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

Dr. Rangan Chatterjee 0:00 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?

Dr. Annice Mukherjee 0:14 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,

Dr. Annice Mukherjee 1:15 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-

Dr. Rangan Chatterjee 1:36 Yeah

Dr. Annice Mukherjee 1:36 ... 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-

Dr. Rangan Chatterjee 2:04 Okay

Dr. Annice Mukherjee 2:04 ... 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.

Dr. Rangan Chatterjee 2:45 Yeah.

Dr. Annice Mukherjee 2:46 This is easy, but it's not something that we tend to do in conventional medicine.

Dr. Rangan Chatterjee 2:49 Yeah.

Dr. Annice Mukherjee 2:49 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.

Dr. Rangan Chatterjee 2:57 Yeah.

Dr. Annice Mukherjee 2:57 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-

Dr. Rangan Chatterjee 3:51 Yeah

Dr. Annice Mukherjee 3:52 ... 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.

Dr. Rangan Chatterjee 4:35 Mm.

Dr. Annice Mukherjee 4:35 It's about starting where you are and making small changes. I sometimes describe them as microdosing your lifestyle.

Dr. Rangan Chatterjee 4:42 Yeah.

Dr. Annice Mukherjee 4:42 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-

Dr. Rangan Chatterjee 5:04 Oh, is she sort of 70, 80?

Dr. Annice Mukherjee 5:06 She's just turned 77.

Dr. Rangan Chatterjee 5:08 Yeah.

Dr. Annice Mukherjee 5:08 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-

Dr. Rangan Chatterjee 5:24 [laughs]

Dr. Annice Mukherjee 5:24 ... 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.

Dr. Rangan Chatterjee 5:42 She's really strong, isn't she?

Dr. Annice Mukherjee 5:43 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.

Dr. Rangan Chatterjee 6:29 Mm-hmm.

Dr. Annice Mukherjee 6:29 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-

Dr. Rangan Chatterjee 6:53 Yeah

Dr. Annice Mukherjee 6:53 ... 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-

Dr. Rangan Chatterjee 7:15 Right

Dr. Annice Mukherjee 7:15 ... 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.

Dr. Rangan Chatterjee 7:36 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?

Dr. Annice Mukherjee 8:05 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-

Dr. Rangan Chatterjee 8:24 Yeah

Dr. Annice Mukherjee 8:24 ... 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-

Dr. Rangan Chatterjee 8:46 Totally

Dr. Annice Mukherjee 8:46 ... 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."

Dr. Rangan Chatterjee 9:06 No, I get that.

Dr. Annice Mukherjee 9:07 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-

Dr. Rangan Chatterjee 9:16 Yeah

Dr. Annice Mukherjee 9:16 ... to use lifestyle, but medication is never a substitute. It, it won't make you achieve-

Dr. Rangan Chatterjee 9:22 Yeah

Dr. Annice Mukherjee 9:22 ... 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.

Dr. Rangan Chatterjee 9:54 Mm.

Dr. Annice Mukherjee 9:54 Because living longer should be about quality of like, life and being well, like Joan MacDonald, right?

Dr. Rangan Chatterjee 10:02 Yeah.

Dr. Annice Mukherjee 10:02 At 77, who's s- stronger than she was, you know, probably when she was in her younger adult life.

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Dr. Annice Mukherjee 11:05 Um, you don't get that through any medication.

Dr. Rangan Chatterjee 11:07 Yeah.

Dr. Annice Mukherjee 11:07 You will only get that through empowerment and making sure that your body is working well.

Dr. Rangan Chatterjee 11:14 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.

Dr. Annice Mukherjee 12:45 Yeah.

Dr. Rangan Chatterjee 12:45 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.

Dr. Annice Mukherjee 12:52 Yeah, definitely, and the other non-hormone options that women can have.

Dr. Rangan Chatterjee 12:56 So, so let's go into those, 'cause there will be women who say, "Yeah, I can't have hormones."

Dr. Annice Mukherjee 13:00 Yeah.

Dr. Rangan Chatterjee 13:00 "What else can I do?"

Dr. Annice Mukherjee 13:01 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.

Dr. Rangan Chatterjee 13:18 What does that mean, central antihypertensive?

Dr. Annice Mukherjee 13:19 So it, it's a blood pressure-lowering medication, and it works through mechanisms within the brain.

Dr. Rangan Chatterjee 13:24 Okay.

Dr. Annice Mukherjee 13:25 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-

Dr. Rangan Chatterjee 13:55 Mm

Dr. Annice Mukherjee 13:55 ... 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.

Dr. Rangan Chatterjee 14:27 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.

Dr. Annice Mukherjee 14:49 Mm.

Dr. Rangan Chatterjee 14:49 Does the same principle apply just for a short period of time until you no longer need it?

Dr. Annice Mukherjee 14:54 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-

Dr. Rangan Chatterjee 15:15 Yeah

Dr. Annice Mukherjee 15:16 ... which has an impact on your mood. And, and so it depends on what happens to that woman later-

Dr. Rangan Chatterjee 15:19 Yeah

Dr. Annice Mukherjee 15:20 ... 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-

Dr. Rangan Chatterjee 16:21 Mm

Dr. Annice Mukherjee 16:22 ... for women who can't take HRT because it doesn't work through estrogen.

Dr. Rangan Chatterjee 16:25 Wow.

Dr. Annice Mukherjee 16:25 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-

Dr. Rangan Chatterjee 16:36 Yeah

Dr. Annice Mukherjee 16:36 ... by the HRT conversation.

Dr. Rangan Chatterjee 16:39 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?

Dr. Annice Mukherjee 16:58 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-

Dr. Rangan Chatterjee 17:16 Mm

Dr. Annice Mukherjee 17:16 ... 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-

Dr. Rangan Chatterjee 17:39 Right

Dr. Annice Mukherjee 17:39 ... 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-

Dr. Rangan Chatterjee 17:51 Mm

Dr. Annice Mukherjee 17:52 ... be motivated to do-

Dr. Rangan Chatterjee 17:53 Yeah

Dr. Annice Mukherjee 17:53 ... 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-

Dr. Rangan Chatterjee 18:14 Yeah

Dr. Annice Mukherjee 18:15 ... 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-

Dr. Mindy Pelz 19:00 Yeah

Dr. Annice Mukherjee 19:00 ... 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.

Dr. Mindy Pelz 19:08 Yeah.

Dr. Annice Mukherjee 19:08 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-

Dr. Mindy Pelz 19:18 Yeah

Dr. Annice Mukherjee 19:18 ... who, who really, it's gonna be very difficult for them to just go on a diet and lose that weight.

Dr. Mindy Pelz 19:23 Yeah.

Dr. Annice Mukherjee 19:23 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.

Dr. Mindy Pelz 19:39 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.

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Dr. Mindy Pelz 21:23 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.

Dr. Rangan Chatterjee 21:51 [Instrumental music]

Dr. Mindy Pelz 21:52 You mentioned two hormones there that people may not be familiar with-

Dr. Annice Mukherjee 21:57 Yeah

Dr. Mindy Pelz 21:57 ... or they may not fully understand them, estrogen.

Dr. Annice Mukherjee 22:00 Mm-hmm.

Dr. Mindy Pelz 22:00 But also you mentioned a term called insulin resistance.

Dr. Annice Mukherjee 22:03 Yes.

Dr. Mindy Pelz 22:03 Could you just explain, first of all, what insulin resistance is-

Dr. Annice Mukherjee 22:06 Yep

Dr. Mindy Pelz 22:07 ... and then, I guess, expand on what estrogen is?

Dr. Annice Mukherjee 22:10 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-

Dr. Mindy Pelz 22:31 Mm-hmm

Dr. Annice Mukherjee 22:31 ... 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.

Dr. Mindy Pelz 22:54 Mm-hmm.

Dr. Annice Mukherjee 22:55 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.

Dr. Mindy Pelz 23:13 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-

Dr. Annice Mukherjee 23:25 Mm

Dr. Mindy Pelz 23:25 ... 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-

Dr. Annice Mukherjee 23:34 Hmm

Dr. Mindy Pelz 23:35 ... or in women.

Dr. Annice Mukherjee 23:35 Yeah.

Dr. Mindy Pelz 23:35 I know a lot of research is biased because-

Dr. Annice Mukherjee 23:37 Yeah

Dr. Mindy Pelz 23:37 ... it's done in men.

Dr. Annice Mukherjee 23:39 Yeah.

Dr. Mindy Pelz 23:40 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-

Dr. Annice Mukherjee 23:46 Yep

Dr. Mindy Pelz 23:47 ... to women. But one thing he told me is that between the ages of 20 and 60, our metabolism is rock solid. He said it doesn't change, whereas we think our metabolism slows down. And he said the research shows, certainly the research he was sharing with me-

Dr. Annice Mukherjee 24:03 Mm-hmm

Dr. Mindy Pelz 24:03 ... is that actually, no, our, our metabolism is the same, but because of our lifestyles and how busy modern life is-

Dr. Annice Mukherjee 24:11 Mm

Dr. Mindy Pelz 24:11 ... we put on fat, we put on visceral fat, and that visceral fat is what slows our metabolism down, not the other way around.

