← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Eat, Exercise & Recover Through Your Menstrual Cycle with Dr. Sarah E Hill
01:26:26
Ever feel like your body speaks a different language each week of your cycle? Dr. Sarah E Hill decodes the secret messages of your hormones and optimizes health & fitness! Listen in for insights on navigating PMS, maximizing workouts, and honing your self-awareness. Watch the full episode at https://youtu.be/xvvWb8l2W58
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- [00:00]
A
I mean, our body is literally shifting gears from head to toe, right? So it's like we're becoming a different version of ourselves. And this is something that, you know, it's like on the one hand we recognize that hormones influence behavior or influence how we feel, but I don't think that we've really given it the importance culturally that it needs. And I think that we've tried to minimize the impact of women's sex hormones on the way that they think and feel and experience the world.
- [00:32]
B
Hello my friends. Welcome back to another episode of better with Dr. Stephanie tis me, your geeky host, Dr. Stephanie Esteema. I have a fantastic conversation for you today. If you've ever felt different across your menstrual cycle and maybe you're listening to these online influencers that are telling you that nope, you're not different, it's just, you just gotta suck it up, buttercup. This is going to be the episode for you. My guest today is Dr. Sarah Hill and we are talking all about how the ever changing hormone hormonal landscape in a woman's menstrual cycle, whether she is in her fertile years and wants to get pregnant or in perimenopause, changes the brain and changes the way that we approach even our mates, the way that we approach nutrition and the way that we approach exercise. This is going to be a phenomenal conversation for you to understand yourself better. For you to understand that the changes that happen in the luteal phase are a feature and not a bug. There's nothing wrong with you and in fact it is biologically, it is in it's information. So when you are feeling more sensitive, when you are feeling a bit more vulnerable, this is the information and the way that your body is talking to you. And perhaps it's an evolutionary and modern day mismatch in terms of the way that we live our lives, which is very much male dominated. The way that our structure in society is, is, is set up and for you to not to feel like you're broken. Okay, so who is Dr. Sarah Hill? Well, she's pretty important. She's an award winning researcher, consultant, writer, scientist, communicator and professor with nearly 25 years of experience. She's authored over 100 research publications and two books on hormones and birth control. Dr. Hill earned her PhD in evolutionary psychology from the University of Texas at Austin in 2000. She divides her time between her TCU research lab and educating students, organizations on and organizations and the public on human and female biology. So we are talking today about the two different phases of the menstrual cycle, the the follicular phase and the dominant hormone, their estrogen and the luteal phase and the dominant hormone, their progesterone, which is the topic of her new book, the Period Brain. And the central thesis is how the second half of the cycle, the luteal phase, has been overlooked and how we might think about relating to ourselves and being better stewards for ourselves in the second half of the cycle. I know you're going to enjoy this. This is for every woman everywhere and for all the men who love them. So without further delay, please enjoy my conversation with Dr. Sarah Hill. There is a new darling in the supplement world and it is showing some incredible applications for recovery, muscle strength, endurance, joint health in degenerative diseases like osteoarthritis and even brain health with Alzheimer's disease. It is called Urolithin A and is something we actually already make in our guts, but like most things, it tends to decline as we age. Urolithin A is anti inflammatory and also has antioxidant properties and it is involved in recovering from workouts. So as our own natural production declines in midlife, the potential for inflammation, poor energy and poor recovery also increases. As a perimenopausal woman, I know that I am in a fight against time to preserve my muscle strength, my muscle endurance and my recovery needs are greater. I take Timeline's Urolithin A both in pill and now their delicious gummy form to protect against this. A serving size is two just delightfully delicious gummies which gives you 500mg which is the clinically relevant dose to get all of the muscle endurance and strength benefits, recovery, bone health and brain health. I am so excited to share that listeners of this podcast that's you now can get 20% off of your first timeline purchase. Head over to timelinenutrition.com better and use code better at checkout. That's timelinenutrition.com Better and use code better to check out to receive 20% off today. All right, and we're live. Dr. Sarah Hill, welcome to the Better Show. I am so delighted and excited to have you on the show today.
- [04:52]
A
Thank you for having me. I'm super excited to be here.
- [04:55]
B
Well, we are going to dive right in your new book Period Brain. At the time of this recording we are releasing it as the book is coming out and I wanted to dive into maybe one of the central tenets of the book, which is that women essentially have two brains over the course of the menstrual cycle. So let's talk about the menstrual cycle and how we change over the course of that. Call it 26 to 34. However long the cycle is. We'll call it 28. Maybe for simplicity, how our brains differ in the follicular versus the luteal phase of the cycle.
- [05:30]
A
Right? So what you're alluding to is just the fact that women, we have two halves to our whole, right? And that is that our body sort of works together to coordinate two distinct sets of activities that are necessary for reproduction each month. And those two sets of activities are sex, which of course is required for reproduction, and then the second half is pregnancy. Right. And so our brain and our whole body sort of gears together within the course of a single menstrual cycle to work together to solve each one of these two problems. Right. What are all of the problems that are required in order to have sex? Right. So during this time when estrogen is the dominant hormone, our brain and our body is all working together to do everything that's necessary to attract mates, to be able to better tell the difference between high and low quality mates. It's all about having a lot of energy and being drawn toward the environment. So everything seems really exciting. There's a lot of reward value in rewarding things like social activities and potential partners. Women tend to have higher sexual desire, they have more sex. So in addition to desiring it, they're actually actioning on that. And so that's the first half of the cycle, the first 14 days when estrogen is the dominant hormone and estrogen coordinates activities related to sex and attraction. Then after an egg is released and that empty egg follicle starts releasing women's second primary sex hormone, which is progesterone. That is when women's bodies are gearing up for all of the activities that are required for implantation and for pregnancy. And this is a totally different set of activities, right? It's not about being able to go out and meet partners and having lots of sex and feeling sexy and alive and having the environment seeming full of possibilities where you just want to go out and do things and sample new things and take risks. It's instead about conserving energy. It's about building an endometrial layer which requires a lot of energy. It's actually incredibly energetically expensive. It's a time when sex cannot lead to conception. So women generally tend to be less interested in sex. It's a time when we need to be safe, we need to conserve energy and we're more vulnerable. Right. Because progesterone, which is that hormone that's released in the second half of the cycle is also the hormone of pregnancy. It's like we release it in huge amounts during that time. And it's about safety. Our decision making tends to become more conservative. It's more sort of inward facing instead of outward facing. And so there's, there's two halves to our whole. Right. And each one of those reflects the different evolutionary activities that women have had to reliably engage in or over evolutionary time in order to reproduce.
- [08:20]
B
You mentioned high and low quality mate selection. I would love for you to maybe detail that's a bit of a subjective term. How does that actually alter over the course of the cycle? So some things that we might value, let's say when estrogen is the dominant hormone, when we are feeling, you know, the first half of the cycle you mentioned is all about sex. What might be some of the qualities that a woman might find desirable in a mate in the first half of the cycle? And how does that shift in the second half of the cycle?
