A (4:53)

Yeah, I'm thrilled to be here. Thank you for inviting me.

B (4:55)

I wanted you to come on the show because of your breadth of expertise in fat loss and we're going to talk all about that today and we're going to carve out our perimenopausal and menopausal women. Before we get into that though, maybe we can just start with some groundwork in terms of and this is the number one question that I get and so I will pose it to you so that we can get lots of responses here for our Bettys. Is it possible for someone to simultaneously lose fat and gain muscle or is it better to do one in tandem? Maybe you build, you know, you have a build phase, you build a lot of muscle and then you, you are in a fat loss phase. Or can we do it at the.

A (5:37)

Same time so it's, it can be done at the same time. I always say that that's more the exception than the rule. But we have plenty of scientific evidence reporting people from all beginners, even, even people more advanced now, it's less likely to happen in someone who's been lifting weights for five or 10 years. But it can absolutely can happen. We can lose fat and gain muscle simultaneously. But I would never promise somebody or design a program, hey, this is your, this is your, your guarantee to build muscle and lose fat? I think it's better. And how. I personally coach people, I always have them identify what is your primary goal. If it's fat loss, then we want to put our resources into fat loss. But I'm, I and you appreciate we don't want to lose muscle, so we still have safeguards and so we don't lose muscle. And on the other side of this, what is if your primary goal is to build muscle? Well, let's put our resources into that and same thing. We don't want to gain a ton of body fat during that process, but we may have to live with the fact, hey, we might gain a little bit of body fat when we're trying to build muscle.

B (6:52)

Yeah, I think that's important. Starting with your goals certainly is going to be the way that we set out any type of plan for someone. I think for women in particular, we've just always been taught you have to be as small as possible in every parameter. And we're gonna dig into, into that today. So I almost feel like most women are so scared of what you just said, which is like you're gonna put on muscle and just being, accepting that you're gonna put on a little bit of body fat. I think for some women that might be terrifying for them. So maybe we can start with a fat loss piece where we can get. Everyone's comfortable with that and we can move into muscle hypertrophy.

A (7:30)

Sure.

B (7:30)

So how can we determine how much body fat we have? Like how, what, how do we measure body fat?

A (7:36)

So there's, I look, look at this as, as a scientist, there's two different ways. There's research based methods and then there are field based methods. So your research based methods Are your more expensive devices Dexa machine, BOD pod and then we have on, you know, that anybody can use skinfold calipers or scales that use BIA technology. And now over the last few years, we've been having what I think is a very good, a very good introduction. Some of these BIA scales like in bodies are really research grade, but they're being incorporated into like health fitness centers. So you're bringing a research grade device to the masses where you don't have to go to a lab. So all of those types of devices measure body fat and some of them are very dependent on the skill of the technician. Some of them are highly inaccurate. So one example, be careful about your bathroom scale. That also will tell you your body fat percentage. The most important thing for people if they want to get an estimate of how much body fat they have, is to use the same device each time under the same conditions. Even if the device you're using is not perfect, if you're using the same one, it's always, it's going to be imperfect, ideally the same amount every time. So as long as you're able to use the same device or the same person, if they're using skinfolds, can you detect that you're gaining body fat or losing body fat? That's the most very important a concept as you, as you want to get this data on yourself.

B (9:19)

And where does hydration come into that? So when we're thinking about, let's say it's an imperfect, it's the bathroom scale or even, you know, Dexa, if you come, if you're doing a regular, you have the same technician, but your hydration levels, let's say, are different. How do we con, Is there a way to control for that?

A (9:37)

There's a way to greatly control for that. And that is, and this is where I tell people we have to approach this as scientists. Always get your body composition done in the morning, after you've gone to the bathroom and before you've consumed any food or beverages. So unfortunately, a lot of fitness centers will advertise programs or testing and they don't really ever care when you do it because they get the same amount of money. But as soon as you put food into your body or as soon as you've consumed a liter of water, now that body composition value, the amount of muscle and fat that it's going to say you have is completely inaccurate, skewing the results towards less fat or more body fat depending on the algorithm of the device. So the best thing you can do just be consistent when you get the test the best time, first thing in the morning. Because let's say you drank a ton of water the day before. Well, a lot of that's going to dissipate overnight. Or if you were dehydrated yesterday, I mean, not ideal. You would like your hydration to be consistent. But at least if you're going under consistent conditions, which is first thing in the morning, and that may mean going to the fitness center. If you're using an embody or if you're using your bathroom scale, just be same type of clothes. I always weigh myself just naked.

B (11:01)

If you can't. If you're, if you're in your home, just like take off all the clothes.

A (11:04)

Yes.

B (11:04)

And go to the bathroom and do it.

A (11:05)

Yeah, do that every day. I keep my boxers on every time, so. But at least it's the same. Not the same pair of boxers, but the same type of clothing every time I do it. But hydration, yes. If you're drinking a gallon of water on one, you know, in the morning and then you go get your test and the next time you didn't drink any water and you do your test at night, those are things that really create a lot of havoc in your health journey because you're going to have, you're going to be basing your programming and nutrition on data that is not valid. And sadly, a lot of people do that. They, they even, even as people that have the money to get a dexa, when they go to different places with different DEXA machines and a different technician running it, that's not good. You get, you can get very different results. Even though it's a DEXA machine.

B (11:58)

Yeah. So once we have our fat loss, we've, we've measured on the scale. We've been consistent, as you've been saying, we go to the, you know, we have our weight and, you know, maybe we have the percentage of fat where. What are targets of percentage of fat? Like total body percentage of fat for, you know, my audience is women. So we can start with women and then, you know, just for, you know, to round it out. We can talk about male targets as well. But if you're a woman who's trying to optimize and we're going to, we'll blend this with a conversation in terms of lean muscle mass, but in terms of fat percentage, total percentage of fat on the body, what is a, what is a target that women want to be aiming for?

A (12:37)

So I'm going to, I'll, I'm going to Give a number and it will be shocking. But the. The average female, not overweight, not excessively lean. An average female body composition. And this comes from research, I believe, from the 1970s called Reference Woman. She has 27% body fat on her body. So that's a. That is just a landmark. Okay. Am I average? More than a quarter body fat. The more than proper. Again, I'm a fat loss researcher. I've done. There are very few people on this planet who have tested more body fat assessments on women than I have. It is rare to have a female less than 20% body fat. That is rare. I wouldn't even say that's ideal. In some cases. It is. It depends on your lifestyle. What kind of sports do you play? But this notion that I have to be 10, 12%, when we see that in women, and I've tested them, that is what we see on social media. And they are never that lean, very long. They will get in that condition, do all of the photo shoots, and then that is what gets put out for the next four months. Giving the appearance of this is normal. I can maintain this all the time. It's not. So 27% is average. Above that, we're getting into an unhealthy or excess body fat realm that we want to avoid. Getting leaner than that, to an extent, I believe is healthier. But getting. If I say, you know, 20%, a lot of women will say, wow, that's. That's high. All these people I follow are, you know, 10 or 12 or 15. Well, I just gave that one caveat. And two, I always want to tell people, women are different than men. Women have breast tissue, they have more fat around the reproductive organs. So women need more body fat for normal physiological functions. So just to summarize, 27% is average. Getting less than 20% is. Is rare.

B (14:47)

So an ideal to shoot for is somewhere between. It sounds like what? And I'm paraphrasing, but redirect me here. Is it 20 to 27% is what we should be sort of aiming for in terms of a healthy body fat percentage.

A (14:58)

Yes. Yep. And let me also say I'm sensitive to women who want to be leaner than that. And I have many years in my career helping women get lower levels than that in a healthy manner. So I don't. There's nothing wrong with going lower if that's somebody's goal, assuming that their health is not compromised. But I will say getting down to very low levels of body fat, that is never healthy. And the women that typically do this. Except for the genetic outliers, they don't stay there very long.