Dr. Annice Mukherjee 24:20 Hmm.

Dr. Mindy Pelz 24:20 So I found that really empowering to say, okay, it's not an inevitability that we're gonna put on weight as we get older. But how does that fit in perhaps with what you just said, which is-

Dr. Rangan Chatterjee 24:31 You know, 'cause men don't go through that huge hormonal change-

Jessie Inchauspé 24:34 Yeah

Dr. Rangan Chatterjee 24:34 ... like women do in their 40s-

Jessie Inchauspé 24:35 Yeah

Dr. Rangan Chatterjee 24:35 ... right? You're saying that as estrogen starts to go down, women naturally become more insulin resistant. So do you think that fits alongside with what Dr. William Li said?

Jessie Inchauspé 24:46 Y- yeah, I would love to see the study because I bet it wasn't done on women.

Dr. Rangan Chatterjee 24:49 Mm-hmm.

Jessie Inchauspé 24:50 And it probably wasn't done on menopausal women or perimenopausal women. So this is the part of the conversation I want to start to pull out, is we need to study women by ourselves, and we need to study women going through perimenopause and menopause. So I'm not discrediting anything that he's saying. I'm asking the world, can we just start to study women in isolation so we know more specifically? So that- that's h- what my response to the study would be. Now,

Jessie Inchauspé 25:20 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.

Dr. Rangan Chatterjee 25:36 Hmm.

Jessie Inchauspé 25:36 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.

Dr. Rangan Chatterjee 25:53 Mm-hmm.

Jessie Inchauspé 25:53 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.

Dr. Rangan Chatterjee 26:12 Mm-hmm.

Jessie Inchauspé 26:12 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.

Dr. Rangan Chatterjee 26:32 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-

Jessie Inchauspé 26:41 Yeah

Dr. Rangan Chatterjee 26:41 ... 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.

Jessie Inchauspé 27:09 That's right.

Dr. Rangan Chatterjee 27:09 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.

Jessie Inchauspé 27:22 That's it.

Dr. Rangan Chatterjee 27:22 So I actually think it could fit alongside what Dr. Li was saying.

Jessie Inchauspé 27:25 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.

Dr. Rangan Chatterjee 27:38 Yeah.

Jessie Inchauspé 27:38 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.

Dr. Rangan Chatterjee 27:50 Yeah.

Jessie Inchauspé 27:50 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-

Dr. Rangan Chatterjee 28:45 Mm-hmm

Jessie Inchauspé 28:45 ... more insulin resistant, and we have progesterone going down, destroying your ability to handle stress, making cortisol go up.

Dr. Rangan Chatterjee 28:54 Hmm.

Jessie Inchauspé 28:54 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.

Dr. Rangan Chatterjee 29:04 Yeah. I mean, no wonder so many women find it tough-

Jessie Inchauspé 29:07 Yeah

Dr. Rangan Chatterjee 29:08 ... at that age.

Jessie Inchauspé 29:09 That's right.

Dr. Rangan Chatterjee 29:09 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.

Jessie Inchauspé 29:21 Yeah.

Dr. Rangan Chatterjee 29:22 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-

Jessie Inchauspé 29:33 That's right

Dr. Rangan Chatterjee 29:33 ... and how they change throughout a 28-day cycle.

Jessie Inchauspé 29:36 Yeah.

Dr. Rangan Chatterjee 29:37 Of course, it's not always just 28 days, but doesn't really pay attention to a woman's needs through their cycle, but maybe also doesn't pay attention or as much attention as it should to their needs throughout their lifetime.

Jessie Inchauspé 29:51 Yeah. You know, f- I read a statistic the other day that w- uh, women, depending on how long you live, will spend 40% of their life in menopause. 40% of their life will be without these hormones. Why aren't we studying this? Why aren't we creating a culture that can talk about this? Why aren't we, uh, helping women understand this? And that's the thing that I'm trying to bring to the world, is like c- if we just could talk about it, we could all come up with some solutions.

Dr. Rangan Chatterjee 30:19 Yeah.

Jessie Inchauspé 30:19 But instead what's happening is the 45-year-old woman is trying harder at weight loss. She's working out harder. She's dieting more, trying to get this result that she got at 35, but she's not looking at it through a hormonal lens. And the minute you, you flip the whole discussion on its head, the minute you start to look at it through a hormonal lens, and now that woman can start to get some serious weight loss results when she comes at it from hormones, not from grit-

Dr. Rangan Chatterjee 30:47 Yeah

Jessie Inchauspé 30:47 ... and discipline.

Dr. Rangan Chatterjee 30:49 So we're saying it's not inevitable, it's just harder for women as they go into their 40s-

Jessie Inchauspé 30:54 That's right

Dr. Rangan Chatterjee 30:54 ... unless they start making some changes.

Jessie Inchauspé 30:57 Yeah.

Dr. Rangan Chatterjee 30:57 You've also mentioned the relationship there between stress, increased stress-

Jessie Inchauspé 31:01 Yeah

Dr. Rangan Chatterjee 31:02 ... increased levels of the stress hormone cortisol-

Jessie Inchauspé 31:04 Yeah

Dr. Rangan Chatterjee 31:05 ... and belly fat.

Jessie Inchauspé 31:06 Yep.

Dr. Rangan Chatterjee 31:06 Now, one big source of stress for all of us, men and women alike, is a lack of sleep.

Jessie Inchauspé 31:12 Ooh, yeah.

Dr. Rangan Chatterjee 31:12 So what's the relationship between a lack of sleep and belly fat?

Jessie Inchauspé 31:17 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.

Dr. Rangan Chatterjee 31:37 Mm.

Jessie Inchauspé 31:38 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-

Dr. Rangan Chatterjee 31:57 Mm

Jessie Inchauspé 31:57 ... 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.

Dr. Rangan Chatterjee 32:33 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.

Jessie Inchauspé 32:41 Yeah.

Dr. Rangan Chatterjee 32:41 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.

Jessie Inchauspé 32:54 That's right.

Dr. Rangan Chatterjee 32:54 But what are they meant to do? I mean, you say we need some different hacks.

Jessie Inchauspé 32:58 Yeah.

Dr. Rangan Chatterjee 32:58 What are some of your-

Jessie Inchauspé 32:59 Yeah

Dr. Rangan Chatterjee 33:00 ... top tips, then, for women to, to get better sleep?

Jessie Inchauspé 33:02 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.

Dr. Rangan Chatterjee 33:37 Mm-hmm.

Jessie Inchauspé 33:38 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.

Dr. Rangan Chatterjee 34:33 Yeah.

Jessie Inchauspé 34:34 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-

Dr. Rangan Chatterjee 34:51 Yeah

Jessie Inchauspé 34:51 ... 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.

Dr. Rangan Chatterjee 35:02 Oh, wow.

Jessie Inchauspé 35:02 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-

Dr. Rangan Chatterjee 35:17 Mm

Jessie Inchauspé 35:17 ... in, in your brain. Um, weighted blankets become really helpful for perimenopause and menopausal women. Like, there's a whole sleep strategy.

Dr. Rangan Chatterjee 35:26 What's the evolutionary case for a weighted blanket?

Jessie Inchauspé 35:28 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.

Dr. Rangan Chatterjee 35:40 Mm.

Jessie Inchauspé 35:41 What happened in the cave person day? We used cow hide or animal hide-

Dr. Rangan Chatterjee 35:46 Mm

Jessie Inchauspé 35:46 ... on top of us to sleep, and we slept on a cold ground. We didn't have mattresses. So w- our body is primed for when it gets cold, all of a sudden we get into more of a parasympathetic state.

Dr. Rangan Chatterjee 35:58 Mm.

Jessie Inchauspé 35:59 When you have a heavy blanket on you, again, same thing, going more into parasympathetic. Now, if you go back to what, uh, progesterone did, progesterone helped you access that calming part of your nervous system. So now she's gone or going away, so when you get in bed, we gotta do everything we can to activate that parasympathetic system.

Dr. Rangan Chatterjee 36:24 Mm-hmm.

Jessie Inchauspé 36:24 And that's where a cold mattress, a dark room, a, a weighted blanket, all of those things now start to prime your parasympathetic nervous system.

Dr. Rangan Chatterjee 36:34 Yeah, I mean, I've also seen so many patients do well with weighted blankets.

Jessie Inchauspé 36:38 Yeah.

Dr. Rangan Chatterjee 36:38 So many kids-

Jessie Inchauspé 36:40 Oh, yeah

Dr. Rangan Chatterjee 36:40 ... do really well.

Jessie Inchauspé 36:41 Yeah.

Dr. Rangan Chatterjee 36:41 And it's really interesting to hear that potential evolutionary perspective.

Jessie Inchauspé 36:45 Yeah.

Dr. Rangan Chatterjee 36:45 It sort of makes sense, doesn't it? Why, why, you know, why would it not be the case?

Jessie Inchauspé 36:49 Yeah, yeah.

Dr. Rangan Chatterjee 36:50 The other thing I'm, I'm hearing as you're talking, Mindy, is this idea that, you know, let, let's, let's be honest, the modern world is tough.