- [08:52]
A
Yeah, no, it's, it's really interesting because. So during the first half of the cycle, again, this is this period of time when sex can lead to conception. And there's been a lot of research that indicates that during times in the cycle when fertility is high, meaning that women can become pregnant from sex, that women tend to place a heightened emphasis on qualities related to what we would call like good genes. Right. So essentially they're shopping for genetic quality for their children. And one of the qualities, for example, that has been found to be paramount in terms of women's attraction in the early phases of the menstrual cycle are, are cues related to testosterone. And testosterone is a hypothesized good genes marker just simply because testosterone is immunosuppressive. And so if a man is able to, during development, release high amounts of testosterone throughout his development, allowing him to develop that chiseled jaw, right, Those deep set eyes, and a brain that's sort of geared toward what we'll call behavioral masculinity and social dominance, that suggests that the man's immune system is so well put together that he is able to release all of that testosterone reliably throughout development, despite the fact that it's immunosuppressive. Because the fact is, if your body isn't able to protect itself from pathogens such as has to happen with our immune system, our body won't allow a lot of testosterone to be released. It'll suppress testosterone. And so the idea that a man's body throughout development was able to continue to release high levels of testosterone is an indicator that he's got what we'll just call for shorthand, good immune genes during the early parts of the cycle when estrogen is high. What research finds is that when estrogen is rising across the cycle, so too does women's preference for testosterone markers in men. And so women tend to be more attuned to things like facial masculinity, vocal masculinity, and what I always call behavioral masculinity, which is like cues to social dominance. And so women tend to have a heightened preference for these types of qualities in the early part of the cycle. And they're also better able to distinguish really small differences in these qualities between men during the estrogenic phase of the cycle relative to the progestogenic phase of the cycle during the progestogenic phase of the cycle. So the second half of the cycle, you can show a woman pictures that are very, there's very fine tuned differences, so the exact same man's face, but you can masculinize it slightly using computer software. And a woman in the estrogenic phase of the cycle is really quick to be able to tell the difference between those men, saying like, oh no, that guy's, that one's different than that one. But you show that same facial gradation to women in the luteal phase. And they're not able to tell the difference until the differences are much greater than what women can see in the early phase of the cycle. Just going to show that women's brains are really attuned to qualities related to potential things like genetic compatibility, which is believed to be communicated via cues. So women are just like, more attuned to whether or not they like the smell of a person at high fertility. So during the first part of the cycle compared to the second part of the cycle, and then in the second part of the cycle, when progesterone is the dominant hormone. And again, we have to remember that these hormones are responsible for coordinating different activities in the body and in the brain. Right. And that first hormone, estrogen, is all about sex and attraction. So like choosing a partner and having sex with them. Second half of the cycle is all about preparing for pregnancy. During this time, women are more sensitive to differences in cues related to investment. And so women tend to be really interested in connection forming connection with their partners. And they're also more attracted to those kinds of qualities in partners. So it's like women's partner choices are sort of a balance. When you look at women's long term mates, they tend to reflect a woman striking a balance between cues related to what we'll call just good genes, right? And then also cues related to provisioning and parenting. Because both of these sets of qualities have played a really important role in the survival of offspring throughout evolutionary time. And you know, when you look at sexual behavior in women, it also sort of fall, it differs across the cycle in ways that reflect these different adaptive, well, let's call them different adaptive challenges, right? The first adaptive challenge being those related to mate, you know, sort of choosing somebody with, choosing a partner with good genes and then, you know, partnering, you know, having sex with them. And then the second sort of set of adaptive challenges are those related to, are those related to provisioning and parental care. And most women's long term preferences reflect a, a balance, right? Striking a balance between these two types of qualities. Choosing somebody with good genes who's also going to be a good provider and somebody who's investing in offspring. And what we tend to see is that in the second half of the cycle, instead of having sex be something where it's about just sex for the sake of sex, which is what women are looking for in the early parts of the cycle, with women's sexual desire being relatively high during the second half of the cycle, it's more about connection. And what we tend to see is that women tend to exhibit a heightened preference for, you know, sex as a tool of connection during the second half of the cycle. And we find that women who are feeling insecure in their relationships. So women who have a lot of attachment anxiety, they tend to have really high sexual desire in the second half of the cycle during this really not, I mean, which is a time that's totally non conceptive. And it goes to tell us a little bit of something about what the function of sexual behavior is in women during the second half of the cycle. Because humans are kind of interesting in this way because most mammals, the females do not have sex in the non fertile points in the cycle. They only have sex during the fertile points. Because, you know, it was long believed that the only function of sex was conception. But it turns out that when you look at a species like us where dual parental care has played a really important role in terms of gene transmission. It's both things that matter, right? It's about getting the genes and then it's also about forging connection to be able to maintain a relationship with somebody who's Going to help provide resources for yourself and for your offspring.
- [15:25]
B
I love what you're saying here. It's very. I've heard Esther Perel talk about this idea of maintenance sex, like the sex that we typically see on, you know, in movies. And it's like this passionate, like everyone's ripping off their clothes and they can't get to each other fast enough, which is maybe more archetypal of the estrogenic phase of the cycle. Or maybe it's, you know, maybe it's more of a, you know, male representation of what they think sex should be, which is an entirely different discussion. But Perel talks about this idea of maintenance sex and how that's almost like the glue that holds couples together and that it's very, very important for long term mating, which I think is exactly what you're talking about here is like this progesti, you know, when we are in this luteal phase or even just long term relationships, that this idea that sex is a tool for connection rather than just for procreation or even just for orgasm, I think is. Is maybe often underlooked as a, as a desire for women or a requirement for women to engage in sexual activity. Would you agree with that? Thoughts on that?
- [16:24]
A
Yeah. No, 100%. I mean, yes. And, you know, there's not a lot of species who do this. It's like us, the prairie voles, and then there's a couple of other ones. And it's all about maintaining the relationship. Right. And so like, for it's in, you know, evolution would not have forged this as something that we do. Because sex during the luteal phase is actually costly. Just because anytime that you are introducing anything foreign into the vaginal canal, it's going to cause an immune response. And this is something that obviously, in the context of conception, isn't ideal. And the fact that we continue to have sex during this phase in the cycle nonetheless suggests that it serves a really important evolutionary function. And that evolutionary function is, as Esther Perel so beautifully put it, is relationship maintenance.
- [17:12]
B
Okay, so if we have. The other thing I wanted to ask about is the necessity of orgasm. And maybe this is something we've learned from our wonderful friends the prairie voles. But is orgasm also? I know that for a lot of men, that is one of the, like, one of the big drives, of course, is like, you know, to ejaculate, spread the seed, et cetera. Is a. Is that the same requirement for women as well? Is orgasm the end game for us? And does that change over the cycle? Too.
- [17:37]
A
Yeah, no, that's such an interesting question. And, you know, for men, when you look at the, you know, in the psychology world, whenever you're talking about a motivated behavior, you talk about the reward value of the behavior, right? So how rewarding does our brain find this to be? And, and when you look at the research, it's really fascinating because for men, the reward value of sex is very much tied to orgasm. And so it's like if they have an orgasm, then their brain feels rewarded from sex, and then it wants to repeat it, right? It wants to do it again. For women, it's not this way. And so the reward value from sex for women doesn't come from orgasms. It comes from whatever their goal was that they were initiating the sexual behavior for. So if your goal for having sex is to have an orgasm, then the reward value for sex for you will be having the orgasm as a female. But if the reward value, like if the reason that you want to have sex is connection with your partner or the reason you want to have sex is so that way they'll shovel the snow off the driveway, you know, the reward value that we get from it is linked to what it is that we're actually seeking to do. And so in that way, it's like the female brain uses sex more instrumentally. So it's less about like, okay, I need to do this and I need to have this orgasm, and instead it's more like, I want to do this and it doesn't even need to be conscious, right? It's just like, I want to do this to connect with my partner. I want to do this because I'm in a bad mood and this will cheer me up with or without an orgasm. And it's just really interesting the way that our brains sort of treat that just in terms of sex differences with women, not sort of their sexual behavior and their motivation for sex not being tied to whether or not they have an orgasm. But for men, it is. And I think that this is one of the reasons that men tend to get really anxious about orgasms. And when you look at the literature for females, it's so much more variable than it is for men. The variability in the rate and consistency of orgasms with women is huge. I mean, there's so much variability in that, and for men there's not. And again, it's in part because women, I mean, a, an orgasm isn't necessary for conception for women, and it is for men. And two, it's like sex means so many different things to women. In a way that's a little bit different for men. And I think that because for men, the reward from sex is about the orgasm, I think that that's why men tend to get freaked out if they have a partner who's having orgasms less frequently than they are themselves. And so this is another place, and I talk a lot in my book about communication with partners, but this is another place where communication with partners can really go a long way and just letting men understand that our psychology is different than theirs is.
- [20:24]
B
And is there any. As you're talking about the luteal phase and maintenance, sex and sex as a tool for communication with or without the presence of orgasm. Is there a place for oxytocin here? So we often hear about oxytocin, like the love hormone, the bonding hormone. Is there some driver, Is there a relationship between progesterone and oxytocin that maybe that is driving some of this underlying behavior in terms of how and why women seek out sex in the luteal phase differently than maybe they do in the follicular phase?
- [20:57]
A
I mean, certainly, you know, certainly. And I think that when you look at the prairie voles have told us a lot about oxytocin and about sex and bonding. And indeed, this is one of the drivers of that feeling of connection that we get from sex and is the release of oxytocin. And I think that I have not seen any research on this question in particular, but my guess is that during the luteal phase, when this connection and relationship formation is paramount, that the release of oxytocin itself would actually be more rewarding to the brain than it is in the follicular phase, when estrogen is the primary sex hormone, because it's a little bit less, you know, sex is less about connection during that time, and it's more about connection during the luteal phase.
