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

Dr. Rangan Chatterjee 0:01 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?

Dr. Stacy Sims 0:21 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.

Dr. Rangan Chatterjee 1:07 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.

Dr. Stacy Sims 1:52 Yes.

Dr. Rangan Chatterjee 1:52 I wanna talk about that, but I guess the way I wanted to frame it, Stacy, was to pose a theoretical question to you.

Dr. Stacy Sims 2:00 Mm-hmm.

Dr. Rangan Chatterjee 2:00 I often talk about what I consider the four pillars of health, food, movement, sleep, and relaxation.

Dr. Stacy Sims 2:07 Yep.

Dr. Rangan Chatterjee 2:08 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.

Dr. Stacy Sims 2:32 Mm-hmm.

Dr. Rangan Chatterjee 2:33 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?

Dr. Stacy Sims 2:45 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.

Dr. Rangan Chatterjee 5:47 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.

Dr. Stacy Sims 6:06 Mm-hmm.

Dr. Rangan Chatterjee 6:07 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?

Dr. Stacy Sims 6:27 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.

Dr. Rangan Chatterjee 10:31 Mm-hmm.

Dr. Stacy Sims 10:31 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.

Dr. Rangan Chatterjee 11:10 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?

Dr. Stacy Sims 12:14 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.

Dr. Rangan Chatterjee 13:09 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-

Dr. Stacy Sims 13:34 Yeah

Dr. Rangan Chatterjee 13:34 ... 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-

Dr. Stacy Sims 13:53 Right

Dr. Rangan Chatterjee 13:53 ... societal as well.

Dr. Stacy Sims 13:54 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.

Dr. Rangan Chatterjee 14:31 Hmm.

Dr. Stacy Sims 14:31 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.

Dr. Rangan Chatterjee 15:14 Yeah.

Dr. Stacy Sims 15:14 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.

Dr. Rangan Chatterjee 15:25 You mentioned some of the changes that happen when a female goes through puberty, okay, and, and ex- and, and gets exposed to those, uh, sex hormones, like estrogen and progesterone and also testosterone. What is it that happens when a woman gets into her 40s that is significant for us to know which may then help us understand why strength training and HIIT training is so important? Because I guess, Stacy, a- as I've been researching you, more and more, 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 16:35 Yeah

Dr. Rangan Chatterjee 16:35 ... so that we can make that case. And frankly, if that's-

Dr. Stacy Sims 16:38 Yeah

Dr. Rangan Chatterjee 16:38 ... all we do in this podcast is make the case for those two things, I think we'd both be really happy.

Dr. Stacy Sims 16:43 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 37, 38, 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 28 to 35 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 40s 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. We don't want to 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

Dr. Stacy Sims 20:16 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 proteins. 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.

Dr. Rangan Chatterjee 22:03 Mm.

Dr. Stacy Sims 22:03 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 onto 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, 80% to 110% 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 insulin. It 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 23:55 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-

Dr. Stacy Sims 24:35 Yeah

Dr. Rangan Chatterjee 24:35 ... changes that occur. Okay. NowThrough 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?

Dr. Stacy Sims 24:54 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 25:16 Yeah

Dr. Stacy Sims 25:16 ... 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 25:42 Mm-hmm.

Dr. Stacy Sims 25:43 So what is the evolutionary thing around it? No one really knew-

Dr. Rangan Chatterjee 25:46 Yeah

Dr. Stacy Sims 25:46 ... 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 26:17 Yeah.

Dr. Stacy Sims 26:17 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 27:09 Mm-hmm.

Dr. Stacy Sims 27:10 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 27:30 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 a 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's 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

Dr. Rangan Chatterjee 28:30 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-

Dr. Stacy Sims 28:48 Mm

Dr. Rangan Chatterjee 28:48 ... contraceptive pill. How does that potentially change things or influence the things that you've just been talking about?

Dr. Stacy Sims 28:58 You won't know if you're in perimenopause because the whole goal of an oral contraceptive pill is to downregulate 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 and 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 if we need to understand how your body is through perimenopause, it's 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 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 an 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 an 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 32:32 Yeah.

Dr. Stacy Sims 32:32 So that's where we look at strength training and high-intensity work.

Dr. Rangan Chatterjee 32:35 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. BON CHARGE are a wellness brand that have a fantastic range of products designed to help you feel better, live better, and sleep better. From blue light glasses to red light therapy devices and beyond, BON CHARGE make it really easy for you to prioritize your wellness at home, and I myself have been using many of their products for well over five years now. One of my current favorites is their Demi Red Light Therapy device. I've been following the research on red light therapy for many years, and the potential benefits include enhanced recovery, better skin, improved eye health, and also improved sleep. Now, since I got this panel, I've been sitting in front of it for about 10 minutes every morning whilst reading and 10 minutes every evening, and I'm definitely finding that I feel more relaxed, I'm falling asleep much faster, and overall, I would say I've had a big increase in energy. To get 20% off all of their products, go to boncharge.com/livemore. 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

Dr. Rangan Chatterjee 34:37 changes. So let's go into detail then on strength and HIIT training. Um, strength training, okay? Or you, I think you used the term resistance training.

Dr. Stacy Sims 34:48 Mm-hmm.

Dr. Rangan Chatterjee 34:48 And again, all these terms, I think, often get confusing for people because they all... 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?

Dr. Stacy Sims 35:12 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 38:19 Mm.

Dr. Stacy Sims 38:19 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 38:43 Yeah.

Dr. Stacy Sims 38:43 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 39:35 Yeah. There's so many interesting points there to unpick. Okay, the, the, the first one for me is you mentioned the phrase muscle toning, and for those of you who are just listening, um, Stacy put toning in inverted commas as she was saying that to me. Okay, so I think this is important because I think we need to address often the elephant in the room, right? Yes, people want to improve their health and their hormonal profiles, but I think it's fair to say that vanity is also important-

Dr. Stacy Sims 40:10 Huge

Dr. Rangan Chatterjee 40:11 ... to many people, right? And it's as if you can't really say that anymore. And I guess coming on from that, that is, what do you think of the phrase muscle toning? And are these changes or these, um, recommendations that you make around strength training and HIIT training, are they going to help women with their physique and losing belly fat as well as their hormonal profile and long-term health?

Dr. Stacy Sims 40:43 It will do more for them in a shorter amount of time than if we're following the traditional fitness muscle toning type workouts. And I say muscle toning at, with air quotes-

Dr. Rangan Chatterjee 40:56 [laughs]

Dr. Stacy Sims 40:56 ... or inverted, inverted quotes because it is a fitness phrase. It's not in physiology. It's not in any strength and conditioning journal. It has just become something that has gendered the language around strength training. So I like to bring it into perspective where the strength training world is very, very gendered and sexist because if you are a woman now who goes into a traditional gym, and you're very uncomfortable with your body composition, and you wanna look to lose weight, but you don't necessarily wanna say that, unfortunately, you go to most of the gym chains who are out there, and there's gazillion of them, a woman will come in and they'll say, "Oh, here's the class schedule for all, or our spin classes and our boot camp," but they won't be directed to the weights. Whereas a guy will come in and might have the same thing, where, "I want to change my body composition. I want to feel better about myself," and they'll say, "Okay, how much muscle do you wanna gain? Here are the lifting platforms." So we're already up against it as a woman walking into this situation of strength training and the gym. So if we say muscle toning, that is a gendered language to make it seem like it's okay for women to be lifting lighter weights and they're doing strength training. But it's not the same. It's more of a metabolic stress. But if we're going to look at a metabolic stress, and we want to change our body composition, and we want to look good for summer, then we need to really put in the work. It doesn't mean spending 90 minutes doing a workout, because that puts womens fully in a metabolic stress that is too easy to be hard to be zone two or recovery or relaxation or improve our parasympathetic and is way too easy to be hard enough to instigate any kind of adaptive change that we want for body composition and longevity.So when I talk about muscle toning, I get very frustrated with that because it's such a gendered term that has no place in any of the conversations that's going to improve women's confidence and to break through this barrier of the sexism that exists in the strength training world.

Dr. Rangan Chatterjee 43:24 Yeah, I appreciate your clarity with that. As you were talking then, I was reflecting on my own experience of working out as a man, and, you know, I don't go to gyms now. Having said that, I, I do a lot of body weights, I do a lot of strength training in my garden, which we can talk about later for sure. But you're right, that phrase toning, it doesn't do anything for me as a man. I'm like, yeah, whatever, you know? It, it... I, I do associate it as a female term, and it's, it is incredible when you think about it. It, it's just pure marketing. It's pure marketing, isn't it?

Dr. Stacy Sims 43:55 It is.

Dr. Rangan Chatterjee 43:55 It's pure marketing. Um, and of course, you know, again, without being overly prejudicial to men v women, of course, it is designed to appeal to one sex more than another.

Dr. Stacy Sims 44:08 Yeah.

Dr. Rangan Chatterjee 44:08 Um, and then I guess you mentioned time there. So I wanted to go at Pilates, and I'm not trying to pick on Pilates here at all. It's just 'cause you mentioned Pilates, okay? Because there, there... I'm sure there's plenty of women and men listening to this podcast right now who do enjoy Pilates-

Dr. Stacy Sims 44:25 Mm-hmm

Dr. Rangan Chatterjee 44:26 ... and have found it helpful for maybe their back or their core or whatever it might be, and y- you as well.

Dr. Stacy Sims 44:31 Me.

Dr. Rangan Chatterjee 44:31 Okay.

Dr. Stacy Sims 44:32 Yeah.

Dr. Rangan Chatterjee 44:33 Great.

Dr. Stacy Sims 44:33 Yeah.

Dr. Rangan Chatterjee 44:33 So this is where this nuance gets missed these days, right?

Dr. Stacy Sims 44:38 Absolutely.

Dr. Rangan Chatterjee 44:39 So Pilates, okay? You're not against Pilates, I'm guessing, but you're saying that actually Pilates per se will not be doing what you're asking women to pay attention to once those hormonal changes start to kick in, potentially at the early age of 37, right?