Dr. Stacy Sims 36:59 Oh, yeah.

Dr. Rangan Chatterjee 37:00 You know?

Dr. Stacy Sims 37:01 Oh, yeah

Dr. Rangan Chatterjee 37:01 Modern world is tough for many of us, particularly for women, who I think often are bearing the brunt of all kinds of pressures, work pressures. Still potentially there's a pressure-

Dr. Stacy Sims 37:11 Yeah

Dr. Rangan Chatterjee 37:11 ... to look after everyone at home-

Dr. Stacy Sims 37:13 Yeah

Dr. Rangan Chatterjee 37:13 ... elderly parents, whatever it might be. And it sounds as though what you're saying, or one way of interpreting it, is that, you know what? You can get away with it in your 20s and 30s.

Dr. Stacy Sims 37:25 That's it.

Dr. Rangan Chatterjee 37:26 Right? You can get away with it-

Dr. Stacy Sims 37:27 Yeah

Dr. Rangan Chatterjee 37:27 ... and your hormones are probably helping you in some way, but those changes or those lifestyle behaviors that you're not paying attention to that you're currently getting away with, as you go into the perimenopausal years, you're probably not gonna get away with them anymore.

Dr. Stacy Sims 37:43 That's exactly it. So when you eat something sweet, what's happening is you're getting a dopamine release in your brain.

Dr. Rangan Chatterjee 37:49 Yeah.

Dr. Stacy Sims 37:49 There's a pleasure hormo- molecule that gets released in your brain, and that pleasure can feel like energy. You feel perked up. You feel like, "Whoa, I feel awake." That's not energy. That's dopamine.

Dr. Rangan Chatterjee 38:01 Mm.

Dr. Stacy Sims 38:01 On the inside, in your mitochondria, the ability for your body to make energy is getting reduced. You're getting less and less good at making energy, yet you might think, "Oh my God, I need more and more sugar to wake myself up, more and more caffeine." And so you have this impression of, like, the dopamine rush, and then on the inside, things are breaking down. If you actually want to allow your body to make energy like it was always supposed to make it, which is efficiently, beautifully, easily, you have to reduce the glucose spikes, and you have to work with your mitochondria. Your mitochondria just want you to have a great time.

Dr. Rangan Chatterjee 38:34 Yeah.

Dr. Stacy Sims 38:34 They just wanna give you all the energy in the world. So we need to work with them because they're so powerful. And when you steady your glucose levels, you give them back that power to give you the energy that you really want.

Dr. Rangan Chatterjee 38:45 Mm-hmm.

Dr. Stacy Sims 38:46 And what's cool about the hacks as well is that I'm not asking you to never eat sugar ever again.

Dr. Rangan Chatterjee 38:50 Mm-hmm.

Dr. Stacy Sims 38:50 I'm teaching you how to eat it in a way that gives you all the pleasure, all the dopamine, but with less impact on your glycation, on your mitochondria, and on your health. That's why it's so powerful.

Dr. Rangan Chatterjee 39:01 We're g- gonna get to some of those really-

Dr. Stacy Sims 39:03 Yeah

Dr. Rangan Chatterjee 39:03 ... really shortly. Okay, so super clear on mitochondria. Uh, insulin.

Dr. Stacy Sims 39:07 Yeah. So your body knows that glucose spikes are not good for it, and it's trying to reduce the glycation and the mitochondrial overload, and it has one little tool that it uses. Your pancreas releases insulin into your body when a glucose spike is happening, and insulin is amazing. Her job is to take excess glucose out of the circulation and to store it away-

Dr. Rangan Chatterjee 39:33 Mm

Dr. Stacy Sims 39:34 ... in places where it can no longer do harm. And insulin stores glucose away in your muscles, in your liver, and also in your fat cells, and that's one of the ways that we gain weight or fat on our body, is by our body putting glucose away into our fat cells. Now, the problem is too much insulin over time also has consequences, the most common one being insulin resistance and type 2 diabetes, but also something that's becoming more and more common in females, which is polycystic ovarian syndrome or fertility problems. The more insulin you have in a female body, the more your body is gonna produce testosterone.

Dr. Rangan Chatterjee 40:10 Mm.

Dr. Stacy Sims 40:10 That means in a female body you're gonna have this excess of male hormone. This leads to consequences: missed periods, cystic ovaries, infertility, acne, balding, hair growth on the, on the face, et cetera.

Dr. Rangan Chatterjee 40:23 Yeah.

Dr. Stacy Sims 40:24 And often, and I'll just do a little PCOS sidebar here, often, um, the way that PCOS is treated is by giving females the birth control pill, because the pill contains female hormones. And so when you ingest female hormones with the pill, you're kind of bringing back the balance between female and male-

Dr. Rangan Chatterjee 40:40 Mm

Dr. Stacy Sims 40:40 ... hormones. But then when you stop the pill, if you haven't addressed the underlying issue, the problem is still there. And so you see many people who go off the pill because they wanna have a baby, and then they stop the pill and they're like, "Oh my God, I don't have my period."

Dr. Rangan Chatterjee 40:52 Yeah.

Dr. Stacy Sims 40:53 "What's happening? I'm not ovulating." And that's often a sign of this excess insulin. And so that's why one of the most common things that I see in my readers is getting their period back. And in my pilot experiment for the Glucose Goddess Method, three women who had been told they were never gonna be able to have babies naturally got pregnant in those four weeks.

Dr. Rangan Chatterjee 41:12 Wow. It's really, really powerful, that, because again, it speaks to this idea, are we treating symptoms or dealing with the root cause? And I've seen the picture you just, uh, illustrated there play out with so many women with PCOS in practice in the past. I really have. I've seen it so many times. And, you know, those symptoms, I can think back to certain patients. They are so distressing for women. You know, yes, not being able to get pregnant, sure, that, that is clearly a massive thing. But, you know, if you're a woman and you've got facial hair-

Dr. Stacy Sims 41:50 Or you become... You're, you're balding

Dr. Rangan Chatterjee 41:51 ... or you're going bald or-

Dr. Stacy Sims 41:52 Yeah

Dr. Rangan Chatterjee 41:53 ... really thinning hair.

Dr. Stacy Sims 41:54 Yeah.

Dr. Rangan Chatterjee 41:54 And one of my big frustrations in medicine is that we are not really taught to go for that root cause. And I think, again, broadening out the lens on blood sugar, if I think about... And you, you do this in both books actually really well at the start about really clearly demonstrating why this book and this approach is relevant to all of us.

Dr. Stacy Sims 42:14 Mm-hmm.

Dr. Rangan Chatterjee 42:16 You mention infertility. You mention PCOS. You mention menopausal symptoms.

Dr. Stacy Sims 42:20 Mm-hmm.

Dr. Rangan Chatterjee 42:20 Right? The menopause is something that is talked about a lot these days. It's one of the hot topics in health, and I understand why, 'cause for many years, um, a lot of-

Dr. Stacy Sims 42:30 Nobody was talking about it

Dr. Rangan Chatterjee 42:31 ... a lot of women don't feel it was taken seriously. A lot of women feel as though they were ignored by their doctors perhaps.

Dr. Stacy Sims 42:37 Mm-hmm.

Dr. Rangan Chatterjee 42:37 But you're also showing how stabilizing your blood sugar-... can lead to an improvement in menopausal symptoms.

Dr. Stacy Sims 42:43 Listen, the scientific studies are very clear.

Dr. Rangan Chatterjee 42:45 Yeah

Dr. Stacy Sims 42:45 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.

Dr. Rangan Chatterjee 43:06 Yeah

Dr. Stacy Sims 43:06 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.

Dr. Rangan Chatterjee 43:19 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.

Dr. Stacy Sims 43:32 Yeah

Dr. Rangan Chatterjee 43:32 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."

Dr. Stacy Sims 43:49 Mm-hmm.

Dr. Rangan Chatterjee 43:50 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.

Dr. Stacy Sims 44:00 Yep.

Dr. Rangan Chatterjee 44:00 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.

Dr. Stacy Sims 44:08 Absolutely. So I actually just did a Live with an amazing, um, woman, Aviva Romm, who's really-

Dr. Rangan Chatterjee 44:14 Oh, brilliant

Dr. Stacy Sims 44:14 ... 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-

Dr. Rangan Chatterjee 44:25 Mm-hmm. Yeah

Dr. Stacy Sims 44:26 ... 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-

Dr. Rangan Chatterjee 45:08 Yeah

Dr. Stacy Sims 45:08 ... 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-

Dr. Rangan Chatterjee 45:18 Yeah

Dr. Stacy Sims 45:18 ... 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.

Dr. Rangan Chatterjee 45:26 I, I love that. There is, there's a lot of people at the moment-

Dr. Stacy Sims 45:29 [laughs]

Dr. Rangan Chatterjee 45:29 ... who are high-functioning glucose rollercoasters, right?

Dr. Stacy Sims 45:34 I love it. I love it.

Dr. Rangan Chatterjee 45:35 Yeah.

Dr. Stacy Sims 45:35 Yeah.