B (15:29)

Yeah, it's usually get up on stage for a body, you know, for a bodybuilding show, you know, they're in physique, their, you know, wellness or their bikini or whatever it is. To your point, it's like they diet down for like 12, 16 weeks and then they get up on stage, it's for that one hour that they're at whatever percentage, percentage they are. And then they go out that evening and have the pizza and all the things because they're usually starving.

A (15:50)

That's exactly right.

B (15:52)

And when you say getting underneath 20%, as long as it's healthy. So can we define what healthy is? Is that the maintenance of a menstrual cycle? Are you just looking to make sure that cortisol levels or other markers on labs are staying within a healthy range? When you say healthy, can you do, can you put a little bit of like qualitative, you know, can you sort of define that for us?

A (16:12)

Yeah, so I, I, I think, I tend to think of two things. One would be yes, a menstrual cycle. That's, that's something that again, the leaner you get, you will not maintain a normal menstrual cycle. And then two, I look at muscle equals health and excess body fat equals sickness. So if you are sacrificing a lot of your muscle to get this really skinny or thin or very low body fat body that is no longer healthy. We need our muscle mass and when we do that, we're also losing bone mineral density. And if you're a young woman, you do not get that. I mean, you don't get that back. Yeah, well, yes, you, you basically. So if a teenager is dieting like I, it really bothers me when young teenagers that don't need to diet. Right. They don't have excess body fat. I'm always that just like, oh, that's, that's a warning to me. Now some of the, the great thing about this bodybuilding sport is these women are lifting weights and that's great for bone mineral density acquisition. So there's a lot of healthy aspects to that type of training. But yeah, I look at a normal functioning menstrual cycle and not losing muscle mass, not sacrificing muscle to get to a, a scale weight where we're just, we don't care about the muscle.

B (17:33)

Fantastic. And then how do we, how do we measure skeletal muscle? Like if you are looking at someone and you're, we, we can understand like We've talked about how we measure fat percentage in the body. How is it that we are qualifying skeletal muscle?

A (17:46)

So all of those devices that I mentioned earlier, I'll just name some of them again, an inbody or a bathroom scale, dexa, bod, pod, ultrasound, almost all of them will give you a body fat measure and a lean body mass measure or muscle mass. Some of them will call it muscle mass, some will call it fat free mass. So as you're getting your body composition tested, you're going to get, you want to walk away with two numbers. How much total body fat do I have and how much total lean mass do I have? Now the lean mass, that's a lot more variable because we talked about hydration earlier, that, that has more of an impact. So just be prepared that your lean mass will be more variable from test to test. And it's, and technically the machines aren't as valid in testing that dexes are really good. I'll just say if, if, if you've been dieting really hard and you lost five pounds of lean mass, maybe it was only four, maybe it was three, but you've lost lean mass. And then I also want to put out this morning if you are losing muscle during a diet process that makes it extreme, much more difficult to maintain your, your fat loss as soon as your diet is over. There's a whole host of, I got complete lectures on this and in fact it's what drives my lab. We, we, we, we try to do everything we can to prevent these negative consequences of dieting. So your muscle mass also think of that as a way to think of long term weight loss success.

B (19:27)

Yeah, I love that. And I think that people often overlook that when we are in this game of weight loss, which is really what we're talking about is fat loss. Nobody wants to lose muscle, nobody wants to lose organ weight, nobody wants their bones to get more brittle and lighter. But I think that that is often very much overlooked because to your point, you will not be able to maintain the results. And in fact I would also add on top of that that you're probably worse off. Like you start to become this, you know, this tofi type of, like this thin on the outside, fat on the inside type of body composition where you have, you know, your, maybe your body fat percentage has come down, but your lean muscle mass, which your body absolutely will sacrifice, especially as you get very close to whatever weight goal you've set for yourself, is also going to be sacrificed at the altar of, you know, of weight loss. And so we really have to be thinking about this long term, because long term that can cause, you know, all the things that we can, we'll dive into that. But like the metabolic mayhem and like, you know, all the things that muscle, the other muscle can provide. So I think your point is really well taken there. All right, so keeping in mind that our goal is fat loss, organ and lean muscle, lean tissue preservation. And when I say lean tissue, we're sort of lumping in muscle in there with organs and bones and things. What are some of the top ways to lose fat? So what are the interventions that. And we'll get to medications. We're gonna use that maybe as a separate class later in our conversation. But how do we, how can we, you know, the individual say, okay, I, I'm gonna embark on this fat loss journey. What are some of the levers that I can pull in terms of things that I can do to help me lose fat? Specifically?

A (21:03)

We basically have two major levers we can pull. One is reducing our food intake and the other one is increasing our caloric expenditure through exercise. So it's going to be a combination of diet and exercise. And that is where the art of a fitness professional, your preference, all of that comes into play. But there's, there's not really any shortcuts or hacks. I know, I'll just give an example. Ice water baths, they may have some great benefits in other areas, but nobody's losing a, a identifiable amount of body fat from doing ice water baths. Don't do it for that reason. If you're going to do it, hopefully it's for some other reason. So if you're gonna lose body fat, you're either gonna have to reduce your food intake or you're gonna have to increase how many calories you're burning.

B (21:52)

Yeah, I, yeah, there's, there are definitely influencers online that have said things along the lines of like, nothing burns fat off your body like getting in a cold plunge. And I personally. Cold plunge, I think it is a great recovery tool. I think it's actually really great for my mood. It's good for, you know, sort of my, I would say performance as well, like recovery and then performance later on. But there's no way I am not fooled in at any way that that is going to be the way that I am going to burn. I, I think I found some online calculator and it's like each time I'm in there for like 10 minutes, it burns like 30 calories. It's like, you are not, you are not going to do anything with that, even if you're doing that several times a day. So, okay, so. So we have sort of this, this cico, C. Co or however you want to say it.

A (22:38)

Sico. Yep. Calories in, calories out.

B (22:40)

Yeah. So you're talking about both, like either of those equ. Like calories in, in terms of how much food is coming in or calories out in terms of how much energy expenditure you are doing. And is that in the. So I have a. I love resistance training. That is my bias. But this can also be achieved obviously with aerobic or cardiovascular training as well. Correct?

A (22:58)

Absolutely. Yes.

B (22:59)

Yeah. All right, so we have someone now who wants to lose body fat. They're doing, they're controlling for hydration, they're weighing themselves in the morning. How do we determine what if, if we just take this seat, like this. Calories in part of the equation. What, how do we determine, how do we determine what our baseline is? So our rmr, our resting metabolic rate or maintenance calories. And then I have a follow up question which is, and then once we've established that, how much do we reduce our calories by. If we're just talking about cr. If we're just talking about caloric restriction.

A (23:35)

Yeah. So you're asking questions exactly how I love to approach this. Everybody should know how many calories they need to consume in a day to maintain their current body weight. Because then if you have that and we call that maintenance calories, we know. Or you will know. Okay, if I want to lose body fat, I know I need to eat less than this, or if I eat more than this consistently, I'm going to gain body fat. So there's, there's two general ways that people can estimate their maintenance calories. And I want to just separate maintenance calories from RMR or resting metabolic rate. Yeah, resting metabolic rate is a huge component of your maintenance calories, but they're not the same thing. And I've, I've learned over the years a lot of people think I got to get my resting metabolic rate tested so that I know how many calories I need to eat to, to lose weight. And that's, that's not a good approach because your resting metabolic rate is, it's important and it's, it's valuable to know. But that is the number of calories that you're burning. If you were to lay down in a bed for 24 hours, that doesn't count the number of calories getting up to prepare lunch, the, the, the stress.