Dr. Stacy Sims 45:00 Correct. Yeah. So we look at Pilates, it is... I shouldn't say it's not strength training, because it is very muscle-centric, but Pilates is designed to be more isometric and to give lots of proprioception, balance, control, breathwork, which is all really good things.

Dr. Rangan Chatterjee 45:21 Okay.

Dr. Stacy Sims 45:21 We want all of these things. But when we're looking at building strength for longevity and creating power and looking at how we are going to encourage lean mass and bone to develop and stay, we need heavier loads than what Pilates offers. So when women are like, "Oh, you're so anti-Pilates," I'm like, "No, it just isn't the bread and butter of your strength training." When I'm talking about lifting heavy loads, we're minimum two days a week, preferably three, and if you really love Pilates, you can do Pilates in there, too. I don't want to take away people's soul food. I'm saying if we're looking at what optimizes a woman's body as she's going through perimenopause and into post-menopause, because what we do in perimenopause, we want to carry it through the rest of our lives. There are things that you can optimize from an external load to really create a stress-resilient, strong frame, both mental and physical frame, to carry you through to your late years of life. And we also have room for soul food. For me, my soul food is going and riding my gravel bike for hours and hours, but that doesn't fit into HIIT and strength training. But it fits into what I call soul food because it's good for my brain, I like being outside, seeing my friends. So Pilates can fit in there.

Dr. Rangan Chatterjee 46:48 Yeah. It, it's kind of interesting. It, it, it sort of implies to me that even the word exercise or even movement perhaps is too broad, right? Because by saying one pillar of health is movement, which I say and I, I agree with, okay? And I wr- wr- wrote a book with that in it, right? So it's-

Dr. Stacy Sims 47:11 [laughs]

Dr. Rangan Chatterjee 47:11 ... not that I'm necessarily disagreeing with that, but the problem is then is that different movements, different forms of so-called exercise provide different stimuli to the body, and therefore, different adaptations. So we as a society have to be more specific with the adaptation we require. Once we know the adaptation we require, we can choose the right movements or exercises to give us that adaptation. So going back to Pilates then, and again, I want to emphasize that we're not picking on Pilates here, okay?

Dr. Stacy Sims 47:45 [laughs]

Dr. Rangan Chatterjee 47:45 When I had a bad... But I did Pilates for years, okay? I, I, I don't anymore, but I, but I did for, for a long period of time, okay? Um, time plays a role here, right? So if, let's say, let's say you're a woman, you're 40 years old, or, or, you know, whatever. But let's, let's say you're 40 years old and you go to a one-hour Pilates class a week. You know, you- you're-

Dr. Stacy Sims 48:08 Mm-hmm

Dr. Rangan Chatterjee 48:08 ... busy with, you know, whatever, work, being a mom, like, the, the things of life, but you've found time to go to a one-hour Pilates class a week, and perhaps you go for a few walks throughout the week when you can. If all you have is that one hour, outside those walks perhaps, to dedicate to your health and wellbeing, I guess then the further question is, is that the best use of your hour, or might you, Stacy, argue that if you've only got an hour, you might wanna do three 20-minute, um, strength training sessions instead of Pilates? Or help us think about that a little bit for the woman who's time-pressed.

Dr. Stacy Sims 48:50 Yeah. I mean, that's almost who I talk to every day.

Dr. Rangan Chatterjee 48:53 Okay.

Dr. Stacy Sims 48:54 Like, women who are in their 40s, they're working, they're married, they have kids, or they have a partner and they're not married, but their lives are very full. I have a group of women who say they're the 5:00 AM club because that's... They have to get up and get their stuff done and be back by 6:00 AM. So fully understand that. So if we're looking at a woman who has maybe one hour a week that she can dedicate for herself, and then, like you said, throw in a couple of walks here and there, maybe after work or on the weekend-We have to look and focus on that one hour. What can we do? Maybe we can split that up into three 20-minute strength training sessions, but that would require, you know, three separate days, and maybe she only has that one hour. So if I were to look at that one hour, I would s- structure it into three 20-minute segments, where the first one is we're doing lots of mobility work, so we make sure that we stay injury-free. So we're looking at opening the joint capsules and creating more range of motion. So it's not stretching, but it's working on proprioception, it's working on in-range, it's loosening up the tendons and the ligaments. Then I would do 20 minutes of compound heavy resistance training. Then I would finish with some sprint interval work. So this would be 30 seconds as hard as you can, 110% effort, and then you have two to three minutes full recovery, and you might do that two or three times. AssaultBike's great for that. Maybe you're doing kettlebell swings. But that stimulus at the end of the mobility and the resistance training is what you need instead of a 35 or 40-minute HIIT class. So we're looking at that one hour, and you can do that once a week. That's a bare minimum that's going to help create the impetus for better body composition change and brain health. Because the other thing about heavy resistance training is it works on the neuroplasticity of the brain, and when we're looking at neuroplasticity, we want that because we want to be able to maintain our ability to have cognition and not experience cognitive decline.

Dr. Rangan Chatterjee 51:06 Yeah.

Dr. Stacy Sims 51:06 And then you can look at your walks. Maybe one of your walks with your dog, you go, okay, well, instead of just going on this normal 3K walk with my dog, I'm gonna take the dog and I'm gonna divide that 3K up and maybe I'm going to pick up the pace for a minute or two, and then I'm gonna have a minute recovery. So you take that into a HIIT session. So there's ways of looking at what you're doing during the week, even if you are time-constrained. I have some women who are on the early crew for the breakfast shows, so they're getting up at 2:30, 3:00 in the morning to be on set by 3:30 or 4:00. And they get up and they do a 10-minute, um, high intensity with kettlebells to wake themselves up, but it also helps with the circadian rhythm shift that happens when you start doing those kind of night shifts. So there's things that we can do with very short amount of time that's gonna maximize our adaptations to improve all the things that we need to improve for better metabolic and body composition.

Dr. Rangan Chatterjee 52:10 Yeah. I guess so, so a helpful, um, perspective or a helpful framing for someone to think about this might be, once I become perimenopausal, I am undergoing certain hormonal changes, and there are two particular things that I need to be focused on in terms of my movement as I get older as a woman, right? Resistance training and HIIT training. So I guess you would argue, I think, that it's not that you're against Pilates or yoga or walking. Those things are all great, and you would encourage those things, but you have to be aware that those things are not addressing a lot of those hormonal changes that are kicking in, right? So do them and do the other stuff, but if you can't find time for the other stuff, maybe that should be where your priority is first. Is that an accurate representation of how you would look at this?

Dr. Stacy Sims 53:10 Yep. If we have minimal time, let's make the maximum gains.

Dr. Rangan Chatterjee 53:14 Yeah.

Dr. Stacy Sims 53:15 So if we have minimal time, let's make sure that we are working hard and recovering from that hard work.

Dr. Rangan Chatterjee 53:21 Okay. So let's-- W- we have covered strength training, but I just want to make sure that it's super clear, okay? So you mentioned that this is the power end of the spectrum. I'd love to understand what do, what does that actually mean? And are you talking about, you know, the heaviness of the weight? You also mentioned speed, right? So is it the speed at which you pick it up? Because I'm guessing that, you know, a kettlebell swing, for example, depending on what weight you use, has got a degree of intensity to it. Whereas, I don't know, if, if you're doing a, a heavy deadlift, for example, are you asking women to not only, uh, pick up heavy, but also pick up heavy fast? Are, are both those inputs as important as each other?

Dr. Stacy Sims 54:06 So when we're looking at the strength training component, it's about lifting the heavy loads.

Dr. Rangan Chatterjee 54:11 Okay.

Dr. Stacy Sims 54:11 So this is your zero to six, maybe seven reps. We like to talk about it as reps in reserves, where I'll tell a woman, "Go pick up the dumbbell that you usually pick up for your, um, shoulder press or your bench press." And then I tell her to put it down and pick up the next one. "Okay, let's try to do that movement with the next one. How many reps can you do?" Most of the time they'll eke out 10 to 12. Tell them to put that down and pick up the next one, and that's their starting weight, 'cause most women are so conditioned to undervalue their strength, they don't lift heavy enough. So it is a phase-in, because when we're talking about this, it's a learned skill. So if someone's never done any kind of resistance training, they're not gonna hop into the really heavy loads right away. It could take up to six months to a year to learn how to lift heavy properly. So in that timeframe, yes, you're going to be using lighter loads and more reps. You're trying to condition the muscle and the tendons-

Dr. Rangan Chatterjee 55:10 Mm

Dr. Stacy Sims 55:10 ... and the ligaments. When we start adding the speed component in, that's part of strength training from a plyometric and an intensity standpoint, and that's different. So we can use that as a metabolic stress, but we're looking at specifically the power-based end of strength training. This is where we say it's the zero to six to maybe seven, eight reps.And we do a periodized program with that.

Dr. Rangan Chatterjee 55:37 Okay.

Dr. Stacy Sims 55:37 And then if we're looking at the plyometric stuff, then that can be put into high-intensity interval training or it can be sprint interval training.

Dr. Rangan Chatterjee 55:46 Okay. So for the strength training, you wanna focus on power lifting heavy, a weight that you can perhaps li- lift six to seven times, and you wanna repeat that. Like, you do that, let's say you lift that weight six times, you have a rest, and then you repeat that a few times?

Dr. Stacy Sims 56:04 Well, this is where you have to look at what kind of programming you're doing.

Dr. Rangan Chatterjee 56:06 Okay.

Dr. Stacy Sims 56:07 So we say a, a typical, a typical example is the 5x5, where you have five sets of five reps with two to three minutes between each set. So you would do five heavy deadlifts, rest two minutes, do another five heavy deadlifts, rest two minutes, and probably by the time you get to the fifth set of five, you're like, "I can't finish that five." So you're almost to fatigue, and that would be a really good heavy-lifting session. So when we're looking at 5x5, that's what we talked about.