Dr. Rangan Chatterjee 45:35 But you walk around, you will see that, and-

Dr. Stacy Sims 45:38 Mm-hmm

Dr. Rangan Chatterjee 45:38 ... it, it kind of will correlate with the 11 o'clock snack-

Dr. Stacy Sims 45:43 Yes

Dr. Rangan Chatterjee 45:43 ... the extra coffee that's needed, the bit of chocolate to keep you going, right?

Dr. Stacy Sims 45:47 The after-dinner sugar, you know, the just scrolling on Instagram to reduce your stress. Like, there's so many of our habits that could be linked to trying to function on a glucose rollercoaster. And also, most people don't know they're on a glucose rollercoaster, so it's not their fault. They're trying their best.

Dr. Rangan Chatterjee 46:05 Yeah.

Dr. Stacy Sims 46:05 They're trying to survive with all these symptoms, thinking the symptoms are normal, that if they can't handle them, they're weak or they don't have enough willpower, or feeling ashamed or guilty. I want people to know that you can actually reduce those symptoms and they will go away. The first place to start is to steady your glucose levels.

Dr. Rangan Chatterjee 46:22 Yeah

Dr. Stacy Sims 46:22 And you'll have such a different experience of your life. Instead of feeling controlled by these impulses and these symptoms that you can't do anything about, you can become reconnected with your body, with yourself, and you know, you can partner with your mitochondria. I mean, it's just a much more, it's a much nicer place to be.

Dr. Rangan Chatterjee 46:40 This stress response often leads to sweats as well-

Dr. Stacy Sims 46:45 Hmm

Dr. Rangan Chatterjee 46:45 ... I've seen with patients. And I know you write a little bit about this actually as well, that because if your body's under stress, you know, that is one thing that may happen. Depending on who you are or what's going on in your life, you may get sweats or, you know. One of the common reasons I've seen that people struggle with sleep is they wake up, like, three hours or so after going to bed because they've had a sweet snack before they go to bed, and the sugar goes up.

Dr. Stacy Sims 47:08 Yeah, and the crash, and y- you wake up with a pounding heart-

Dr. Rangan Chatterjee 47:11 Exactly

Dr. Stacy Sims 47:12 ... and you're, you know, sweaty, and you're like, "Whoa, what's going on?" And that could be just because of a glucose crash in the middle of the night.

Dr. Rangan Chatterjee 47:17 Yeah. The solution to that-

Dr. Stacy Sims 47:19 Mm-hmm

Dr. Rangan Chatterjee 47:19 ... is not the Oura Ring, right? It's not a sleeping pill. The solution to that is stabilize your blood sugar.

Dr. Stacy Sims 47:25 Yeah

Dr. Rangan Chatterjee 47:26 Because then if you're not getting that up and down at night, your sleep quality's gonna be improved, right?

Dr. Stacy Sims 47:30 You sleep much better. Yeah. Some recent studies are actually showing us that, you know, the steadier your glucose levels are, the more restful your sleep is going to be, the deeper your sleep is going to be. Glucose and sleep are like two peas in a pod.

Dr. Rangan Chatterjee 47:42 Mm-hmm.

Dr. Stacy Sims 47:42 They're very connected. And then if you haven't slept well, you're more likely to think, "I need sugar for energy," therefore creating another glucose rollercoaster. So it can either be a virtuous cycle or it can be a vicious cycle.

Dr. Rangan Chatterjee 47:53 Yeah, and this is something, again, I think certainly my own experience of wearing a CGM has taught me, really speaks to what you just said, which is you can think you've had a good night's sleep, but some days y- you know, you think, "I slept, but I'm waking up. I don't feel rested, but I don't think I was up that much." And of course, there's a million possible reasons-

Dr. Stacy Sims 48:13 Yeah

Dr. Rangan Chatterjee 48:13 ... confounding factors, right? This is not, me talking about this is not a scientific study, right?

Dr. Stacy Sims 48:18 Yeah

Dr. Rangan Chatterjee 48:18 You've just mentioned a scientific study. I'm just mentioning my n of 1 experience, but I have seen a strong correlation between when my sugar is stable in the evening and at night, I have more energy the next day-

Dr. Stacy Sims 48:30 Absolutely

Dr. Rangan Chatterjee 48:30 ... even if I think I've slept for the same amount of time.

Dr. Stacy Sims 48:33 Absolutely. I've become sort of a sleep, uh ... I- I'm really interested in sleep these days, and I have everything. I have, like, the cool room and the dark thing and the no noise and the pillow and everything. I just love sleeping.

Dr. Rangan Chatterjee 48:44 Yeah. But-

Dr. Stacy Sims 48:45 [laughs]

Dr. Rangan Chatterjee 48:46 You love stable blood sugars-

Dr. Stacy Sims 48:48 Yes

Dr. Rangan Chatterjee 48:48 ... and sleeping.

Dr. Stacy Sims 48:49 I, I love sleeping. Yeah, I do. Do you like sleeping?

Dr. Rangan Chatterjee 48:51 I love sleeping.

Dr. Stacy Sims 48:52 Sleeping is the best.

Dr. Rangan Chatterjee 48:53 I love early nights. I love waking up feeling fresh and full of energy.

Dr. Stacy Sims 48:57 Oh, it's beautiful.

Dr. Rangan Chatterjee 48:58 You know, I-

Dr. Stacy Sims 48:59 It's so nice.

Dr. Rangan Chatterjee 49:00 Yeah. Let's talk about some more hacks. Okay, so at the start of the conversation, you mentioned food order.

Dr. Stacy Sims 49:06 Mm-hmm.

Dr. Rangan Chatterjee 49:07 And I really hope people put that into practice straight away, 'cause the... it can be transformative just switching a few things around.

Dr. Stacy Sims 49:13 Yeah.

Dr. Rangan Chatterjee 49:15 Vinegar.

Dr. Stacy Sims 49:16 You wanna talk about vinegar?

Dr. Rangan Chatterjee 49:17 I love-

Dr. Stacy Sims 49:18 Let's talk about vinegar

Dr. Rangan Chatterjee 49:18 ... to talk about vinegar.

Dr. Stacy Sims 49:19 Yeah.

Dr. Rangan Chatterjee 49:19 I'd also love you to just drop in as well how certain cultures-

Dr. Stacy Sims 49:24 Yes

Dr. Rangan Chatterjee 49:24 ... have had this within them as well. So I think give us the modern science, but give us the ancient wisdom as well.

Dr. Stacy Sims 49:29 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.

Dr. Rangan Chatterjee 50:06 [laughs]

Dr. Stacy Sims 50:06 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.

Dr. Rangan Chatterjee 50:18 Who funded that study? Was it big-

Dr. Stacy Sims 50:20 Oh, I checked

Dr. Rangan Chatterjee 50:20 ... big, was it Big Vinegar?

Dr. Stacy Sims 50:21 Big Vinegar? No, no. [laughs]

Dr. Rangan Chatterjee 50:24 [laughs]

Dr. Stacy Sims 50:24 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.

Dr. Rangan Chatterjee 51:19 Yeah.

Dr. Stacy Sims 51:19 And I have-

Dr. Rangan Chatterjee 51:19 There's a whole week de-

Dr. Stacy Sims 51:20 There's a whole week

Dr. Rangan Chatterjee 51:20 I saw it in the new book.

Dr. Stacy Sims 51:22 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.

Dr. Rangan Chatterjee 51:31 Well, actually, in the book-

Dr. Stacy Sims 51:32 Yeah

Dr. Rangan Chatterjee 51:32 ... there was, there was this, um... The, the photography's gorgeous-

Dr. Stacy Sims 51:37 Thanks

Dr. Rangan Chatterjee 51:38 ... i- in the new book, it really is. And there was one image, I can't remember what it was, it was in the vinegar section, where it almost looks as though you're in a bar-

Dr. Stacy Sims 51:47 [laughs]

Dr. Rangan Chatterjee 51:47 ... having a cocktail, but actually it's vinegar, right?

Dr. Stacy Sims 51:51 Yes. And I have s- I made all these really gorgeous, delicious vinegar mocktails because why not create a little, you know, special occasion, a little ritual around having your vinegar once a day? Why not? Um, yeah, there's one... One of my favorite mocktails in the book is the mother apple spritzer.

Dr. Rangan Chatterjee 52:06 Yeah.

Dr. Stacy Sims 52:06 And I thought apple cider vinegar is the most commonly used vinegar, but you can use any of them. And I thought, hey, you know, we don't often think about apple cider vinegar's mother, which are apples. So I wanted to make a mocktail that really, you know, helped apple shine. So anyway, that's a sidebar. You't find it in the book. It's gorgeous. Vinegar before a meal, beautiful, simple impact on your glucose levels. There are even some pilot studies showing that by adding vinegar once a day, females with PCOS are able to reduce their testosterone without changing anything else about their diets.

Dr. Rangan Chatterjee 52:37 Yeah, I mean, this is profound. I mean-

Dr. Stacy Sims 52:40 But isn't it crazy?

Dr. Rangan Chatterjee 52:41 It is.

Dr. Stacy Sims 52:41 It's crazy.