B (24:53)

You need to stay Alive?

A (24:54)

Yes.

B (24:55)

What it is to stay alive.

A (24:56)

Yes. So it's about 70% of the calories of your maintenance calories. So with that out of the way, what I like to have, what we do in all of our research studies, when we do a weight loss study, is for two weeks. We have all of our subjects track all food that they consume, food and beverages. So how many calories are you eating every day? And we also have them weigh themselves every single day. And what we're seeing is during these two weeks, are you gaining weight or are you losing weight or are you maintaining your body weight? And maintaining would be plus or minus about a pound because. But it really helps to do two straight weeks because we all know if you do weigh in every day, some days you weigh more, some days you weigh less. But you take a weekly average, it gets that data becomes very reliable and actually pretty tight from week to week. So let's just say they realize, okay, I've tracked all my food intake and there's so many good apps to help us do this. I realize I'm consuming 2,400 calories and I've gained 2 pounds over two weeks. So what does that tell us? Well, that tells us that 2,400 calories is above your maintenance calories because you've gained weight. So your maintenance calories to help you maintain your body weight is something less than 2400. Is it 21? Is it 22? Well, we probably need more data, but what normally happens when we tell people, don't change anything about how you eat, just eat how you normally do. But we're going to track it all and you're going to weigh yourself. What we normally see is that is somebody's maintenance calories and that is the best because. And I'll give the other way here in a second, which I don't think as good, although it is quicker. What I just described, it takes two weeks to get these numbers, but what it is based on is your nutrition and your body. So there is nothing better to estimate these numbers than you and your dietary habits and your daily physical activities. So that is the best. The other way, which is what a lot of people do, is you plug into the Internet to a website. This is my height, my sex, my age, my weight, my physical activity. And it will spit out, this is how many calories you need per day to maintain your weight. Now, that's not bad, but it's making a lot of assumptions. It's making an assumption of your resting metabolic rate. It's making an assumption of how active you are. It's making an assumption of your genetic profile to some extent. So it's better than nothing. But I love the more disciplined and investment approach of let's, let's have you count your calories and track your weight. And that way we're not assuming anything. Why I'm assuming honesty that you're, that you are actually tracking your food appropriately. So hopefully that answered your question.

B (28:00)

Yeah, no, that's great. So in the past we've, we've used if people are like, no, I want to get ready right now. It's like the Harris Benedict equation, which is like just what you're saying. You sort of plug in a couple of numbers. I know there's online calculators that'll say how active are you are? Do you do one to two to three hours of moderate to heavy, you know, and then it sort of gives you sort of an estimate of, of, of what your, your maintenance, your, your calories might be. The other thing that I find too, with the method that you just described, with the two weeks of tracking, I actually already feel like there's even just the art of asking people to watch what they're eating. I don't know if you find this, but I almost find that they're eating almost improves instantly because they know that somebody's gonna be looking at this information.

A (28:41)

Oh, it, it absolutely happens. And it's. You can look at a lot of research, but we go out of our way to tell our. And we mean we actually bias our subjects. Like this is what, what you just said. We tell them if they haven't tracked before.

B (28:56)

Yeah.

A (28:56)

We say now. It's funny, 10 years ago when I was doing this research, nobody tracked. There were no apps. Maybe my fitness pal. And then over the years, a lot people are so much more educated on food. This, it's been really good for me as a researcher. But we say do not, please do not change. If you are, if you are an alcoholic and you drink and you drink, you know, eight cans of beer, please do that during this period of time. Because we want what you normally do. We cannot. The study depends on your ability to be accurate. And again, we're going to make changes as soon as the intervention starts. But whatever you normally do. So we kind of over educate in that to prevent that. But if you don't do that, you're absolutely right. Just the act of writing down what. Even if nobody's watching, if you just journal. I have, you know, oatmeal, eggs, orange juice, for whatever reason, the act of being aware, of writing down, you start to think, oh, do I really need two glasses of orange juice? I think I'll stop with one. So it is amazing that just food journaling creates a significant stimulus for weight loss.

B (30:05)

Yeah. It's also the difference between sort of measuring, you know, your olive oil on your dressing versus just like the long pour.

A (30:12)

Oh, that's.

B (30:13)

I know olive oil's good for me. But then you just sort of like, let it go without measuring it. And that's, you know, that can add 3, 4, 500 calories to easily to your meal. I was, I recently, actually, for me, my long pour is with egg whites. So in the morning, I love, I like to make two eggs and I like to sort of top it up with egg whites. And again, it was just like a long pour. I was eyeballing it and I was, I was never able to finish it. So I was so full by the end of breakfast and I was like, I wonder how much I'm actually doing here? And it ended up, it was like two cups of egg whites on top of the two eggs I was having. So, yes, it's protein. Yes, it's great. We love, we're going to talk about protein today. But it was so much food for me with my other stuff like the mushrooms and the spinach and the coffee and all the things and the berries and all the things that I like to have in the morning. So trim that back a little bit as well. So I think that there's a wonderful thing. There's a wonderful thing to be said about just. And we'll talk a little bit about eating disorders and maybe, you know, especially for women who have a history of eating disorders, tracking can be very triggering for them because they can, you know, it can sort of bring back these thought, like these reminiscing and ruminating thoughts of control and, like, must control every single thing that goes into my mouth. But I do think for the vast majority of people, understanding your portions can be incredibly useful. And you would be so surprised. Like, I, My kids love mini wheats and I would just like grab a couple and by the end of the day I would have had like 20 or 30, like mini wheats. You know, just, I've taken it, you know, dry from the cereal box or I'm taking it from their, from their bowl. And it, like, it adds up over time. Right. So if you're, if you're trying to work the calories inside of the equation, I think it would be, I think it would behoove everybody, save for maybe people with eating disorders, where this can be very triggering for them to be tracking our food and to be thinking about what an appropriate portion size is for us.

A (32:02)

Yeah. And just back to your egg white example. I'll tell you something that I think is fascinating. It is. I have never found a study where fit people. I'll just say people who are resistance training when you, when, when researchers. And I've done this in my own lab in females, if you overeat on protein, you do not gain body fat. It's, it's crazy. But I've seen it. I have, I've. I've written about this multiple times. So the lesson I take from that is, if you're going to overeat, overeat on protein. And in your life, let's make sure we measure the olive oil. But if I'm gonna splurge, don't worry about measuring the extra, you know, two seconds of egg white pour.

B (32:52)

Yeah, well, for me, it was just like my, I couldn't finish it, so I just ended up eating it midday. I was like, well, I'll just eat this at 10, you know, and then I would. I ended up eating it anyway. But I was like, why am I, I want fresh. Like, if I'm gonna have a snack at 10, like, I want it fresh. So I was. That's, that was sort of my, my, my, my thinking there. But I think to your point around, it's much, it's much easier. We'll say it this way. It's much easier to overeat on fat and carbohydrates than it is to, you know, you have to be. It's very hard to do. Overdo it on protein. And then to your point, even if you do overdo it on protein, you have the long pour of the egg whites or whatever. The, you know, the literature is clear in terms of, like, it's not really going to affect your body composition, that it may actually positively. In, in terms of muscle protein synthesis, you know, may positively influence your body composition that way because you're having so much protein. But I think I always think about this when I travel. It's so hard to find protein when you travel. At the airport, I'm usually reduced to eating like, beef jerky because that's all that they have that has high protein at the, at the airports. But it's so easy to find the chips and the donuts and the sandwiches and the, all the things that are like high fat, high, high carbohydrate.

A (33:57)

Yep, absolutely.

