still suffering from symptoms. So then I think, well look, I've got to find out if they're already on treatment, how do I make them better? If,

2. 1:15 – 2:04

   Rule out “menopause lookalikes”: anemia, thyroid issues, and comorbidities

   1. AMDr. Annice Mukherjee1:15

      if they can't have that treatment, how do I help these pa- patients get better? And so my clinical experience then went to my general medical experience and looking at a patient holistically, looking at any other medical problems that might be contributing, and that's important because, you know, I might say w- women in perimenopause might be anemic. Y- if you treat that, you're reducing-

   2. RCDr. Rangan Chatterjee1:36

      Yeah

   3. AMDr. Annice Mukherjee1:36

      ... the burden of symptoms. Hypothyroidism is actually, although w- we can diagnose it much easier now because of thyroid function tests, hypothyroidism is, it's 10 times more common in women than men. It's really common in the demographic 40 to 60 years. Other medical problems should be treated. So, you know, I, I addressed that. There are other non-hormone medications which we haven't talked about, which I'd like to cover, for those women who are told you can't have HRT, and they feel like they're missing out-

   4. RCDr. Rangan Chatterjee2:04

      Okay

3. 2:04 – 3:52

   Lifestyle patterns driving symptoms: overcommitment, sleep debt, alcohol, and stress

   1. AMDr. Annice Mukherjee2:04

      ... because we're talking about HRT all the time. But then, you know, I, I would talk to my patients and they'd, you know, we'd try a few things and we'd optimize the anemia or the thyroid or, you know, try some non-hormone medications. And they'd go, "Yeah, but I'm s- you know, I'm still feeling exhausted. I've still got aches and pains." So then, you know, and this is clinical experience, this, really, is that I'd then go, right, I'd go, "Just tell me a little bit about your lifestyle." And it would invariably, themes come up of overcommitment, of women expecting too much of their bodies, not having enough downtime, not having good sleep patterns, not having good nutrition, often too much alcohol, too much smoking. This is not rocket science.

   2. RCDr. Rangan Chatterjee2:45

      Yeah.

   3. AMDr. Annice Mukherjee2:46

      This is easy, but it's not something that we tend to do in conventional medicine.

   4. RCDr. Rangan Chatterjee2:49

      Yeah.

   5. AMDr. Annice Mukherjee2:49

      We have too-short consultations and so I, I started to look into this. And actually, funnily enough, when you, when you get good at it, it doesn't take that long to go over it.

   6. RCDr. Rangan Chatterjee2:57

      Yeah.

   7. AMDr. Annice Mukherjee2:57

      A- and the other thing is major life events because again, talking about that midlife rollercoaster, as we get older, major life events hit us more and more, you know, men and women as you [laughs] as you, as you get older. And the other thing is historic trauma is a big factor in, in the experience of symptoms with other medical conditions. So there's lots of themes, and I will ask patients about different, you know, lifestyle, historic traumas. Um, and then it's about there are themes as, as to what, what people can do, but it's not the same for everybody. And as you say, there's not a one size fits all, not with medication, not with lifestyle. Because if you're absolutely exhausted, you're s- you're sitting at your desk and then you're sitting on your sofa, you don't see daylight, you haven't got energy to go and cook fresh food, so you're eating ready meals-

   8. RCDr. Rangan Chatterjee3:51

      Yeah

4. 3:52 – 6:29

   “Microdosing” lifestyle change: start where you are and build slowly

   1. AMDr. Annice Mukherjee3:52

      ... maybe smoking and drinking too much as coping strategies, and again, alcohol is a cope- an unhelpful coping strategy, it can, over a number of adult years as your life gets busier or more stressful, you know, it, it can all sort of hit you. You then got hormone symptoms, and we're expecting a miracle cure with hormone treatment, but actually we need to be sitting back. So the first thing I would say in terms of lifestyle to every woman I see regarding menopause is how much are you moving? And I'm not saying go and do a marathon. I'm not saying go and, you know, be an expert at yoga or do HIIT classes because there's no one size fits all, and actually, if you try and do too much too quick, you're back to square one. It's snakes and ladders.

   2. RCDr. Rangan Chatterjee4:35

      Mm.

   3. AMDr. Annice Mukherjee4:35

      It's about starting where you are and making small changes. I sometimes describe them as microdosing your lifestyle.

   4. RCDr. Rangan Chatterjee4:42

      Yeah.

   5. AMDr. Annice Mukherjee4:42

      And, um, just tiny moments. If you're exhausted, don't expect yourself to go for a 30-minute walk, but if you do, if you don't do any exercise, you could start off by just going around the block and getting some daylight for five minutes in the morning, and then building very, very slowly. There is an amazing woman who I follow on social med- media called Joan MacDonald. Her Instagram is trainwithjoan. She-

   6. RCDr. Rangan Chatterjee5:04

      Oh, is she sort of 70, 80?

   7. AMDr. Annice Mukherjee5:06

      She's just turned 77.

   8. RCDr. Rangan Chatterjee5:08

      Yeah.

   9. AMDr. Annice Mukherjee5:08

      Joan at 46 didn't really do much exercise, and then she decided with her daughter to, um, start doing some exercise. She didn't think I'm gonna be, at 77, I'm gonna be like, ah, you know, an internet sensation-

   10. RCDr. Rangan Chatterjee5:24

       [laughs]

   11. AMDr. Annice Mukherjee5:24

       ... which she is, actually. She didn't think that. She just, she just said, "I just went one day at a time and I built up slowly." She never had... She didn't put pressure on herself. She didn't have over expectations. Joan is like a miracle. I mean, she's amazing. She's absolutely amazing.

   12. RCDr. Rangan Chatterjee5:42

       She's really strong, isn't she?

   13. AMDr. Annice Mukherjee5:43

       She's incredibly strong. She's built up gradually. And she's not saying, you know, "I'm, I'm in a deficiency state and I'm a mess." If you look at Joan, she is the picture of, I think, what pretty much most women would think they want to be like when they're 77. It's, or if not every single woman on the planet. She's amazing. She's so healthy.And she's, she's done it all through lifestyle. The, the key to that is make small changes, because Rome wasn't built in a day. N- and we all want quick fixes. We all want to do a miracle diet, a c- a clever hack, a, you know, a boot camp for six weeks and, and suddenly drop, you know, the, you know, four stone in weight that we've gained over three decades, you know, or suddenly be fit when we haven't done any exercise for 20 years.

   14. RCDr. Rangan Chatterjee6:29

       Mm-hmm.

5. 6:29 – 8:05

   Nutrition simplified: prioritize clean whole foods and reduce ultra-processed staples

   1. AMDr. Annice Mukherjee6:29

      And that isn't realistic. So it's about starting where you are and building up. So that exercise, uh, nutrition, I mean, as, as you're aware, nutrition is a real trigger topic. Loads of people have different views. My mantra regarding nutrition is clean whole food. Keep your plate full of real food, not processed, ultra-processed. Not packets, jars, you know-

   2. RCDr. Rangan Chatterjee6:53

      Yeah

   3. AMDr. Annice Mukherjee6:53

      ... ready meals, but actually just real food. You know, fresh fruit, veg, nuts, seeds, lentils, pulses. We eat a lot of processed foods. I think... I say to my patients, "Do you eat processed food?" They go, "No." And I said, "Oh, do you have any bread, pasta, cakes, biscuits, pizza, pastry or noodles?" And they're going, "Oh yeah, I have those." And I went, "Well, that is processed, right?" So, and I'm not saying exclude it-

   4. RCDr. Rangan Chatterjee7:15

      Right

   5. AMDr. Annice Mukherjee7:15

      ... but that shouldn't be your staple diet. I keep it simple. And then having a social network, having laughter is really, really important, and all of those things will help your weight management because, you know, increasing weight, you know, having an excess weight as you get older is, is not good for long-term health risks. So everything ties in when it comes to lifestyle.

   6. RCDr. Rangan Chatterjee7:36

      Oh, yeah, I mean, first of all, I really appreciate you, you sharing Joan, sharing the advice that you give your patients. Tying it back to hormonal symptoms, are you finding that when you can help women to make these small sustainable changes to their lifestyle, and of course different women will choose different things and go at different rates, are you finding that often the symptoms that they came to see you with are also getting better?