Dr. Rangan Chatterjee 52:42 Well, what's crazy is that, I mean, those numbers are frankly incredible, right? And what's also crazy is that this has been in cultures for a long time, for thousands of years. There's a lot of natural health proponents, naturopaths, um, nutritional therapists-

Dr. Stacy Sims 53:03 Mm-hmm

Dr. Rangan Chatterjee 53:03 ... you know, who for many years will have been recommending apple cider vinegar. They will have said, you know, if you have some, you know, have that to blunt your blood sugar response. So I think there's been a lot of wisdom that's been out there. Perhaps, you know, the modern scientific method has only just kind of explained and given the credibility to some people who need that. May-

Dr. Stacy Sims 53:27 I a- actually really appreciate knowing how it works-

Dr. Rangan Chatterjee 53:30 Yeah

Dr. Stacy Sims 53:30 ... and seeing the data. Um, it's easier for me to adopt a new habit if I'm able to see the scientific studies showing like, hey, this worked. But there's also other things that we can't do a scientific study about that I'm still going to do, you know? I'm not gonna wait for people to say, I don't know, having friends is important for your blood sugar for me to do it. I mean, it makes sense that if you're happy, relaxed, emotionally connected, your blood sugar's gonna be better, but I'm not gonna wait for that study.

Dr. Rangan Chatterjee 53:54 Let's talk about vinegar then. So what does that practically look like? So let's say someone's gonna have their lunch, right? And they're... It's a work do, right? So they can't really change too much about the content of what's in that lunch.

Dr. Stacy Sims 54:08 Yeah.

Dr. Rangan Chatterjee 54:08 But they're concerned, based on what they've heard, that it may spike their blood sugar, and it may cause them a 3:00 PM crash-

Dr. Stacy Sims 54:16 Mm

Dr. Rangan Chatterjee 54:16 ... needing more sugar and more coffee, right? So they've now heard about vinegar. So let's say their lunch meal is at 1:00 PM.

Dr. Stacy Sims 54:24 Yeah.

Dr. Rangan Chatterjee 54:25 Right? Let's... You know, talk us through what you want them to do, or at least consider doing, with vinegar to blunt their sugar response.

Dr. Stacy Sims 54:33 Before I answer that, I will say I also am often caught saying that you should only do the hacks when it's easy. So if it's too-

Dr. Rangan Chatterjee 54:41 Okay

Dr. Stacy Sims 54:41 ... stressful to organize a vinegar drink, don't do it. It's okay. But if you have vinegar accessible, let's say your lunch is at 1:00 PM, I want you at 12:45 to go grabA tall glass of water. I could demonstrate. I even have sparkling water here. A tall glass of water, sparkling water, any water, tea, whatever, one tablespoon of vinegar, poof, in it. It can be apple cider vinegar, it can be white wine vinegar, it can be cherry vinegar, whatever. Just avoid the very syrupy balsamic glaze vinegar, 'cause that's more sugar than it is vinegar. And then, um, you just drink it. So you can have it with a straw if you wanna be extra cautious of protecting your teeth's enamel. But once it's diluted, it's usually fine. And then, um, you just go have your lunch. That's about it. The ideal timing is to have this 10 minutes before you start eating, but you can also have it during or after the meal, and it will also have an impact.

Dr. Rangan Chatterjee 55:33 Yeah, I lo- I love the way you just make it so practical, that ideally it's 10 minutes-

Dr. Stacy Sims 55:39 Yeah

Dr. Rangan Chatterjee 55:39 ... right? But, hey, if it's 15 minutes before or 5 minutes before or during or after, you're still gonna get-

Dr. Stacy Sims 55:46 Exactly

Dr. Rangan Chatterjee 55:46 ... a benefit. And I think that's so important, because one thing I've experienced from trying to write books or trying to give, uh, information to people to try and improve their lives, is that sometimes it's, it's, it's taken very literally. "Oh, you said 15 minutes." And then that could [laughs] create a stress that-

Dr. Stacy Sims 56:03 Absolutely

Dr. Rangan Chatterjee 56:03 ... "Oh, man, it's 12:46. She told me to have it at 12:45. I've missed it." But it's not that. And I think that wider point as well is really, really important, that, hey, listen, if you don't have vinegar around, don't worry about it.

Dr. Stacy Sims 56:14 Exactly.

Dr. Rangan Chatterjee 56:15 It's when you can do them.

Dr. Stacy Sims 56:16 Some Sundays I wake up and I want chocolate ice cream for breakfast, and I'll just have it. No vinegar before, no veggies before, whatever. I'll just eat the ice cream that I want to eat. Like, what I want people to take away from all this is the science of the glucose hacks. But then doing the hacks, and also not doing the hacks, are both part of this new revolution-

Dr. Rangan Chatterjee 56:37 Yeah

Dr. Stacy Sims 56:37 ... you're using on your body and you're helping your health with. So it's not a diet, it's not restrictive. Just use it, use the hacks when you can, and the rest of the time live your life. Just by using one hack for, you know, once in a month, is already better than not using it.

Dr. Rangan Chatterjee 56:50 Yeah. How often do you have chocolate ice cream on a Sunday morning?

Dr. Stacy Sims 56:53 [laughs] Last time, I think it was probably six months ago.

Dr. Rangan Chatterjee 56:56 Six months ago?

Dr. Stacy Sims 56:57 Yeah, yeah. It doesn't really happen very often, but you know, it has happened. And I want people to know that when I want to, I do.

Dr. Rangan Chatterjee 57:03 Yeah. No, I love that. I never thought I'd be talking to the glucose goddess, talking about having chocolate ice cream on a Sunday morning.

Dr. Stacy Sims 57:10 And you know-

Dr. Rangan Chatterjee 57:10 But I love that. I think people are gonna really love that image

Dr. Stacy Sims 57:12 ... people have a misconception about me. They think that I never eat sugar and I never eat starches. I'm actually a huge sugar fan. I love sugar. I love pasta. I probably eat sugar every single day. So I'm not here to tell you to never eat a- eat it again. I'm not here to demonize it. I'm here to tell you, let's eat it, maximum pleasure, minimal impact on our body. Because I don't want people to suffer. I don't want people to get diabetes. I want people to put diabetes into remission. I want people to get their period back. I want their mental health to be better, their skin to be clearer, to sleep better, et cetera. But also, the cool thing about this science is that it, it allows us to do all that without giving up any of the foods that we love.

Dr. Rangan Chatterjee 57:49 Yeah.

Dr. Stacy Sims 57:49 And that's so beautiful, and that's why in The Glucose Goddess Method, the, the new book, I teach you every week to put a hack in place in your life, like a gentle giant.

Dr. Rangan Chatterjee 57:58 Yeah.

Dr. Stacy Sims 57:58 And the rest of the time you do whatever you want. There's no restrictions at all. And it's incredibly powerful, as you see from the results.

Dr. Rangan Chatterjee 58:07 What I think's so clever about it is that by making it feel achievable, it becomes very inclusive.

Dr. Stacy Sims 58:16 Mm.

Dr. Rangan Chatterjee 58:16 People want to follow you, people want to do it, and they're gonna feel so much better so quickly-

Dr. Stacy Sims 58:24 Yeah

Dr. Rangan Chatterjee 58:24 ... that it will lead to what I call a ripple effect.

Dr. Stacy Sims 58:27 Mm-hmm.

Dr. Rangan Chatterjee 58:27 That that one change is gonna lead to a barrage of other positive changes.

Dr. Stacy Sims 58:32 Yes.

Dr. Rangan Chatterjee 58:32 Right? So let's say, I know we can-- and we're gonna talk about movement r- in relation to blood sugar, but let's say just generalized movement. We know that moving more is typically a good thing, and many of us are not moving enough, right? But a lot of the time people are not moving enough is 'cause they feel rubbish, and they're tired, and they're sluggish. They've got no energy, so they're like, "Oh, I can't be bothered going to the gym. I can't be bothered going for a walk." Stabilize your blood sugars with these very gentle hacks. You're gonna have more energy. Your memory's gonna be better. Your brain's gonna function c- more clearly, and then you're naturally gonna actually move your body more, right? So you must-- I'm sure you've had that experience from people in your community.

Dr. Stacy Sims 59:12 Absolutely. And I think the, the issue you described where somebody is just sluggish and doesn't wanna do stuff, they're often met with the advice of, "Just eat better and exercise more."

Dr. Rangan Chatterjee 59:21 Mm-hmm.

Dr. Stacy Sims 59:21 And unfortunately, for a lot of people, that advice is too vague to even, you know, sort of start doing anything about it. It becomes overwhelming. It's, like, daunting. What do you mean eat better? More vegetables? Exercise more? Like, I don't know. What I've solved, I believe, is a very important motivation issue. I've distilled the science down into these very simple things-

Dr. Rangan Chatterjee 59:40 Mm

Dr. Stacy Sims 59:40 ... that are additive to your life. And as a result, you know, you put your foot in the... What's it called? The étrier in English, the thing on the horse, you know? You put your foot in the-

Dr. Rangan Chatterjee 59:49 Oh

Dr. Stacy Sims 59:49 ... stirrup.

