← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Is Eating Less & Training More Hurting Your Hormones? A Perimenopause Reset with Dr. Stacy Sims
01:04:16
Hydration, stress management, and cool vs. cold plunges—let’s talk! Dr. Stephanie gets into a profound conversation with Dr. Stacy Sims about how women in midlife can optimize their recovery and health. Watch the full episode at https://youtu.be/BUNv4ZEvfWc
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- [00:01]
Dr. Stacy Sims
So estrogen and progesterone both affect our fluid retention hormones as we get closer and closer to menopause because we've had this dysregulation of our fluid absorption hormones, we have a muted thirst sensation. So we have to be very cognate that what we are drinking works with our physiology. And we're consciously aware that we have to drink.
- [00:22]
Dr. Stephanie Estima
It's just like appetite.
- [00:23]
Dr. Stacy Sims
Yeah, right.
- [00:23]
Dr. Stephanie Estima
Women have a really funny. They're like, oh, I just worked out, I did a fasted cardio and I'm not hungry anymore. It's like, you definitely need to eat. You definitely should not push back your meal. Hello, my friends, and welcome to another episode of better with Dr. Stephanie tis me, your host, Dr. Stephanie Stima. And today I am bringing you part two of my conversation with Dr. Stacy Sims. In our first conversation, we talked about exercise and nutrition for women. And this episode is all about that critical missing piece, which is recovery. We talk about all types of recovery. Recovery. We talk about sleep, we talk about hydration, we talk about cold, we talk about heat. We talk about it all. And if you are a woman who is in any shape or form an athlete, whether you are a professional athlete or you are a weekend warrior or anything in between, this episode is going to show you and teach you how to recover. Why it's important what are some of the metabolic and physiological adaptations that we miss out on if we are not recovering properly? And especially in perimenopause and menopause, how that changes. So, Dr. Stacy Sims, in case you are unfamiliar, she's an international exercise physiologist and her body of work explains the crucial differences in training and nutrition between menstruating, perimenopausal and menopausal women. We love Stacy because she simplifies complex concepts, ensuring that you get the practical knowledge you need to optimize your health and performance. And again, you can be someone who is a professional athlete, someone who likes to train and likes to exercise a couple times a week, someone who's only able to make it on Saturday and Sunday. And you are going to find value in this episode. So please enjoy my conversation with Dr. Stacy Sims. What if you could get the benefits of a 45 minute run in just five minutes? Well, that's exactly what Carol Bike does. It is an AI driven workout that is scientifically proven to improve your fitness, your metabolism and your brain performance in record time in just three sessions per week, clocking in at five minutes each. This can roll back your metabolic age by a decade. Carol is not just another exercise bike. It is a time machine for your health. And this is so important for us ladies because our VO2 max, which is how well our bodies use oxygen, is one of the biggest predictors of our longevity. The problem is that it naturally declines with age and in fact, 95% of people never sprint again after the age of 30. And I do not want to be part of that statistic. And I know you don't. E Carol Bike is the first workout scientifically proven to reverse that decline in VO2 max in just five minutes three times a week. And the result is a 12% boost in VO2 max in only eight weeks, meaning better cardiovascular fitness, sharper brain performance and a younger metabolic age. It is efficient, evidence based and designed for consistency. No excuses, just science and action. Head over to carolbike.com and use code better for a hundred dollars off of your purchase. Again, that's carolbike.com and use code better at checkout. Dr. Stacey Sims, back for round two. Welcome back to the show.
- [03:42]
Dr. Stacy Sims
Oh, thanks for having me. We didn't get nearly enough time last time, so I'm excited today.
- [03:48]
Dr. Stephanie Estima
Me too.
- [03:48]
Dr. Stacy Sims
I.
- [03:48]
Dr. Stephanie Estima
Me too. As soon as I was just saying to you in the pre chat, as soon as we were done, it was like a couple days later and I emailed, I was like, can we please do a part two? Because we did not get to what we had to get to. So we're gonna talk all about recovery today. We're gonna talk about hydration, sauna, cold plunge, why it's different for women, all of that. When we met last time, were podcasting last time we talked, we laid this powerful foundation around the importance of stress from training. We talked about nutrition strategies and so let's start with recovery. I know that it's not just limited to rest. There's actual rest when you're on the couch and maybe you are doom scrolling on Instagram, but there's also other modalities. Let's talk about. Let's start with recovery. Why is this so important, particularly for women in perimenopause where they might be as I am noticing that I don't recover as quickly as I used to. I actually need a little bit more of a Runway before I get back into the gym and you know, and repeat a workout.
- [04:46]
Dr. Stacy Sims
Yeah. So there's quite a few different things that we should really identify here. So we're thinking about recovery. It's a lot of people don't realize or don't connect the fact that the exercise stress is the breakdown. And so you need recovery to actually get stronger and adapt. So if you're always going in kind of half fueled with regards to muscle recovery, central nervous system recovery, and you're trying to do a workout, then you're not actually going to get the training stress you need to create the adaptations. So a lot of times people will go, oh well, I just went through the motions and it was kind of a half assed workout. It's like, well, you probably shouldn't have actually done that workout to that or tried to get to that intensity because you weren't actually pushing to the appropriate training stress to get the adaptations. So if we're talking about recovery in general, you have your acute recovery, which you know, we talk about right after exercise and what do we do to bring our metabolism back down, instigate the body to get into an anabolic or building and repairing state. And then we have the chronic recovery. And this is where you're looking at your periodization models. And when you're doing intensity, when you're doing low, low intensity days, how you're sleeping, how you're eating between sessions, and as we get to perimenopause, it becomes a factor that people really need to focus on because the body is under a significant amount of stress. We see this because every system of the body is being affected by a change in hormone status. We're having a change in our ratios of estrogen, progesterone, we're having more and more anovulatory cycles, which means we're not producing progesterone. And when we are looking at what happens with estrogen and the pulse of estrogen going up and down at a different rate than what it used to, then it affects bone, muscle, brain, central nervous system, everything. So you will find that you're not recovering as well as you used to and you can't hit it as hard as you used to. And when we look at why that is, not only are we having all these changes from the hormones themselves, but we also have an increase in our sympathetic drive. Because when we're looking at the stress the body is under now, we see that women are now more tired but wired. And it is from a sympathetic drive. So if we're already in that flight or fight state, or that sympathetic drive state, it's really hard to get another level up to hit an intensity to stress the body. And we find a lot of women will fall into more of a moderate kind of training, just kind of going through the motions, which then exacerbates that Tired, but wired and sympathetic drive. So there's a lot to unpack there.