Dr. Rangan Chatterjee 56:42 Okay. For the woman who hates gyms-

Dr. Stacy Sims 56:47 Mm-hmm

Dr. Rangan Chatterjee 56:47 ... right? Who, for whatever, for whatever reason, they don't like going to gyms, okay, what are some things that they can do at home? Appreciate you might need some instruction, and there's a risk of injury, and you have to build up slowly. You know, I, I understand all those things. But for someone who feels that they could and they want to start strength training, but they wanna do it at home, I, I mean, for, for example, I, I've fallen in love with sandbags over the past year. So I've got these-

Dr. Stacy Sims 57:16 Yep

Dr. Rangan Chatterjee 57:17 ... sandbags in the garden. I've got a three or four, and, um, one of them I've underfilled a bit, so I know the kids can carry them, so I'm trying to just gently encourage my children to copy me and mimic me, which is, is semi-working, [laughs] uh-

Dr. Stacy Sims 57:31 Awesome

Dr. Rangan Chatterjee 57:31 ... depending on what day of the week it is. But what about a sandbag, for example? If, if someone has that in their garden, can they just lift a sandbag over their head five by five? Or, or, or, or what are some other options for people who wanna do all of this at home?

Dr. Stacy Sims 57:45 Yeah. I mean, you can start with loading a backpack up and using that with air squats, right? So you can put canned goods, or you could put a sandbag in your backpack. [laughs]

Dr. Rangan Chatterjee 57:56 Mm-hmm.

Dr. Stacy Sims 57:57 So there's ways of adding external load while you're at home. There's some really fantastic apps available now, too, of guiding women at home first through resistance training body weight into adding load at body weight, or I mean adding load with their body weight, and it could be buying a couple of kettlebells. It could be using sandbags. It could be, uh, old tires that you're using tire flips, or maybe you're doing deadlifts, deadlifts with old tires. Like, there's lots of things that you can do that doesn't require you to actually go to a gym. It's understanding what your environment is, how you feel about being by yourself working out, or do you need a partner to work out-

Dr. Rangan Chatterjee 58:36 Mm

Dr. Stacy Sims 58:36 ... work out with? Um, because community is huge. We see women really gravitate, especially if they have a lifting partner or a friend who's on the same journey, see better, um, adherence and, and better progression when you have community around you. So it depends on the individual, but everything is totally doable at home. It depends also on what you want to invest in. But starting out with your body weight and then adding load through a backpack or sandbags, like you're talking about, a weighted vest, anything that's gonna add a little bit of external load, it's all extra stress on the muscul- musculoskeletal system that is going to benefit you. But when we start lo- talking about the true power-based loads, this is where we have to look at using gym equipment. Like, I have a rig and stuff in my garage 'cause I don't necessarily wanna go to the gym, but I have the capacity to lift heavy in my garage, but that's an investment that people may or may not want to, to make. So yeah, it's where you are in your journey, and let's figure out where you are in your journey, and maybe it's connecting with the Betty Rocker or Hailey Happens or Loretta Loves Lifting that all guide you through starting the journey and then, boom, now you feel confident to go to a gym.

Dr. Rangan Chatterjee 59:52 Yeah, I love it. And, and, and I guess the key point is if you're not lifting heavy, there are certain adaptations which you're just simply not going to get, which you probably really, really wanna get as you go through perimenopause and beyond. 'Cause frankly, what we're talking about, or I know I've mentioned the age 40 quite a lot so far, but it's not just that you need to do this when you're 40, right? This is kind of the pattern for the rest of your life, like, through the menopause, even into post-menopause. In fact, you've got this quite catchy phrase, don't you? "Be the oldest person in the gym, not the youngest person in the nursing home."

Dr. Stacy Sims 1:00:29 Exactly. Yep. And I, I like to point out the Instagram account, um, Train with Joan. So Joan is 72 or 73 now, and she started her strength training journey in her late s- was it late 60s, mid-60s? She hasn't been lifting very long, but she was facing a lot of the typical things that a peri/post-menopausal woman faces, extra visceral fat gain, pre-diabetes, low bone density, and her daughter's a personal trainer, and she's like, "I want exercise. I don't want drugs." So she started strength training, and now she is this phenom who started lifting late and is benching, you know, 55 kilos as her, her bench press, and she's deadlifting 100 kilos, and it's just the progression that she's had, and she's a really great image to show what heavy lifting can do for you. And I think one of the reasons people gravitate towards muscle toning is they're afraid of getting bulky.But it's really, really, really difficult for women to get bulky unless they have a genetic predisposition for it, and that's a rarity. So, a, one of the other fears for women getting into the gym and start doing the power-based stuff is they don't wanna look like all the CrossFit athletes or the power lifting athletes.

Dr. Rangan Chatterjee 1:01:57 Mm.

Dr. Stacy Sims 1:01:57 They work really hard to build that muscle and keep that muscle. If you're a woman who's just doing the strength training and the power-based stuff and eating well, you're not gonna get bulky. You're gonna get strong, you're gonna have really good cognitive faculties, and you're gonna have really strong bones, and those are the things that we're after.

Dr. Rangan Chatterjee 1:02:17 We've mentioned stress before and how, you know, a lot of women, a lot of, a lot of men as well, to be fair, but, but let's keep this on women, a lot of women feel, particularly in midlife, that there's a lot going on. There's a lot they're having to juggle, and they're dealing with a lot of chronic stress.

Dr. Stacy Sims 1:02:36 Mm-hmm.

Dr. Rangan Chatterjee 1:02:37 We know that different forms of exercise can put different levels of stress on the body. So for that woman who does feel chronically stressed and that they don't have much time, is there a risk that strength training and lifting heavy is going to be an additional stressor which can cause problems? And I guess piggybacking off that is a phenomenon that I've seen in patients before, Stacy. Um, I've got a few people in mind, actually. Let's say, a couple of those patients had autoimmune, uh, disease. They were quite, uh, unwell and tired and i- i- and, you know, for, for a variety of different reasons. But in order to get going, they would hire a personal trainer, which I think-

Dr. Stacy Sims 1:03:27 Mm-hmm

Dr. Rangan Chatterjee 1:03:27 ... if you have the budget and you have the resource, can be fantastic, for sure. But of course, not everyone does. But what I notice is a lot of the personal training sessions are one-hour sessions, and sometimes I have seen women who would go and do these one-hour PT sessions, and it would almost be too much for their immune systems. That was, you know, they'd come out in viral outbreaks, or they'd get sick. And I've seen that a lot.

Dr. Stacy Sims 1:03:53 Mm-hmm.

Dr. Rangan Chatterjee 1:03:53 And I think one of the things you talk about, which I really like, is that actually you probably don't need to lift weights for a whole hour, right? Maybe even 20 minutes of lifting heavy will give you a great stimulus. So can you address that point, but also the more broader point, which is what does strength training do to our stress load?

Dr. Stacy Sims 1:04:14 Yeah. So I'll start with what does it do to our stress load. If we are lifting properly, and what I mean by that is if we have the goal to go in and do heavy l- heavy loads, it's not a metabolic stress, so we're not going to get the subsequent increase in cortisol and not have a s- a, a response to counter it. So when we're looking at a central nervous system response, we'll have a lot of women who will go to the gym, and I'm like, "Look, we want you to go in, and we want you to assess, how do I feel mentally on a scale of one to 10? How do I feel physically on a scale of one to 10?" Often they'll front up, and they're super busy and they're tired, and they're like, "Mentally, I feel like a two. Physically, I probably am a six." Okay, so let's warm up. Let's actually do a couple of heavy lifting reps there, 'cause often we see that that sparks up the central nervous system, and then mentally they come up to that six.

Dr. Rangan Chatterjee 1:05:10 Mm.

Dr. Stacy Sims 1:05:11 And then as they go through their session, they feel tired, fatigued, but elated. It's different from tired but wired.

Dr. Rangan Chatterjee 1:05:22 Hmm.

Dr. Stacy Sims 1:05:22 Because it's not a metabolic stress. And when we're talking about the heavy loads, it can only be 20 minutes. If we're doing compound movements, if we're doing s- heavy squats or we're doing deadlifts, we focus on that compound movement for 20 minutes. It opens up and, and it stimulates central nervous system. It doesn't invoke a metabolic stress, which a lot of people associate with heavy loads and hard classes, where we've been conditioned to feel smashed at the end.

Dr. Rangan Chatterjee 1:05:54 Hmm.

Dr. Stacy Sims 1:05:55 We don't have to do that. So that's the beauty of strength training, is you can have a really solid session and walk out feeling good and not smashed. And this is the one thing that I really am trying to educate women, that the idea of having a sweat session and feeling smashed at the end of a, of a class or at the end of an exercise session is not the norm. There are some sessions, yes, where we're looking at doing a true high-intensity interval session, when we are doing sprint intervals, where yes, you're gonna get sweaty, but you shouldn't feel smashed at the end. Because we've all been so conditioned that we have to go to a 45-minute spin class and hit it hard for 45 minutes and come out feeling sweaty and just completely smashed by that class, or a boot camp class.

Dr. Rangan Chatterjee 1:06:46 Yeah.

Dr. Stacy Sims 1:06:47 But that's not the load that we want.

Dr. Rangan Chatterjee 1:06:49 Yeah, so m- maybe perhaps the take-home for an individual, but also let's say there's a personal trainer, uh, listening to our conversation right now who trains a lot of women and is recognizing, wow, yeah, actually, sometimes one hour of pushing my client is, is too much for them, so they keep getting injured or they're knackered and they're, or they come down with a cold, so they're having to cancel that session, because this happens a lot. Um, perhaps it's about thinking up new business models. So could I offer 30-minute sessions? Or I guess it could even be maybe in that one hour, after a 10-minute warm-up, we only do 15, 20 minutes of strength training, and then we work on mobility and, you know, other kinds of things. Again, I'm not trying to tell anyone-

Dr. Stacy Sims 1:07:36 Yeah

Dr. Rangan Chatterjee 1:07:36 ... how to do their job, but does that sound like a reasonable approach for someone to take, perhaps?