Dr. Rangan Chatterjee 59:49 Yes.

Dr. Stacy Sims 59:50 You put your foot in the stirrup, and then, you know, you ride the horse. And that first step is so freaking difficult, but with the hacks it becomes very, very, very easy.

Dr. Rangan Chatterjee 1:00:01 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-

Dr. Stacy Sims 1:00:36 Yeah

Dr. Rangan Chatterjee 1:00:36 ... so that we can make that case. And frankly, if that's-

Dr. Stacy Sims 1:00:39 Yeah

Dr. Rangan Chatterjee 1:00:39 ... all we do in this podcast is make the case-

Dr. Stacy Sims 1:00:41 [laughs]

Dr. Rangan Chatterjee 1:00:41 ... for those two things, I think we'd both be really happy.

Dr. Stacy Sims 1:00:44 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-

Speaker 1:00:56 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.

Dr. Rangan Chatterjee 1:07:56 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-

Speaker 1:08:36 Yeah

Dr. Rangan Chatterjee 1:08:36 ... 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?

Speaker 1:08:55 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-

Dr. Rangan Chatterjee 1:09:16 Yeah

Speaker 1:09:16 ... 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.

Dr. Rangan Chatterjee 1:09:43 Mm-hmm.

Speaker 1:09:43 So what is the evolutionary thing around it? No one really knew-

Dr. Rangan Chatterjee 1:09:47 Yeah

Speaker 1:09:47 ... 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.

Dr. Rangan Chatterjee 1:10:18 Yeah.

Speaker 1:10:18 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.

Dr. Rangan Chatterjee 1:11:10 Mm-hmm.

Speaker 1:11:11 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.

Dr. Rangan Chatterjee 1:11:30 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.

Speaker 1:12:51 Mm-hmm.

Dr. Rangan Chatterjee 1:12:51 How does that potentially change things or influence the things that you've just been talking about?

Speaker 1:12:59 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.

Dr. Rangan Chatterjee 1:16:33 Yeah.

Speaker 1:16:33 So that's where we look at strength training and high-intensity work.

Dr. Rangan Chatterjee 1:16:36 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.

Speaker 1:17:41 Mm-hmm.

Dr. Rangan Chatterjee 1:17:41 And again, all these terms, I think, often get confusing for people. We say, "Oh, what, what qualifies? Is, you know, when I'm holding my weight up in yoga or Pilates, does, does that qualify? Do I need to go to the gym? I can't stand the gym," you know, all these kind of things. So let's slowly unpick it. When you say resistance training and lifting heavy, what exactly do you mean by that?

Speaker 1:18:06 So resistance training is the umbrella term of a push-pull against your body, meaning that you are pushing or pulling a load that is heavier than just your body weight, and this is how we increase our overall strength or our power. When we're looking at lifting heavy or specific strength training, this is when we're getting in the nuts and bolts of how we do it. So if we're looking at strength training, this could be anywhere from air squats and pushups to tire flips and Olympic lifting. When we look at heavy lifting, this is the power end, where we're trying to really use central nervous system responses to increase our muscle capacity, meaning our ability to have a very strong muscle contraction, a fast muscle contraction, and a stimulus to build and keep our muscle itself and our bone. We look at the other end, which is more of what women are more comfortable doing in the 40 onward set. This is our higher reps, our lower loads, our Pilates, our boot camp, that kind of stuff that-Fitness world will say tones muscle, but when we're looking at it from a physiological perspective, it's more of a metabolic stress. So it means your muscle is working, it's learning how to use fuel, but it's not really getting the stimulus to become stronger from a nervous system standpoint. And it's really important to understand the distinct s- distinctive differences between those, because when we're looking at perimenopause into postmenopause, the two really critical things that we need to remember so that we can age w- well and not get old, is we need to be muscle centric and strong. So if we're s- looking at how estrogen really stimulates what we call the satellite cell or the stem cell of muscle, and now all of a sudden we don't have estrogen to do that, we need to find something else that's gonna stimulate the stem cell of muscle to keep building muscle. We also see that estrogen is tightly tied to myosin, that muscle protein that I was talking about earlier. So when we lose estrogen, myosin is kind of like, "Ugh, I don't know what to do." But if we have a l- a heavy load that comes in, then myosin's like, "Oh, okay, I need to bond to that other one really strongly 'cause I have to lift this load." And then the other thing, estrogen is tightly tied to where we store a neurotransmitter called acetylcholine. And acetylcholine is what helps the nerve jump what we call a, a gap from where the nerve is conducted down to where it stimulates the muscle itself. So it has to have a little jump, and acetylcholine is like the boat that allows that to happen.

Dr. Rangan Chatterjee 1:21:13 Mm.

Speaker 1:21:13 When we don't have a lot of estrogen, then the amount of acetylcholine that's there is reduced, so we don't have the capacity to have a really fast nerve conduction coming over. So when we're looking at the power-based end of lifting, the heavy lifting, it's that external load that is now going to tell the central nervous system, "Hey, you know what? We need more acetylcholine there."

Dr. Rangan Chatterjee 1:21:36 Yeah.

Speaker 1:21:37 Not only that, we need to have myosin bond to actin really heavily and strongly, and we need more muscle fibers in itself, 'cause we need more muscle to contract to lift this load. Whereas if we're at the other end, where everyone's talking about strength training as in Pilates and boot camp and, um, more reps less load, we don't have that same stimulus. We have a, a change in the muscle where we're using more carbohydrate and we're using more ATP, and we're having that metabolic response, but it's not going to benefit women who want to be able to be living independently when they get to be in their 80s and 90s or beyond. Because they will not have had the stimulus to create a very strong muscle-centric body.

Dr. Rangan Chatterjee 1:22:28 Yeah. We must go into bone health, because I think bone health has been undervalued.

Speaker 1:22:33 Completely.

Dr. Rangan Chatterjee 1:22:34 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-

Speaker 1:22:43 Yes

Dr. Rangan Chatterjee 1:22:43 ... 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.

Speaker 1:22:49 Thank you.

Dr. Rangan Chatterjee 1:22:49 So I really wanted to make sure-

Speaker 1:22:50 Yes

Dr. Rangan Chatterjee 1:22:50 ... we, we focused here. A lot of this book is talking about the incredible benefits of movement.

Speaker 1:23:00 Mm-hmm.

Dr. Rangan Chatterjee 1:23:00 And of course, you have this wonderful acronym-

Speaker 1:23:02 Acronym

Dr. Rangan Chatterjee 1:23:02 ... FACE.

Speaker 1:23:02 Mm-hmm.

Dr. Rangan Chatterjee 1:23:03 Right?

Speaker 1:23:03 Mm-hmm.

Dr. Rangan Chatterjee 1:23:03 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-

Speaker 1:23:14 Yes. Mm-hmm

Dr. Rangan Chatterjee 1:23:14 ... 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?

Speaker 1:23:26 Yes.

Dr. Rangan Chatterjee 1:23:26 So when it comes to movement, what kinds of things can we do that will directly improve the health of our bones?

Speaker 1:23:33 Yes. Let's just assume you're losing bone density. Let's make it a given.

Dr. Rangan Chatterjee 1:23:36 Okay.

Speaker 1:23:37 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.

Dr. Rangan Chatterjee 1:24:31 In our 20s.

Speaker 1:24:32 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-

Dr. Rangan Chatterjee 1:24:52 Mm

Speaker 1:24:52 ... 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.

Dr. Rangan Chatterjee 1:25:03 Mm.

Speaker 1:25:03 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.

Dr. Rangan Chatterjee 1:25:21 Mm.

Speaker 1:25:22 You know, it's all those things we see athletes doing, hopping over cones, um-Uh, jumping over little, uh, hurdles. Even I was teaching, uh, a US celebrity how to do toe taps and heel taps, and then alternate them really quickly because we lose the neuromuscular coordination that helps us jump over our work bag that sits-

Dr. Rangan Chatterjee 1:25:45 Mm

Speaker 1:25:45 ... by our desk and trips us every day, right?

Dr. Rangan Chatterjee 1:25:48 Mm-hmm.

Speaker 1:25:48 We may be fine until we lose our balance and fall down.

Dr. Rangan Chatterjee 1:25:53 Yeah.

Speaker 1:25:53 So we can't forget to do that in our, in our general mobility, but specifically for bone if we're talking about it.

Dr. Rangan Chatterjee 1:26:01 Yeah. See, it's interesting, things like swimming and cycling-

Speaker 1:26:06 Mm-hmm

Dr. Rangan Chatterjee 1:26:06 ... are fantastic aerobic-

Speaker 1:26:08 So good

Dr. Rangan Chatterjee 1:26:08 ... activities.

Speaker 1:26:09 Mm-hmm.

Dr. Rangan Chatterjee 1:26:09 But I say, personally, in my own life over the last years, I've really been thinking about weight-bearing activities.

Speaker 1:26:17 Yes.

Dr. Rangan Chatterjee 1:26:17 And if I have limited time to move, and I'm making more and more time to move as I get older, I'm... L- let's-- we'll, we'll come to strength shortly, but in terms of more, I guess, what you would call in inverted commas, aerobic activities, I really focus on walking and running.

