This Is Why You’re Gaining Belly Fat After 40 (And How to Reverse It) | Dr. Stacy Sims

1. RCDr. Rangan Chatterjee0:01

   What would you say are some of the common mistakes you see women making as they get older when it comes to losing body fat, increasing vitality, and I guess more broadly, improving their overall health and wellbeing?

2. SSDr. Stacy Sims0:21

   I think the biggest thing is following traditional trends, where if we're looking at women who are in this kind of 40-plus or maybe 45-plus age group at the moment, grown up in the whole diet culture of move more, eat less, and that's what people tend to do when, especially when they're trying to lose weight. But if we were to switch it and say, "You know what? I actually want you to do more high intensity and to eat more to shift your body composition," it becomes a little bit of, uh, a disconnect, and people can't get their head around it. But it's following the traditional trends that have been so, so well-versed in the fitness world that really do not work.

3. RCDr. Rangan Chatterjee1:07

   Yeah, it's interesting. As I've been researching you and the things that you talk about, it's very clear that first of all, you're, you know, a big part of what you do is to help people understand that women and men are fundamentally different. They're physiologically different. They're biologically different. You, of course, have your phrase that women are not small men. But what's super interesting for me is that as women get into their 40s, you are very clear that two things need to happen with respect to movement. There needs to be resistance training, and there needs to be HIIT, high-intensity interval training.

4. SSDr. Stacy Sims1:52

   Yes.

5. RCDr. Rangan Chatterjee1:52

   I wanna talk about that, but I guess the way I wanted to frame it, Stacy, was to pose a theoretical question to you.

6. SSDr. Stacy Sims2:00

   Mm-hmm.

7. RCDr. Rangan Chatterjee2:00

   I often talk about what I consider the four pillars of health, food, movement, sleep, and relaxation.

8. SSDr. Stacy Sims2:07

   Yep.

9. RCDr. Rangan Chatterjee2:08

   And so my question to you is gonna be, if a woman, let's say 45 years old, okay? So in that perimenopausal period, is nailing her food, whatever that means, we can maybe discuss that later. She's nailing her sleep. She has low stress levels, and for her movement, she is walking for 60 minutes a day.

10. SSDr. Stacy Sims2:32

    Mm-hmm.

11. RCDr. Rangan Chatterjee2:33

    So her lifestyle's really good, but she's not doing HIIT training, and she's not doing resistance training. Is that enough for her to age well and be well?

12. SSDr. Stacy Sims2:45

    If we're talking about the walking component of movement, and that's what she's doing, no, it's not. 'Cause if we're looking at walking, we're falling into the idea that we're doing cardiovascular work, which is good. I mean, we want that. But when we start looking at what does it mean to age well, we need to look at, uh, how strong and powerful we are just to be able to carry groceries when we're 80. Think about our bone and bone density, and we also really want to examine what does cardiovascular fitness look like? Because when we start getting into perimenopause onwards, because we've lost the epigenetic exposure of estrogen and progesterone, and to some extent testosterone, that affects every system of the body, we have to really understand what that means. 'Cause if we think about puberty and the first expression of these hormones in a, in a major way, we see all these changes that happen from a biomechanical and a physiological perspective in girls and boys. And girls tend to put on more body fat. They end up having less of an aerobic capacity as we compare it to age-matched or puberty-matched boys. We see, uh, so many different things that occur with brain, brain health, and, and mood development. And so when we get to the other side of things and we're seeing the unwinding of ovarian function, every system of the body is affected, including vascular compliance. So if we're thinking about walking for cardiovascular health and burning some calories, we're not optimizing the vascular compliance that we need to control blood pressure and to help with our lipid profile. So we see a really significant increase in LDL and our total cholesterol in women who are mid to late perimenopause, and it has to do with the way estrogen is no longer there working for anti-inflammatory properties, and there's a misstep the way that we're having conversations within the system to really use free fatty acids as a fuel. So when we start looking at all the pillars that I agree with, 'cause I talk about it all the time, we look at physical, then the emotional or the relaxation, parasympathetic, the sleep, and, um, the nutrition, right? So if we're nailing all of those and there's a misstep and we're still not seeing body composition change, we're not seeing change in our lipids, our blood glucose, and a lot of women don't, and this is where they start falling into, "Well, my body composition isn't changing, so I need to up my walking, or I need to eat less, or I need to do fasted exercise." And there's all these things that start to play in that really create a misstep in what will accumulate into a better longevity profile.