B (33:58)

Yeah. Yeah. Okay. So still continuing with the calories in piece, we've, let's say we'll just choose 2,000 calories because that's a reasonable amount of calories for some females. Imagine that is our number. And now we say, okay, that's our maintenance number. We've been tracking for two weeks. And that's about the number where we don't gain, we don't lose. We're about the same. What is the, what do we need? What is a reasonable amount or the minimum effective dose that we can reduce our calories by? And is there a percentage recommendation reduction? Is there an absolute number recommendation like how do we think about reducing our calories without being too aggressive?

A (34:38)

Yeah. So I always love, and I'm glad you phrased it like this, I love a percentage reduction because whether you're £400 or £94 when you talk in percentages, that's the same advice for every single person. So what, and I would say this is what. If my lab has perfected anything, it has been the art of losing fat and maintaining all muscle mass. So I'm going to give the number that, where we've, we've, you know, and people can check the, the published studies that we have that, that have, that has documented this. A 25% caloric deficit, assuming that people are lifting weights and, and ingesting optimal protein. So 0.75 to 1 gram per pound of body weight, or for Europeans, 1.6 to 2.2 grams per kilogram. So a relatively higher protein intake and resistance training if you reduce your calories by 25%. So what does this look like? You, you mentioned 2000 calories is my maintenance. So let's take that down to 1500. In that case, it's a 500 calorie deficit every day that we've been able to show. And, and these are in metabolically healthy people. So we have a, I look at women going through menopause is almost a whole different creature that we've documented multiple times. Almost all of the weight lost and in some cases all of the weight loss is coming from body fat stores and maintaining all, all lean tissue.

B (36:18)

And it's not so aggressive that you are, you know, you're, you're disrupting your ghrelin and your leptin signal. I mean, you're probably going to feel a little bit hungrier. I think that expectation is important to pat, you know, to, to predict for people, but it is not so much that you can't think and you are hangry. You know, 25% seems like a reasonable amount.

A (36:38)

Yeah, I, I, I, to me it's a main, and everything about my research is helping people optimize their physiques within a maintainable lifestyle. So I, I agree. Now that doesn't mean that for some people there, maybe they're, maybe they would say, hey, that's too aggressive for me. All right, 20%, 15%, it will take you longer. And the newest area that my lab is, is looking into is extreme fat loss strategies. Now that has always been a, A, a, a very negative and horrible phrase for me, but I need to give the context. Extreme or rapid fat loss strategies that do no harm. So we're, we're moving into that era area now where, how, basically it's this, how extreme can we be for a limited period of time? Like that's because again, I do, we don't want to do harm, we don't want to lose muscle. I'm, I'm defining harm as loss of muscle.

B (37:34)

Yes, that was my question. Okay, great. Well, before we get there, can you speak to, so we talked about a 25% reduction if it's at 2000 calorie a day. We're talking about 500 calorie deficit per day, which is about maybe a pound a week. Ish. How does that change in your, or what have you observed at least in the clinical or in the lab setting? How is that different for perimenopausal and or menopausal women?

A (37:57)

So I have not seen this in the lab, but it's never been studied in the lab. And we're starting to, my lab's starting some of this research. What I have is what I believe are thousands of direct messages, comments back to me as I, as I talk about menopause. And in all honesty, watching my wife go through menopause, what I've observed is what I just described. This 25% caloric deficit will cause weight loss relatively easily in metabolically healthy women. It seems like that does not move the weight. The fat loss needle. For, for, for some women going through.

B (38:36)

Menopause are metabolically healthy or who are.

A (38:40)

Not, I would say even that are, or because my, my, I'm, I'm, I'm obviously I'm very close to my wife. I refer to her experience a lot with this. She was healthy and then she went through menopause and she gained weight and she's married to the best man in the world and her husband is also a fat loss researcher.

B (39:02)

Yes.

A (39:03)

And I, she couldn't lose body fat And I'm like, this is not good. Like I, if I can help you with, and I can't help with much, but if there's one thing, I should be able to help you to lose body fat. And we. Her calories were like 1100 calories, God, for several weeks. And it's just she wouldn't lose it. And I had heard other people say this over the years as a fat loss researcher, but it never really registered. But now I'm seeing it. So I take this, I start talking, asking questions. And what I. The place where I'm at now is it seems like for some women now, some women in menopause have no problem losing weight. So this is not a blanket statement, but there is and I refer to this as kind of like a train wreck group. There's a certain maybe it's. Hopefully it's a small percentage of women going through menopause that have a very bad experience. And part of that experience for some of them is gaining weight that is very hard to lose. So the way that I conceptualize this is what would normally be a 25% deficit to lose X amount of body fat, it might need to be a 40%. Like you have to diet so hard to get this body fat down that it's not sustainable, not enjoyable, and probably not healthy. So what do we do? And this is where I have a thousand questions because I'm just starting to look into this again. A lot of women don't struggle with this going through menopause, but some do and it's extremely frustrating.

B (40:41)

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A (43:12)

I, I think for many women, yes. And I there I can actually speak to some research. So I'll just briefly talk about two studies that one sets up. The other one study had postmenopausal women do a resistance training program and then they gave premenopausal women the same resistance training program. So we're talking early 40s, let's say to late 50s, and there's no HRT in this study. No hormone, no estradiol, no testosterone, no progesterone. Both groups of women responded favorably to the resistance training program. They both gained muscle mass, they both lost a little bit of body fat. But the outcomes were significantly better in the pre menopausal women. So they responded significantly better to the same stimulus as an older postmenopausal women. So there's the backdrop. Another study gave women post menopause early. That's just key. Early postmenopausal women. So think early 50s.

B (44:18)

Early 50s, yeah.

A (44:19)

An estradiol patch or a placebo patch. While resistance training the estradiol patch, women gained significantly more muscle mass, lost significantly more body fat. So we have research in a randomized controlled trial, awesome study where restoring estrogen estradiol levels clearly helped bring back an anabolic response to training, help them lose body fat better. So I look at that research and I'm like, this is it. This solves the problem for all these women. But unfortunately, I guess is, is how I would phrase this. I, I have much, much fewer messages and direct dms, but still enough to think where women are saying, hey, I'm on HRT and I still can't lose weight and I'm still not responding well. So it seems like it's very helpful for some women, but it is anecdotally it is not going to solve the problem for every woman. And let me just be clear. I hope to be in my career for another 30 years. This is, this is my passion now. I, I want to find out why and what. And part of the solution will be pharmacology. In fact, I think it's, it's probably one of the first things we should be doing.

B (45:37)

Yeah. And I think, if I may be so bold, I think that hr, I'm a big fan of hrt. I will absolutely be on it when it is warranted for me to do so as well. And I think the, what I, what I want to maybe, I don't know if the word is caution against or maybe I'll comment on it. And I would love your, love your thoughts on here. I think that every woman, I think first the issue is access. Right. So we have to have the conversation Women when they're going to their primary healthcare providers saying that they can't sleep, saying that their body composition is changing, that their mood and their affect, their anxiety, all the things that we know about, you know, the, the hot fl, like the very obvious signs like the, you know, the thermal dysregulation, the hot flashes, all of that. And then also the more subtle signs like the mood and the affect, the anxiety, the confidence, all these things like to believe women when they're telling their PCP that and to have access to the hormone replacement therapy. So that's the number one. But the second point that I wanna make is after that's been done, after we believe women and we give them access to the hormones that they so desperately need to also understand that the hormones are not gonna lift the weights for you. The hormones are not going to build your plate and choose what you eat and what you don't eat. The hormones are not gonna set healthy boundaries with your family or your career like that. That has to happen with you. And this is where, you know, I was talking to you offline about a couple of subjects that I wanna broach. And I think here's where, maybe where we will broach one of them, which is we have to. We can't abdicate our responsibility in terms of some of these lifestyle choices that we've been talking about. Like, we've been talking about the calories, in part, for most of our conversation. We'll get to calories out in a moment. But I think that we can use HRT or MHT, as it's more accurately called now, as a tool to help ameliorate some of these symptoms that we're talking about. The body composition changes and having this anabolic response, which is awesome. But you also have to do it with the resistance training. You can't just take the estradiol patch and then sit down like you would in a body. You know, if we look at bodybuilding in the physique world, you know, we don't just give people testosterone and say, okay, you can just sit down and, like, watch tv now, like, they still have to go to the gym and work. Like, you still gotta put the work in. And so this is where I sort of strongly. What I often find with pharmacology in general, and again, feel free to weigh in and tell me that I'm dead wrong or you agree or what. Or anything in between. But I feel like so often we jump there as the primary solution and we abdicate our own involvement and our own ability to effect the change that we're looking for.