Dr. Stacy Sims 1:07:40 Absolutely. Absolutely. And the other thing I like to remind women is that-We have a societal pressure where we have to follow instructions really well, and we can't apologize, or we over-apologize and we can't take control. And I tell women, "Look, you're paying for the PT session. You're paying for the CrossFit class. You're paying for the Orange Theory. You're paying for these things. Make it work for you and your body." So if you go and you hire a PT, you should have a relationship where you could say, "You know what? For my body in perimenopause, these are the things I need to do. I need to lift heavy for a shorter period of time within this hour, and I need to really spend a long time warming up so I don't get injured. So let's make this, this work for us, where we have mobility, strength, um, you know, get into the heavy lifting, and it takes time to warm up to be able to execute the heavy loads properly, and then have a really good cool down. Or maybe we're gonna split that hour up, where we're lifting for one half of it, and then the other we work on some sprint capacity." But you have to have those conversations, otherwise you're just gonna show up and they're gonna tell you what to do, and it might not be right for your body during this life phase.

Dr. Rangan Chatterjee 1:08:59 Yeah. I really appreciate you saying that, because I've... I, I mean, you do see this in men, of course, as well, but I've definitely seen this in female patients before, where they come in and say, "Yeah, but the class was doing this," or, "The person at the gym wanted to do this, and I didn't feel I could say anything." And I guess that's a much wider point about finding our inner voice and actually-

Dr. Stacy Sims 1:09:17 Mm-hmm

Dr. Rangan Chatterjee 1:09:17 ... you know, trusting ourselves and having the confidence to speak up for ourselves and say, "I get that you want to run your class like that, which is fine, but I'm not gonna do those two things at the end," or, "That doesn't work for me." But too often we're scared about fitting in and not offending anyone, and, you know, I think that's a, that's quite a, it's a very, very important point that I think you just raised there. So hopefully that will give a lot of women that confidence. Strength training, before we just move on to HIIT training then in detail, just remind us, Stacy, if you will, there are certain changes that happen, um, once a woman hits around 40, although it probably starts a bit earlier, and you're saying that strength training is one very effective way to mitigate some of those changes. Just top line remind us of the changes that strength training does which helps us, uh, i- in that regard.

Dr. Stacy Sims 1:10:15 There's so many things, but I'll try to be brief. [laughs] So we look at, um, improving our overall power and our strength capacity. So that means our grip strength, our ability to carry our groceries, our ability to, uh, right ourself if we step off a curb wrong. So all of these things that are just part of life. We see that the, um, central nervous system involvement helps with neuroplasticity, which is brain health, which helps reduce the risk factor for cognitive decline. We see that strength training improves our gut microbiome, which means that now we have a better diversity, which reduces the stimulus for an obesogenic outcome of our gut microbiome. And we see that it's a push/pull on the bone, which improves our bone density. So those are our high touches.

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Dr. Stacy Sims 1:13:13 When we look from more of a cardiovascular standpoint, we can also see that strength training helps with our vascular compliance, so it helps with our blood pressure. We see that improves our metabolic control as well. So the more lean mass we have, the more active muscle we have, the more we have of a glucose suck. So that means that we have better blood glucose control. So there's so many things that happen through, um, perimenopause, that if we put strength training in and become more muscle-centric, where we're building our muscle, building our strength, our power, our bone, then it also attenuates some of these side effects that we see from perimenopause.That women really are like, "Ugh, I'm putting on visceral fat. I'm losing my lean mass. I'm getting weak, and my, um, resting blood glucose is suddenly in the pre-diabetic range." Strength training helps with all of those things.

Dr. Rangan Chatterjee 1:14:09 Yeah, I mean, you- you've, you've made the case, right? [laughs] Increase in your power, increase in your balance, your strength, central nervous system responses, reduced risk of Alzheimer's, increase in bone density, lowering your visceral fats, improving your body composition, better blood pressure, better cardiovascular health, better metabolic health, better glucose control, all of which you can directly address by lifting heavy for a small amount of time several times a week, okay? So we've, we've made that case, Stacy, I think. You've made it beautifully, and for the men who are listening, um, we're also gonna get a lot of those benefits as well. Even though we don't have those hormonal changes, we're still gonna get incredible benefits, aren't we?

Dr. Stacy Sims 1:14:58 Absolutely, because as we age, both men and women, we become more anabolically resistant to exercise and protein. So the more strength training you put in, the more your body responds to building muscle and building bone, both men and women. So yeah, it's just when we look at aging, we see women have this definitive point in time where all of a sudden they're feeling the effects of aging, and it's perimenopause. Whereas men age in more of a linear fashion. We see a blip in their 40s, and we see a blip in their 60s, but it's not as overt as what's happening to women in perimenopause.

Dr. Rangan Chatterjee 1:15:38 So there's almost a sense of urgency for women. Like, the biology is changing. Your physiology is changing, and, it, I mean, would you say that's fair to say that your message is, it's one of empowerment, but it's also one of urgency? Yes, you've acknowledged Joan, who started training late, so it's never too late. At the same time, why wait until your 60s and 70s? If you can get the message now, why not start in your 30s?

Dr. Stacy Sims 1:16:06 Yeah. Yeah. And I say this coming from an incredible endurance background.

Dr. Rangan Chatterjee 1:16:13 Mm-hmm.

Dr. Stacy Sims 1:16:13 Like, I was an ultra runner. I raced IRONMAN. I raced road bikes. I did XTERRA. Like, fully vetted in endurance world. But strength training is something that was exposed to me early days, but I didn't really understand the value and the power of it until I started working with Marci Stefanick at Stanford in the Women's Health Initiative data-

Dr. Rangan Chatterjee 1:16:39 Mm-hmm

Dr. Stacy Sims 1:16:40 ... where we really started looking at the outcomes and longevity from DEXAs of who had more lean mass and who did strength training versus those who didn't. So it wasn't really even about attenuating any of the menopausal symptoms. It was about let's look at the viability and the quality of life for women who entered the study when they were in their 60s and now they're in their 80s or 90s, who's doing the best? And it was those women who were more muscle-centric and strength-oriented, and I was like, "Okay, now let's really start getting into the strength training thing."

Dr. Rangan Chatterjee 1:17:15 Okay, let's move on to the second key exercise that you are recommending women pay attention to as they get older, HIIT training, high-intensity interval training. That is a term that is used a lot. It is misunderstood a lot. So why don't you take it from the top. What is it, and why is it so important for all of us, but particularly, I guess, for women to do as they get older?

Dr. Stacy Sims 1:17:43 Yeah, so, um, globally, Western society's become very comfortable in environments that doesn't challenge the body, right? We sit in rooms that are temperate. We have food and water available all the time. So when we ask someone to become uncomfortable, they're like, "Eh." High-intensity interval training is the uncomfortable part of exercise that really does invoke positive change. So when we talk about high-intensity interval training, it is where we're looking at polarizing a session, where our intervals are 80% or more of our maximum effort, and our recovery can be anywhere from one to four minutes at 50% of our capacity.

Dr. Rangan Chatterjee 1:18:31 Ca- can I just pause you there, Stacy? Only because-

Dr. Stacy Sims 1:18:33 Yeah

Dr. Rangan Chatterjee 1:18:33 ... the term polarized, some people who are listening maybe haven't heard that. If you could just explain what polarization is.

Dr. Stacy Sims 1:18:41 Mm-hmm.

Dr. Rangan Chatterjee 1:18:41 But also, then when you say 80% and 50%, you're not necessarily implying that people have to get heart rate monitors and measure all this stuff, are you?

Dr. Stacy Sims 1:18:49 No, not at all.

Dr. Rangan Chatterjee 1:18:49 So could you just clarify those two things just so everyone's on board with, with this as we go forward?

Dr. Stacy Sims 1:18:55 Sure. Sure. So when I talk about polarized, I mean the top end of effort and the very bottom end of effort. We wanna stay out of the middle.

Dr. Rangan Chatterjee 1:19:02 Okay.

Dr. Stacy Sims 1:19:03 'Cause the middle is what we call the gray zone, and I mentioned it earlier, where it's too easy to be hard, and it's too hard to be easy. So you don't really get very much adaptation in that kind of middle zone. So we want the really hard part and the really easy part, and then we call that polarized training. When I talk about 80%, on a scale of 1 to 10, you're hitting an 8, 9 or a 10 in our efforts, and for our recovery, we're hitting a 4 or 5 in our effort. So we're really like, okay, bring it right on down to really easy, trying to recover fully before we hit the next interval. So when we're talking about high-intensity interval training, there's also a subset in there, sprint interval training, which I'll get to in a minute. But an example, a really good example of high-intensity interval training is something that we like to say EMOM, every minute on the minute. So for one minute, you might be doing-Uh, tuck jumps or star jumps. The next minute you might be doing some kettlebell swings. The third minute you might be doing some, um, jump lunges, and then the fourth minute, maybe you're throwing kettlebell swings back in. The fifth minute's fully off. So you have four minutes where you're working probably 50 seconds, so you have 10 seconds to go to the next exercise. So four minutes of pretty hard work, one minute of full recovery, and then you hit the four minutes again.

Dr. Rangan Chatterjee 1:20:39 And that's a form of high-intensity interval training?

Dr. Stacy Sims 1:20:42 Right. So you really... It's four minutes of work, one-minute recovery. So that's high-intensity interval training. If I talk about the subset of sprint interval training, this is where the recovery's really important and it's longer. So with sprint interval training, it's 30 seconds or less as hard as you can possibly go, and then you have two to three minutes of full recovery because you're trying to be able to do that interval just as hard, if not harder. And it doesn't mean running sprint. The sprint term is really about the effort. How hard can you go for 30 seconds or less? It could be running up stairs, it could be kettlebell swings, it could be battle ropes, it could be, um, running, it could be assault bike, could be rowing erg, it could be, uh, swimming. It could be any kind of, of mode of exercise as long as the intensity is at that 10 on a scale of 1 to 10 for 30 seconds or less. And then the recovery is two to three minutes to fully recover your central nervous system and some of your metabolic capacity to be able to hit that interval again. Most people were like, "That sounds really easy, so I have to push really hard for 30 seconds. Maybe I'll be able to do four or five of those." When they first start doing them, after the second one, they're like, "Whoa, I'm done. I don't wanna do those again." But it's really important to understand that subset versus high-intensity interval training because they do two different things. So if we look at sprint interval training, so that's, uh, 30 seconds or less as hard as you possibly can with full recovery in between, this is such a strong stimulus and stress to the body that it creates a myriad of epigenetic changes. So this means more permanent changes within the skeletal muscle. Most importantly, we talk about the GLUT4 protein. So if we think about, um, insulin as a key, it opens the door to the cell to allow glucose to come in, but as we get to be perimenopausal and onwards, insulin doesn't work so well. It's like a rusty key in the lock. It doesn't quite open the door. So that's insulin resistance. We talk about GLUT4 proteins. This is like the secret passageway that opens up and says, "Hey, glucose, come on in." So when we're doing that super high-intensity work, we start to express more of those GLUT4 proteins, so now we have availability of glucose coming in, and so we really do get the benefit of better glucose control. The other thing with that super high-intensity work is we now have a greater amount of myokines that are released. So these are those little hormone messengers that get released from skeletal muscle under work. And what the myokine does is it goes and it signals to deliver that we don't need to change the molecular structure of these free fatty acids, acids into an esterified fatty acid. So esterified fatty acids is the form that gets stored as visceral fat. So instead, the myokines say, "No, we want them to stay as free fatty acids so that we can pull them into the mitochondria to use it as rest." So it improves our total lipid profile as well.