6. 8:05 – 13:01

   Lifestyle improves symptoms—but meds can create the platform to begin

   1. AMDr. Annice Mukherjee8:05

      Yes. So building up movement and exercise is a stress reliever, so you're reducing the impact, that stress burden on your body. Um, eating whole foods, you're gonna have more nourishment, proper nourishment. Um, too much alcohol and smoking worsen hot flushes, vasomotor symptoms. Alcohol is very-

   2. RCDr. Rangan Chatterjee8:24

      Yeah

   3. AMDr. Annice Mukherjee8:24

      ... disruptive to good quality sleep. If you... The other thing about food is if you're eating a lot of ultra-processed foods, people talk about sugar crashes, which, and, you know, sugar surges and crashes, which is not really a medical term, but it, it, people do get reactive hypoglycemia, which is essentially a sugar crash if they eat a lot of processed foods and, and that kind of perpetuates a craving-

   4. RCDr. Rangan Chatterjee8:46

      Totally

   5. AMDr. Annice Mukherjee8:46

      ... for sh- for high sugar carbs. And so, you know, all of these things, there's actually more science behind lifestyle than there is with any medication. The thing that I would add to that is if a woman who's going through severe symptoms is listening to, you know, us talking about how important lifestyle is, she'll go, "I, I can't. I can't do that."

   6. RCDr. Rangan Chatterjee9:06

      No, I get that.

   7. AMDr. Annice Mukherjee9:07

      So what I would say there is that, okay, there are medications that can help to try and lessen your symptoms to give you that opportunity then-

   8. RCDr. Rangan Chatterjee9:16

      Yeah

   9. AMDr. Annice Mukherjee9:16

      ... to use lifestyle, but medication is never a substitute. It, it won't make you achieve-

   10. RCDr. Rangan Chatterjee9:22

       Yeah

   11. AMDr. Annice Mukherjee9:22

       ... im- improvement in, in, in your long-term health and wellbeing, but it can give you a platform from which to start what you need to do. One thing that's often talked about is that we're living longer now. So they probably, you probably got more, for the average woman, more adult life after menopause than you have before it. So then somebody arguing the opposite point would say, "No, no, but you must have hormones for longer because we're living longer." But I will stick with what I say, is that during that hormone transition, we need support to get our lifestyle optimized.

   12. RCDr. Rangan Chatterjee9:54

       Mm.

   13. AMDr. Annice Mukherjee9:54

       Because living longer should be about quality of like, life and being well, like Joan MacDonald, right?

   14. RCDr. Rangan Chatterjee10:02

       Yeah.

   15. AMDr. Annice Mukherjee10:02

       At 77, who's s- stronger than she was, you know, probably when she was in her younger adult life.

   16. RCDr. Rangan Chatterjee10:08

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   17. AMDr. Annice Mukherjee11:05

       Um, you don't get that through any medication.

   18. RCDr. Rangan Chatterjee11:07

       Yeah.

   19. AMDr. Annice Mukherjee11:07

       You will only get that through empowerment and making sure that your body is working well.

   20. RCDr. Rangan Chatterjee11:14

       Yeah, I appreciate you clarifying those points, and I guess what I'm really trying to emphasize is I do think in medicine we can over-medicalize things sometimes. I think it's quite a big problem taking it beyond female health just into all kinds of things now. They become medical things that needs a medical diagnosis and treatment, and I, I also completely agree with what you said. Sometimes hormones or, I don't know, let's use a non-female health example. Um, migraines, for example, right? Um, if someone comes in and I diagnose them with a migraine, what I tend to say is, "Look, I think this is a migraine. There are a number of options here, okay? There are some medications that are likely to help you reduce the pain. There's also some things in your lifestyle that I feel I can help you with that may also help."What approach would you like to take? And, you know, I always respect what a patient's gonna say. Like, a patient may go, "Look, I don't really want to take medication." Yeah, sure, help me. Let's see if we can tackle this another way. I would say the majority, a lot of people will say, "Well, look, I'm interested. Can I have the pill just at the moment to help me get through?" And, and that's why I feel it can be really useful. It's like, okay, this is gonna help you with the pain. It might help you get back to work. It might help you have more energy so you can go to the gym, so you can cook yourself a fresh meal. And then over time, the medication actually allowed you to make those changes. And I, and I think we're, we're saying the same thing can sometimes happen with HRT.

   21. AMDr. Annice Mukherjee12:45

       Yeah.

   22. RCDr. Rangan Chatterjee12:45

       It can help you feel so much better that you can then put in those other changes that are gonna help you now, but also beyond.

   23. AMDr. Annice Mukherjee12:52

       Yeah, definitely, and the other non-hormone options that women can have.

   24. RCDr. Rangan Chatterjee12:56

       So, so let's go into those, 'cause there will be women who say, "Yeah, I can't have hormones."

   25. AMDr. Annice Mukherjee13:00

       Yeah.

   26. RCDr. Rangan Chatterjee13:00

       "What else can I do?"

7. 13:01 – 16:39

   Non-hormonal symptom relief: clonidine, low-dose antidepressants, and a new hot-flush drug

   1. AMDr. Annice Mukherjee13:01

      There are a number of different medication options that we've had available for many years that can work to help the menopause symptoms, but it depends on the specific symptoms. So the, the, you know, the, there's a number of medications. Uh, the, the longest used one is clonidine, which is an old-fashioned central antihypertensive medication.

   2. RCDr. Rangan Chatterjee13:18

      What does that mean, central antihypertensive?

   3. AMDr. Annice Mukherjee13:19

      So it, it's a blood pressure-lowering medication, and it works through mechanisms within the brain.

   4. RCDr. Rangan Chatterjee13:24

      Okay.

   5. AMDr. Annice Mukherjee13:25

      Lowers blood pressure, but it also reduces hot sweats and flushes, and the, the heat sensitivity symptoms associated with menopause transition. So it was, it's been used for a long time. It does tend to have side effects in that it can make you a bit dizzy. It can make you a little bit drowsy, so in high doses, and it can obviously lower the blood pressure. So if you've got low blood pressure, it, you m- you may not tolerate it. But for a woman I see who, who can't have HRT, who may have high blood pressure or other medical problems, clonidine can be a good fit-

   6. RCDr. Rangan Chatterjee13:55

      Mm

   7. AMDr. Annice Mukherjee13:55

      ... if her main symptom... It also can help with sleep and migraines. So it depends on the s- particular symptoms that a woman has. There, there are other medications, a lot of antidepressant medications, which are given a really bad rap today in relation to menopause because people go, "Well, you know, it's hormonal depression. It's not depression." But actually f- some of the antidepressants in very low doses, so not even antidepressant doses, can reduce vasomotor symptoms, so hot sweats, flushes, flushes. They can help with mood, and they can help with sleep.

   8. RCDr. Rangan Chatterjee14:27

      So let's say a woman, for whatever reason, cannot take HRT, and you're saying now that some medications that are typically colloquially called antidepressants, you're saying that in small doses potentially they can positively help some of those symptoms that you would've normally got HRT for.

   9. AMDr. Annice Mukherjee14:49

      Mm.

   10. RCDr. Rangan Chatterjee14:49

       Does the same principle apply just for a short period of time until you no longer need it?

   11. AMDr. Annice Mukherjee14:54

       Definitely, yes. If I start somebody on it and I'm seeing them, I would, I would review it, and, you know, I would only use it for as long as it's needed. But it's, it's, i- it's individual because, you know, for example, many of the women who end up going onto those treatments, um, can't have HRT because of an estrogen receptor-positive cancer, so they've also gone through a major life event-

   12. RCDr. Rangan Chatterjee15:15

       Yeah

   13. AMDr. Annice Mukherjee15:16

       ... which has an impact on your mood. And, and so it depends on what happens to that woman later-

   14. RCDr. Rangan Chatterjee15:19

       Yeah

   15. AMDr. Annice Mukherjee15:20

       ... down the line. And there are other medications. There is one brand-new medication which is going to be licensed this year, we think. It was due to be licensed by the FDA in America in February, but it has been delayed. Um, and it's called fezolinetant, and this is a group of, of... Well, it's a, a neurokinin 3 receptor antagonist which works centrally in the brain, in the hypothalamus, directly targeting the menopause hot sweat mechanism, which was only found a few years ago. It's an amazing new treatment. It's, looks as if it's pretty much as effective as HRT for, uh, the vasomotor symptoms, sleep, uh, fatigue, and even, um, you know, s- some of the studies suggest it might help with weight management as well. So it's really exciting to have. It's the first time in my career that we've had a new alternative to HRT that actually has a, a correct mechanism of action-

   16. RCDr. Rangan Chatterjee16:21

       Mm

   17. AMDr. Annice Mukherjee16:22

       ... for women who can't take HRT because it doesn't work through estrogen.