A (48:09)

Yeah, I think. Do you agree?

B (48:10)

Not agree. You think that I.

A (48:11)

No, I 100% agree. And there's even arguments that you want to have your lifestyle kind of in check so that the hormones that you're taking can do what they're designed to do. So that's. It's a very good point. And are. Yes. Are we. Do we have a plan to exercise? Are we doing our best to not consume an excessive amount of highly processed foods? Do we Prioritize sleep. Like yes. So these lifestyle factors go hand in hand with the hormonal environment. So I love that you said that.

B (48:53)

Let's finish off the C calories in piece of it. So assuming we have somewhere around a 25% reduction in calories, assuming the woman, maybe she's not part of that subgroup in perimenopause that is just thrashing around and not being able to affect any change that she wants, how long can we stay in a caloric deficit? So you, you know, you mentioned these women on social media, they diet down, they take pictures and that's their, you know, how long do we stay in a caloric deficit? Or what are, what are the markers that we know that maybe we've run the course of this fat loss phase and now we can maybe come off of it.

A (49:31)

Yeah. So I, I again your questions are, are right, right in my wheelhouse in terms of what I like to study, what I have studied. One thing is we want to avoid a perpetual dieting mindset. So we want to have a defined period. I want to lose fat, but we don't want to live a life of dieting. It's miserable. I, I, I, I really don't like dieting. I diet a lot over my career, some from professional reasons, some because I just, I, I lack discipline, come from an obese family. So I'm, I'm, it's easy for me to gain body fat.

B (50:04)

Yeah, same.

A (50:05)

But let me just put one anchor out there. Any diet that is planning to last for six months or longer is, is a, not a good plan. Now an exception to this, if somebody has, if somebody is morbidly overweight, they have excess adiposity. I'm not referring to, to, to this type of individual. So individuals with, let's say severe excess adiposity for most of our population, six months, very, very long. So what I would like to suggest is almost phases. So if I have £20, I'm going to lose, I may say, okay, I'm going to try to lose this £20. And this is, this is a very good example. Over this next year I'm going to lose £20. So somebody would look at that and say, well, I could lose a pound a week and be done in 20 weeks. Why are you saying a year? Well, because I don't want you dieting consecutively for 20 straight weeks or 52 weeks. Diet for a month, take two weeks off. In the research we call them diet breaks. Diet for another month, take two weeks off. Something I love. And we did A study on this in males and females. Some people refer to it as the weekday diet. We would have our subjects diet Monday through Friday and then on the weekends when, by the way, we naturally want to eat more food or we do eat more food naturally on the weekends. What we did was we increased their calories back to maintenance calories so they weren't overeating on the weekends, but they were, they weren't dieting. And what this does is Monday through Friday, our bodies are in a catabolic environment that's good for fat loss. But the longer this catabolic environment is extended, it's also catabolic to muscle tissue. So that's not good. So the beauty of this, let's diet for five days and then go back to maintenance calories on the weekend. Now we are in a potential anabolic state for two out of seven days. And that's a great time for our bodies to maintain the muscle mass that we may otherwise lose if we did an extended caloric deficit. So just a summary statement. Don't go on a perpetual week, month after month of dieting as much as you can. Break it up with periods of maintenance calories. And the easy thing here is if you're on vacation, don't. I would really try not to diet. It's miserable dieting on vacation. Use those times to go back to maintenance calories. And again, in my own life, I pretty much probably will never diet on a weekend again. That will be a maintenance phase for me if I'm trying to lose weight.

B (53:00)

That's so freeing because so often online we'll see the reason why you're not losing weight is because everything on the week, you're ruining all your progress on the weekend. But I do like the qualifier where you're taking a break, but that break is not you're having two pizzas. The break is that you, you know, that you're going back to your maintenance calories, which you've, if you've done this correctly, you've already established by tracking for two weeks. So let's say it's that 2,000 back to that exam. It might be the 2,000 calories. You go back to that on Saturday and Sunday, and then Monday to Friday, it's a, you know, 1500. If we're, you know, using the 25%, yes, deficit rule, Monday to Friday, it's 1,500. And I think that that's also, you know, metabolically a nice idea because it helps you push through plateaus perhaps a bit faster. But I think psychologically is probably where this really shines because I think it's psychologically taxing. You know, you mentioned, you said, like, I don't, who wants to be on the diet, on a diet their whole life or on, on vacation or on the weekend? I think it's psychologically taxing. If you're getting together with friends, you're like, oh, I can't have that. You know, I do love this. It's almost a psychological break. From what? From the goal.

A (54:08)

That is exactly right. And when you've just gone from, and you're, when we do this approach, we normally will diet a little more aggressively Monday through Friday, knowing that we're taking the weekends off. So as an example that it may be a 30% caloric deficit or 35% Monday through Friday. But one thing that, that, that is very noticeable when you go back to maintenance calories, it doesn't feel like maintenance calories because you've just been restricting your calories for the last five days. It feels, and this goes back to your, your comment about a psychological break. It feels like, wow, I get all this extra food. Well, it's really not extra food relative to your maintenance calories, but that's what it feels like and it's pretty powerful.

B (54:55)

One last question about calorie. Well, I have many. But when we are thinking about tracking our calories. So we've been using this example of 2000 and 1500. Are you. So my pre, my preference is to actually track my macros, which I know is a form of calorie tracking. But do we just look at total calories? Is that the most important thing or do we want to look at macros? And when I say macros, of course I'm talking about proteins, fats, carbs.

A (55:23)

Yeah. So I, I advocate for macro tracking, but it, it is Calorie tracking is the same thing, but with macro tracking, two levels here. From a population based education perspective, if you have, if you, if we had all of our children, I'll just say all of our elementary school children track their macros for two months as a school assignment for the rest of their lives. That is an education that sticks with you for life. Once you start identifying, oh, butter is a fat, broccoli is a carb, egg whites are like you, you are educated for life. It's. I wish everybody would track macros for six months of their life because that you cannot unlearn what you've learned about food. And I think you appreciate as well as I do, many people sadly do not have this education they, they have no concept that vegetables are carbs and that oils are fats. It's. And again, so I'm a big advocate of tracking macros. Now I also want to be sensitive to, we don't want this to be obsessive and where it's ru. You know, just controlling your life. Every gram of lettuce needs to go into my body. That, that would be disordered eating. So there's this balance of I need, I want to be educated and for somebody like me who struggles with gaining weight and again, family, I come from an obese immediate family. I have to be on top of this, otherwise I gain weight pretty quickly. So for me it's, it's a lifestyle kind of out of necessity. And I'm a scientist, so, and I like data, so it's, it's not a chore for me. Actually that's not true. Sometimes I do get tired of it and I stop and then I gain body fat and then I have to go on a diet.

B (57:15)

You're like, damn it.