Speaker 1:26:37 Yes.

Dr. Rangan Chatterjee 1:26:38 Don't get me wrong, I like cycling, I like swimming, but I'm thinking, yeah, but those things are not really putting load through my joints.

Speaker 1:26:47 They're not.

Dr. Rangan Chatterjee 1:26:48 Right?

Speaker 1:26:48 Mm-hmm.

Dr. Rangan Chatterjee 1:26:48 So they're great, but they're not loading my joints, whereas walking and running are literally putting pressure through my joints. So I personally am prioritizing those. As a sports medicine specialist-

Speaker 1:27:01 Yes

Dr. Rangan Chatterjee 1:27:01 ... as an orthopedic surgeon, what's your take on that?

Speaker 1:27:04 Um, I agree. I am not against swimming, great for aerobics.

Dr. Rangan Chatterjee 1:27:07 Yeah, for sure.

Speaker 1:27:08 I am not against cycling, aerobics, and building butt, core, and hips muscles. But if you're concerned about, uh, building better bones, not only is walking fine, it produces about one point five times body weight with the steps. Running's fine, about two and a half times body weight. To, to build better bone, we need four times body weight.

Dr. Rangan Chatterjee 1:27:31 Okay.

Speaker 1:27:32 So if we really wanna get after it, we're gonna jump, and we're gonna, we're gonna jump at least off an eight-inch step because that will produce four times body weight and impact 'cause this is the way bones work chemically. The biomechanical impact of you landing hard on both feet from an eight-inch height and then jumping up straight in the air and landing again, that biomechanical impact becomes, through little channels of fluid in your bone, biochemical signal that tells the building cells, "Oh, I better lay down more bone. She's jumping around again." So the impact becomes the biochemical signal to build bone, but it has to be intense enough. So when you jump off-- uh, when you're running, I would stop and jump up and down ten to twenty times. Or you can do it all at one time. Three da- three days a week, you can spend ten minutes jumping in multi directions. I just, uh, posted, um, reintroducing hopscotch-

Dr. Rangan Chatterjee 1:28:37 Yeah

Speaker 1:28:37 ... to the world, right? Because it's multidirectional play jumping.

Dr. Rangan Chatterjee 1:28:41 Mm-hmm.

Speaker 1:28:42 So, um, that's what I would add. And, and there are lots of studies, uh, to substantiate that. In fact, one that I published in this research group looking at what, what kind of activity, number one, answering the question, can we maintain our bone density by being active across a lifespan? The answer to that study was yes. Uh, the subsequent study was, well, okay, what kind of activity maintains bone density best? And it seems logical, but we were studying, um, the, the Senior Olympics, which is Olympics for people over fifty.

Dr. Rangan Chatterjee 1:29:19 Mm-hmm.

Speaker 1:29:19 We found, not surprisingly, that the jumping sports like volleyball, basketball, because of the impact, maintained bones better-

Dr. Rangan Chatterjee 1:29:27 Wow

Speaker 1:29:28 ... than the swimming, the running, the, the badminton, the bowling. Um-

Dr. Rangan Chatterjee 1:29:33 That's really interesting.

Speaker 1:29:34 Isn't that fascinating?

Dr. Rangan Chatterjee 1:29:35 And can I-- just a point to clarify, so many people these days are jumping on trampolines or on rebounders. Now, what's interesting on those, of course, there's give-

Speaker 1:29:44 Mm-hmm

Dr. Rangan Chatterjee 1:29:45 ... when you land.

Speaker 1:29:46 Mm-hmm.

Dr. Rangan Chatterjee 1:29:46 So I'm guessing that you're saying, no, no, you must make sure it's against a hard surface?

Speaker 1:29:50 If you have a choice, if you are not so arthritic that you can barely move-

Dr. Rangan Chatterjee 1:29:55 Mm

Speaker 1:29:55 ... please impact on against a hard surface. Um, that being said, NASA has some good evidence that when they bring astronauts back down-

Dr. Rangan Chatterjee 1:30:04 Yeah

Speaker 1:30:04 ... from the space station, they use rebounders.

Dr. Rangan Chatterjee 1:30:06 Right.

Speaker 1:30:07 You know? And, and it can be beneficial. But all things being equal, if you can jump on a hard surface, jump on a hard surface.

Dr. Rangan Chatterjee 1:30:14 Yeah. Okay, I love that. And of course, skipping ropes are brilliant as well for this.

Speaker 1:30:17 Oh, skipping, just skipping on a track. I mean, that kind of impact, getting your knees up really high adds some impact.

Dr. Rangan Chatterjee 1:30:25 Okay.

Speaker 1:30:25 Mm-hmm.

Dr. Rangan Chatterjee 1:30:26 So let's zoom out again and go, well, one of the themes of this conversation is this idea, this central idea from your book, that our body doesn't fall apart with age, it falls apart from neglect.

Speaker 1:30:36 Mm.

Dr. Rangan Chatterjee 1:30:37 You've spoken about the hormonal changes that happen-

Speaker 1:30:41 Yes

Dr. Rangan Chatterjee 1:30:41 ... in a man's life and in a woman's life, and why in that critical decade, thirty-five to forty-five, particularly for women-

Speaker 1:30:48 Yes

Dr. Rangan Chatterjee 1:30:48 ... hormones fall off a cliff, and it has a consequential impact on multiple aspects of our health: brain, heart, musculoskeletal system-

Speaker 1:30:57 Yes

Dr. Rangan Chatterjee 1:30:57 ... whatever it might be.

Speaker 1:30:58 Yes.

Dr. Rangan Chatterjee 1:30:58 And we've just gone deep into bone health.

Speaker 1:31:01 Yes.

Dr. Rangan Chatterjee 1:31:01 The impacts on bone health and the sort of things that we can do to help improve it.

Speaker 1:31:06 Mm-hmm.

Dr. Rangan Chatterjee 1:31:06 Okay. But then if we just take that broader theme in general about how we don't have to age with frailty, we can age with vitality-

Speaker 1:31:18 Yes

Dr. Rangan Chatterjee 1:31:19 ... a big part of your book is around movement.

Speaker 1:31:23 Mm-hmm.

Dr. Rangan Chatterjee 1:31:23 In fact, I think chapter two is literally making the case for movement.

Speaker 1:31:27 Yes.

Dr. Rangan Chatterjee 1:31:27 Um, so could you make the case for movement? Explain to us why-- we, we, we've all heard that exercise is good for us.

Speaker 1:31:35 Mm-hmm.

Dr. Rangan Chatterjee 1:31:36 Just build that case for us about movement. Why is it so important that we move in a variety of different ways-

Speaker 1:31:42 Mm-hmm

Dr. Rangan Chatterjee 1:31:43 ... particularly as we get older?

Speaker 1:31:46 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.

Dr. Rangan Chatterjee 1:33:08 Mm.

Speaker 1:33:08 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.

Dr. Rangan Chatterjee 1:33:53 [laughs]

Speaker 1:33:53 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.

Dr. Rangan Chatterjee 1:34:28 [laughs]

Speaker 1:34:28 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.

Dr. Rangan Chatterjee 1:34:46 Mm.

Speaker 1:34:46 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.

Dr. Rangan Chatterjee 1:34:57 Mm.

Speaker 1:34:57 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.

Dr. Rangan Chatterjee 1:35:14 [laughs]

Speaker 1:35:14 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.

Dr. Rangan Chatterjee 1:35:22 Mm.

Speaker 1:35:23 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.

Dr. Rangan Chatterjee 1:35:34 Oh.

Speaker 1:35:34 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-

Dr. Rangan Chatterjee 1:35:54 Yeah

Speaker 1:35:54 ... 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-

Dr. Rangan Chatterjee 1:36:05 Yeah

Speaker 1:36:05 ... 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-

Dr. Rangan Chatterjee 1:36:14 Yeah

Speaker 1:36:15 ... 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.

Dr. Rangan Chatterjee 1:36:31 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.

Speaker 1:36:43 Uh-huh.

Dr. Rangan Chatterjee 1:36:43 DNA change and damage-

Speaker 1:36:45 Yeah

Dr. Rangan Chatterjee 1:36:45 ... mitochondrial dysfunction, senescence, fuel gauge malfunction, and stem cell exhaustion.

Speaker 1:36:51 Yes.

Dr. Rangan Chatterjee 1:36:51 And then you cross-reference that-

Speaker 1:36:54 Mm-hmm

Dr. Rangan Chatterjee 1:36:54 ... with different kinds of exercise.

Speaker 1:36:56 Yes.

Dr. Rangan Chatterjee 1:36:57 And basically, you follow that chart. You go, wait a minute. If you do this hybrid training program-

Speaker 1:37:04 Mm-hmm

Dr. Rangan Chatterjee 1:37:04 ... that you outline in your book-

Speaker 1:37:05 Mm-hmm

Dr. Rangan Chatterjee 1:37:06 ... you are basically gonna make sure you've hit every one of those six.

Speaker 1:37:10 Yes.