   18. RCDr. Rangan Chatterjee16:25

       Wow.

   19. AMDr. Annice Mukherjee16:25

       So, uh, the studies are underway for a similar drug in women with breast cancer at the moment. So that's, that's really exciting for women who feel left out-

   20. RCDr. Rangan Chatterjee16:36

       Yeah

   21. AMDr. Annice Mukherjee16:36

       ... by the HRT conversation.

8. 16:39 – 19:39

   Midlife weight gain: menopause isn’t the only driver (and stigma blocks progress)

   1. RCDr. Rangan Chatterjee16:39

      Weight gain in midlife for women is something that commonly comes up. If we just go really specifically around the issue of weight gain in perimenopause, does that time in a woman's life cause stroke, contribute to weight gain?

   2. AMDr. Annice Mukherjee16:58

      In men and women, weight goes up in midlife. Metabolism goes down slightly, probably a little bit more in the menopause transition. But it's, it's, it's a few calories' worth. It's not, you know, it's not the three stone that you've gained in the last 20 years that you suddenly gain another half a stone-

   3. RCDr. Rangan Chatterjee17:16

      Mm

   4. AMDr. Annice Mukherjee17:16

      ... because there's other things going on in your life. You're busy. Midlife, it goes back to that whole you're busy in midlife. You're drinking too much. You're not able to focus on enough exercise or, uh, good nutrition, and the weight is going up for other reasons. And we cannot blame weight gain on menopause hormone change throughout society because the whole of society [laughs] is gaining weight-

   5. RCDr. Rangan Chatterjee17:39

      Right

   6. AMDr. Annice Mukherjee17:39

      ... from, from, from small children because of our lifestyles. You know, HRT, I see patients who say they go on HRT and they gain weight. I see some women who say, "Oh, I've lost some weight since I started HRT," because it, it's helped them-

   7. RCDr. Rangan Chatterjee17:51

      Mm

   8. AMDr. Annice Mukherjee17:52

      ... be motivated to do-

   9. RCDr. Rangan Chatterjee17:53

      Yeah

   10. AMDr. Annice Mukherjee17:53

       ... more exercise. Overall, the impact is pretty small. But the other thing that I would say about weight is that, you know, obesity stigma is a real problem for progress, okay? And there are many people, because of the way the food industry is regulated and all sorts of other reasons that we haven't got time to go into, we have got an obesity epidemic-

   11. RCDr. Rangan Chatterjee18:14

       Yeah

   12. AMDr. Annice Mukherjee18:15

       ... and having severe obesity is a problem for health longer term. Um, and, and it's associated with a number of other multi-morbidities. AndW- th- there's a whole field of healthcare m- medical and surgical weight management to help people who have problems with their weight. Because when you've gained a certain amount of weight and your body mass index might be 35, 40, 45, or 50, th- these are, you know, very high BMIs. And BMI isn't a great way to describe, you know, w- whether you're overweight, but it's, it's probably the, the easiest, crudest measure that we have. But y- y- it's very difficult to lose all of that weight and get into a normal body mass index when you're at that level, because you get more insulin resistance, which is-

   13. MPDr. Mindy Pelz19:00

       Yeah

   14. AMDr. Annice Mukherjee19:00

       ... basically going against your metabolism. So we shouldn't be saying obesity is bad. We should be saying we need to be helping people who need to lose weight.

   15. MPDr. Mindy Pelz19:08

       Yeah.

   16. AMDr. Annice Mukherjee19:08

       And we also have some amazing, again, the first time in my career, new medications to help people who have gained weight through their adult life, perhaps even since childhood-

   17. MPDr. Mindy Pelz19:18

       Yeah

   18. AMDr. Annice Mukherjee19:18

       ... who, who really, it's gonna be very difficult for them to just go on a diet and lose that weight.

   19. MPDr. Mindy Pelz19:23

       Yeah.

   20. AMDr. Annice Mukherjee19:23

       So we need to be looking at things differently. But if you're a little bit overweight when you're hitting menopause, y- y- you know, there are ways that you, you can, you know, in terms of exercise, movement, j- you know, adjusting your nutrition, managing your stress, managing your sleep, that help with weight management.

9. 19:39 – 25:20

   Insulin resistance explained—and why women’s hormone transitions must be studied directly

   1. MPDr. Mindy Pelz19:39

      So if you're just living the traditional life, and you've been doing the calorie in, calorie out routine, and, and you're, you, you think it's about exercising more, eating less, yes, you will gain weight as you age. But what I'm asking people to do is to look at this through the hormonal lens. And with women, what we see is that as estrogen goes down, you become more insulin resistant.

   2. RCDr. Rangan Chatterjee20:04

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   3. MPDr. Mindy Pelz21:23

      So estrogen starts going down in our early 40s, and all of a sudden the diet you did at 35 doesn't work for you at 43 or 44. So you have to start to make a change, and if you do, then weight gain is not going to be in your cards. But if you're not w- willing to look at a lifestyle shift through those perimenopausal and menopausal years, yeah, then you're gonna gain weight, because your whole hormonal profile changes.

   4. RCDr. Rangan Chatterjee21:51

      [Instrumental music]

   5. MPDr. Mindy Pelz21:52

      You mentioned two hormones there that people may not be familiar with-

   6. AMDr. Annice Mukherjee21:57

      Yeah

   7. MPDr. Mindy Pelz21:57

      ... or they may not fully understand them, estrogen.

   8. AMDr. Annice Mukherjee22:00

      Mm-hmm.

   9. MPDr. Mindy Pelz22:00

      But also you mentioned a term called insulin resistance.

   10. AMDr. Annice Mukherjee22:03

       Yes.

   11. MPDr. Mindy Pelz22:03

       Could you just explain, first of all, what insulin resistance is-

   12. AMDr. Annice Mukherjee22:06

       Yep

   13. MPDr. Mindy Pelz22:07

       ... and then, I guess, expand on what estrogen is?

   14. AMDr. Annice Mukherjee22:10

       Yeah. So e- uh, insulin is the hormone that drives glucose into the cells. So I l- I think of it as like an escort. It's like you eat a meal, you get a bunch of glucose, and then your brilliant body will make insulin, and then it, the insulin will come along to the glucose and say, "Hey, okay, let's get you in the cell-

   15. MPDr. Mindy Pelz22:31

       Mm-hmm

   16. AMDr. Annice Mukherjee22:31

       ... so that we can put you to use." When we're insulin resistant, that system doesn't work. And so there's two... The, the basic principle of that is that the opening for glucose to go into the cell via the escort of insulin is clogged. So you can't get either glucose or insulin to the, into the cell. So what ends up happening is your body has to store it somewhere.

   17. MPDr. Mindy Pelz22:54

       Mm-hmm.

   18. AMDr. Annice Mukherjee22:55

       So it stores it as fat, and that's insulin resistance in, in the most basic sense that I can really picture it in my mind, is that the, it's a chemical reaction that is not working properly. And so when it doesn't work properly, your body will store insulin, the hormone, glucose, the molecule, as fat.

   19. MPDr. Mindy Pelz23:13

       Yeah. W- well, let's come to estrogen in just a minute, 'cause I think what you just said there about insulin resistance is really interesting. So I spoke to Dr. William Li a few months ago-

   20. AMDr. Annice Mukherjee23:25

       Mm

   21. MPDr. Mindy Pelz23:25

       ... on this podcast, and he was sharing with me some research he came across. Now, to be clear, I don't know if this was research in men-

   22. AMDr. Annice Mukherjee23:34

       Hmm

   23. MPDr. Mindy Pelz23:35

       ... or in women.

   24. AMDr. Annice Mukherjee23:35

       Yeah.

   25. MPDr. Mindy Pelz23:35

       I know a lot of research is biased because-

   26. AMDr. Annice Mukherjee23:37

       Yeah

   27. MPDr. Mindy Pelz23:37

       ... it's done in men.

   28. AMDr. Annice Mukherjee23:39

       Yeah.

   29. MPDr. Mindy Pelz23:40

       And, you know, for many years now, we've, well, I think we've, we're finally getting this understanding that we just can't extrapolate that research-

   30. AMDr. Annice Mukherjee23:46

       Yep
10. 25:20 – 31:06

    The hormone ‘double whammy’: estradiol and progesterone decline, stress reactivity, and belly fat

    1. JIJessie Inchauspé25:20

       th- the way my brain thinks this through, so we have three forms of estrogen. Estradiol is the major, most powerful form of estrogen that has been coming into a woman's body since the day, first day of puberty.