A (57:16)

Yeah. But I take notes. So it makes me a better, actually makes me a better fat loss researcher because of this. But yeah, a macro tracking. And the, the second reason is separate from this population based education. I, I embrace a protein anchored flexible dieting approach. And by tracking macros or having your attention on macros, you are sure to be aware of and ideally prioritize protein in your diet. And, and if you prioritize protein, guess what? You're not con going to consume as much of processed carbs, processed foods in general. So there's a tremendous value in tracking macros in my opinion.

B (58:00)

I love that. And I'll, I'll give you sort of a real world example. My children, of course, growing up with me, I'm like, you need to know that, you know, carbs are, vegetables are carbs. One of the biggest realizations for them was that cheese and nuts are primarily fats. You know, I think that they thought that it was like very much like, oh, this is like a protein sour. Like, well, look at the label. You know, look at the label of the. And that's the other thing that they're learning is like how to read a label and how to very quickly estimate whether something is a high protein or a, you know, high carb or high fat food. And the. I actually picked this up from Dr. Ted Naiman who was on the show where you just basically take the protein amount. So whatever's on the label, let's say that it's 10 grams of protein. Well, the if you multiply that by 10 and the total calories on the label is equal to, let's say if it's 10 grams of protein, in this case the calories are a hundred or less, then you know that the food that you're about to consume, this packaged, whatever it is that you're about to eat, is at least 40% protein.

A (59:00)

Wow, that's a great little. I love that.

B (59:01)

Isn't that so great? So you just look at, and this is so helpful for travel because they have air quote, I'm using air quotes here. Protein bars in these little like self. These little 711 type food, you know, stores in the airport. And they, if you actually look at the label sometimes it'll say, oh look, it has 20 grams of protein. You're like, oh great. But it has 350 calories, you know.

A (59:24)

Yeah.

B (59:25)

So it's like, well this is very much, far less than 40% of the total calories coming from protein. So hat tip to Ted Naiman for that. But label reading I think is also. And when we're talking about public education, like learn how to read your labels as well. Okay, so we've been talking a lot about calories in. I do wanna shift slightly to calories out. And I wanna talk about muscle hypertrophy and resistance training and cardio. My bias, I shall state it here, is that resistance training is my method of my preferred method for body composition changes. Overall it's more of a longer delta. I think that where. And I am in perimenopause. I'm 47, so I've grew up in the era where it was like, you know, you count your grapes, that's your like 10 grapes and you know, maybe two almonds is your snack. And if you want to move more then that means you get on the treadmill and you run for 45 minutes. So I think that when we are thinking about, see you know, calories in, calories out, it's like eat less, move more. Most people are going to assume moving more is a cardiovascular type of activity, which I'm not poo pooing, I think it's important. But that usually has like a certain amount of caloric expenditure ascribed to it. Versus if you were to like this morning I did shoulders. I have no idea what my calorie caloric expenditure was. But I know that over the long term I'm gonna have nice big juicy delts and that's kind of what I want. And you know, same for legs, same for back. All, you know, all the body Parts that you train. So I guess my, I guess my question here is when we are thinking about calories out, where do you fall in terms of is there one type of activity that you prioritize over the other? And if yes or if no, how do you structure, how do you think about incorporating both resistance training and cardiorespiratory fitness into somebody's program?

A (61:17)

So my philosophy is a resistance training prioritized like I would prioritize resistance training. That does not mean that cardiovascular aerobic endurance training is not good and it's not important. It's just that I believe there is a better benefit to resistance training, particularly as we, if, if, as my research is starting to focus more on a middle aged female, what we see happening is we know that they start to lose muscle mass. Well, if we're resistance training, that's the best defense we can to prevent that. And if you lose muscle mass, by the way, now your metabolic health is going to suffer when we also gain body fat. Again, just because I'm saying I prioritize resistance training and I also want to say generally we want to think about lifting relatively heavy. So here's just a caveat. I just came up a pretty long discussion with my wife. Essentially if you pick up a weight and you can lift it more than 20 times, that weight's too light. Now I can make arguments that if you take that weight to failure, if you do 44 reps, you're still going to get an anabolic stimulus. All of that is true, but I think I'm doing more good by saying if you can do a weight more than 20 times in one set, let's, let's choose the next heavier weight to do to do your routine. Now conversely, if some, because I'm a fat loss researcher, if somebody said I want to lose as much fat as I can in the next two weeks, should I prioritize cardio or resistance exercise? My answer would be cardio. Cardio burns more calories in the moment because it's continuous resistance exercise burns calories, but it's more of a long game in terms of shaping your body, burning more calories over the long term, metabolic health, increasing bone mineral density. So again I, I, if the answer is how do I lose body fat now? Do a lot of cardio. But that's very short sighted because resistance training will give you a lot of metabolic health benefits and probably gives you the body that you think you want by doing that form of training.

B (63:36)

Yes, the so called toned appearance for women, which is a word that I get sort of like an angry tick at. Because just being in practice for, you know, 20 years or however long, like tone when we are. The only appropriate use of the word tone is actually when we're making a comment about the nervous system. Hypertonic, hypotonic atonia. Like, these are like, that is appropriate. That is an appropriate description of nervous system function. It is not. You are not going to get long, lean muscles. Like, your attachments don't change, you know, like, it's like you're going to get long muscles. It's like your muscles, if they're long, they're already. They're just going to stay the same length. You're just going to increase the, you know, the size of them. So I love that. Okay, so let's talk about some of the principles of muscle hypertrophy you've already talked about. Lift heavy weights, which, I mean, you're singing to the choir here. I'm so happy that you're saying that. I certainly talk about this almost ad nauseam on the podcast at this point in time. But it's also, I have to hold myself back at the gym when I see these women that are like the two pound or the five pound and they're, you know, they're doing lunges with them. It's like girls, you know, if you've, even if you've just had a child, like all the moms, like, just think about how much that car seat with the baby weighs. Like, the baby's like 8, 9, 10 pounds. You know, the car seat's like another 10 pounds. Like, that's 20 pounds on your arm. So can we be thinking about just what are, how do, how does this, you know, we work out in the gym, obviously for the aesthetic reasons, but we also work out in the gym not just to work to get good at working out in the gym, we work out at the gym to get good at life so that you can lift your baby, so that you can squat down and lift a couch if you want, you know, whatever. So what are, what are some of the myths maybe that you see persist around or what. What is the fear, do you think, around lifting heavy weights for women?

A (65:27)

I think historically it's been that it will make them look too mat too. They'll build too much muscle. I don't want to look like a man if I lift heavy weight. So I think there's less of that today than, than in the past, but maybe, maybe not. And one other just a thought that came into my mind, which was when you're you're seeing some of this two pound stuff when you're in the, the actual commercial gym. How sad is that? Because they've done, they're there, they're com. Like they've done all the hard work. They've got in their vehicles, they've driven, they're ready to work out. And there's just something that's like, that's stopping them from actually getting a stimulus that will be meaningful to them.

B (66:10)

Yeah.

A (66:11)

So, yeah. But other than the fear of building too much muscle or, and maybe it's a, oh, it hurts more. And I don't have an answer to that. Yeah. If, or maybe injuries harder. It does hurt more, but people are scared when you're done. I'll give an example. Yeah, I, I, I can't stand squatting. Like, I, I'm like barbell squatting. I did it yesterday. Every day I'm like, I try. I don't want to do this. And I haven't always felt like that. But, man, when I'm done and I look at, you know, I'm very blessed by God. Like, I'm, I'm healthy, I've got, and I've got great joints. I can squat. So why would I not do that again? That's just my own personal battle that I have with squatting.