13. RCDr. Rangan Chatterjee5:47

    Yeah. There's so much there to unpack. Um, a couple of words you used there, which I'm not sure all of my audience will fully understand, epigenetic and vascular compliance.I'd love for you to explain please what those two things mean.

14. SSDr. Stacy Sims6:06

    Mm-hmm.

15. RCDr. Rangan Chatterjee6:07

    But also, I think a useful way to look at this would be to maybe start in utero and explain to us, you know, the differences between women and men, or boys and girls, males and females, starts from a very, very early age, doesn't it?

16. SSDr. Stacy Sims6:27

    Yeah. I mean, when we're looking at the first, uh, p- development really of the, of the fetus, right? We're looking at how much of an X chromosome is expressed, and this will determine if the fetus is gonna be a girl or a boy, typical XX or XY, because right now that's the bulk of the research. So as I'm talking, I apologize for this, but it's the way that the science goes is, like, we really only understand XX versus XY, maybe XXY. But when we're talking in utero, we see that the fetus that's XX is more stress resilient. We see that upon birth when we're looking at XY versus XX, there's distinctive sex differences within things like muscle morphology, which means the type of muscle fibers that we have, as well as how our body will fuel itself as it starts to get older. Um, things like, uh, mood and response to stress in the external environment is significantly different between a baby girl and a baby boy. And we see all of these things that progress through life, but from a sociocultural perspective, it hasn't been identified as these biological or genetic sex differences. It's been, "Oh, it's because you're a girl and you're expected to be this way," or, "You're a boy, you're expected to be that way." So if we bring it right down to sex differences at birth, and we're looking, okay, if, if the baby is born XX, we see that this baby has a smaller heart, smaller lungs. We see that the, um, muscle morphology is gonna be one that leans towards being more endurance-oriented and able to use free fatty acids a lot easier than a boy baby. And then the boy baby is born with more what we call glycolytic or fast-twitch fibers, which means that through life is gonna be able to, uh, produce more power and force, and is going to use more carbohydrate rather than, um, free fatty acids. So then as we develop through puberty and we see that now all of a sudden we're having an exposure to estrogen and progesterone in girls, and exposure of testosterone, that's what we start to see with epigenetic changes. So that means that the exposure of these hormones is creating a change within the body that is really unlocking some genetic predisposition. So for girls who are, are now having estrogen, progesterone that comes into play, we see that this changes their whole biomechanics. So their hips get wider, their shoulder girdle widens. They tend to grow longer arms and legs faster than their core strength. So we see a disconnect in the way that the body's able to move. We see there's differences in, um, brain development and progression, which changes mood and the way that someone will respond to an external environment. So that's why we see things like when you're talking to young girls in sport, they want to be more team-oriented and they don't want to be pulled out and said, "Okay, well, I want you to, to drive the kick." They want to be together. Whereas a boy, you can really be, uh, f- up front and forward 'cause they're very competitive and aggressive from testosterone exposure. So when we start pulling out all these sex differences, and then we put on the sex hormones, then we see this huge, um, differentiation of the way that, uh, a, a person will respond to external stresses of exercise and how they will respond to internal, um, feedback from the nutrition that they're getting and the nutrition timing and circadian rhythms. So when we start to really look at all of that and then apply it to modern day, it's like, okay, well, we look at women, and women have been following all of these things that have been put out in the fitness and nutrition world that's been based on male data, and they're not optimizing.

17. RCDr. Rangan Chatterjee10:31

    Mm-hmm.