- [21:45]
B
I want to talk a little bit about some of the difficulty that I would venture to say most women have in the second half of the cycle. So, so many women will say that they feel, myself included. And it was one of the central tenets of my first book is like, I felt great the week that my period finished. Man, like, could not. I felt sexy, I felt good, I felt energetic, I felt outgoing. And then, of course, you know, I ovulated, and then I didn't want to talk to any. So, which I'm sure is I'm not just. Not just me, but so many women suffer with premenstrual syndrome. They feel inflamed, they feel you know, they're holding onto water, they don't feel as sexy, et cetera. Talk to us about why. I mean, on the. And I was talking to you about this before we got going. I feel like that's an evolutionary mismatch for two weeks, you know, somewhere between 12 to 16 days out of our menstrual cycle where we're not necessarily feeling our best and in many cases, you know, to the extreme. Of course, we can bring in PMDD into this conversation too. It's a debilitating thing that many women have to deal with. So I recently did something that helped me easily feel 10 years younger in just a couple of months. It's called Qualia senolytic. And if you care about aging well, you are going to love this. We all have cells in our body called senescent cells. Sometimes they're called zombie cells. They're basically worn out cells that don't really provide any useful health benefit anymore. They're just kind of hanging around, not quite dead, not quite alive. And they cause a lot of inflammation and divert our energy and nutritional resources to them. As we get older, our body accumulates more and more of these zombie cells and they're linked to declining physical and mental energy and slower workout recovery. Basically the stuff that kind of makes us feel old. Qualia Senolytic is a new formula with nine of the most research backed senolytics that actually help our body naturally eliminate senescent cells. So let's enjoy the wisdom and perspective that our years have earned us while having the physical and mental energy of someone half our age. We want to have the privilege of aging right, and this is going to help us age well. Take control of your aging with Senolytic. Visit qualiolife.com better and use code better to get 15% off. That's Q-U-A-L-I-A L I F E.com better and use code better at checkout. If your 40s has brought a little brain fog, little moody energy, some creaky joints, welcome to the club. You're not broken, you're in perimenopause. And this is where smarter basics really can help. Two daily staples on my counter the Purality Health, liposomal zinc and liposomal turmeric. But honestly, their entire line is pretty incredible. And here's the win. Purality wraps nutrients in tiny micelles than in liposomes. These are tiny fat bubbles that your body recognizes, so they actually make it through your gut and into your bloodstream so that you can feel what you're taking and it gets delivered where it should be going. Zinc is my go to for immune resilience, skin integrity and just day to day energy and vitality. It's a blueberry flavored liquid, so just a quick tablespoon I can take straight from the bottle or mix it in with water and turmeric is my move. Well, think clear Ally. It supports healthy inflammation response. It's great for joints, it's great for muscles, and it's great for focus. Their formula includes a full spectrum turmeric with fulvic acid and vitamin D and it's sugar free. Both are non GMO and free of gluten and dairy. And Purality backs them with a 180 day money back guarantee, which is pretty incredible. So if you don't love how you feel, you can send it back, no questions asked. Head over to puralityhealth.com better and use code better at checkout for 10% off of your first purchase. Why do we deal with so much PMS? Why do most of us deal with some flavor of pms? How is there this evolutionary mismatch between that and maybe modern life?
- [25:46]
A
Well, the answer to that is pretty complex. So the reason that women have PMS is really twofold, maybe threefold. So the first is the progestogenic phase of the cycle. So as we shift from, you know, this really high energy, you know, feeling really sexy, you know, estrogen dominant phase of the cycle into the luteal phase, I mean, our body is literally shifting gears from head to toe, right? So it's like we're becoming a different version of ourselves. And this is something that, you know, it's like on the one hand we recognize that hormones influence behavior or influence how we feel, but I don't think that we've really given it the importance culturally that it needs. And I think that we've tried to minimize the impact of women's sex hormones on the way that they think and feel and experience the world.
- [26:36]
B
Oh, I think there's a pretty hard eye roll even just around the term hormonal. And before, before you actually answer this, I just want to say men are also very hormonal as well. This is something that gives me a bit of an angry tic where it's like, oh, she's hormonal. It's like, you know what, your testosterone.
- [26:49]
A
Will go up if you see a gun.
- [26:52]
B
A gun, okay.
- [26:53]
A
Like you see like an attractive person, you watch a movie where there's explosions, your testosterone goes up, you Watch your sports team win, your testosterone goes up, your sports team loses, your testosterone goes down. And so, yeah, no, men are 100% hormonal.
- [27:06]
B
They are hormonal as well. So all of the evidence based Internet trolls that are like, there's, you know, there's no evidence for women changing over the menstrual cycle. Please listen to what Dr. Hill is about to say. So with that.
- [27:17]
A
Yes, exactly. So, you know, so men have one hormone and it changes dynamically based on the environment. Women have two that cycle just based on cues in the internal environment. And so it's like, in some ways men's testosterone is more reactive than our hormones. And so in some ways men are the ones who are more fickle and capricious because their testosterone rises and falls based on things going on in the outside world in a way that women's does not. Now, women's does respond to things going on in the environment, but it's not as dynamic as testosterone, not by a mile. And as women are shifting into the second half of the cycle, again, our body is shifting gears and so we're gonna feel differently than how we feel during the first half of the cycle. And some of those things are things that we tend to think of as being less fun. So just to give an example of this, one thing that happens in the brain during the luteal phase of the cycle is that our brain deliberately finds rewarding things less rewarding than it does outside this phase of the cycle, right? So the idea of hanging out with your friends, for example, as you said, it seems less exciting, right? You don't really want to do it, you kind of want to stay home. And there's even been some really fun research with baboons showing that when female baboons are in the first half of the cycle, they're down and grooming one another and hanging out with the other females. And then when they go into their version of the luteal phase, they go and hide in a tree.
- [28:44]
B
I feel you, girl.
- [28:45]
A
I know, it's so funny. I was reading that research, I'm like, yep, no, if I had a tree that is 100% where I would be as well. But it's like, you know women, it's like the world, the outside world seems less exciting and stimulating and it's like we wanna pull in and that doesn't feel exciting, right? And in fact, when things feel kind of subdued, that's a little, I mean, it feels kind of low key depressive, right? Where you're just kinda like, I Don't wanna go shopping, I don't wanna see my friends. And you're kind of tired because one of the other things that happens during the second half of the cycle is when your body is releasing progesterone is that progesterone gets broken down by the body. And one of the things that it releases is this really beautiful neurosteroid called allopregnanolone. And it stimulates GABA receptors in the brain. And that just chills us out, but it makes us kind of sleepy, right? So we're kind of relaxed and we're kind of tired and nothing seems really exciting. And sex doesn't have the appeal that it used to have, you know, except for as a means of connection. But just like sexual, this sexy endeavor doesn't seem as exciting to us. And you tend to see a little bit of a downturn in sexual desire. Women feel less sexy themselves because again, sex won't lead to conception during this point. So it's like natural selection is not rolling out the carpet and making us feel as sexy as we possibly could because it's costly and it's not necessary for reproduction anymore. And so you get some of these types of psychological changes that make us feel a little bit low key. Blah. And so that's one answer, right? It's just that our body is shifting gears. And because we've never been told that it's normal to shift gears from the first half of the cycle to the second half of the cycle, we've all been taught that it's this pathology or this syndrome called pms. We feel like there's something wrong with us. And this is all because our idea of what it means to be human is based on a male ideal, right? And the male way of being is that there's one size fits, all right? Every day is the same day, hormonally. And so for a man, a day is a day is a day, but that's just not true for women. So part of the reason that we experience PMS is that we've never really had a language for the idea that there's two halves to our whole. The second part of the PMS experience is that it feels a whole lot worse for us than it needs to, because our lack of awareness about the fact that our body is shifting gears and that our body's needs change and that our physiology changes actually creates pathology. And just to give you an example of this, one of the things that research finds that happens when women shift into the luteal phase of the cycle is that their basal metabolic rate increases, meaning that a person burns more calories during the day in the second half of the cycle than they do in the first half of the cycle. And the degree to which our basal metabolic rate increases is up to about 10 to 11%. Right. And that's significant. So if you eat like 2,000 calories a day, you're going to need an extra between 150 and 200 calories a day. That's a lot. Right? But we're all fed this one size fits all nutritional guidance that's built on male physiology. And we're told you need to eat X number of calories a day. So what happens is a woman in the luteal phase is eating X number of calories a day because that's what she's been told is normal. And she's like, I'm hungry, I'm tired, and now I've got food cravings. Right? And so we create this pathology because we're not actually listening to what our bodies need. Right? And on top of that, then we tell ourselves a story about ourselves, right? Because we're feeling hungry, we're eating the number of calories we were told that we're supposed to eat, right? And we're feeling hungry and we're having food cravings, and then we end up, you know, going to the pantry and, you know, eating peanut butter out of the jar with a spoon. And, you know, and then we start telling ourselves a story about how we don't have any self control and how our body is the enemy and why can't I just. Failures. Yeah. And, yeah, and we believe that, you know, it's like we, we've been, as women, we've been internalizing that message since the day we were born, practically, where it's like we're given this, you know, wisdom or this like, advice about what we're supposed to be doing to take care of ourselves that was never made with our bodies and mind. And then when our bodies misbehave, they're not misbehaving, they're reacting, you know, they're reacting to following a set of rules that were never made for us. And so another part of pms, you know, in addition to the fact that there is some stuff that's happening that actually makes physiological, adaptive sense, and it's actually part of our inherited wisdom that we've gotten from our ancestors. Another part of it is that we experience actual pathology that happens as a result of not giving our body what it needs during this time. And then the third thing that comes into play in terms of creating the experience of PMS is that these environmental mismatches that you talked about have created an experience where women aren't able to ride the wave of hormonal change with as much sort of grace and nimbleness as we used to be able to do. And the reason for this is that a lot of the research seems to suggest that the major culprit in terms of women experiencing what we can consider severe pms, so where they're just feeling it all, they're just feeling deeply depressed or deeply anxious, and they're really bloated, and their breasts are sore and this and that and the other thing, and they can't sleep, sleep, and they're tired and they feel like everybody hates them. A lot of this is the result of the lack of resilience of our cells in our brain and in the rest of the body to riding the waves of these hormonal changes. Because as our hormones change, it requires our bodies to be able to quickly adapt, right when estrogen is rising and falling. And then when progesterone is rising and falling, it requires the body and the cells in the body to be able to quickly adjust. And one of the things that stands in the way of our body being able to quickly adjust to hormonal changes are things like inflammation and cellular inflammation. And all of the things that we do that are not positive for our health, right? So not getting sunlight, not getting exercise, not eating a diet comprised of whole nutritious food foods, not having social connection, not getting enough sleep, all of these things erode our resilience to hormonal changes. And when we don't have that resilience to hormonal changes, when we go through, in particular, the big ups and downs of hormones that happen in the luteal phase, because they are big. Even though that graph that we all see about what's happening hormonally across the cycle shows that the luteal phase increase in progesterone is just a little bit higher than the estrogen rise in the first half of the cycle, that isn't drawn to scale. And if you actually look at those things carefully, the axis on the right hand side that's showing Progesterone is at 10 times the amount relative to the X axis showing the levels of estrogen. And so the amounts of progesterone rise and fall about 10 times more than levels of estrogen rise and fall during the first half of the cycle. And so the hormonal changes that happen in the second half of the cycle are huge. And they require the body to be able to adapt really quickly. And when you don't have that flexibility, that cellular flexibility that allows you to be able to ride the wave of hormonal change, it makes us feel anxious, it makes us feel tired, it can make us more bloated than we need to be because it can lead to dysregulation in mineral levels and all kinds of things that aren't necessarily positive for our bodies.