Dr. Rangan Chatterjee 1:24:15 So, so when you say free fatty acids, you're talking about, for, in layman's terms, fats.

Dr. Stacy Sims 1:24:20 Mm-hmm.

Dr. Rangan Chatterjee 1:24:20 And you're saying that this fat, instead of being stored as visceral fat, which is that sort of harmful internal fat that cakes our organs, that is associated with an increased risk of, frankly, a lot of different chronic diseases, you bypass that basically when you're doing sprint interval training. W- so this directly is gonna help people with their visceral fat, also their belly fat? Is that fair to say?

Dr. Stacy Sims 1:24:50 Yes. So that's... When we're talking about the metabolic control of things that have changed, sprint interval training is super important to getting that metabolic control, to being able to have better blood glucose, to being able to have better blood lipids, to have less storage of abdominal fat, the visceral and subcutaneous. And because it's such a strong stress, we see the sheer stress on the vessels, so the, the amount of blood that's running against our blood vessels, it causes more what we call VEGF, which is a growth factor that allows our blood vessels to become more compliant, to be able to stretch and-

Dr. Rangan Chatterjee 1:25:33 Mm

Dr. Stacy Sims 1:25:33 ... and contract a lot faster. So we're getting that sheer stress that's allowing our blood vessels to adapt to then have better blood pressure control. So when we're looking at all the things that happen to a perimenopausal woman from a clinical perspective, we see an elevation in our, um, blood lipids, particularly our LDL and our total cholesterol, a change in our orthostatic tolerance or actually an increase in our resting blood pressure. We see a change in our bl- resting blood glucose 'cause we have more insulin resistance.So if we are doing just maybe two of these sprint interval sessions a week, we get these permanent changes, these epigenetic changes that is going to change that clinical outcome for the good. So we get better blood pressure control, we have better blood glucose, we have better blood lipid profiles, and of course, we have the reduction in the visceral fat gain.

Dr. Rangan Chatterjee 1:26:34 Al- although this is overly simplistic, and of course the body doesn't work like this, [laughs] right? Can we say that the strength training that we've been through in detail is better for our nervous system, and our power, and our balance as we get older, and the sprint interval training is better for our metabolic health? I, I know they're both linked. I know you can't-

Dr. Stacy Sims 1:26:59 Well-

Dr. Rangan Chatterjee 1:26:59 ... separate it like that. But is it, is it useful to look at it like that?

Dr. Stacy Sims 1:27:02 Yep, absolutely. It is very useful to look at it that way because there are... When women are faced with what's going on, some women are faced with more scary clinical outcomes with regards to what's happening from a metabolic standpoint, and they might not be seeing as much decrease in their strength.

Dr. Rangan Chatterjee 1:27:23 Yeah.

Dr. Stacy Sims 1:27:23 So they're going to want to put more of an emphasis on metabolic control.

Dr. Rangan Chatterjee 1:27:27 Yeah.

Dr. Stacy Sims 1:27:27 So they're gonna lean into the sprint stuff. Most women start to see aesthetic changes of body comp, and that scares them more than the clinical because the clinical is just on the edge. So they're gonna gravitate more towards the strength training 'cause they want the power and the strength, and they want more of the aesthetic value of building muscle. So it is that individual choice. It's like, but we know these things are happening. It's just when we look at the bell curve, there are people all over the place. So from an individual standpoint, it's like, what's the most important point right now that we can work on? Is it the metabolic control and the metabolic outcomes? Let's lean into high intensity and sprint interval training. Is it the bone density and the lean mass loss? Let's lean into the strength training.

Dr. Rangan Chatterjee 1:28:17 Yeah.

Dr. Stacy Sims 1:28:18 And then we'll add the other one back. We'll add the other one down the line.

Dr. Rangan Chatterjee 1:28:22 Yeah. Okay. This is fantastic, Stacy. Really, really clear and very, very practical. If we just focus on HIIT for a bit longer-

Dr. Stacy Sims 1:28:34 Mm-hmm

Dr. Rangan Chatterjee 1:28:34 ... I think you've just split HIIT up into two broad categories. Um, E-M-O-M or EMOM, um, every minute on the minute, where it was kind of this four minutes of maybe not max intensity, but you know, you're, you're working hard with these different exercises, and then you're having a minute off. So four minutes on, one minute off. And you contrasted that with sprint interval training, or SIT, where it's kind of 30 seconds on as hard as you can, and two to three minutes off. You've just been through the specific benefits of sprint interval training.

Dr. Stacy Sims 1:29:17 Mm-hmm.

Dr. Rangan Chatterjee 1:29:17 How does that compare to EMOM, every minute on the minute? Is it the same? Is it similar? Or are there, you know, some quite significant differences in the adaptations that we're going to get?

Dr. Stacy Sims 1:29:30 Yeah, so if we're looking at the HIIT interval, so high intensity, um-

Dr. Rangan Chatterjee 1:29:37 Can I just pause you there, St- Stacy, only so I've got this clear in my head?

Dr. Stacy Sims 1:29:43 Mm-hmm.

Dr. Rangan Chatterjee 1:29:43 HIIT is the umbrella term, right? Which there's many ways of doing HIIT.

Dr. Stacy Sims 1:29:49 Mm-hmm.

Dr. Rangan Chatterjee 1:29:49 Um, one way of doing HIIT is sprint interval training. Another way is EMOM. Is, is that, is that accurate?

Dr. Stacy Sims 1:29:57 So EMOM is a type of workout in there. High intensity interval training is the umbrella term. Sprint interval training is a subset of that umbrella term. The other half of that is what people typically think of as HIIT, where we are doing between one and four minutes of work at 80 to 90%, or an eight to nine on the scale of 1 to 10, and we have one to two minutes recovery between those intervals.

Dr. Rangan Chatterjee 1:30:24 So, so another form of HIIT that is beneficial?

Dr. Stacy Sims 1:30:27 Mm-hmm.

Dr. Rangan Chatterjee 1:30:28 Yeah.

Dr. Stacy Sims 1:30:28 Yeah.

Dr. Rangan Chatterjee 1:30:28 Okay. Got it.

Dr. Stacy Sims 1:30:30 So when we look at that, it's more, you're spending more time in intensity that's not quite as high as sprint interval. So you have more of a calorie burn, which people are concerned about for some weight loss. You also are creating a greater time under stress that's going to improve mitochondrial health.

Dr. Rangan Chatterjee 1:30:53 Hmm.

Dr. Stacy Sims 1:30:55 And we're also improving, um, blood flow because we have more time of muscle perfusion, so that means we're gonna get the impetus for building more red cell, more plasma volume, um, and having better blood pressure control and, and, and actual change of, of blood flow. So when we're looking at what's happening from a little bit lower intensity and having more time under tension or more time under intensity, it is truly a metabolic response for muscle perfusion. So that means more blood flow to the muscle, more oxygen carrying capacity, more calorie burn, and you're also building more lean mass in that timeframe because you need more muscle to be able to do the activity. The other thing about the little bit lower intensity, longer duration, is the post-exercise response.

Dr. Rangan Chatterjee 1:31:55 Hmm.

Dr. Stacy Sims 1:31:55 So we look at post-exercise response. This is, the big thing that we hear a lot is perimenopausal, post-menopausal women shouldn't do HIIT training because it increases cortisol. So there's a caveat in there. If you're going to a HIIT class-They try to fill the class up 45 to 60 minutes. You can't hold proper intensity that long. So you will get an increase in cortisol because cortisol is released during exercise, but you won't get the post-exercise response that you need to bring it down. Because in that 45 to 60-minute class, you really aren't doing high-intensity work. You're in moderate intensity. You're in that gray zone. So if I bring it back and say, we're gonna do it properly, where we're doing two rounds of four minutes with one minute off, and you're gonna really work to maintain that intensity, post-exercise, you get a boost of growth hormone and testosterone that drop cortisol. So just like your resting heart rate starts to drop as you get fitter over three to four weeks, your baseline cortisol drops over time. So now you are not as sympathetically driven. You can get out of that tired but wired state and have better ability to hit parasympathetic responses. So this is where we have the nuance of what is really high-intensity interval training versus what is the fitness world projecting high-intensity interval training. And that's why I'm like, when we're talking about it, we have to be very specific in what that intensity is and how long we're holding it. Because a true HIIT class shouldn't be any more than 30 minutes. You have a little bit of warmup, you do true intensity and recovery, and then you have a little bit of a cool-down. A true sprint interval session might be 10 minutes total, where you have a warmup, you do a couple of true intervals with recovery and a little cool-down.

Dr. Rangan Chatterjee 1:34:08 Yeah.

Dr. Stacy Sims 1:34:08 Doesn't take a lot of time, but they're both very powerful.