    2. RCDr. Rangan Chatterjee25:36

       Hmm.

    3. JIJessie Inchauspé25:36

       That is the version of estrogen that leaves starting around 40. And if you look at the human body, there are receptor sites for estradiol on every major organ, cardiovascular system, our, within our gut, on our brain, in our kidneys.

    4. RCDr. Rangan Chatterjee25:53

       Mm-hmm.

    5. JIJessie Inchauspé25:53

       So you are losing a major hormone that has been activating all these processes in your body, including metabolic ones. You're losing that hormone, which is making you not process blood, the glucose as efficiently, and that's what we need to study.

    6. RCDr. Rangan Chatterjee26:12

       Mm-hmm.

    7. JIJessie Inchauspé26:12

       Because I can put you in a room of hundreds of thousands of women that will all raise their hand and tell you, "At 40, I just couldn't lose weight anymore." And it's because you lost this powerful form of estrogen, and she was helping every system in your body. And now she's gone, and every system's starting to have issues now.

    8. RCDr. Rangan Chatterjee26:32

       Yeah. You know, what's interesting as I reflect on that, I think what you're saying could fit completely alongside what Dr. Li is saying, actually-

    9. JIJessie Inchauspé26:41

       Yeah

    10. RCDr. Rangan Chatterjee26:41

        ... because he was simply saying that metabolism is the same, right? So let's, let's just assume that's correct for a minute. So let's say a woman's metabolism is the same as they're going into their 40s. It could be that their estrogen is going down. They're becoming resistant to one of the most important hormones in our body, insulin, which is gonna drive weight gain if we're still doing the same things.

    11. JIJessie Inchauspé27:09

        That's right.

    12. RCDr. Rangan Chatterjee27:09

        The s- the things that women could do in their 30s when, let's say, they're more insulin sensitive, as they go into their 40s a- and they become more insulin resistant, that could be driving the weight gain as opposed to metabolism changing.

    13. JIJessie Inchauspé27:22

        That's it.

    14. RCDr. Rangan Chatterjee27:22

        So I actually think it could fit alongside what Dr. Li was saying.

    15. JIJessie Inchauspé27:25

        Yeah, for sure. I mean, the, this is where we gotta get everybody in one room and, like, have a big discussion, or you listen to a podcast like this and share it out and, and, and open up the discussion because we don't have the research yet.

    16. RCDr. Rangan Chatterjee27:38

        Yeah.

    17. JIJessie Inchauspé27:38

        So we've gotta have discussions like this, and we've gotta let women express themselves and share, like, yeah, it's tough going through perimenopause and menopause. All the tricks aren't working anymore.

    18. RCDr. Rangan Chatterjee27:50

        Yeah.

    19. JIJessie Inchauspé27:50

        But we don't have a society that allows women to say that, so everything is sort of done at ladies' night and, and, you know, at the gym and on walks and everybody's sharing stories there. So why can't we bring this to the research forefront? Um, and then the other thing I wanna bring up, which is another nuance here, is that we lose progesterone starting at 35. Now, progesterone calms us, so when we get into our 40s, now all of a sudden we don't have this hormone that was stimulating things like GABA, which is a neurotransmitter that calms us. We react to stress much more acutely, and that reaction to stress creates a cortisol surge, and cortisol, when you have too much of it, is going right to your belly. So we have a double whammy. We have estradiol going down, making you-

    20. RCDr. Rangan Chatterjee28:45

        Mm-hmm

    21. JIJessie Inchauspé28:45

        ... more insulin resistant, and we have progesterone going down, destroying your ability to handle stress, making cortisol go up.

    22. RCDr. Rangan Chatterjee28:54

        Hmm.

    23. JIJessie Inchauspé28:54

        And there you go. Now you've got menopausal belly weight because cortisol's up, and you're insulin resistant, and really it was because these two hormones were exiting.

    24. RCDr. Rangan Chatterjee29:04

        Yeah. I mean, no wonder so many women find it tough-

    25. JIJessie Inchauspé29:07

        Yeah

    26. RCDr. Rangan Chatterjee29:08

        ... at that age.

    27. JIJessie Inchauspé29:09

        That's right.

    28. RCDr. Rangan Chatterjee29:09

        And you called it a double whammy. We could even call that a triple whammy and go, yes, estrogen's going down, making you more insulin resistant. Progesterone's going down, meaning you don't have that calming effect anymore.

    29. JIJessie Inchauspé29:21

        Yeah.

    30. RCDr. Rangan Chatterjee29:22

        But then many women are living in a culture, a societal construct in many ways, that actually has not really paid attention to women's needs-
11. 31:06 – 42:43

    Sleep as a metabolic lever: circadian rhythm, light timing, meal timing, cool rooms, and weighted blankets

    1. RCDr. Rangan Chatterjee31:06

       Now, one big source of stress for all of us, men and women alike, is a lack of sleep.

    2. JIJessie Inchauspé31:12

       Ooh, yeah.

    3. RCDr. Rangan Chatterjee31:12

       So what's the relationship between a lack of sleep and belly fat?

    4. JIJessie Inchauspé31:17

       Yeah, so this is where it gets really dark, so hang, hang with us as, as we go through this, because whenever I really explain, like, what's going on for a woman who's over 40, it gets... it's a bit depressing, um, because she can't sleep. She's struggling to sleep. So when, because progesterone was the hormone that helped her sleep.

    5. RCDr. Rangan Chatterjee31:37

       Mm.

    6. JIJessie Inchauspé31:38

       So when progesterone goes away, now she's waking up in the middle of the night. She can't fall asleep. So when, uh, I think we do a disservice when we go out publicly and we're like, "Hey, weight loss and sleep. You gotta sleep so that you can lose weight," again, we're leaving the perimenopause and menopausal woman out of the conversation. She's trying. She's-

    7. RCDr. Rangan Chatterjee31:57

       Mm

    8. JIJessie Inchauspé31:57

       ... tossing and turning, trying to sleep, but she can't because she lost progesterone, and progesterone was that hormone that helped her get into that restful sleep. So again, we have to come up with another set of hacks, another set of tools for her that are gonna be different than a younger woman or even a man. But yeah, I mean, you burn fat when you sleep. Your brain detoxifies when you sleep. You reorganize information when you sleep. Your l- all your organ systems will repair. Your liver dumps blood sugar when you sleep. There's so much magic to sleep. We just gotta help that woman fall asleep.

    9. RCDr. Rangan Chatterjee32:33

       Okay, so first of all, we don't want women who used to be able to sleep well and now are struggling to sleep, we don't want them to feel bad.

    10. JIJessie Inchauspé32:41

        Yeah.

    11. RCDr. Rangan Chatterjee32:41

        And I think what you've just said is, is really quite empowering, because it's like, no, no, no. Yes, you used to sleep well in your 20s and 30s, but there may be a hormonal reason why you're not sleeping as well in your 40s.

    12. JIJessie Inchauspé32:54

        That's right.

    13. RCDr. Rangan Chatterjee32:54

        But what are they meant to do? I mean, you say we need some different hacks.

    14. JIJessie Inchauspé32:58

        Yeah.

    15. RCDr. Rangan Chatterjee32:58

        What are some of your-

    16. JIJessie Inchauspé32:59

        Yeah

    17. RCDr. Rangan Chatterjee33:00

        ... top tips, then, for women to, to get better sleep?

    18. JIJessie Inchauspé33:02

        It's a great, it's a great question. So I think we have to reset us- ourselves to the circadian rhythm. So I'm a real big fan of women getting up close to the sunrise, so you're seeing that red light. Even just if you could get outside if you, if it's a sunny day, and just sort of get that red hue. What it will do is it will turn melatonin off, which is the hormone that helps us sleep, and it starts your circadian rhythm. It will bring you back into a more insulin-sensitive place. And then about an hour after you get up, you're gonna get some cortisol, because your eyes registered light, that red morning light.

    19. RCDr. Rangan Chatterjee33:37

        Mm-hmm.

    20. JIJessie Inchauspé33:38

        And so once cortisol kicks in about an hour later, go move your body. So you gotta get up and walk. You gotta get up and work out so that you can use that cortisol, not store that cortisol. Then the second thing I think that women have to do is just, I mean, these are little simple things that you can build into your lifestyle. You gotta go out in the sun midday without sunglasses on and let the receptors in your eyes see in, the daytime. So we gotta be able to see that it's midday. And then at night when the sunset happens, can you, you know, even sit in a chair and look out, using light to really help train that circadian rhythm? Now, the other thing I would say is for the perimenopausal and menopausal woman, w- timing a dinner is really, really important. If you're eating dinner at, in the dark, when melatonin goes up, you're going to be more insulin resistant.