- [36:44]
B
You know, as you, you were saying, you know, inflammation, you know, when we are getting appropriate sunlight and diet and exercise and social and sleep. These are all things that I think most women struggle with in the luteal phase. And I think the more, if I hear what you're saying correctly, which I'm completely in accordance with, the luteal phase is a feature. It's not a bug. You know, it's not something that we have to fix. Whereas I think a lot of the, especially on social media, we see a lot of individuals who will say they're usually men, but there are some women as well who will say things like, it's only your calories that matter. Your menstrual cycle plays absolutely no role in your mood, in your ability to push at the gym. And you just have to, if you're feeling crappy, you just have to push through it. And I used to do that. I used to white knuckle my way through the luteal. I was like, no, I gotta, I gotta eat the same, like the calories, you know, not like I don't care. It's like hands. It's like, hear no evil. See? No, I was like, I don't want to hear it. I don't want to hear that I have to increase my nutritional intake of calories because that feels really scary for me. And I think I'm not alone in. In that where I think a lot of women maybe feel to some degree that it's like, oh, it's just, you know, it's just 10%. It's just like 150 calories. Like I can just. If I just don't eat that, then I'll just be in a greater caloric deficit, right? And then you end up, like you were saying, you know, rocking on the floor in the corner somewhere because you just had two jars of peanut butter and you don't. You. You had it faster than you could even realize what you were doing.
- [38:12]
A
Right?
- [38:13]
B
So talk to us a little bit about some of the adaptive changes that might be Beneficial for women to maybe invite in, in the luteal phase. And I would love for you to outline nutritional. You already said whole food, whole diet. Maybe we can talk a little bit about some of the specific nutritional adaptations maybe you've seen work either in clinical practice or in the literature, as well as exercise modifications that we can think about over in the second half of the cycle as well.
- [38:38]
A
Right. So to introduce us to this conversation, one of the things I just want women to really understand is that when I say your body is shifting gears when you go from the first half to the second half of the cycle with the sort of release of progesterone, it is really switching gears. Our digestion slows down so that way our body can pick up more nutrients. And this is why women who have IBS will oftentimes report worse symptoms during that time. This is also one of the potential contributors to bloating. Our immune system shifts from what's known as a TH1 type of immune response to a TH2 type of immune response. So in other words, it's shifting from more of a pro inflammatory immune response to an anti inflammatory type of an immune response. And this is something that can lead to changes in the way that we experience autoimmune disease if we're somebody who has a chronic autoimmune disease. So that's changing gears, right? Our brain is changing gears again. We're releasing progesterone, which gets picked up by its metabolite, allopregnanolone. It gets picked up by the GABA receptors. So it shifts us into a more of a relaxed, less pleasure and reward seeking state. It changes our sexual desire because generally testosterone also decreases during the luteal phase of the cycle. So you feel like less motivation for sex. You also generally feel less motivation for anything. That's where you're like looking to win. Right? Women have less of a killer instinct during the second half of the cycle than they do during the first half of the cycle because of these hormonal changes that we experience. I mean, we change from head to toe, our body temperature increases. And this is one of the things, if you wear wearable tech like I do, it shows you when your temperature is increasing. And with that increase, you get increases in your resting metabolic rate so you're warmer. Exercise recovery is more difficult in part because our body temperature is higher. Our heart rate variability decreases because our heart rate increases. I mean, there's a lot that's going on. And our body, in building the endometrial layer is an absolute HOG for amino acids. So it will try to break down muscle in the body. Like, it will try to do anything if we're not getting enough protein during this time. And they've done these really cool studies where they look at amino acid profiles in women's bodies at different points in the cycle. And what they find is that after the peak luteal phase, so during that period, right before you get your period, so after progesterone was at its highest, and then when it's falling, your levels of amino acids are so low because your body has been using them all for building this endometrial layer, which doesn't sound like it should be that hard. You know, it's like I feel like I could build an endometrial layer without causing, you know, all this havoc. But I know it's a lot of, it's a lot of havoc in our body. So it's like our body is like literally shifting gears with just about everything. Right.
- [41:29]
B
I mean, so you're making a five star hotel, right? Whether or not you're gonna have a visitor or not.
- [41:33]
A
Exactly.
- [41:34]
B
That's what you're doing.
- [41:34]
A
No, I love that. I love that. A five star hotel. Yeah. And you're right. And it's whether you want to have kids or not, that's what your body is doing. And so it can feel really scary to be told, like, hey, you are actually less able to put on muscle mass during this time, so maybe you shouldn't work out as hard because it turns out that estrogen activates a bunch of really cool pathways because it is anabolic. It activates a lot of these cool pathways that help us build muscle from doing resistance training. Progesterone is the opposite. It's catabolic. And so it likes to break things down. And they've done studies where they've looked at the rate at which women are able to build lean muscle mass based on whether they're doing most of their lifting in the early stage of the menstrual cycle. So during the follicular phase, when estrogen is the dominant hormone, and then looking at a comparison group of women who are told to do the same number of exercises, but for them, they're doing most of their lifting during the luteal phase of the cycle when progesterone is the dominant hormone, what they find is that if you do most of the heavy lifting in the estrogenic phase of the cycle, you build more muscle mass than doing the exact same workouts during the luteal phase, when progesterone is dominant. And so what all of this tells us is we probably need to change how we're taking care of ourselves during the second half of the cycle compared to the first, to the extent that it's possible. So this isn't one. You'll see things on TikTok where it's somebody saying, have your boss schedule meetings around your cycle, so that way you're. And it's like, that's not realistic, you know, but we can do small things. And like you were saying, it can feel scary to feel like, you know, I need to eat more and exercise less during this time. But I'm telling you, it really makes all the difference. And one of the things that I like to tell women is trust your hunger. Right. I think that one of the things that we've been taught since we were little and everybody was obsessed with what our bodies look like and were telling us what our bodies look like and they're too big or they're too small or whatever, whatever. And telling us what to eat is we have been taught to ignore our bodies and to teach our body, like, treat our body like it's an enemy. And we think of it as being the thing that's standing in the way of our goals because we're so hungry and, you know, and. And. But we're not supposed to eat anymore. And I say scrap that. Right. And if you're eating a bunch of processed foods, obviously you. Your. Your body can play tricks on you because those foods are literally made to be addictive. And the more you eat them, the hungrier you get. And that's like, actually the opposite of what real food does. Like, I don't even know that it should be called a food because one of the ways that we define food is that it helps to nourish the body and fill it up as you eat.
- [44:17]
B
Satiety. Yeah.
- [44:18]
A
Yeah. And ultra processed foods don't do that. They make you hungrier as you eat them. But if you stay away from the ultra processed foods and you eat real whole foods, learning to trust your hunger and. And use that as a guide is so incredibly useful. I mean, we spent most of our evolutionary history living without nutrition labels, you know, like, that's made things worse. You know, our hunter gatherers weren't, like, going out and, like, picking up, you know, like, a piece of fruit and looking to see, you know, like, what the calorie content is and whether or not it has enough fiber. But, like, if you sticker have a.
- [44:54]
B
Four or a nine on it.
- [44:55]
A
Yeah. Exactly. It's like, it's like if you eat real food and learn to trust your hunger, what's ultimately going to happen is you are going to eat more in the luteal phases of the cycle because you're hungrier. And if you trust that and you just eat more at meals. So for example, if you're like, gosh, you know, I really want a second piece of chicken or whatever, eat it, you know, because that's going to save you from later on being in the pantry again, not knowing what to do and then eating peanut butter right out of the jar, which is the thing I'll do sometimes when I'm like super hungry.
- [45:24]
B
I've been there too.