Dr. Rangan Chatterjee 1:34:11 Yeah. Th- this is great because, as we've already acknowledged, many people, many women feel time-pressured. And actually, a lot of your recommendations are very, very time-efficient. Um-

Dr. Stacy Sims 1:34:25 Absolutely

Dr. Rangan Chatterjee 1:34:25 ... you know, really time-efficient. And, and I think there's a really interesting point that I just wanna highlight. We're basically saying that there are certain hormonal changes that happen as a woman approaches menopause. There are things that you can do with specific forms of exercise to mitigate the effects of that. One of those things is this high-intensity type work. But if you're not careful, you won't do it correctly and you'll end up in moderate intensity. So moderate intensity is not giving you the stimuli that you are wanting from the high intensity, and I guess relating to what you just said, because I think a lot about the stress load of exercise-

Dr. Stacy Sims 1:35:20 Mm-hmm

Dr. Rangan Chatterjee 1:35:20 ... in an already busy, stressed out population. I know for me, for example, and we'll probably get to zone 2 in just a minute, one of the things I enjoy doing is doing one hour on my indoor Carroll bike at very low intensity. I might listen to a podcast, I might prepare for a podcast, I might, whatever, um, because I know it's a very low stress load on my system. It keeps me pretty parasympathetic and doesn't drive me into, in, into sympathetic, and it doesn't take me long to recover from that. But what was really interesting in what you said, true HIIT, true high intensity, although it feels very intense, actually is not driving you into that sympathetic, overly stressed state. After the workout, it's helping you come down into parasympathetic, into that relaxation state. That's a kind of critical point I think for people to understand, because it's this whole, you know, stressed out, we're tired and wired, we can't switch off. High intensity is actually gonna potentially help with that, isn't it?

Dr. Stacy Sims 1:36:24 Absolutely. And that's the thing, that's a messaging that gets mixed up in when we talk about it in the fitness world. Because there's this big push for high-intensity interval training, 'cause we see that gives the best body composition outcomes. But when it's not done correctly, we see so many women that get overstressed, they get injured, they maintain that tired but wired, they don't see results. But when you pull it back and you actually hit it hard when you need to hit it hard, recover properly from that, then hit it hard again and recover, then you do get that post-exercise response. 'Cause your body's like, whoa, that was a really strong stress. I need to be over to, be able to overcome it. So I need to repair the tissues, drop the inflammation, drop the oxidation, and I need to be able to fully relax to garner that adaptation. So we see women who are doing true HIIT training then subsequently sleep better.

Dr. Rangan Chatterjee 1:37:29 Mm-hmm.

Dr. Stacy Sims 1:37:29 If you sleep better, then everything gets better.

Dr. Rangan Chatterjee 1:37:33 Yeah. I mentioned the term zone 2 or low-

Dr. Stacy Sims 1:37:38 Mm-hmm

Dr. Rangan Chatterjee 1:37:38 ... heart rate training there. I know not everyone knows what that is. But I wonder if you could just summarize, where has this push to do more zone 2 or low heart rate training come from? What is that type of training, and why perhaps is it more beneficial for men than it is for women?

Dr. Stacy Sims 1:38:02 Yep. So I think the zone 2 conversation really started on the backside of COVID when we started having more of the Peter Attias and Huberman podcasts, and they were really looking after themselves and started leaning into, okay, what's best for my mitochondrial health? And we see that when you are doing low-intensity work-You are relying more on free fatty acids, and that's fine. But remember when I was talking at the beginning of the podcast about the differences in muscle morphology, where women are born with more of our endurance type fibers and men are born with more of our fast twitch type fibers?

Dr. Rangan Chatterjee 1:38:51 Mm-hmm.

Dr. Stacy Sims 1:38:52 So when we look at the endurance type fibers and what zone 2 does for it, it doesn't really do much. Because women, by the nature of being born XX, already have more mitochondria, more mitochondrial protein, better mitochondrial health because they have more endurance fibers. Men don't have that as much, and they are not as metabolically flexible because they also don't have the exposure of estrogen and progesterone across reproductive years, which changes the way that a woman's body fuels naturally. So over the course of the menstrual cycle, we have a change from using more carbohydrate to using more free fatty acids, and we are very metabolically flexible as women. So when it comes down to the zone 2, which is a low intensity, you can hold it for a very long period of time. It's not very stressful. You can have a conversation, and it is getting the heart rate up a little bit, so it's not like you're doing nothing. The whole idea behind it was to improve mitochondrial health and metabolic flexibility. And in, in men, in the male data, works beautifully. But for women, doesn't do the same thing. It's not that I say you shouldn't do zone 2 as a woman, but when we're time-pressed and we're looking at what's the biggest bang for our buck, zone 2 isn't it. It works well for men. Men should spend time doing it, and I say men should spend more time doing it to become more like women, who are already metabolically flexible and have great mitochondrial health. So zone 2 is what we call our soul food for women. I'm not saying don't do it. I'm saying just be careful how much you do, 'cause it's not gonna give you the same benefits as what you're reading in the literature, nor is it going to give you the same benefits for body comp, cognition, and all the things that we've been talking about on the podcast that men will get from doing zone 2.

Dr. Rangan Chatterjee 1:40:58 Yeah. Super clear. Okay. Really, really clear. And I guess the key thing you were saying there is, look, it's not, it's not harmful to do. If you've got infinite amounts of time as a woman and you want to do a load of zone 2 and I guess go for long, slow runs or whatever it might be, what- whatever your passion is or what you call your soul food, go for it. But you're not gonna get the same adaptations or the same benefits as a man is going to get. So therefore, if you are limited on time, just be careful how you are proportioning out that time.

Dr. Stacy Sims 1:41:36 Exactly.

Dr. Rangan Chatterjee 1:41:37 Yeah. Okay. So in my own household, we have an indoor Carol bike, which sits, uh, very near the kitchen. So me, my wife, and the kids are passing it all the time, and I very much love going on it, particularly when the weather's bad or it's cold and I don't have the motivation to go outside for whatever reason. My wife, for example, and me may go to that bike, and we may want to do different things, okay? So I enjoy doing those zone 2 rides. I'll often put on some '80s rock and, uh, it's a switch off for me, right? It's, it's, it's fun time for me to, to kind of do that. But if Ved was gonna get on that Carol bike, for whatever reason, I guess you would probably say think about some form of sprint interval training, would you? Would you say do the 30 seconds all out, rest for two, three minutes, and just maybe do that two or three times, which will take you about 10 to 12 minutes max? Is that what you would say if she was your client?

Dr. Stacy Sims 1:42:40 Yes, absolutely. One workout that I really like to give women who are more endurance focused is, like, here's 45 minutes, okay? And we're gonna get on that bike, and you're gonna cruise along, maybe 10-minute warm-up, super slow, have a couple of, of pedal ups. And then on minute 11, you're gonna go as hard as you possibly can, and you're gonna throw it into big gear, and you're gonna go as hard as you possibly can for 30 seconds. See what that power is. See how long you can maintain it. And then the next four and a half minutes, super low intensity. Super, super low intensity. Then on minute six, you're gonna hit it for 30 seconds as hard as you possibly can and see if you can match that wattage or higher, 30 seconds only, and then cruise it for the next four and a half minutes. So maybe you can do that again, but if that wattage drops, stop, and then just cruise it. So you're getting those sprints, and you're still spending some time on the bike, 'cause from an endurance-spoken person, they like to be on the bike like you do because it's a mental, "Ha."

Dr. Rangan Chatterjee 1:43:50 Hmm.

Dr. Stacy Sims 1:43:50 But for a woman, we need to throw in those sprints.

Dr. Rangan Chatterjee 1:43:54 Yeah. When you are talking to one of your clients, I understand that there are four key areas you look at, sleep, physical, nutrition, and then mind, body, and the parasympathetic state across all of the above three.

Dr. Stacy Sims 1:44:15 Mm-hmm.

Dr. Rangan Chatterjee 1:44:16 Now, when I've heard you talk about this, it's really interesting to me that you start with sleep, then you go to physical, and then you come to nutrition third.

Dr. Stacy Sims 1:44:25 Mm-hmm.

Dr. Rangan Chatterjee 1:44:25 Why do you come to nutrition third and not first?

Dr. Stacy Sims 1:44:32 Like people to understand what a physical challenge is like. So we see people who start to implement movement, and they start to feel better about themselves, and they start to feel better in their body, and they're not changing nutrition. And the reason I say that is because it's so much harder to break through the cultural barriers and the mindset around nutrition to instigate real change that people wanna stick with. Whereas we have the physicality, we start to see improvements in strength in as little as three to weeks.

Dr. Rangan Chatterjee 1:45:10 Hmm.

Dr. Stacy Sims 1:45:11 And we start to see changes in body composition in a little as four weeks without dietary change.

Dr. Rangan Chatterjee 1:45:16 Wow.

Dr. Stacy Sims 1:45:17 When people start feeling better about themselves and seeing that, then you have a greater impetus on changing nutrition. Whereas if you start with nutrition, people are like, "Hmm, but is this a diet? Is this a lifestyle? I don't really know." And it's harder to invoke change in nutrition because of all the things that are wrapped around it. But some people wanna do nutrition first. It's just, in general, through all of the practice and experiences that I've had, I've found that sleep's first, 'cause you can't do anything, invoke any kind of change without really good sleep. Then the physical part comes, 'cause people are, are now bracing for a challenge, and they wanna embrace that challenge. And then they start to feel better and see a new kind of pattern in their life, and they wanna match the nutrition to keep feeling better and moving forward in that progression.

Dr. Rangan Chatterjee 1:46:10 Yeah. Thank you. I love that. I mean, it's, it would be easy to go into a rabbit hole now on nutrition, but I think I'm gonna just park that for hopefully a part two with you at some point in the future. Let me just close off a couple of loose ends from earlier. We mentioned HRT and how you're not a big fan of that term, okay? So let's address that, and the context again is there are these hormonal changes that are occurring as women get older. What can we do, what can a woman do to reduce the impact on them? We've mentioned already exercise in detail. We've hinted at how nutrition can do that. But of course, some women have, are being told that they must take HRT in order to address that. What is your perspective on this area?