    21. RCDr. Rangan Chatterjee34:33

        Yeah.

    22. JIJessie Inchauspé34:34

        And if you go to bed when you are in that, your, as your body is digesting food, you are not gonna sleep as well. I mean, I can tell you, I've ti- I've looked at it on [laughs] on my Oura Ring over and over again. Like, the minute I go to bed late, uh, or eat a late dinner and sleep, I don't get-

    23. RCDr. Rangan Chatterjee34:51

        Yeah

    24. JIJessie Inchauspé34:51

        ... the same. So we've gotta go back to simple things that women might not be doing. And, um, uh, the book The Menopause Reset, I, we reissued that with a sleep chapter.

    25. RCDr. Rangan Chatterjee35:02

        Oh, wow.

    26. JIJessie Inchauspé35:02

        And I just put all my sleep hacks in there so that w- for perimenopause and menopausal women. There's a lot. Like, you know, the, keeping the room cold, that's really important because as estrogen goes down, your t- your, it signals to turn up the heat-

    27. RCDr. Rangan Chatterjee35:17

        Mm

    28. JIJessie Inchauspé35:17

        ... in, in your brain. Um, weighted blankets become really helpful for perimenopause and menopausal women. Like, there's a whole sleep strategy.

    29. RCDr. Rangan Chatterjee35:26

        What's the evolutionary case for a weighted blanket?

    30. JIJessie Inchauspé35:28

        Yeah. I, I think, I, I had a really interesting discussion with a woman who's a sleep expert, and we came up with this thought. Now, I have no proof, but we are so primally driven.
12. 42:43 – 49:00

    Stabilize glucose to reduce stress, improve sleep, and support hormonal health

    1. SSDr. Stacy Sims42:43

       Listen, the scientific studies are very clear.

    2. RCDr. Rangan Chatterjee42:45

       Yeah

    3. SSDr. Stacy Sims42:45

       The more glucose spikes you have, the more insulin you have, the worse your menopause symptoms, whether it's hot flashes, insomnia, et cetera. Like, your hormonal system cannot function properly if your glucose and your insulin are out of whack. It's just, the hormonal axis is not gonna work if you're on a glucose rollercoaster. And this is true for menopause symptoms, for PCOS, for PMS.

    4. RCDr. Rangan Chatterjee43:06

       Yeah

    5. SSDr. Stacy Sims43:06

       So, you know, the premenstrual syndrome, endometriosis, fibroids, everything that's hormonally linked will get better when you steady your glucose and insulin levels. It is truly the foundation of hormonal health, is to have steady, balanced blood sugar.

    6. RCDr. Rangan Chatterjee43:19

       Yeah. It's, um, it's pretty incredible, and I think, I don't know how you view this, Jessie. When I would talk to patients about blood sugar rollercoasters, and I'd, I'd often draw them a graph.

    7. SSDr. Stacy Sims43:32

       Yeah

    8. RCDr. Rangan Chatterjee43:32

       You know, in a 10-minute consultation, I'd sit there and say, "Look," like and I'd, I'd just grab a piece of paper, you know, and I'd literally draw it out and I'd explain that, "This time you're having this food, right? This is what's happened to your blood sugar. And then maybe two hours later, after it's high, it's coming down, it's crashing. And sometimes if you've been doing this a while, it will overshoot."

    9. SSDr. Stacy Sims43:49

       Mm-hmm.

    10. RCDr. Rangan Chatterjee43:50

        So one thing I would often say is that this is not just a blood sugar problem at that point. It's also a hunger problem. It's also a stress on the body.

    11. SSDr. Stacy Sims44:00

        Yep.

    12. RCDr. Rangan Chatterjee44:00

        Wonder if you could speak to that, because I think that, for me at least, that really landed with patients. Your blood sugar falling rapidly is a stressor.

    13. SSDr. Stacy Sims44:08

        Absolutely. So I actually just did a Live with an amazing, um, woman, Aviva Romm, who's really-

    14. RCDr. Rangan Chatterjee44:14

        Oh, brilliant

    15. SSDr. Stacy Sims44:14

        ... specialized in this, uh, in glucose and stress, adrenal steroids, and she taught me a lot. She explained that when your body is going through this glucose rollercoaster, there is a certain amount of biological stress-

    16. RCDr. Rangan Chatterjee44:25

        Mm-hmm. Yeah

    17. SSDr. Stacy Sims44:26

        ... that happens as a consequence, and that then impacts your, your hormonal axis, your thyroid axis, your adrenal axis. And that stress in and of itself can then lead to other problems in your body, whether it's mental health disturbances, whether it's inflammation, whether it's hormonal problems. Because your body, like, if you're stressed out, adrenals are stressed out, you're on a glucose rollercoaster, your body doesn't think it's safe to conceive. So you have all these side effects of that stress, that biological stress, that lead to downstream symptoms, and we need to look back at the fact that, yeah, that glucose rollercoaster is causing stress on top of the inflammation and the glycation and the insulin release. Truly, I don't think there's a better place to start-

    18. RCDr. Rangan Chatterjee45:08

        Yeah

    19. SSDr. Stacy Sims45:08

        ... for your health. Like, it is truly the foundation. You cannot have a healthy body if you're on a glucose rollercoaster. It's just not possible. You can manage-

    20. RCDr. Rangan Chatterjee45:18

        Yeah

    21. SSDr. Stacy Sims45:18

        ... maybe. You can be a high-functioning glucose rollercoaster, but [laughs] it's just, it's just not gonna work. You n- you need that baseline.

    22. RCDr. Rangan Chatterjee45:26

        I, I love that. There is, there's a lot of people at the moment-

    23. SSDr. Stacy Sims45:29

        [laughs]

    24. RCDr. Rangan Chatterjee45:29

        ... who are high-functioning glucose rollercoasters, right?

    25. SSDr. Stacy Sims45:34

        I love it. I love it.

    26. RCDr. Rangan Chatterjee45:35

        Yeah.

    27. SSDr. Stacy Sims45:35

        Yeah.

    28. RCDr. Rangan Chatterjee45:35

        But you walk around, you will see that, and-

    29. SSDr. Stacy Sims45:38

        Mm-hmm

    30. RCDr. Rangan Chatterjee45:38

        ... it, it kind of will correlate with the 11 o'clock snack-
13. 49:00 – 1:00:01

    Practical glucose ‘hacks’: vinegar timing, flexibility over perfection, and habit ripple effects

    1. RCDr. Rangan Chatterjee49:00

       Yeah. Let's talk about some more hacks. Okay, so at the start of the conversation, you mentioned food order.

    2. SSDr. Stacy Sims49:06

       Mm-hmm.

    3. RCDr. Rangan Chatterjee49:07

       And I really hope people put that into practice straight away, 'cause the... it can be transformative just switching a few things around.

    4. SSDr. Stacy Sims49:13

       Yeah.

    5. RCDr. Rangan Chatterjee49:15

       Vinegar.

    6. SSDr. Stacy Sims49:16

       You wanna talk about vinegar?

    7. RCDr. Rangan Chatterjee49:17

       I love-

    8. SSDr. Stacy Sims49:18

       Let's talk about vinegar

    9. RCDr. Rangan Chatterjee49:18

       ... to talk about vinegar.

    10. SSDr. Stacy Sims49:19

        Yeah.

    11. RCDr. Rangan Chatterjee49:19

        I'd also love you to just drop in as well how certain cultures-

    12. SSDr. Stacy Sims49:24

        Yes

    13. RCDr. Rangan Chatterjee49:24

        ... have had this within them as well. So I think give us the modern science, but give us the ancient wisdom as well.

    14. SSDr. Stacy Sims49:29

        Let's talk about the ancient wisdom first. So for centuries, there are countries around the world where vinegar has been consumed. I mean, I'm French, right? In France, we have vinaigrette on everything. Or in Iran, where making apple cider vinegar is a sort of a tradition that people do in their home, and they drink it every day. And in the 18th century, vinegar was even given as a tea to people with Type 1 diabetes. And so we've known culturally for a while that this is a good thing to eat, but only recently we've discovered actually how it works. And to be perfectly transparent, when I was f- when I first came across the vinegar stuff, I was like, "This must be a fad." Like, I just, I just didn't believe it.