- [45:25]
A
Yeah, it's like, oh my gosh, I have nothing in here, you know, and like eating peanut butter out of the jacket. But, you know, really learning to trust your hunger and understanding that your nutritional needs are greater in the second half of the cycle. I also encourage, I encourage you, like, consider more protein during this time. And it doesn't need to be animal protein if somebody's a plant based eater. Everybody has, there's different ways to eat healthy. And the research shows, as I talk about in my book, you know, there's no consensus on what the best diet is. It's really, everybody's a little bit idiosyncratic in terms of what works for the best for them. But if you eat a, you know, whole foods diet, that's plant forward. Whether or not you include animal protein is totally up to you. But increasing protein, whether it is from an animal source. And I like, you know, I do eat animal products. I don't eat them a ton, but I do eat them. And you know, during the luteal phase, I definitely eat more of them than I do in the early phase of the cycle. But adding more protein, it increases satiety, so it keeps you fuller, longer. And given that research that shows that big amino acid deficit that we experience right before our periods because of all of the building activities that are going on in the luteal phase in response to progesterone, the best way to get a really full robust amino acid score from your food is by eating protein sources. And so I always up my protein intake a little bit during this time and I find that it definitely keeps me fuller, longer and it helps me meet my other needs as well. What's scary about the idea of eating more during this time is that another recommendation that I make based on the research literature is also to do most of your heavy weightlifting during the first half of the menstrual cycle, because again, estrogen helps to build muscle and estrogen increases in the cycle in tandem with testosterone. They're like two buddies skipping through the forest together. They tend to rise and fall with one another. And they're both really good at helping. They activate a bunch of pathways in the body that help to put on lean muscle mass. And so I prefer to. And this one took me a while, this one took me a couple years to actually buy into because like many women, I had a workout routine that I felt good about. I feel pretty good about my body. Like, I feel like, you know, like it's okay. Like it's okay. I didn't want anything to change. I was afraid that if I would not lift heavy weights in the luteal phase of the cycle, that I would get weaker, that I would lose a lot of this muscle mass that I'd spent all of this time trying to build up. And I was afraid that then my clothes wouldn't fit right and all these bad things would happen. And so I'd known about this research showing the differences in the ability to put on muscle mass at different points in the cycle for a couple of years. I finally put it into play. I decided I was going to do a three month experiment on myself and that after that three months, that if I felt like everything was falling apart with my fitness, that I would give it up. But I did it for three months. And what happened and what I did is I essentially shifted to focus all of my strength training and the higher resistance cardio to the first half of the cycle. And a really practical way of doing this is just starting out when you get your period is shifting gears. That's when I would start lifting weights and that's when I would start doing more high intensity cardio training. And so those two weeks of my cycle, I would lift weights, go on the elliptical machine. I like to run on the elliptical machine, running on the elliptical machine. And then as soon as I get the temperature rise that I get with ovulation, like showing that ovulation has happened. Now I'm in the luteal phase. As soon as I got the temperature rise, I stop with the weights and I shift to more of a walking. So instead of running, I'm walking and I'm doing yoga instead of doing resistance training. And what happened after three months is I got stronger. And this was actually. And it's not like I got so much stronger, right? Like, wow. But I was able to increase the amount of weight I Was lifting like on upper body, I was able to go up by five pounds, which is a lot for me because I'd been stuck, I'd been plateaued for a really long time in terms of the resistance training. And I was able to increase by 20 pounds in my lower body. And this was a big step forward for me because I hadn't, like I said, I hadn't moved much in years of doing resistance training. And so to get stronger really spoke to me. I mean, honestly, even though I'd seen the science, it always surprises me when there's something that's so counterintuitive and then you see it in yourself. And we've also done research now with a cycle based wellness company called 28 Wellness and they offer, you know, cycle based nutritional and exercise guidance. And we followed women for, we've now been following them for six months. But even just at the initial intake visit, where we're measuring their satisfaction with their body, their satisfaction with their sort of fitness goals, satisfaction with their nutrition goals, what we find is that the women who are implementing these cycle based adjustments in their nutrition, so eating more in the luteal phase and then doing more of the heavy resistance training in the early phase of the cycle that these women reported being more likely, the more frequently that they were doing that. In other words, the more frequently that they were dialing in their nutrition and exercise to the needs of their cycle, the better they were doing, the better they felt, the more they felt like their goals were being met. And so I think that we need to. And it's so hard to undo all the messaging that we've gotten our entire lives that says one size fits all. Every day, the same thing, every week. Your workout should look exactly the same. You need to do these many days of resistance training and these many days of cardio and instead shifting gears and listening and doing things that are more in tune with your body. Not only will you feel better doing the exercise, because I'll tell you, I used to lifting weights for me in the luteal phase felt like a beat down. I hated it because I was always tired and I didn't feel like I wanted to go out. And you know what I mean? It's like I could listen to as much pump up music as I wanted to and it just didn't do it. And so my brain was very thankful when I made the shift. So it felt better to me. And then when I was going and doing the training in the estrogen, you know, the estrogenic phase of the cycle, and the follicular phase and lifting weights, it just felt good, you know, so taking that break was like, really helpful to me. And, you know, and I think honestly, when we think about women's rhythms in general, you know, it's like we are very much about push and rest. I mean, that's even how we have babies, right? It's like when you're in the doctor's office and giving birth, they tell you to push, but then they also tell you to rest. And there's a lot of power that comes to women when we push and then we rest. And so I think that taking that seriously with respect to our nutrition and with our fitness helps us feel better, and it also can give us better outcomes.
- [52:35]
B
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- [55:59]
A
That is really fascinating. I have not seen any data on that. I have seen the motor coordination, but I haven't seen any data like learning a new skill, like a new, you know, physical skill. But I mean there's, there's no reason that that should be wrong. Like, it, it, it just seems, I mean given all of, you know, given that estrogen and testosterone do have us firing on all cylinders, it makes perfect sense that this would be a really great time to learn complex movements. And you know, I find like, as I, as I was saying with my weightlifting because I, I lift weights similarly, I lift and I only do things that have compound movements. Because I'm like, I'm not gonna waste my time with these little.
- [56:34]
B
You know what I mean?
- [56:35]
A
Like, yeah, like, yeah, you know what I mean? That's just like, I'm not gonna. That's not me. And so really focusing on those in the. In the follicular phase has been. Has been really huge. And it's also, you know, I would assume that would help prevent sports injury because you also have the issue with progesterone. Your body will release this other hormone called relaxin. And this is something that's really great for pregnancy because it allows your joints to become relaxed. So that way you can make room for a baby. But if you're trying to do something like a squat, you gotta be really careful because having relaxed joints isn't necessarily going to be helping you. And just one other thing just to say as a quick note, not everybody has control over their workouts. So, for example, if you're a female athlete and you have practice, practice. And so the idea here isn't that you can't do these things. It just means it's going to be harder. And so one of the things that I really recommend, if women are either, you know, reluctant to shift their exercise across their cycle or just have no control over whether they can shift their exercise across their cycle, it's just making sure that they really prioritize recovery. Because it is. I mean, recovery is harder anyway in the luteal phase. And if you have, like, if you wear an aura ring or you wear a whoop band or an apple watch, you've probably had the experience that I have where in the luteal phase, it's like, almost like it shames you. You know, it's like. It's like you get these lower recovery scores and you feel like you did.
- [58:01]
B
Something wrong to aura. I have.
- [58:03]
A
Have you really?
- [58:04]
B
Yes, because I was so upset. I was like, twice a month. It's like your readiness is terrible. It's like, well, it's because my temperature is higher. Like, you can't ding me for that.
- [58:12]
A
Well, I know. And your heart rate variability decreases and your heart rate goes up, and it's like. And that's just our body. And. Yeah, it really makes me. That really irritates me. And so. And this is just all the way to say that you need to really prioritize recovery during this time, because our body is not. It's harder to recover during this time. It just is. Our body is, like, doing a lot. Our heart rate is up, our respiration is up. Our respiratory drive is up, which is the thing that makes us feel like we need to breathe, which is why women often get worsened and asthma symptoms during the luteal phase. And if you've ever had the experience when you're like running during the cause, I used to have this and I didn't know what it was. And then when I learned about it, I was like, oh my gosh, that's what that is where you feel like your heart or your lungs have a hole in it where it's like you just can't. You feel like you can't get enough breath. And that happens to me in the luteal phase when I'm doing intense, intense cardio treatment. And that changes. I mean, there's so many changes that happen that we aren't given language to express or that we aren't given the information to talk about because we're all given one size fits all sets of, you know, guidance on things. And if you need to exercise or you still want to exercise heavy during the second half of the cycle, just be really mindful about getting enough sleep, right? Because recovery is going to be harder on your body. Maybe doing something like non sleep deep rest, you know, which is a type of like Nidra yoga, where you can do that for like 10 or 20 minutes during the day and it can reset you. There's been really neat research looking at the fact that it actually does dial the brain down in a way that's very similar to what you get from actual sleep just during a 10 to 15 minute meditation. Doing things like limiting or avoiding alcohol, just doing anything that you can to help your body reset. Take a hot bath before you go to bed. Anything that you can do to try to support your recovery is gonna be doubly appreciated by your body during the luteal phase.