Dr. Stacy Sims 1:47:02 So, um, as you noticed, I call it menopause hormone therapy and not hormone replacement therapy, because we're not trying to replace hormones. We can't do that. Our body is naturally unwinding. It's a natural part of aging. And we have changes more than just hormones dropping. Like I said, we have changes in our gut microbiome, we have changes in our receptors, we have changes in our sensitivity to hormones. So when people are like, "I'm gonna go on, um, hormone therapy because I want to stop all of these changes," it doesn't happen. You still have to put in the work. The only thing that menopause hormone therapy has been vetted to do is stop hot flashes and help with bone health. It doesn't stop visceral fat gain. It doesn't stop changes in our lipid and our blood glucose. It'll slow the rate of change, but doesn't stop it. When I talk about hormone replacement therapy, that is more when we think about thyroid, we think about all the other hormones-

Dr. Rangan Chatterjee 1:48:08 Hmm

Dr. Stacy Sims 1:48:08 ... that actually need to be replaced 'cause you're deficient. Perimenopause is not a female hormone deficiency syndrome. It's not a deficiency in hormones that need to be replaced. That's why it's menopause hormone therapy, because it's a tool in the toolbox, and there are some women who really do suffer significantly from the effects of losing their estrogen and progesterone. So we have rage, we have mood changes, we have poor sleep, we have significant metabolic distress, we have significant bone loss, and we see that using menopause hormone therapy in conjunction to lifestyle is a win. But it's not for everyone. Not everybody needs to go on it, and that's where I get frustrated in what's being projected in social media and in popular media that every woman needs to be on it, because it's, it, the longevity hasn't been shown in this, and not everybody suffers from the same thing.

Dr. Rangan Chatterjee 1:49:09 Hmm.

Dr. Stacy Sims 1:49:10 So we have to individualize it. I'm not saying no one should be on it, but I'm also not saying that you shouldn't be on it. I'm saying that it's a tool.

Dr. Rangan Chatterjee 1:49:19 Yeah.

Dr. Stacy Sims 1:49:20 People should make that choice, have that conversation, and it's a very effective tool, but you do also have to put in lifestyle changes-

Dr. Rangan Chatterjee 1:49:28 Yeah

Dr. Stacy Sims 1:49:28 ... to get the benefits to keep progressing well.

Dr. Rangan Chatterjee 1:49:31 Yeah. I agree, and just to follow on from that, I'm not against it. I think for some women it, it's, it's game-changing, okay? But it has to be-

Dr. Stacy Sims 1:49:38 Yeah

Dr. Rangan Chatterjee 1:49:38 ... individualized. We have to look at it in the context of everything else. And what I've found with many, many patients in the past is that they have symptoms that are related to these changes in their hormones. But if you can, and are able to, pay attention to those four pillars of health, particularly I found when we can, uh, you know, really help reduce stress levels in women for a variety of different reasons, you will often find, not always, but often, that a lot of their symptoms actually go away, right?

Dr. Stacy Sims 1:50:13 Yeah.

Dr. Rangan Chatterjee 1:50:13 'Cause they're downstream from all of these other physiological changes, and if you can address them with lifestyle... And a- again, some women can't, they're not able to, they don't have time to, or whatever it might be, but it's so much more nuanced than your hormones are going down, therefore you need to replace it with this therapy.

Dr. Stacy Sims 1:50:34 Right. Exactly. There was a really interesting presentation in the, um, International Menopause meeting where they're looking at CBT or cognitive-

Dr. Rangan Chatterjee 1:50:43 Mm

Dr. Stacy Sims 1:50:43 ... behavior therapy and mild hot flashes, and they found that CBT worked better at stopping mild hot flashes than menopause hormone therapy. I was like, "That is telling," 'cause it goes right in with let's address the stress-

Dr. Rangan Chatterjee 1:50:58 Exactly

Dr. Stacy Sims 1:50:58 ... and change the behavior around it, which will then help the body just get below the level of triggering the hypothalamus and the serotonin to create this hot flash.

Dr. Rangan Chatterjee 1:51:09 Yeah. You, you just said there that sometimes you get frustrated by some of the things you see in popular media or in the health space these days about various things to do with female health, and it's really interesting, Stacy, that when I listen to you talk, what comes across to me is someone who deeply cares, is full of compassion, is full of empathy, and really just wants to help make the world a better place.

Dr. Stacy Sims 1:51:41 Thanks.

Dr. Rangan Chatterjee 1:51:43 Two or three weeks ago, you, you posted something very emotive on your Instagram account. I think it was a photo of you looking a bit frazzled, and you basically said something to the effect of, "I'm knackered. I didn't sleep well. Um, feeling stressed out and getting frustrated by all the bro science that's out there." It was something to that effect. What was interesting to me is that you posted something like that, and, and I think you deeply care, right? So it... I, I got a sense of, man, I keep putting out this information to the world, but I can't seem to stop this other information getting out there. So can you just talk to me a little bit about what was going on, what was so frustrating for you, but also how all the love you received in the comments, which is l- so profound. I mean, the amount of people who commented to say, "Stacy, you've changed my life. You've changed the life of all the women in my family or all the women in my practice," or whatever it might be. Just talk to me a little bit about that post, 'cause I think it will give us an insight into who you actually are.

Dr. Stacy Sims 1:52:54 Um, yeah, so that was a few weeks into a long trip, and because I live in New Zealand and I do a lot of stuff in the States, I feel like I've spent more time away from my family in the Northern Hemisphere than I have here, 'cause I effectively have been gone since December, and I just got back this past Sunday.

Dr. Rangan Chatterjee 1:53:14 Wow.

Dr. Stacy Sims 1:53:15 And that particular post, um, I had been blasted in social media by some rather large voices countering some of the fasting, um, work that I put out, talking about how women shouldn't be fasting, and strength training, saying that women shouldn't lift heavy, and they're coming from more of a strength and conditioning world and not a physiological metabolic world, and they're like, "Where are your references? Where are your references?" And so they were on my page, and they are demanding references, and I'm giving them to them, and they're creating a cascade of misinformation on my own page, and I am having to constantly pull out references. And there's a, there's a, a definite gender issue within social media where if a woman puts something out, it's always, "Where are the references? I want the references." But if a man or a male influencer puts something out, no one ever asks. And I just get so frustrated sometimes where I'm like, why am I the one that is being hated on when I'm providing all of the science-

Dr. Rangan Chatterjee 1:54:28 Mm

Dr. Stacy Sims 1:54:28 ... and I'm providing all of the information? And I'm doing this, and it's taking me away from my daughter, my husband, and my life, and all I want to do is get the information out, and I want women to be empowered and understand that they can take control of the situation, that things aren't happening to them. They can push back and have the availability to control the situation-

Dr. Rangan Chatterjee 1:54:55 Yeah

Dr. Stacy Sims 1:54:55 ... and not feel like things are happening to them, 'cause they're not. Things are happening, but it's not to them. It's things are happening, and now you understand it. Let's do something about it.

Dr. Rangan Chatterjee 1:55:05 Mm-hmm.

Dr. Stacy Sims 1:55:06 Let's grow this community, and let's do something about it.

Dr. Rangan Chatterjee 1:55:10 Yeah. Well, thank you for sharing that. It must have been lovely, I'm sure, to read all the comments that you got. A-

Dr. Stacy Sims 1:55:16 It's very bolstering.

Dr. Rangan Chatterjee 1:55:18 Yeah, because you, you mean a lot to many people around the world. You, you've had a huge impact, and, you know, this lack of empathy that you're seeing there on social media, I, I know you've spoken about this recently. It's interesting that you're saying as you travel the world, which you do regularly, you've noticed this lack of empathy increase over the years a- as I have, and I, I'm interested to know, what do you think is driving that?

Dr. Stacy Sims 1:55:46 Well, I can see what's driving it from a cultural standpoint. You have the haves and have-nots, and it's becoming more and more divisive, and you're having political unrest, and there's so many things-

Dr. Rangan Chatterjee 1:55:56 Mm

Dr. Stacy Sims 1:55:56 ... and people are very isolated because there's lack of community, and it's just snowballing into all of these things.

Dr. Rangan Chatterjee 1:56:04 Yeah. But I think there's many things that can c- contribute, but I think everything we've been talking about today in this podcast i- is absolutely relevant because when you feel better in yourself and your wellbeing and your brain and your hormonal profile is better, you're gonna be more compassionate. You're gonna be more empathetic, right? So what we're talking about, yes, it's about hormones, but it's also about compassion. It's about if you treat your body in the way that we need to or can do as we get older-It's not only our body that's gonna be better, our mind is gonna be better. The way we communicate with others is gonna be better. You know, Stacy, I had this realization in the last few months actually that although on the surface it looks like I'm a medical doctor trying to share health information, yeah, that's true. At the same time, I don't think what I'm doing is only about health. I think it's about creating a more compassionate world. Because health, why- why do we want better health? Well, I think we want better health so then we're, we've got more vibrancy, more energy, uh, we're- we're better with the people around us, and ultimately we create a kinder, more compassionate world, which is kind of the world I want my kids to inhabit as they get older.

Dr. Stacy Sims 1:57:23 Yeah.

Dr. Rangan Chatterjee 1:57:23 So I actually don't think what I do is about health. It is, but in many ways it's more about compassion.

Dr. Stacy Sims 1:57:30 I, yep, I agree. I think that's- that's exactly what it is, and the whole conversation around longevity, I- I look at it as like, do you want to live a long time being isolated and not so nice, or do you wanna be surrounded by friends and you're all doing Zimmer frame races and laughing?

Dr. Rangan Chatterjee 1:57:49 Yeah.

Dr. Stacy Sims 1:57:50 Like, let's- let's create a robust, happy community.

Dr. Rangan Chatterjee 1:57:54 Yeah. Stacy, there was one thing you said right at the start about common mistakes that women make, and one of the things you said was that they follow the traditional advice to eat less, and you're saying that women actually, uh, perhaps should be eating more. Why did you say that? What is it that women need to understand about their food intake as they get older?