    15. RCDr. Rangan Chatterjee50:06

        [laughs]

    16. SSDr. Stacy Sims50:06

        I was like, "This is another Instagram thing. I don't..." But then I looked at the studies, and they're actually incredible [laughs] clinical trials showing the impact of vinegar on our glucose levels. So now I'm a big vinegar fan. So let me explain.

    17. RCDr. Rangan Chatterjee50:18

        Who funded that study? Was it big-

    18. SSDr. Stacy Sims50:20

        Oh, I checked

    19. RCDr. Rangan Chatterjee50:20

        ... big, was it Big Vinegar?

    20. SSDr. Stacy Sims50:21

        Big Vinegar? No, no. [laughs]

    21. RCDr. Rangan Chatterjee50:24

        [laughs]

    22. SSDr. Stacy Sims50:24

        No, actually, legit scientists across the world. In Brazil, um, they... there was this one review study that was incredible. Um, it's all linked on my website and book if you wanna check it out. But the science showed that one tablespoon of vinegar before a meal, so either as a dressing, um, or in a drink, it can be water, it can be tea, reduces the glucose spike of that meal by up to 30% and reduces the insulin spike of that meal by up to 20%, without changing what you're eating afterwards. Simply by adding this vinegar at the beginning of your meal, you can see an impact on your glucose levels. Now, of course, you know, I don't want people to think, oh, it's a magic pill. I'm just gonna change nothing and just do the vinegar. The vinegar is one of several tools that become very useful in your day-to-day life. What I recommend in the, in the Glucose Goddess method, in week two, we go over vinegar.

    23. RCDr. Rangan Chatterjee51:19

        Yeah.

    24. SSDr. Stacy Sims51:19

        And I have-

    25. RCDr. Rangan Chatterjee51:19

        There's a whole week de-

    26. SSDr. Stacy Sims51:20

        There's a whole week

    27. RCDr. Rangan Chatterjee51:20

        I saw it in the new book.

    28. SSDr. Stacy Sims51:22

        And there's all these beautiful recipes, and I made it really fun and gorgeous because people are like, "Oh, vinegar? Like what? I don't drink vinegar. That sounds gross." Don't worry, I have a lot of delicious mocktails and teas for you.

    29. RCDr. Rangan Chatterjee51:31

        Well, actually, in the book-

    30. SSDr. Stacy Sims51:32

        Yeah
14. 1:00:01 – 1:22:28

    Why women over 40 need resistance training + HIIT: muscle, metabolism, and long-term independence

    1. RCDr. Rangan Chatterjee1:00:01

       I think one of the key points I wanna get across in this conversation for women is why those two things must be done as you get older, because I think there's a lot of my audience who might fall into that category. They're, they're doing really well with, you know, that conventional stuff. They're doing well with the four pillars. But on the movement aspect, I, I know many women, friends of mine, who perhaps are not strength training and are not doing high-intensity training, but they are walking regularly, and they would probably think that that's enough. So let's go through those changes-

    2. SSDr. Stacy Sims1:00:36

       Yeah

    3. RCDr. Rangan Chatterjee1:00:36

       ... so that we can make that case. And frankly, if that's-

    4. SSDr. Stacy Sims1:00:39

       Yeah

    5. RCDr. Rangan Chatterjee1:00:39

       ... all we do in this podcast is make the case-

    6. SSDr. Stacy Sims1:00:41

       [laughs]

    7. RCDr. Rangan Chatterjee1:00:41

       ... for those two things, I think we'd both be really happy.

    8. SSDr. Stacy Sims1:00:44

       Exactly. Okay. So, um, when we start looking what's happening in perimenopause, most women don't really understand that it could start as early as-

    9. SPSpeaker1:00:56

       Thirty-seven, thirty-eight, where we start having more and more what we call anovulatory cycles. So that means we're not ovulating, we're not producing an egg. If we're not doing that, then we're not going to have progesterone. But you will still have a menstrual bleed. So a lot of women don't realize that they're having more and more of these anovulatory cycles. And what happens there is we start to have a change in the ratio of our estrogen and progesterone. So when we're looking at our reproductive years, we go through a cyclical change every twenty-eight to thirty-five days with our menstrual cycle, where we have estrogen that comes up, then we have estrogen and progesterone that comes up, and then it drops down, then we have a bleed, and it, it's a repetitive cycle. So our body gets used to this rhythm and these specific, um, ratios of estrogen and progesterone. When we start getting into our early forties and having more of these anovulatory cycles, there's a change in these ratios of estrogen and progesterone. Why this is important is because these sex hormones affect every system of the body. Primarily, estrogen and progesterone together work to improve bone density. They also work to help with our blood glucose control, our resting blood glucose. It helps with how our body, uh, fuels itself at rest, using more free fatty acids and having, uh, a conversation between the liver and the muscle that says, "You know what? We want to use these free fatty acids, and we don't wanna store them as visceral fat." And we also see that estrogen is tightly tied to how our blood vessels respond to things like hot and cold, how they will constrict and dilate, so our blood pressure is very tightly controlled. When we start losing more and more of these hormones, we start to see a stiffening of our blood vessels, so we don't have as much, um, what I call vascular compliance. So our blood vessels are very slow to constrict and to dilate. So it affects our blood pressure. We see that, um, we have a change in how our, our body will fuel itself. Well, we'll see more insulin resistance, so that means that we have an increase in our resting blood glucose. If we don't do something, then we're gonna end up in a pre-diabetic, potentially a metabolic syndrome type situation. We also see that progesterone is tightly tied to what we call our vagal tone, so our ability to become more parasympathetically activated. When we have a change in these ratios, we see women are very tired but wired. They just cannot relax. So we see an increase in our baseline cortisol. So cortisol is not an evil hormone. Everyone says, "Oh, you know, my cortisol is elevated." Well, we have natural responses. It's just now our baseline is a bit higher and we stron- respond more significantly to small stressors during the day, which also doesn't help with longevity and cardiovascular health. So when we start looking at something like resistance training, why is it so critical? And we hear conversations out there where I'm talking about we wanna lift heavy loads, other people like just regular strength training. The very first thing that happens before we see a loss in lean mass is there's a disconnect the way our muscles contract, because we have a change in some of the expression of our, our contractile protein. So if we think about muscle contraction as a ladder that's coming together, we have myosin and actin, and they bond together to pull fibers together to create a contraction. When we start losing estrogen, we start losing the ability for myosin to hold on to actin strongly, so we become weaker. We don't have as much power. When women are talking about this, they're like, "I can't open the jar of pickles anymore. I have a really difficult time opening a jar of pickles 'cause my grip strength isn't there. I might be a runner, but now all of a sudden my running pace is really slow, and I don't know why." Their body composition hasn't started to change yet, but their overall strength and power has. Then about a year or so later, we'll start to see a significant loss of lean mass and an increase in, in body fat. There are two things that are going on here. One, we have that disconnect of estrogen and the way that it's affecting the, our muscle contractile strength, but we're also having a change in our gut microbiome. 'Cause when we start losing our sex hormones, we start losing some of the gut bugs that are responsible for some of the ways that these sex hormones are able to be pushed back out into circulation. So we have a decrease in the diversity of our gut microbiome, and because women are tired but wired, the bacteria that grows is more of a firmicutes phyla, so that means it's more of the obesogenic phyla. So this encourages the, um, body to hold on to body fat. So when I bring it back down to what are we gonna do to counter this, because we can't counter what's happening with the downregulation of our estrogen, progesterone receptors, or that our ov- ovaries are starting to wind down naturally. So we look at those external stressors. Resistance training for lifting heavy loads, it's going to create an adaptation that makes myosin and actin hold on to each other strongly to be able to have a central nervous system response for really strong muscle contraction. If we look at high intensity interval training, and when we talk about it as, like, true polarized, we're going as, you know, eighty percent to a hundred and ten percent of our max, and then having significant recovery between each effort. This creates a change that allows our muscles to pull carbohydrate in and glucose in without insulinIt also creates more of a conversation with what we call myokines, which are hormones that are released from the skeletal muscle to circulate to say, "You know what? We don't need these free fatty acids to be changed and stored as visceral fat. We need these free fatty acids to be used as fuel." So it improves the way that our mitochondria are using our free fatty acids and improves our metabolic flexibility. So when we're talking about why resistance training is so important, it's all about maintaining strength and power as well as lean mass. Why is high-intensity interval training so important? It gives us much better metabolic control and more feedback to reduce the buildup of that dangerous visceral fat.