B (66:58)

That's my, my battle with Bulgarian splits. So I put them the first, they are the first exercise that I do in my workouts. I can get it over with and then I can enjoy the rest of my workout. But I know I've done my Bulgarians and then I can kind of get to the rest of the, get to the rest of the workout. So I feel you on that.

A (67:12)

Yeah. Yeah. Those are, those are brutal. Is that where your leg is behind you is up on a. Yeah.

B (67:16)

Oh, yeah, yeah, yeah. So I will either do that on a Smith machine or I'll do it with dumbbells. I've occasionally done it with a barbell, but I do prefer it on the Smith, where I have sort of that.

A (67:24)

Predictive line of barbells is very, you got to be well balanced.

B (67:28)

Yeah. There's a bit more of a stability component there too, but it's, and, you know, depending on how far, you know, sort of forward you're leaning or how far your chest comes, that you can sort of bias the quads or the glutes, kind of depending on what you want to do. But I definitely always put them first because I absolutely hate them. And if they don't, if they're not first in my routine, I skip them. So that's my, that's my fail safe there. Okay, so let's talk. So when we're talking about, and I'm again so aligned with your philosophy around lifting heavy weights, if it's more than 20, I mean, the literature is very like, my understanding of the literature is like 5 to 30, you know, anywhere in there, as long as you're within, you know, muscle failure, like 3, 4, 5 reps of failure, or maybe not 5, 1, 2 and 3 reps of failure, that is going to be enough of an anabolic response. But I do agree with the principle there because I think that the tendency is like, oh, well, I can do 25 then, and I can just keep the two pound weights or the five pound weights because it feels hard at 23 versus challenging yourself. So there's two ways essentially to build muscle. One is the mechanical tension which we've been talking about. Can you speak a little bit about maybe in those higher rep ranges like the 15, 16, 17, 18, 19, 20, what is happening there? Why is that also effective? Why can we also build muscle at some of those larger rep ranges as well?

A (68:44)

So we, there's really, I mean, the research goes up to 70 reps in a set.

B (68:50)

Oh my God.

A (68:51)

Where you can build muscle. Now that there's a huge assumption there, that assumption is that you go to failure. Which means if I'm doing, you know, a four pound dumbbell and I'm curling it 88 times or 70 times, I have to keep curling it until I cannot do another rep. And I will tell you if, if you don't know, I mean, I know, you know, the amount of lack lactate that's building up in your arm will be extremely painful by the time you get to 30 repetitions. And then you're getting to 40 and 50.

B (69:26)

Yeah.

A (69:26)

So it's a brutal way to lift. So I don't think anybody practically is using lightweights to build muscle. But as you said, the research actually does and you're, you're very on top of the research up to 30 repetitions. As long as you go to failure or near failure, you get an anabolic stimulus past 30, you still build muscle, but it does become not as much muscle as less than 30 reps. So 30 would be this demarcation. If you're trying to build muscle, you never want to lift a weight above 30 reps because we know that you're not optimizing the anabolic stimulus. The, the, there's the, the two. When we talk about the Mechanisms of muscle hypertrophy. You mentioned mechanical tension. I always like to just think that is the pulling of the muscle fibers on the tendons and the bones for a given muscle tissue. That is very important. And then we also have another component called metabolic stress. So that is this oxygen being pushed into the muscle, the lactate being produced during these sets that is more accentuated in the, you know, past 10, 12, 15, 20 repetitions. So we, the, if we're lifting a very heavy weight, we're optimizing mechanical tension. If we use lighter weights, what I would, I would even say moderate weights, we're biasing the, the, the mechanism towards metabolic stress. So that is why when you think, okay, both of these are important for muscle Hypertrophy, typically about 6 to 12 reps, blends both mechanisms into a very efficient workout where it's heavy enough that we're getting a lot of the benefits of mechanical tension. And it's not so heavy that we're not negating the metabolic stress component. So when I program, most of the exercise that I program for are going to be in the 5 to 15 repetition range because it's efficient, it builds muscle. And we're also getting a strength benefit when we're a little closer to the five repetition, five reps.

B (71:45)

I love that you brought up strength. That was my next question. So my question for a woman in midlife. So I love muscle hypertrophy as a goal for a woman. And then as you said, in that 5 to 15 range, you also get this, you know, you get the strength benefit as well. Even though hypertrophy and strength are related to each other, they are technically two separate outcomes. Is there when we're thinking about a program for a woman in midlife, let's say, and we're not just training for her body right now, but we're like, I like to say we're training for her old lady body. We're training for her grandmother body, maybe even blessed to have a great grandmother body. Should we also be optimizing for strength? And of course, we know that strength is harvested, we'll say in some of these lower rep ranges with a much heavier mechanical load.

A (72:35)

Yeah, the only way to increase strength is to lift heavy weights. 20 reps, 15 reps, you're not, you're not going. That is not a stimulus for building strength. So I, I do believe there is a component. So I like, I like the term periodization. Some of our training should be to, let's, let's focus on strength. Some of our training, let's focus on hypertrophy. I like, you know, 2080, a little less on strength, more on hypertrophy since we lose muscle mass. But this is where I also have to bring in some context. As much as I would love for every woman to be able to do back squats or Bulgarian split squats, these types of things, what I'm learning is joint pain, energy levels are tanked. So I want to at least be conscious of not every woman. It's easy for me to say squat and bench press and do these things if you can. You absolutely should if you're in a current situation where. And again, I'm, I'm going back where I saw this firsthand with my wife and she's given me permission to talk about this publicly. So I don't want you to think that I'm, that she's not going to.

B (73:54)

Be surprised when she's listening to the show.

A (73:56)

Well, she doesn't listen to any of my podcasts anyway. But this is personal. She, she had zero energy. She had a very hard time getting off the couch for, for months. I didn't even really notice it, which I don't. I guess that's sad. But she's like, I, I, you know, I'm not lifting. So what do you do in that situation? I don't, I just want to be careful that, make sure you're squatting. Make sure that you're doing all these things.

B (74:19)

Yes.

A (74:20)

When some women, they can't or they're in such a bad place. And, and to that I would say let's make sure that are we get just what we talked about earlier. If, if MHT is, is appropriate for you, you, you need to have that conversation with your evidence based physician. Are you prioritizing sleep? Are you eating well? Are you able to do anything to get, you know, to move? And then the goal would be once we, once you feel better. Now, yes, you should be squatting. Deadlifting if you're healthy. Bench, you know, heavy compound movements, splits, Bulgarian split squats. These are the things. Yes, they're harder that that your. But it makes your body resilient. So that's the goal. Hopefully if you can do it, you are. And if you're not, I want to get you to where you can do that.

B (75:14)

Yeah. And this is where I like to talk about. You know, we always talk, at least we were always taught like full range of motion. Always. It's like, or if you have an arthrotide, which tends to happen in midlife, you know, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, all the arthrotides, you may not necessarily have full range of motion. So it's like you work as close as you can to muscle failure in a range of motion that you can own with the idea that you will expand that range of motion over time. To your point around preserving and loving up on our joints. And this is where I really like your comment around periodization. Because we can have weeks where we are going really heavy, 5 reps, 7 reps, 8 reps, and then the next week you can give your joints a bit of a break and you can do a bit of higher volume so you're enacting that metabolic stress. So maybe it's like the 10 to 15, maybe even 20 if you need a little bit more, if you need the weights to come down a little bit. But the principle is always the same. Like you're working like one to three reps within failure or you've reached failure. I don't think you need to reach failure. I think it's useful for you to understand what your finite limit of your matter is. But that's not necessary in the context of, you know, muscle hypertrophy. Like, sometimes it's fun if you're like a nerd like me who likes to really push herself at the gym. And like, how far can I actually put. You can, but you don't. That's a, that's not a requirement.