Dr. Stacy Sims 1:58:19 We see as women get older, their appetite changes. Um, in perimenopause there's this incredible increase for craving of more simple carbohydrates, because that's what happens when the brain is over-stressed and tired, and we're starting to have a shift in metabolism. Um, and in a cultural standpoint, women aren't supposed to want to eat. I mean, that's just how we go back to the '80s and '90s of the fat-burning classes and the eat less and the images of s- really thin, thin women, and that's starting to make a comeback now with more and more microdosing of Ozempic, which is scary. And when we talk to women about what they think is a normal calorie intake, especially active women, they're like, "Oh, well, I eat 15 to 1,800 calories a day." That is not enough. 2,000 calories for an active woman is not enough, and it's not just about the calories. It's about the quality of the food. So women who are looking to change body comp or lose weight, they default to the cultural norm of let's move more and eat less, but no one addresses let's eat more of the quality food that is going to benefit our gut microbiome. We have more protein that's gonna benefit our muscles, and all of these are gonna feed forward to the hypothalamus being happy and saying, "Yep, we have abundance, so I can get rid of this extra fat. We have abundance. I can create more neurotransmitters. I can have my thyroid working properly." So we see this huge disconnect of energy availability, especially when women hit perimenopause, where they're trying to fight some of the cravings from a tired brain, and they're also trying to fight body composition, and we've been so culturally ingrained to think that we need to eat less and move more, where in actuality we need to feed our body and nourish it with really good high-quality food and move, and that ends up being more calories than what a- a typical woman thinks is appropriate.

Dr. Rangan Chatterjee 2:00:31 Yeah, but on the face of it, Stacy, some women I think are gonna hear that and go, "Yeah, but haven't we just said that there are hormonal changes that take place that are gonna potentially increase the amount of fat I have on my body, and specifically the belly fat I have which I wanna get rid of?" Many women are gonna go, "Yeah, but in order to lose that, I do need to eat less, 'cause if I'm eating more, how am I gonna lose that fat?" But I guess that then highlights this lack of understanding of how our food intake impacts our hormones and how a lack of food intake for a woman potentially can increase levels of the stress hormone cortisol.

Dr. Stacy Sims 2:01:15 Yes, and it changes, um, how the hypothalamus responds with our appetite hormones. So if we're eating less and we don't have enough nutrient density, then the hypothalamus starts to wind down things, and there becomes a misstep in our appetite hormones-

Dr. Rangan Chatterjee 2:01:33 Mm-hmm

Dr. Stacy Sims 2:01:33 ... where we start to see, um, a- a reduction in the ability to feel satiated in the food that we do eat. We see a change in luteinizing hormone pulse, which it starts to flatten out, which has a direct effect on appetite hormones, and we also see that when women don't eat as much as they should, that they move less incidentally and they crave more simple carbohydrates. Because the brain is like, "Hey, wait, what's going on?" Hypothalamus is going, "Wait, there's not enough nutrition coming in," and then that feeds forward to storing more fat.

Dr. Rangan Chatterjee 2:02:12 Yeah.

Dr. Stacy Sims 2:02:12 So when women are like, "I have this extra fat I need to lose," it's not about reducing calorie intake. It's becoming more conscious of what we're eating, eating according to our circadian rhythm so that we maintain optimal pulse of our luteinizing hormone and our appetite hormones and our cortisol awakening response so that the hypothalamus works appropriately, so that we can have the ability to alter our body composition in a positive way.

Dr. Rangan Chatterjee 2:02:42 Yeah. Okay. I love that, and that's something to-Definitely dive into deeper in the future. Um, if I could just finish off with, um, one more thing I thought about early on in this conversation, um, and that's young girls or teenagers. Y- You're making this case that actually the female is different from the male, and at various times in a female's life, things change, puberty being one of them. Of course, men change at puberty as well, but let's specifically talk about, uh, girls and, uh, and, and women. I've got one daughter. I, I think you've got a daughter as well. Um, what is it we should be thinking about with girls as they go through puberty and into their teenage years when it comes to movement that perhaps is relevant to those hormonal changes that we've been talking about?

Dr. Stacy Sims 2:03:39 Yeah. So one of the big things that happens when we have these biomechanical changes with puberty, so, you know, like I said, the hips widen, so that puts more stress in the knee, and we have differences in our center of gravity, where we see a girl's center of gravity drops lower than a boy's, and a girl feels very uncomfortable in her total movement. So the biggest thing that we can do is reteach fundamental movement. We can work through functionality, where we can improve strength through functional movement, where we're reteaching how to run, how to throw, how to land, how to jump. Yes, maybe six months ago, we could, the girls could do pull-ups on the monkey bar, and now she can't. We just have to say, "Well, you know, what's happening is our center of gravity has changed. Your arms have gotten longer. It's harder to pull. So let's work on that."

Dr. Rangan Chatterjee 2:04:31 Mm-hmm.

Dr. Stacy Sims 2:04:31 "Let's work on all these movements so that you feel better in your body, and you're able to move better," because it's a short period of time where the body changes so much so rapidly, but no one addresses these fundamental movements in girls. And we see that this is one of the reasons where girls will start to drop out of sport, is they don't feel like they can move as well. They feel sluggish. They feel slow. They don't feel as coordinated. And then we start seeing brain changes that invoke-

Dr. Rangan Chatterjee 2:05:02 Mm-hmm

Dr. Stacy Sims 2:05:02 ... um, more of the self-awareness, where they feel like everyone is watching them. So if we can just encourage, all movement is great, but let's work on the strength through these particular natural movements so that they know how to run well, they know how to land well, they know how to jump, they know how to pull, they know how to throw in the new biomechanics and the new, um, body composition that's occurred.

Dr. Rangan Chatterjee 2:05:30 And is, is there an age where strength training is too young? Like, can a 12-year-old girl do strength training? Can they lift weights? What is the consensus at the moment?

Dr. Stacy Sims 2:05:41 Yeah, all strength training is good, but it's not about lifting heavy loads. It's about the functionality of movement. So maybe we're doing air squats, or maybe they're having a light kettlebell and then doing a goblet squat, so it's a little bit more load. But they have to stay upright and have the right squat mechanics. So when we're talking about strength training through puberty, we want to add load to increase the stress, but we want to make sure that all the mechanics of movement are proper under that load. 'Cause we don't want to, um, create strength in a poor motor pattern.

Dr. Rangan Chatterjee 2:06:17 Mm-hmm, yeah.

Dr. Stacy Sims 2:06:17 And we don't want to actually invoke those poor motor patterns. We're trying to develop better motor patterns, and as we develop those, we can add load as long as we maintain those same motor patterns.

Dr. Rangan Chatterjee 2:06:29 Yeah, so broadly speaking, encourage our young girls and teenage girls to keep being active in as many different ways as possible. Um-

Dr. Stacy Sims 2:06:38 Yeah

Dr. Rangan Chatterjee 2:06:39 ... because there's a big thing, certainly in the UK, that once girls get to 12 or 13, physical activity seems to drop off massively, and I think that's a cultural thing that perhaps is happening in America and New Zealand as well.

Dr. Stacy Sims 2:06:51 Everywhere, yeah.

Dr. Rangan Chatterjee 2:06:51 Yeah, so how can we encourage young girls to keep staying active through what I'm sure is a very challenging time? Stacy, I've thoroughly loved talking to you. There's so many topics I wanted to discuss we didn't get around to, but I definitely think we met the goal of making the case why strength training and HIIT training is so important for women as they get older. Um, for a woman who's listened to this conversation, Stacy, and feels inspired by what they've heard you talk about and feels like, "Yeah, you know what? That's it. I, I'm, I need to do something differently. I'm gonna start making changes to address these hormonal changes," but they don't know where to start, what are your final words to them?

Dr. Stacy Sims 2:07:40 First, find a friend, [laughs] 'cause I'm sure that you have a friend who's going through the same thing, and have a conversation. And then you can look to either go in and get a personal trainer together. But if that's a bit too daunting, you can look at some of the apps that are out there. Like I said, Haley Happens Fitness, Loretta Loves Lifting, the Betty Rocker. Those are all really good, and they all address different levels of fitness. One who just wants to stay at, at home would go with Betty Rocker. One who's really confident in the gym might go with Haley Happens Fitness. One who's just starting to explore strength training and, and wants to add some equipment might go with Loretta Loves Lifting. But there are some really good apps that you can, can download and, and get into the communities there 'cause, again, when I talk about community, it's about having someone to lean into and ask questions but also to support you. And when you start your strength training journey, it's, it's good to have that.

Dr. Rangan Chatterjee 2:08:40 Yeah.

Dr. Stacy Sims 2:08:40 Yes, you're gonna achieve personal goals and benefits, but it's always more fun with community around you to encourage you to push a little bit more than what you really thought you could.

Dr. Rangan Chatterjee 2:08:52 Yeah. Thank you. And of course, for you, for people who wanna, um, go deeper into the world of Stacy Sims, there's your book, ROAR, there's your Instagram. I notice you're more active on YouTube at the moment. Um, but you also have some programs, don't you? What, what are these programs that you offer, and how might women benefit from signing up?

Dr. Stacy Sims 2:09:10 Yeah, we have some online courses. So we have a deep dive into menopause that goes through the history, the, um, changes, the physical activity, the nutrition, the case studies, all that kind of stuff. Um, we have a Next Gen that's similar for girls, um, going through puberty, that's appropriate for the parents, the coaches, even the girls themselves-

Dr. Rangan Chatterjee 2:09:33 Mm-hmm

Dr. Stacy Sims 2:09:33 ... if they're around 15, 'cause it's a little bit of a attention thing. Then we have microlearning courses if you want to deep dive in protein or collagen or energy availability. So all of our courses are listed on our website. Um, and then we have our newsletter that comes out twice a week that has a deep dive on some things as well. So if you just wanna kind of capture everything that's going on, you can come to the website and have a peruse around and figure out where you wanna go.

Dr. Rangan Chatterjee 2:10:06 Yeah. Love it. Stacy, it's been such a joy talking to you. Keep on doing the great work, lifting people up, supporting them, empowering them, and spreading such helpful information. Thank you so much for coming on the show.

Dr. Stacy Sims 2:10:20 Thanks for having me.

Dr. Rangan Chatterjee 2:10:22 If you enjoyed that conversation, then I think you are really going to enjoy this one.

Dr. Stacy Sims 2:10:26 The body thrives in a fasted state 'cause it can access this other energy system that you can't access by manipulating your food. You've gotta let your blood sugar c- come down enough so that your body's forced to switch over into that system.