- [60:06]
B
Well, I love what you're saying in general around recovery because I think that a lot of women listening, I know my community, we're very good at pushing, we're terrible at pausing. And maybe that's because I am terrible at pausing. And so I just have attracted the exact same people that follow me on the show. But I love this. Well, I really, I'm really enamored with this idea of strength training, doing your PRs, everything in the estrogenic and the follicular phase. And then it's this forced, almost forced recovery in the luteal phase. And then of course, you allow for the muscle, the muscle cell turnover, you allow for all the autophagy and all the beautiful strength gains that happen when you rest. There's been times when maybe I've been traveling or, you know, maybe I've just forced a deload week into my schedule. And then when I come back, I'm coming back from vacation or I'm coming back to the gym, and it's been a week, or maybe it's been 10 days, 14 days. And the strength gains are no joke. Like, you feel so great. So I do like this idea, especially if strength is an outcome. You know, if you are. If you are lifting weights and strength is an outcome for you versus maybe muscular hypertrophy, which, I mean, there's overlap, but strength is a specific outcome. I think that that's a really cool way to think about it, is like, yeah, let's take a week or two off and then let the muscles rest, let the joints recover, and then come back to it. Because joints, I mean, we always like muscles. Like the popular girl at the party, everyone always talks about muscles, but we also have to think about the longevity of our joints. Like, you can't squat if you don't have knees. Right? So you need to also think about the collagenous ligamentous recovery, the tendinous recovery. That has to happen, too, with compound movements like squatting and lift and deadlifting, too.
- [61:49]
A
Yeah. No. And I think that it's like we have it built into our biology to fall, you know, to follow this rhythm. And it really is. Like, I was really surprised by the fact that I got stronger because I've been lifting weights for 15 years.
- [62:03]
B
Forever.
- [62:03]
A
Yeah. Yeah. And to finally have things increase is like. Oh. And it's also like I said before, it's like, for me, it felt better. Like, I feel better when I'm not having to do that every single day. And especially in the luteal phase, because my body just. Just doesn't want to. It just doesn't want to. And then I have more excitement for it when I go into it in the estrogenic phase of the cycle. I have more energy for it, and I'm getting stronger. It's like, I think that when we really go into and work with our body instead of working against our bodies, as we've all been taught to do with these rules that are built for men and not for our bodies, it feels so counterintuitive. But it's like we have to relearn the messaging. Right. That our bodies are different and that we need to do things different in order to feel our best.
- [62:52]
B
You mentioned. I just want to come back to this for a Moment sleep. Do we see sleep changes across the cycle? So you mentioned, like, I also know my HRV tanks, respiratory rate goes up. You know, my oura wings always tell me like, you okay, girl?
- [63:03]
A
You okay?
- [63:04]
B
It's like, no, just, you know, just ovulated. That's what happens. But do we have a requirement for more sleep? Do we need more deep sleep? Do we need more REM sleep? Is there any evidence that you're aware of that there's sleep change aberrations over the course of the cycle?
- [63:19]
A
Yeah. So there's not a lot of research in the specific types of sleep and how they might change or how the needs might change across the cycle. Women many times will have more difficult time falling asleep when they're in the progestogenic phase of the cycle. And part of this is the increased respiratory rate and increased heart rate. And, you know, again, when all of that's going, it's harder to wind down. I recommend, you know, again, prioritizing recovery time. And so, like, having, if you have a bedtime routine, starting it a little bit earlier, I think is really helpful. Or you can add a bedtime routine. Like, if you're somebody who sleeps pretty well, you know, most of the time, and you want to really prioritize recovery. I would start doing stuff, you know, in the luteal phase, you can do things like take a hot shower before you go to sleep. That gets you into deep sleep more quickly, which is something that, you know, again, helps. Helps you. Helps you recover. And I also, you know, our body temperature does increase almost a full degree. I turn down the. In the summertime, I turn down the air conditioning by an extra degree or 2 degrees in the luteal phase. And it's made all the difference in my sleep because I'm no longer waking up in the middle of the night, like burning like a furnace, because it's able to keep my body cooler. And so I think that that's important. And I mean, our body, again, is working really hard during this time, and so we do need more sleep. I've not seen a study that's looked at how much sleep we need because it's really hard to quantify that. How do you operationally define sleep need? And it could be performance on this or performance on that. I haven't seen something that's looked at that specifically with a menstrual cycle. But I'd be willing to bet, just given that our body is working harder, that our HRV is lower, our resilience to everything is worse. Extra sleep is always gonna help because sleep promotes recovery in the body. And so during the luteal phase, especially given that falling asleep can be more difficult during this time. Doing things to really prioritize recovery again, like minimizing alcohol. Cause alcohol makes your sleep worse. Going to bed earlier, taking a hot shower, drinking sleepy tea, doing sleep, meditation, whatever it is that's gonna help get, you know, the recovery that you need is going to really help you feel better the next day.
- [65:31]
B
Yeah, anecdotally I can tell you that I am definitely sleepier. Especially the couple days right before my period starts. Even the first day or two if it happens to, if I happen to get my period on a weekend, it's like, yes, I'm going to sleep in. You know, like, I definitely want to sleep in. I have that sleep drive. Um, but it would be interesting to look at that on a population level. I wanted to come back to you mentioned protein. And by the way, I just want to like gold star on your chart. I love that you said like, doesn't matter, animal protein, plant protein. I used to be in the animal only camp, but the literature really does seem to not favor that anymore. That you can be consuming plant proteins. You can be someone who can, like myself, who consumes both animal and plant proteins and the muscle protein synthesis that you're getting, the complete composite of amino acids, it's, it's almost the same. So whether you're vegetarian or vegan, and that's a concern for you, increasing your protein, no matter what source is great. Any thoughts on carbohydrate intake in the luteal phase? Do we want to be consuming more complex carbohydrates, more carbohydrates in general, or is it just like a bump up? If we're thinking about, you know, a 10% or 11% increase in metabolic activity because we're building out this endometrial lining, do we want to allocate most of our clients calories to protein or is there any other considerations like fiber or micronutrients that you have?
- [66:54]
A
So there's been very limited research on, in humans, like looking at the specific types of nutritional needs that might be, you know, met or not met in the second half of the cycle? I will say that there's research showing that women tend to crave more carbohydrates during this time. And this is likely because they're hungry, because they're not eating enough and they're denying themselves food and they're denying themselves food. And so I mean, honestly, like if you're eating complex carbohydrates. And if that's the thing that you're craving, if it's healthy food, you know, like complex carbohydrates, like farro, quinoa, you know, vegetables, fruit, these things are going to be, you know, if that's what your body is telling you to eat, eat it. That's what I say. And there's this really cool research that is new. It's new in the world. In the last five or so years, looking at neurons in the gut, they're called neuropods. And you know, there's always been this sort of idea that your body is like telling you the nutrients that it needs. And for a long time, you know that.
- [67:56]
B
The protein leverage hypothesis.
- [67:58]
A
Yeah, yeah. And there was like this whole idea that, that was like, just like woo, woo, pseudoscience. But now that these neuropods have been discovered and they essentially sense nutrients and are able to send information to the brain, I say, listen to what your body is telling you. I try to increase my protein intake during this time because it keeps me fuller longer. And I do think that the reason it keeps us fuller longer is because you're getting all those amino acids and so your body is like, okay, we're cool right now, right? And so I don't need anything for this endometrial layer and you're not going to have a deficit. But if your body is telling you, like, I really want a big bowl of quinoa, really big bowl of oatmeal. I love oatmeal. In the wintertime, it's like my favorite thing. I make this homemade oatmeal with mashed up, sometimes mashed up, half a banana and sometimes I put honey in it and fruit and nuts and seeds and all kinds of stuff like that. And when I want that, that's what I eat. It's like I'll eat what my body is telling me that it needs to eat. And I think that if we're eating whole foods, that we should really listen to that. And in terms of specific nutrients for this time in the cycle, I don't know that, I don't know that we're at a point yet with the research where we can say, like, you need to do this, you know, like really focus on, you know, these kinds of nutrients in this point in the cycle and these other nutrients at that point in the cycle. But I will say that there's a lot of research that just shows that making sure that you have the key nutrients that you need is going to make your experience across the cycle so much smoother. And so just to give examples of some of these vitamins, everybody knows vitamin D, you know, go outside with short sleeve shirt on and sit outside in the sun for 20 minutes and you're good. Or, you know, you can take a supplement of vitamin D or you can do both. Omega 3 fatty acids are incredibly important. That helps to increase cellular plasticity. And again, it sort of softens the experience that we experience as we shift from one hormone, like, you know, from estrogen to progesterone. We feel that less acutely when we are well nourished with those nutrients. Magnesium is another one. And this is one that I think is important to supplement because we don't get as much in our diets as we used to, because farming practices have changed. And it used to be that when people would eat produce, would eat an apple or pull some carrots from the ground, they would also eat a little bit of dirt, you know, throughout most of history. And that's just not the case anymore. And that was actually a primary source of magnesium for us, was it comes from the soil and it comes from bacteria that are, you know, in the soil. And so taking a magnesium supplement, I think is hugely helpful. And there's some really good evidence that suggests that it might be important. But, you know, eating a whole foods diet, right? So not a diet full of food that you bought at Whole Foods, but things that are actually whole foods that, you know, your great grandmother would recognize. You know, you just have to remember that we spent most of our history living as hunter gatherers, eating a diet that was acquired from our environment, right? So eating as many of those same foods as we can and minimally processed foods. And if we eat that way, I really think, you know, if you listen to your body and are attuned with what you know, it's telling you that that can really be. It can tell you what you need.