Dr. Rangan Chatterjee 1:37:11 So all of the sort of physiological changes in your body that are driving aging in a perhaps unhealthy way or a, or a faster than needed way-

Speaker 1:37:22 Yeah

Dr. Rangan Chatterjee 1:37:23 ... hybrid training targets them all.

Speaker 1:37:26 Thank goodness.

Dr. Rangan Chatterjee 1:37:26 It's very, very inspiring, isn't it?

Speaker 1:37:28 It is. You can hit all the boxes by doing this very simple lifestyle.

Dr. Rangan Chatterjee 1:37:33 You're obviously such a passionate proponent of this.

Speaker 1:37:36 Mm-hmm.

Dr. Rangan Chatterjee 1:37:37 You, you know, you're really worried at 47 of what the hell was going on-

Speaker 1:37:41 Yes

Dr. Rangan Chatterjee 1:37:41 ... with your body-

Speaker 1:37:42 Yes

Dr. Rangan Chatterjee 1:37:42 ... and your brain.

Speaker 1:37:43 Mm-hmm.

Dr. Rangan Chatterjee 1:37:44 And you've really turned things around where-

Speaker 1:37:47 Mm-hmm

Dr. Rangan Chatterjee 1:37:47 ... you know, I saw you at the end of the day in London.

Speaker 1:37:49 Mm-hmm.

Dr. Rangan Chatterjee 1:37:49 You probably had jet lag, whatever.

Speaker 1:37:52 [laughs]

Dr. Rangan Chatterjee 1:37:52 You were on fire on stage.

Speaker 1:37:54 Mm.

Dr. Rangan Chatterjee 1:37:54 Your passion, your energy. I think that's why you're having such an impact in the world. It's not just what you're saying-

Speaker 1:38:02 Mm-hmm

Dr. Rangan Chatterjee 1:38:02 ... it's how you're saying it. So I guess my question to you is, at this stage in your life, are you able to share with us what a typical week of training or movement looks like for you?

Speaker 1:38:16 Sure, sure.

Dr. Rangan Chatterjee 1:38:16 And I appreciate that may not feel achievable for someone who's about to start, but I wonder if we could start off with what-

Speaker 1:38:22 Yeah

Dr. Rangan Chatterjee 1:38:23 ... you do.

Speaker 1:38:23 Yeah.

Dr. Rangan Chatterjee 1:38:23 And then we can perhaps wind back to someone who's never done any of this before and where they can start.

Speaker 1:38:28 Absolutely, yes. Um, and n- number one, I want people to give themselves grace, because sometimes when people say what I'm about to say, they're like, "Ugh, I could never." It's not about that. Start where you are.

Dr. Rangan Chatterjee 1:38:43 Mm.

Speaker 1:38:43 And I'll give you the example. I'm on a book tour right now. I am really busy in different time zones, so I'm not doing everything that I would normally love to do, and I'm gonna give myself grace. It's the period of life, and not judge myself for it. But ideally, this is what I do. Um, I have a flexibility and mobility practice, meaning I am trying to stretch out my tendon, ligaments, and muscles nearly every day. This is where-- I don't do Pilates or yoga, but if you do, this is where that comes in to be marvelous. I do s- a dynamic warmup every day, which gets every joint, every set of tendons and ligaments around my major joints moving, right? So daily flexibility and mobility.

Dr. Rangan Chatterjee 1:39:32 10 minutes?

Speaker 1:39:33 You know, it is just a series, and it's outlined in the book, The Dynamic Warm-Up. It's, it's just a series of 10 things that if I do the inchworm motion, it warms up my ankles, my knees, my hips. If I do, um, hamstring extensions, it gets my hips and my knees.

Dr. Rangan Chatterjee 1:39:51 First thing in the morning? Is that when you tend to do it?

Speaker 1:39:53 No, I do it before I work out.

Dr. Rangan Chatterjee 1:39:54 Before you work out.

Speaker 1:39:55 To work. I d- I put it all together.

Dr. Rangan Chatterjee 1:39:57 Yeah, that's interesting. And, and the only reason I ask is because I do mobility every day, but it's-

Speaker 1:40:03 Yeah

Dr. Rangan Chatterjee 1:40:03 ... part of my morning routine.

Speaker 1:40:04 Oh, that's great.

Dr. Rangan Chatterjee 1:40:04 So I'll get up.

Speaker 1:40:05 Yeah.

Dr. Rangan Chatterjee 1:40:06 I'll-- at the moment, I'm really into meditation, so I'll meditate and then it's in my living room, which has got a carpet on the floor, so it's straight afterwards. I'll probably spend five to 10 minutes just doing a whole variety-

Speaker 1:40:17 Yes

Dr. Rangan Chatterjee 1:40:17 ... of mobility exercises.

Speaker 1:40:18 Mm-hmm.

Dr. Rangan Chatterjee 1:40:18 I almost feel like it's waking up all of my joints-

Speaker 1:40:21 Mm-hmm

Dr. Rangan Chatterjee 1:40:21 ... for the day ahead. So-

Speaker 1:40:22 Yeah

Dr. Rangan Chatterjee 1:40:22 ... you do it before you work out.

Speaker 1:40:24 Yes.

Dr. Rangan Chatterjee 1:40:25 I do it first thing in the morning. But you're-

Speaker 1:40:26 It doesn't really matter

Dr. Rangan Chatterjee 1:40:27 ... yeah, some form of mobility-

Speaker 1:40:29 Yes

Dr. Rangan Chatterjee 1:40:29 ... to keep all the joints moving. Okay.

Speaker 1:40:30 That's right. And then when it comes to, and we'll just use this acronym that you, that you mentioned, F, that's F. A, aerobic. I used to be the marathon running, middle distance, getting my heart rate into middle zones all the time, as so many people did. I now use an 80/20 method. 80% of the time, I am in lower heart rate base training heart rate zone, which is very metabolically efficient. It helps my mitochondria be flexible with what fuel source I'm using, whether it's protein, carbs, or fat, and it burns more fat than the middle distance, middle high intensity exercising that I'll talk about in a minute. So 80% of the time. So that is three hours a week broken up into 45-minute sessions. I choose to do mine either by walking home from work, which is two and a half miles, or I have a treadmill in my room upstairs.

Dr. Rangan Chatterjee 1:41:29 So four 45-minute sessions a week-

Speaker 1:41:32 Yes, mm-hmm

Dr. Rangan Chatterjee 1:41:32 ... in what's typically these days called Zone 2 training.

Speaker 1:41:35 Zone 2.

Dr. Rangan Chatterjee 1:41:35 Which is basically low heart rate training.

Speaker 1:41:38 Yeah. And I, and I came to that based on the research of Inigo San-Millán, who is a physiologist for the Tour de France.

Dr. Rangan Chatterjee 1:41:46 Yeah.

Speaker 1:41:46 So he has a lab in my building, so I use his method and I've, I have the privilege of having my lactate threshold, which is telling me where my heart rate is, uh, done on a, with finger sticks. If you can't do that, then you can estimate it. Um, many wearables estimate it, but you could take your age min- 181 minus your age will give you a range, um, of heart rate.

Dr. Rangan Chatterjee 1:42:09 But you also, and you do share this in the book, that for people who don't wanna get that technical and don't wanna do lab testing-

Speaker 1:42:15 Yeah

Dr. Rangan Chatterjee 1:42:16 ... it's, it's basically a lot easier than you think.

Speaker 1:42:19 Oh, it's brisk walking.

Dr. Rangan Chatterjee 1:42:20 Yeah, it's brisk walking. It's basically where you can still talk, but if there was a person on the phone chatting to you, they would also know that you were working a little bit, right?

Speaker 1:42:30 Yeah, you would be breathless.

Dr. Rangan Chatterjee 1:42:31 Yeah.

Speaker 1:42:31 Yeah. And, and by the end of doing that, I break a little sweat, 'cause I can feel my metabolism revving up.

Dr. Rangan Chatterjee 1:42:37 So, so you're trying to do about three hours of that a week.

Speaker 1:42:39 That's correct.

Dr. Rangan Chatterjee 1:42:40 Okay.

Speaker 1:42:40 And that's when I listen to podcasts-

Dr. Rangan Chatterjee 1:42:42 Yeah, so it's, it's-

Speaker 1:42:42 ... or I learn something

Dr. Rangan Chatterjee 1:42:44 ... so it's relatively, in inverted commas, easy training.

Speaker 1:42:47 Yeah.

Dr. Rangan Chatterjee 1:42:47 Relatively.

Speaker 1:42:48 Yeah.

Dr. Rangan Chatterjee 1:42:49 You're burning fat. It's good for your metabolic flexibility.

Speaker 1:42:51 That's right.

Dr. Rangan Chatterjee 1:42:53 The other thing, which I think a lot of people don't realize about that form of training, is that it doesn't spike your cortisol.

Speaker 1:42:58 Right.

Dr. Rangan Chatterjee 1:42:58 If you enjoyed that conversation, then I think you are really going to enjoy this one. [instrumental music] Most things that adults are doing that is counterproductive have a logic, a certain logic, a twisted logic you might say, that dates back to their early childhood where that behavior made a certain sort of sense.

Speaker 1:43:17 Yeah