    10. RCDr. Rangan Chatterjee1:07:56

        Yeah, really, really clear. Okay, so once a woman goes through perimenopause, there are certain hormonal changes that take place, which, unless we do something about it, may well have a negative impact on things like our bone density, our blood glucose, our metabolic health, how much fat we can use and burn off at various times, and also the state of our nervous system and how stressed out our nervous system will be compared to how relaxed our nervous system will be, right? So there are some-

    11. SPSpeaker1:08:36

        Yeah

    12. RCDr. Rangan Chatterjee1:08:36

        ... changes that occur. Okay, now, through the lens of evolution, how would you say those changes perhaps made sense in a different era, if you would argue that they did make sense?

    13. SPSpeaker1:08:55

        This is the million-dollar, or with inflation, the $1 billion question that is out there, because there's many theories about it. They... You know, one of the theories is that women go through all of these changes, and if they survive them, then they become a, a part of the tribe that's able to take care of the children-

    14. RCDr. Rangan Chatterjee1:09:16

        Yeah

    15. SPSpeaker1:09:16

        ... take care of the other people that are within the tribe without the risk of, of having a baby itself or contributing to a greater calorie need. There's other theories out there that women didn't actually live long enough to go through this, so this is a, a relatively new, industrialized revolution kind of thing that women are going through. And then there's the other theory of it just happens, and no one talked about it until now.

    16. RCDr. Rangan Chatterjee1:09:43

        Mm-hmm.

    17. SPSpeaker1:09:43

        So what is the evolutionary thing around it? No one really knew-

    18. RCDr. Rangan Chatterjee1:09:47

        Yeah

    19. SPSpeaker1:09:47

        ... because no one really talked about it. So when we look from, um, like, a modern kind of standpoint of what's happening, it doesn't make sense. Like, why would this happen to just women and not men, other than we think, okay, well, we're looking at it's all from a reproductive standpoint. Puberty is the onset of reproduction, and perimenopause into post-menopause is the kind of die-off of reproduction. But that doesn't mean the woman isn't viable. It just means that she's no longer viable to have kids.

    20. RCDr. Rangan Chatterjee1:10:18

        Yeah.

    21. SPSpeaker1:10:18

        And, you know, how does that, how does that play into things? When we look at how our sex hormones affect all, every system of the body, most of the time when we're looking at the menstrual cycle, estrogen and progesterone have two very distinct, um, w- I guess, rationales for being in the system in the ratios that they are. Estrogen is creating a very stress-resilient body to have a very robust egg to be released for ovulation to really make sure that that is a viable egg if it's fertilized. And then progesterone's whole job is to shuttle amino acids and carbohydrate and all the building blocks to build a beautiful, lush endometrial lining to house this very viable egg.

    22. RCDr. Rangan Chatterjee1:11:10

        Mm-hmm.

    23. SPSpeaker1:11:11

        So when we aren't in a reproductive status anymore, we don't need these hormones, then we don't need to have an endometrial lining. We don't need to have as much stress resilience. So there's so many different questions in there that people haven't really started digging into because none of this has been in conversation until recently.

    24. RCDr. Rangan Chatterjee1:11:30

        Yeah. It, it, it just, so interesting, isn't it? You know, I love to look at things through the lens of evolution and, and of course there are all these theories we don't know. There's also the grandmother hypothesis and what, you know, is the role of the grandma that we, you know, we can live, females can live way beyond their reproductive lives to then help and pass on wisdom. And, uh, it is beautiful to even, like, explore all these things and think about them. At the same time, we do live in a certain world today. There are certain things that men and women are doing, are expected to do, they expect of themselves to be able to do. And perhaps a more helpful question, at least for a woman in that age category, is to go, okay, well, sure, things may have been a certain way 50,000 years ago, but I want these goals in my life. I'm gonna have these hormonal changes in my late 30s and my 40s. What can I do to start changing things or to negate the impact of them, okay? So I wanna go in, in depth into strength training and HIIT training and how people actually do that. Just before we get there, though, a lot of women have been on or are currently on, uh, birth control, so the oral contraceptive pill.

    25. SPSpeaker1:12:51

        Mm-hmm.

    26. RCDr. Rangan Chatterjee1:12:51

        How does that potentially change things or influence the things that you've just been talking about?

    27. SPSpeaker1:12:59

        You won't know if you're in perimenopause because the whole goal of an oral contraceptive pill is toDownregulate your own ovarian function and take the place. So if we're looking at someone who is on an oral contraceptive pill, if it's a typical what we call monophasics, where it's three weeks of the standardized estrogen, progesterone dose, and then you have a sugar pill week, those three weeks, from a cellular standpoint, you're getting 500 times the dose of what a natural or your normal ovarian hormones would be exposing these cells to. So if you've been on a oral contraceptive pill for 10, 15 years, your body has a, a different baseline from hormone exposure than what a, a natural cycle is. Doesn't mean it's bad. It doesn't mean it's good. It just means it's different. So we need to understand how your body is through perimenopause is coming off the pill, and when you come off the pill, then your body's own ovarian function should kick back in. But what happens when women get into their 40s and they've been on an oral contraceptive pill for so long, and their, um, GP is like, "You need to come off it," they're like, "Okay, I'll come off it, but then what?" So often it's, we'll get off an oral contraceptive pill. We'll give you an IUD and see what happens, a way to kind of have a, a bridge between a high dose of, of exogenous hormones into what your body naturally sets in. Or some GPs who are 100% educated in everything that's going on will go, will go from an oral contraceptive pill into menopause hormone therapy. So then a woman's body never really understands what her own ovarian function does or doesn't do. So it's not good or bad. It's just a different profile. How do we mitigate the changes? We treat every woman the same because what happens, regardless if, if you've been on exogenous hormones or not, you still have a natural downregulation of all your receptors. It's just part of the aging process. It's when does it happen for someone who's been on a oral contraceptive pill versus someone who's not? We also see there's a significant difference between women who have medically induced menopause as well because the whole idea from an evolutionary and a biological standpoint of perimenopause is to slowly unwind the body from having the exposure of these hormones, so this is why we see changes in all the receptors. And when we're having changes in all these receptors is when we start having all these symptoms. So if someone is experiencing medical menopause, they'll go into surgery premenopausal. They'll come out postmenopausal. But the severity of their symptomology is incredible for six months afterwards. For someone who's on a oral contraceptive pill and then all of a sudden they stop, they too could have really severe symptoms because they've gone from a high dose of exogenous hormones to nothing. So it's a case-by-case basis in trying to figure out, okay, what is actually going to happen? But if we take it a step back and say, "Let's look at exercise and nutrition as a way to create an adaptive response so that our body is overcoming these hormonal flux," then let's do that.

    28. RCDr. Rangan Chatterjee1:16:33

        Yeah.

    29. SPSpeaker1:16:33

        So that's where we look at strength training and high-intensity work.

    30. RCDr. Rangan Chatterjee1:16:36

        Yeah, I love that. You, you did mention the, uh, menopause hormone therapy. I, I'm gonna come to that a bit later because I know you don't particularly love the term HRT, and you frame it slightly differently, so we're definitely gonna cover that. Where we're up to, I think, is that we're acknowledging or explaining that as a woman gets older, there are natural changes that are going to happen, and that can have a negative impact on various aspects of your health and wellbeing unless you do something about it. And I think one of the most beautiful parts of what you put out in the world, Stacy, i- is that it's a very empowering message. You're saying to women that, "Look, there are things you can do. There are, there are actually a lot of things that you can do with, yes, your diets, yes, your exercise, but also other areas that can help mitigate those changes." So let's go into detail then on strength and HIIT training. Um, strength training, okay, or you, I think you use the term resistance training.
15. 1:22:28 – 1:31:46

    Bone health and fall-proofing: impact training, jumping, balance, and foot speed

    1. RCDr. Rangan Chatterjee1:22:28

       Yeah. We must go into bone health, because I think bone health has been undervalued.

    2. SPSpeaker1:22:33

       Completely.

    3. RCDr. Rangan Chatterjee1:22:34

       And even I've, I've heard a lot of your interviews, and I think there's... it's easy to focus on, you know, muscle and the strength training and the-

    4. SPSpeaker1:22:43

       Yes

    5. RCDr. Rangan Chatterjee1:22:43

       ... VO2 max, and that's all great, and we're gonna get to that, but I do think bone needs to be raised in our awareness.

    6. SPSpeaker1:22:49

       Thank you.