A (76:28)

Yeah, I like to think of that as. Yeah, it's, it's, it's probably you should do it every few months. So that way you have a, you, you have a baseline for. If I just, if I just use 20 pound dumbbells and I, and I could curl them 16 times. Well, now you know, the next time you're using 20 pound dumbbells and you stopped at 10, that's, you're stopping way too soon. But you wouldn't have known that if you didn't go to failure once a while. I, I refer to them as like test days in our programming.

B (76:59)

That's great. This is very selfish question, but is there a muscle set point? In other words, in the absence of exogenous substances that can help us grow anabolically, is there a cap to the amount of muscle that we can put on asking for a friend? Also, I wanna know if it's like, is there a natty upper limit that I have?

A (77:18)

Yeah, I can't, I can't point to research, but yeah, I think when we look at natural bodybuilders who are in their 40s or 50s, and they've been doing this competitively for 20, 30 years of their life. They've built almost all of their muscle in the early parts of their careers and every few grams in the year after year, it gets harder and harder to build muscle. So, yeah, and to me, intuitively, just intuitively, maybe there's not a cap, but boy, trying to build muscle at the rate that you did in the year, first year of your training, I don't think you're ever gonna see those types of gains. So. I believe there is.

B (78:00)

Yeah. And it's, you know, it comes back to that sort of myth around, you know, especially for women, like getting bulky or whatever. It's like, you know, how many years I've been trying to get bulky. Like, do you know how hard I have worked, how much protein I have consumed, how many hours in the gym? It has not happened yet. And so, yeah, to your point, as you have that muscle cell turnover and you have very efficient tissue quality, contractile tissue like it's, it is, I think that there is, I think that there is sort of an upper limit, particularly for females. Then you have this whole menopause thing where you lose all of your anabolic hormones as so it becomes more difficult in midlife and beyond. I have a question for you. Around cardio, I know we haven't talked too much about that, but there is, I do hear this in the, I hear this everywhere, not just in the physique community, but is there an interference effect with. So let me just back up and say where do. If we are assuming that cardiovascular training is important, maybe it's an important component for fat loss, as we've been talking about, is important for longevity and just good cardiorespiratory function. Do we wanna think about pairing the cardio immediately before, immediately after, or do we want some space in between it? And the question that I'm getting at for the nerds that are listening is is there an interference effect with resistance training and cardiovascular training?

A (79:11)

So I've looked into this, extensively written about this. My, my analysis of the research is that there is no hyper, hypertrophic interference effect. There's a. I'm just going to give the numbers. There's approximately 30 studies that have looked into this. There are more studies reporting more muscle growth with concurrent training than there are studies that report any type of interference effect. So, and let me just define interference effect, meaning we, we maximize muscle growth with resistance training. When we add cardio to our program, do we now build less muscle even if we do the same amount of.

B (79:55)

Resistance training with the same intensity, like same duration, same frequency, same. Okay, okay, okay.

A (80:01)

And the answer is no, not with, not with muscle hypertrophy. You again, more research and the research that shows that you build greater muscle mass is actually the best research where they looked at muscle cross sectional area, muscle biopsies. So. And again, that's not intuitive, I would think. Well, that's a diff, you know, I would think you would not gain as much muscle, but the research doesn't support that. Now for our, for the bodybuilding community, we don't have research in enhanced people who are taking steroids who are, have massive amounts of muscle. Is it possible that if they did a lot of cardio that they would not maximize their, their anabolic potential? Yes, but we don't have data. But for normal people, no. If strength is the question, there does appear to be an interference effect. So if you are trying to be as strong as you can possibly be, and you're signing up to, to train and run a marathon, you will harm your ability to gain maximal strength. And I just use marathon as an, you know, kind of an extreme example. So if, and again, I would. We don't even have examples of marathoners trying in this interference effect. It's usually much more practical. But if you are concerned what you kind of the area that you were just going down, one, you shouldn't be concerned. Do your cardio, do your resistance training. It's not going to impact your muscle mass, but let's just say somebody says, well, I'm really training for strength. Okay, then we want to start with as much as possible, do your strength and your cardio on different days of the week. If you can't do them on different days of the week, try to separate them by about four hours throughout the day. So do resistance training first and then cardio second. But so split them. If you can't do that, then you got to do it at the same time. Do resistance training first. Get that stimulus, end with your aerobic exercise.

B (82:02)

This is so great. I think, I think every woman in midlife, one of her goals should be strength. Either adding on to the strength, either the maintenance of the strength that she has, or adding onto it. And so I love the multiple options that you've given here. It's like just get her done. Like do the resistance training first, prioritize the RT and then do the cardio right after. If that's the only block of time that you have, and if time is available to you, then maybe you can split them up if you're trying to preserve strength. I love that. And I often find, too, I have to be honest, I don't find that I can maintain if I do cardio first and then I go and do, let's say, a back day or something, maybe smaller muscles like shoulders, I could probably punch that out. But I find like a bigger. Bigger muscle groups like back legs. I cannot maintain the same intensity if the resistance training is preceded by cardio. So I actually just generally like to separate them. Like today I mentioned I did shoulders today. Small muscle group. You know, I'm very sore from legs, so this is like a recovery day. But I also did shoulders. So I'm also gonna be doing like a bike ride later on today if I can sort of carve out some time for it. And I like to split them up that way because I am very concerned as a woman in midlife now and approaching menopause, to maintain not only the, well, you know, maintain my hypertrophy build on the muscle that I have, but to really. The important thing for me is to maintain the strength that I've. That I've gained.

A (83:25)

Yes. Yep. And you're a go. You've already done your resistance training workout today.

B (83:30)

This is. Yeah. Woke up early. I was like, I. I actually naturally wake up around 5, 5:30. So I just like, get to the gym, do my thing and then.

A (83:38)

Yeah.

B (83:38)

And then back here. Wonderful. Oh, my gosh. There's. There's a bunch of things that I didn't get to with our conversation, but I just, I know that this is going to be so valuable. Some of your work, like, I've, you know, I didn't say this to you in the, in the beginning. Have followed your work for so long. It has informed so much of what I understand around exercise physiology and body composition recomping for women in midlife. So I just want to thank you for the time that you've spent today and for people who want to follow you. I know that you have a research review that you put out. Your very evidence is your inter. Your Instagram account is incredibly interactive. I'm always like, I wonder if I know it, if it's true or false or what's the answer, A, B, C or D? So can you just give a shout out to all the ways that people might find you, interact with you if you're in Florida, if you're in Florida. If they can, you know, be a participant in some of your many studies, like, just tell people all the places.

A (84:30)

They can find you yeah. So really I'll make it easy. Instagram's really the only place that I'm on social media and that's Bill Campbell, Ph.D. and I have a website that's also Bill Campbellphd.com and that houses my research review, which is the best research review that focuses solely on building muscle and losing body fat. And I, as you've noticed, I've brought in quite a few of middle aged women menopause transition studies over the last few months because that's where my research is going. So naturally that's going to be in there. It is, yeah. Bill campbellphd.com so I just summarized the the best and latest research on losing body fat, building muscle. And then I also bring in expert trainers, physicians, dietitians and for them to apply that research to their clientele. So there's a science and an application based and it is my baby. I love it.

B (85:31)

Wonderful. I will make sure that all that are clickable links in our show notes. Bill, thank you so much for your time today. It's just been a pleasure speaking to you.

A (85:38)

Yes, it was great meeting you in person. I'm so glad we got to meet and hopefully you'll be there next year. I know I will, will be. So I'll see you again.

B (85:45)

I'll see you very soon.

A (85:47)

All right.

B (85:48)

All right. All right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss. Do not replace medicine, chiropractic or any other primary healthcare provider's advice, treatment or care. In the consumption of this podcast, there is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.