- [71:18]
B
All right, friends, how many of these symptoms are you currently dealing with? Bloating, indigestion or reflux? New food sensitivities that's popped out of nowhere? Leaky gut? Autoimmune flares? Post antibiotic issues or mold exposure or just gut problems that never fully go away? Now ask yourself, did these symptoms get worse around perimenopause? If they did, I promise you are not imagining it as estrogen and progesterone decline. They will affect profoundly gut health like motility, microbiome, balance, and your gut barrier. That is why so many women in perimenopause suddenly struggle with gut issues that didn't bother them before. When your gut lining is weakened or it's inflamed, it disrupts nutrient absorption. It ramps up inflammation and even worsens hormonal symptoms. Because gut health is directly tied to hormone detoxification, your ability to produce energy, your mood and your immunity. So that's the bad news. The good news is that you can totally repair your gut with peptides. Level Up Health has formulated the most powerful gastrointestinal healing product, Ultimate GI Repair. It is a clinical grade formula designed to rebuild your gut barrier and calm inflammation from the inside out. Using peptides like BPC157 and GHK Copper. These are very powerful peptides that rapidly repair the gut lining. Lorazatide, which is another peptide that seals leaky gut and improves barrier integrity. Then you have other compounds like zinc, l, carnosine and tributerine. These are things that will soothe inflammation and support digestion. And then quercetin and sodium bicarbonate. These will enhance nutrient absorption and gut resilience. This product, Ultimate GI Repair, is designed to target the root cause of gut issues and it will help heal and protect your digestive system so that you can feel your best whether your symptoms are tied to perimenopause chronic stress. Hello, that would be me. Or past gut issues. Ultimate GI repair will give your body the ingredients it needs to finally heal. Head over to LevelUpHealth.com that's L V L U-P-H-E-A-L-T-H.com and use code Dr. Stephanie to get f 15% off of the entire website. That's L V L U P H E-A L-D-COM and use code Dr. Stephanie at checkout. Thoughts on seed cycling.
- [73:48]
A
So, you know, there's I. So let me say this. There is not good research evidence showing that it does anything, but there's also not good research evidence saying it doesn't do anything. So, like an absence, a lack of evidence is not evidence of absence, right? Yeah. And so we don't know whether or not that works. Nobody's really doing. I haven't seen a randomized control trial done looking at seed cycling versus a placebo. I haven't even seen a good cross sectional study where it's not just asking women about like, hey, do you think this is working? You know, where they're actually looking at whether it's working or not. That being said, I do know women who swear by it, right? They're like, I started doing this my Cycle got on track. And so here's the way. Here's sort of my bottom line on seed cycling. If you want to try it and it works for you, I think that it's amazing. Do it. Why not? You know, it's not gonna be bad for you. And I like. So for me, I eat most of those seeds that you're supposed to have in both halves. I eat most of those seeds every day, like, on both sides, just because I like seeds, and I like them in the oatmeal I was talking about, I put a bunch of different kinds of seeds in there. Cause it's just. I like seeds. I put them in my smoothies, I put them everywhere. I put them in my salads. And so if that's what you want to do, like, I think, Godspeed, you know, it might work, it might not work. And placebo effect is, like, very real. There's a lot of research indicating that when people believe something works, there are actually physical changes that happen in the body that make it work. And so, you know, if you have the money to try it and you want to try it, I say, godspeed, Give it a try. And if it works for you, I think that's wonderful.
- [75:23]
B
I think one of the harder things about being in your line of work and the line of work that I'm in is that the literature is so sparse. It's like. It's just. I mean, it would be great if there was an RCT on seed cycling.
- [75:35]
A
Right.
- [75:36]
B
You know, but it's like we, you know, the biggest. I mean, I won't get into the world, the Women's Health Initiative, but it's like the. The limited research that we do have on women is. I mean, it's. It's start. It's. It's shameful in some ways.
- [75:49]
A
It is. Yeah. No, it's shameful. And I think pretty much all the ways, you know, it's just like, there's just not. And the science that's important to us isn't being done. And even when the federal agencies will dump money into women's health, it's only guided toward very limited numbers of questions that are usually related to pregnancy and anything else that happens in the uterus. And it's really time that we start to understand that women's health is about the health of women. And that means beyond uterus island, Right? So the parts of our body that have, you know, that sort of fall outside of that little island are also influenced by our sex hormones and also differ between men and women. And So I want to see before I leave this world. I'm hoping that we start that at some point science understands that, you know, like something like Alzheimer's disease, for example, which we know happens overwhelmingly more frequently in women than men, needs to be studied separately in women and men. It's probably two different sets of disease processes in women and men. And I've actually seen it argued. There's this really great research paper. I wish I knew the citation that I could send you. I can look around for it. But it was essentially making the argument that the reason in cancer research that we've made so much progress in prostate cancer and breast cancer isn't because there's anything special about prostate cancer or breast cancer. It's that we're studying those things separately because we have to. Right, because only men get prostate cancer and only women get breast cancer. I mean, on the whole, right, you have the odd cases. Yeah, you get odd cases. But for the most part, they do all the studies of breast cancer on women. They do all the studies of prostate cancer in men, and they think that that's the reason that they're getting breakthrough so much more quickly is that our physiology is so different. Disease processes undoubtedly unfold in totally different ways in male bodies and female bodies. And the idea that we're just lumping everybody together and assuming that everything is going to work the same in men and women, and then we only study women in the early part of the menstrual cycle, when hormone levels are low. So that way we're maximally like men. Means that women aren't even studied in the luteal phase. And so it's just a mess. Women's health research is an absolute mess. And it's because they try to shoehorn women as female, as research subjects into a framework for research that was designed for men, and it just doesn't work. And so I, like. I'm hoping that at some point we see that shift where we start to understand that women's health is about the health of women, period.
- [78:21]
B
Yeah, I could. I. Yeah, I mean, well said. I have nothing else to add to that. I think that there's such hubris. I remember interviewing years ago, Dr. Ethan Weiss, like, years, years, years ago. He's a cardiologist, and we were talking about cholesterol and, you know, fatty infiltration of the LDL particle, blah, blah. And he was even mentioning that there's sexual dimorphism between the male and female liver, like the way that our, you know, so you might say, okay, I can Understand the reproductive system. Yes. That's categorically different. Right. But even in the way that our liver works, the way that we secrete IGF1, it's all like, you know, one is very pulsatile versus one that's more steady state. So there are so many differences between men and women and. Yeah, I mean, it is my hope too. It is my hope too. Which is why your work is so, so, so, so important. My last. The last question that I have for you as we're sort of tying this up, is we've been talking about these two different brains, essentially. You know, one that's geared towards sex, the other one that's geared towards pregnancy. In perimenopause, of course, we have this change in the menstrual cycle where we initially will see almost a luteal phase deficiency, where we see a contraction of the menstrual cycle, and then there's an eventual, you know, expansion, elongation of the cycles where they are, you know, more than two months or, or what have you. Everything that we've talked about today, what are some of the adaptations, if any, that a, that a woman in perimenopause might take to some of the action? Is there any differences? Does she have to be thinking about things differently than maybe someone who is in the crux of her fertile years who has a regular menstrual cycle every 28 or so days?