18. SSDr. Stacy Sims10:31

    We see so many missteps, and we hear about the pathophysiological aspects for women, like iron deficiency and eating disorders or low energy availability, um, poor muscle control, poor muscle power. And if we were to just pull it back and say, "You know what? From a female physiology perspective, these are the things that we would like to do to improve and reach your potential. From a male physiology perspective, these are the things that we know work for you. We've seen it in the research too." So we just need to separate and divide. It's not that one is more complicated than the other, it's just we're different and we respond differently.

19. RCDr. Rangan Chatterjee11:10

    Yeah. It's so interesting. Uh, y- you mentioned there the, the female fetus is more resilient than the male fetus, and that's really interesting because, for example, Dr. Gabor Maté, who speaks a lot about trauma, in his last book, he calls women society's stress absorbers. And he says that in relation to the disproportionate amount of women who get autoimmune disease compared to men. So it's quite interesting to me that you're saying biologically as a fetus, women are more resilient to stress, yet at the same time it seems that into middle age, for example, women are absorbing a lot of society's stressors for a, a number of different reasons, which may well be contributing to their increased rates of autoimmune disease compared to men. It's fascinating, isn't it?

20. SSDr. Stacy Sims12:14

    Yeah, and this is where we can get into a discussion of, like, the X chromosome dosage. So we're starting to look more and more at the genetic capacity of what does XX versus XY mean? And if we look at the subset of individuals that are born XXY, they are more predisposed to autoimmune disease even though they present as male, and it has to do with how stress can create epigenetic change within one of the X chromosomes that then triggers these autoimmune diseases. So when we're looking at what does stress resilience mean when we're in utero, it could be effectively they're absorbing more stress, but they're more resilient to, to factors that would ordinarily cause the death of a fetus. So it, it has to do with that whole environmental aspect and how the XX chromosome responds to that.

21. RCDr. Rangan Chatterjee13:09

    Yeah. It's interesting that there's genetics, there's hormones, but there's also our environment in the sense that if women are constantly being told to do things that is based on research that was done for men, that's a huge stressor, right? That's a huge stressor-

22. SSDr. Stacy Sims13:34

    Yeah

23. RCDr. Rangan Chatterjee13:34

    ... because something's not working. They keep following the advice. I'm not losing my belly fat. I'm, you know, whatever it might be, I don't have the composition I want. I'm not aging as well as I want to. And, and, and it's interesting, that word stress can mean so many different things, can't it? It's not just biological. It's also-

24. SSDr. Stacy Sims13:53

    Right

25. RCDr. Rangan Chatterjee13:53

    ... societal as well.

26. SSDr. Stacy Sims13:54

    Right. I mean, one of the examples I like to bring in when we have these kinds of conversations is Alzheimer's. So we see a greater, um, risk factor for Alzheimer's as being female, but what we're not really understanding is that the cohort of women that are being studied now with Alzheimer's had a different sociocultural experience when they were younger than their male counterpart. And what I mean by that is the women who are now in their 80s, when they were in their 30s and 40s, it wasn't appropriate for them to be out having really complex jobs.

27. RCDr. Rangan Chatterjee14:31

    Hmm.

28. SSDr. Stacy Sims14:31

    We didn't see physicians. We didn't see scientists. We didn't see all these more brain-operative jobs when they were in their 30s and 40s. So they weren't really having the neuroplasticity responses that their male counterparts were. So that sociocultural construct of not being out having a job or an environment that created neuroplasticity is directly a risk factor for Alzheimer's. But if we look at today's cohort of women who are in their 30s and 40s, they're out there with the complex jobs and having more neuroplasticity exposure. So we don't know for sure how that's gonna play out later.

29. RCDr. Rangan Chatterjee15:14

    Yeah.

30. SSDr. Stacy Sims15:14

    So it is a sociocultural thing that really does come into play when we're looking at what are the differences in longevity for both sexes as well.

Episode duration: 2:10:41