    7. RCDr. Rangan Chatterjee1:22:49

       So I really wanted to make sure-

    8. SPSpeaker1:22:50

       Yes

    9. RCDr. Rangan Chatterjee1:22:50

       ... we, we focused here. A lot of this book is talking about the incredible benefits of movement.

    10. SPSpeaker1:23:00

        Mm-hmm.

    11. RCDr. Rangan Chatterjee1:23:00

        And of course, you have this wonderful acronym-

    12. SPSpeaker1:23:02

        Acronym

    13. RCDr. Rangan Chatterjee1:23:02

        ... FACE.

    14. SPSpeaker1:23:02

        Mm-hmm.

    15. RCDr. Rangan Chatterjee1:23:03

        Right?

    16. SPSpeaker1:23:03

        Mm-hmm.

    17. RCDr. Rangan Chatterjee1:23:03

        Which is brilliant. Flexibility, mobility, aerobic activity, carrying a load, and equilibrium and fast speeds. But if we simply look at it through the lens of bone for a minute-

    18. SPSpeaker1:23:14

        Yes. Mm-hmm

    19. RCDr. Rangan Chatterjee1:23:14

        ... and, yes, for people who can get a DEXA scan to see where they're at, great. Even if you can't or you won't, there are things that you can do to improve your bone health, right?

    20. SPSpeaker1:23:26

        Yes.

    21. RCDr. Rangan Chatterjee1:23:26

        So when it comes to movement, what kinds of things can we do that will directly improve the health of our bones?

    22. SPSpeaker1:23:33

        Yes. Let's just assume you're losing bone density. Let's make it a given.

    23. RCDr. Rangan Chatterjee1:23:36

        Okay.

    24. SPSpeaker1:23:37

        That, that's a good... That is a good place to start. Men and women are gonna lose bone density, blah. Here are the top things to do for your bone. Number one, optimize your hormones. Estrogen is so critical for bone health in the regulation of these two cells I was talking about earlier, that, uh, it will help rebalance the, the breaking down of bone and the building of bone. Number two, um, building muscle. Number three, and often forgotten, is the E of the FACE acronym, equilibrium and foot speed. Because you may be fine sitting in a chair. You may be fine walking around. But if you lose your balance, we... Our, our neuromuscular pathways controlling balance start to degrade in our 20s. So as you reach for something, you lose your balance, you topple over.

    25. RCDr. Rangan Chatterjee1:24:31

        In our 20s.

    26. SPSpeaker1:24:32

        Yes, but it can be totally re- [laughs] totally retrained. Um, and we can talk about that. But we have to reestablish our balance so that we don't trip over our dog or our rug or just try to pick something up and fall over, 'cause you'll be fine before you fall, and then you have the fatal fall or the, you know-

    27. RCDr. Rangan Chatterjee1:24:52

        Mm

    28. SPSpeaker1:24:52

        ... your child has had a month in a cast. It takes three months for an adult to heal a fracture because of our biology. Think of the inconvenience of that, even if it's a minor fracture.

    29. RCDr. Rangan Chatterjee1:25:03

        Mm.

    30. SPSpeaker1:25:03

        So retrain our balance, and number two in that F-A-C-E, equilibrium, is the long forgotten foot speed, meaning we lose our Type 2 muscle fibers, which is our fast twitch fibers. And so I train people in speed and agility.
16. 1:31:46 – 1:43:17

    Movement as the ‘master intervention’: anti-aging mechanisms and a realistic weekly template

    1. SPSpeaker1:31:46

       So if we have, if we have hypertension, high blood pressure, there's a pill for that. If we have diabetes, metabolic disorder, there are a variety of pills for that. If there is heart disease, a pill for that. But there is one pill, one activity, one set of skills that treats everything, and that is movement baseline. In fact, it is so critical in so many diseases that, um, a pro- I wish I had made this up. I didn't, but there's a professor out of, uh, Columbia University in Missouri in the United States that coined the word sedentary death syndrome. It is the 33 chronic diseases that we die from, including heart disease, that are directly impacted by the amount of movement we do. So how does that work? So, um, let's just take skeletal muscle contraction, mo- movement. Skeletal muscle contraction produces a, uh, a, a cytokine, a hormone called irisin that is directly related to glucose metabolism, uh, insulin resistance. I've already talked about the way the bone talks to the brain and the muscle and the pancreas.

    2. RCDr. Rangan Chatterjee1:33:08

       Mm.

    3. SPSpeaker1:33:08

       So any time we're moving our body, it's not just locomoting us, it's changing us chemically on the inside. When I recommend people sprint at the end of their cardio workout, literally get your heart rate way up, that will change the number of mitochondria, which are the powerhouse units in our cells. It will help stimulate their, uh, the division of something called satellite muscle stem cells, which are called satellite cells. Mobility in the form of exercise causes the transcription and changing of body molecules of more than 9,800 molecules every time you go out for a run.

    4. RCDr. Rangan Chatterjee1:33:53

       [laughs]

    5. SPSpeaker1:33:53

       It's signaling your DNA to express the genes that you need to stay healthy. Um, i- it's just fascinating that, that one modality, mobility, can change us at a cellular level. It can change us at a tissue level. Um, here's an experiment we did in the labs with my partners that I had at University of Pittsburgh. Mobility is actually the fountain of youth for our stem cells. So what the experiment was this. We took little old lady mice. A little old lady mouse is two years old. She's old.

    6. RCDr. Rangan Chatterjee1:34:28

       [laughs]

    7. SPSpeaker1:34:28

       She's just sitting back in her cage waiting for her next meal. So we sampled her muscle, and we took out a few of her little muscle stem cells, and what did we find? We found that her muscle stem cells in sedentary living were dying. Dying cells, it's an active process.

    8. RCDr. Rangan Chatterjee1:34:46

       Mm.

    9. SPSpeaker1:34:46

       You turn on something called programmed cell death. They were dying. They had lost their round plumpness. Healthy cells are round like a grape. They were more like a, a, a branch.

    10. RCDr. Rangan Chatterjee1:34:57

        Mm.

    11. SPSpeaker1:34:57

        They were spindly, and they were no longer reproducing or producing growth factors. That's what these little old stem cells were doing. Then we took these girls, and I spent a lot of money buying mouse treadmills. It's unbelievable how much mouse treadmills cost.

    12. RCDr. Rangan Chatterjee1:35:14

        [laughs]

    13. SPSpeaker1:35:14

        But I bought some, and we put these girls on the mouse treadmills, and they were just like the rest of us. They didn't wanna run, but we encouraged them to do so.

    14. RCDr. Rangan Chatterjee1:35:22

        Mm.

    15. SPSpeaker1:35:23

        Twice a day for two weeks, we ran these girls on treadmills, and then we resampled their stem cells. The spindly dying stem cells were now plump like grapes again.

    16. RCDr. Rangan Chatterjee1:35:34

        Oh.

    17. SPSpeaker1:35:34

        They were producing growth factors. They had turned off programmed cell death. So the simple act of mobility changed our stem cell function and rejuvenated it. It was a signal to these mou- mice bodies, these murine model, that we're not dead. We're living and ex-

    18. RCDr. Rangan Chatterjee1:35:54

        Yeah

    19. SPSpeaker1:35:54

        ... so down to the cellular level. So, and that's what I'm trying to re- to explain to people in the book and give them... I mean, I think my readers are smart. They need to know why, not just-

    20. RCDr. Rangan Chatterjee1:36:05

        Yeah

    21. SPSpeaker1:36:05

        ... go do this program. We can change our mitochondria. We can change the expression of our genes. We can change the amount of inflammation in our body-

    22. RCDr. Rangan Chatterjee1:36:14

        Yeah

    23. SPSpeaker1:36:15

        ... by regulating glucose metabolism and insulin sensitivity, a- and really have profound changes of the hallmarks of aging by simple activities that become how we live, not just programs.

    24. RCDr. Rangan Chatterjee1:36:31

        Yeah, I, I love the bit sort of halfway through the book where you move on to the next section, where you've covered exercise in detail, and there's this beautiful chart where you, you've got listed all the time bombs of aging.

    25. SPSpeaker1:36:43

        Uh-huh.

    26. RCDr. Rangan Chatterjee1:36:43

        DNA change and damage-

    27. SPSpeaker1:36:45

        Yeah

    28. RCDr. Rangan Chatterjee1:36:45

        ... mitochondrial dysfunction, senescence, fuel gauge malfunction, and stem cell exhaustion.

    29. SPSpeaker1:36:51

        Yes.

    30. RCDr. Rangan Chatterjee1:36:51

        And then you cross-reference that-

Episode duration: 1:43:17