- [80:05]
A
Yeah, I mean, yes. So as you noted, the first thing that happens in perimenopause is that your ovulation becomes more sporadic. And when you don't ovulate, you don't release progesterone. And what this oftentimes happens is women go through periods where estrogen levels are pretty high, and then it's never being counterbalanced by progesterone. And that can lead to, you know, different types of psychological symptoms and different physical symptoms. And, you know, it can be kind of a tough time. One suggestion that I have and is do anything that you can to increase your resilience to hormonal changes. Right. And this is something I spent a lot of time talking about in the new book, the Period Brain is really getting at some of these things that we can do to try to increase our cellular plasticity. Because the more plastic our cells are and the more quickly they are able to adapt to hormonal changes, the better time we have in any type of hormonal transition phase. And so we experience hormonal transitions across our cycle. Right. Where we have this period of time when Estrogen is high and then low, and then progesterone is high and then low. But we also experience hormonal transitions across a lifetime, and perimenopause is one of those. And indeed, when you look at the research, you tend to find that women who have the worst PMS tend to have the worst perimenopause transition. They also tend to have the worst postpartum experiences. And it's all about lacking this resilience to hormonal changes. And so anything that you can do, and I go over a number of ways that we can do this in my book, but to increase your resilience to hormonal changes, do those things is going to make it a lot easier. The second thing is not being afraid of hormone therapy. I think that there's been a lot of confusion in. And we just saw this Lancet Oncology published a paper about how hormone therapy linked with breast cancer in young women. And then you read the article, and it's women who are using estrogen only actually have a decreased risk of breast cancer. And the women who had an increased risk of breast cancer were women who were using estrogen plus progestin. So not progesterone, progestin, the birth control pill. And what they find is that women who are using this have an increased cancer risk, but this isn't actual hormone therapy anyway. Progestin is a Franken hormone that's synthesized from testosterone, and it doesn't have any of these really beautiful qualities that actual progesterone has. And progesterone isn't carcinogenic. And so in all of the trials where they're looking at breast cancer risk and other types of cancer risk, looking at either estrogen only or estrogen in combination with progesterone, there's either a decreased cancer risk or no change in cancer risk. And so understanding that progestin and progesterone are different. Right. And that the research seems to support the idea that there's not an increased breast cancer risk with the use of estrogen or progesterone. And just not saying that this means that you have to use hormone therapy, but just meaning that if this is something they are interested in, not being afraid of it, because I think that the media is so confused about the differences between progestin and progesterone that they put these headlines out there about hormone therapy. It freaks everybody out. And then when you actually look at the content of the study, it's totally irresponsible the way that it's being reported. And so don't be afraid of hormones. Like actual hormones. Progestin isn't an actual hormone. Right. It is a medicinal product that was created by drug companies to be patented and used in place of progesterone. But progesterone is actually, it's got a lot of really beautiful qualities that protect the brain. It's neuroprotective. It also has, it has, there's been clinical trials looking at it as a therapy for hot flashes, which makes it a safe alternative for women who can't take estrogen because of heart disease related risks. Because even though estrogen doesn't seem to be linked with an increased risk of breast cancer, it is thrombotic. And so if you're somebody who has cardiovascular risk factors, it's probably not a good choice for you, but you can safely take progesterone because it doesn't have any of those types of side effects. And so the other thing I would say is, you know, so one, increase your resilience to hormonal changes by doing things to support your body and support your body during times of hormonal transition like the ones I talk about in my book. And then don't be afraid of hormones. You know, don't be afraid of biologically identical hormones. And if this is something that you think might support you, and there's a lot of research evidence that supports the idea that it can support women is not being afraid of it and being willing to have those conversations with their doctors.
- [84:47]
B
This has been a fantastic conversation, Sarah. It has been so wonderful having you on the podcast and thank you so much for your time, your focus, your energy. So your new book, the Period Brain, tell people where they can find it. Tell people where they can find you and more about your work.
- [85:01]
A
Sure. So they can find the new book, the Period Brain, anywhere that books are sold. So it's going to be on Amazon if you're an Amazon person. It's also at independent bookstores, if you're an independent bookstore person. So you can find it anywhere. You can also find it on my website, which is where you can find me. And that is@saraehill.com and that is Sarah with an H. So Sarahi hill.com and then you can find me online. My handle is Sarah E. Hill, Ph.D. and I am on all hand, I'm on all platforms with that handle. I'm most active on Instagram and you.
- [85:36]
B
Have some great stuff on Instagram as well. I was checking out your page yesterday in preparation for our conversation today. So definitely give her a Follow there. Sarah, thank you so much. This has been awesome.
- [85:45]
A
Thanks, Dr. Stephanie.
- [85:48]
B
Hello, my Betty verse. Welcome to the afterparty where I tell you exactly what I thought of this interview. And there is a meme that comes to mind when I listen to this, which is if you've ever watched Brooklyn Nine nine and there was a balloon, there was a balloon arch. And right at the end he goes, vindication. I'll see if I can find that for the show notes. But this is how I feel. I feel vindicated. I'm so thrilled at everything Sarah had to say in this episode. And maybe partly because I think that there is a trend online around really dismissing women's. The menstrual cycle at large, especially in the fitness space, like when it comes to muscle hypertrophy, muscle strength, that we just have to suck it up buttercup and white knuckle our way through it. It's just a mental thing. There's lots of, lots of guys. They're guys. But there are some girls, unfortunately, that talk like this around the female menstrual cycle, really discarding the, the complexities and the nuances in terms of the. That ever changing hormonal milieu that many women, including women in perimenopause go through. So a couple highlights for me, the mate selection stuff right at the beginning. Holy banana. How. I don't know if that's a saying, but that was such an interesting topic. How we're basically, when we think about the first half of the cycle, it's all about sex. The second half of the cycle is all about pregnancy and then how that might influence what we find attractive even in the same mate, over the course of the cycle. So, and this is actually really funny, I'll tell you a personal story. So I was just with my husband yesterday. We were at an appointment for him. There's this brilliant, brilliant therapist that he's seeing for his shoulder because he doesn't listen to me. And so we've outsourced it now. And so he was, I am right around ovulation at the time of this recording and he was talking like they were both standing and I was looking at Giovanni, my husband, and I was like, oh my God, I love his arms. And so just talking to Sarah today, I was like, oh my God, that is totally my estrogen. And like the wanting to mate and all the things. So the sex in the beginning of the cycle, you are going to find things like biceps and arms and jaw angle and all the things very attractive maybe in your, in your partner, if you're, of course, in a heterosexual couple. That's what this conversation is assuming. And then in the second half of the cycle that you're really more oriented towards pregnancy and feeling safe. So you might find something like the patience or the gentleness with which your partner interacted with your child with. Or maybe the time that they spent, I don't know, building something for you or fixing something for you in the house might. Might be more attractive for you than maybe his biceps in the. In the luteal phase. So I thought that that was fantastic. I also really so happy that she was talking about men as hormonal. Because I think that it's really easy to ascribe this, like, hysteria to women. It's like, oh, she's so hormonal. It's like, listen, buddies, like, I love you and I love men. I'm raising men, I'm married to one. But like she said, testosterone. Men are much more susceptible to external cues for modulating their hormones. So they can see a gun and their testosterone is going to change. They can see their, you know, soccer team or football team or whatever win and see changes in their testosterone. So I love that. And then overall, I just really appreciated the nuance in terms of how that hormonal milieu, how that shifts and how our perception changes and even why we want sex is gonna change over the course of the cycle. The one area that I found really interesting, and I think I have to sit with it a little bit. Cause I'm not sure how I feel about it, it was when she was talking about estrogen and progesterone. So estrogen being very anabolic. And that's the time that she likes to weightlift. And then progesterone being a very catabolic time. These are, of course, all very true. But she was saying that she completely takes two weeks off of training in the second half of the cycle. And I gotta be honest, I don't think I'm there. I don't think I'm there yet. And I actually said to her in the show, like, this is actually how I've modulated my own weightlifting. And I'm completely willing to be an outlier here. Like, I might be the weirdo that just really loves working out, really loves weightlifting. So for me, in the second half of the cycle, I don't lift heavy, like the same heavy, like absolute number heavy as I do in the first half of the cycle. But I'm still maybe like I'm decreasing the weight, but I'm increasing the volume so it's more repetitions with a lighter weight. So I'm still approaching muscle failure because one of my goals is muscle hypertrophy, muscle like gaining more muscle. But it's not that I'm taking two weeks off. However, that's not to say that that can't work. So I'm really interested. Like she was describing her n of one experiment where she did three months and she got stronger and she was able to go up. I think it was like 5 pounds in the upper body, 20 pounds in the lower body. There is something, something to be said around appropriate recovery and rest to allow for the adaptations in the muscle and the joint to, to take place. So I'm not discounting it. I just for me, I. When I first wrote my book, the Betty Body, I built in almost like a deload week in week four, which is typically, you know, last week before you get your period. It's when most women feel like kind of the crappiest to have that lighter weight, higher rep week. However, I am a bit enamored, as I said in the show, I am enamored with this idea of maybe a bigger. And when I spoke to Stacy Sims, she said the same thing. It's like three weeks on, one week off. And that's sort of where I feel like I probably fall. Like I don't know if I would take two full weeks off. But that's not to say that that can't work for you. So if that's something, when you heard her say that, you're like, oh, maybe I'll try that. I would love for you to do so and then report back and I might even try that myself as well. And then the last thing that I really appreciated was the idea of how this might change in perimenopause. Because of course we see this luteal phase deficiency where we see our cycle initially shortening. I personally have lost a day just putting it out there. I'm a 27 day girl now. Used to be, used to be actually 29. And now I'm. I'm down to 27. So starting to see that luteal phase, for me at least starting to contract, which would be regular and expected at my age. And then doing some of the things she was saying, doing things to increase your resilience and your cellular plasticity, I think is really important. Overall, I would say Sarah is so well spoken. The examples that she gave were so real. When she was talking about the baboons or the.
- [92:33]
A
Was it the.
- [92:34]
B
Was it baboons? Or chimps, I forget which one she was saying. But some an ape who in the follicular phase wanted to hang out and groom each other and play and then the luteal phase hang out in a tree. I was like, yeah girl, same. I've been there. So her her examples are based in, you know, scientific literature. Just really appreciated her on she's a dream guest. I've had her on my dream guest list for a really long time. So let me know what you thought of this episode. Do you are you gonna be trying anything? Let us know if you feel so inclined to let us know on Apple Podcasts or on Spotify. Leave us a five star review if you feel it's it's worthy of that. Or leave us comments. On Spotify we see all of them and we track all of them as well. So until next time, I bid you adieu and I hope you enjoyed 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 health care 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.