- [07:30]
Dr. Stephanie Estima
Yeah, yeah. I love where we're going with this. And I will just say for the listener, you need to ovulate. So you said anovulatory cycle. So we just want to underline that for a moment. In order for your body to release progesterone, you need to ovulate. And so these anovulatory cycles that you are describing, you may still have a bleed, but you may not necessarily have released, you may not necessarily have ovulated. And therefore that second half of the menstrual cycle that you're describing, you're not going to have that release of progesterone, which of course is very important in, you know, I want to talk to you about sleep. We often think about progesterone affecting sleep, but it affects a whole host of other things. Brain, I mean, how. I mean, it affects the body systemically.
- [08:11]
Dr. Stacy Sims
It does, yeah.
- [08:13]
Dr. Stephanie Estima
Okay, so let's talk about, let's talk about progesterone and the effect that it has on recovery in the body. And we, we can start with sleep if you'd like, or if you want to preface it with anything. But I want to really set the stage for what is the role if you are having some of these an ovulatory cycles, which do happen more and more often in your mid-40s and of course up until, you know, the point of menopause where you, you know, don't have a period anymore. What is the role of progesterone in recovery?
- [08:40]
Dr. Stacy Sims
So it's anti inflammatory in some aspects, but it's also counters estrogen. So when we think about what's happening here, we'll see a lot of women will have a heavier bleed with anovulation because estrogen is unopposed. So you get a thicker endometrial lining. So when we're talking about progesterone, its importance for like mitigating a lot of things that estrogen does, we see not only is it within that menstrual cycle or that bleed phase, but when we think about progesterone, how it antagonizes estrogen, we see it affects like our heart rate variability, we see it affects our respiratory rate, our resting heart rate, we see it affects our fuel and our fueling mechanisms. When we start seeing how it affects vagal tone, because it antagonizes estrogen, we have a change in our vagal tone. So our parasympathetic drive. So this is why, when we see what's happening in Perimenopause with a change in our ratios, we get that reduction of vagal tone. So we get that more sympathetic drive. So when we talk about recovery, it's really important to start instigating some more mindfulness and maybe even non sleep deep rest strategies to instigate that parasympathetic drive. So and when we're talking about sleep and how progesterone can somewhat help or interfere with sleep, when we start losing or not having as much progesterone, we do see an absolute change in our ability to get into a deep restful sleep as well as a change in sleep architecture. So when we talk about an impractical means, someone will look at me and go, well, what do you mean? It's like, can I just, you know, what do I do about sleep? It's like, okay, now we have to look at how are we going to create an environment that is going to allow your body to get into a deep restful parasympathetic activation, which is what we need for sleep. So we can look again at some of the mindfulness practices, the non sleep deep rest, which is also yoga nidra. And we can look at different supplements that we can use that is going to stimulate like the GABA system of the brain. And that's what L. Theanine does. L Theanine is a non protein amino acid that is used by the brain, activates more of the alpha waves, which is a parasympathetic drive. We see that having a cool room and drinking something cold before bed, which helps drop your core temperature and which also instigates parasympathetic response. So there are a lot of different things that we can do to really help with the sleep and sleep architecture. Because I think that's one of the very first things that people going through perimenopause will notice is a disruption in sleep. And most of the time they're like, oh, it's just because I'm highly stressed or the kids woke me up or all of a sudden become a light sleeper. And they're not tuning into the fact that there's a change in our hormones which is really interfering with what's happening in our ability to sleep.
- [11:40]
Dr. Stephanie Estima
Well, yeah, and I think with, with perimenopause in general. So of course we have these hormones that you're talking about where we're, we're seeing this overall trending decline in everything in estrogen eventually and testosterone as well. But there's also environmental stressors as well, like our children, you know, Your. Your children. My children are about the same age. Right. They're like in their teens. And then, you know, many women through the, through the journey of perimenopause will see their children off to college. And so there's these stressors from parenting teenagers, which is very different than parenting a toddler, let's say. And then you also have the, you know, if you are the primary caregiver for your parents, you know, seeing them age and now having to manage their medications and visits to the doctors and seeing their, you know, in many cases die. Right. So you're coming into. There's these other environmental stressors that I just want to highlight. So, yes, of course there's physiological stressors that we're talking about. And I think people also miss this idea that you're kind of in a stress sandwich. You have this pressure.
- [12:39]
Dr. Stacy Sims
Yes.
- [12:39]
Dr. Stephanie Estima
From below with these children that you're raising and grieving your loss of, you know, being a mom and as well being, you know, seeing your parents age and, you know, eventually passing.
- [12:51]
Dr. Stacy Sims
Absolutely.
- [12:52]
Dr. Stephanie Estima
Yeah. So I think there's these stressors that we, I mean, women are just really great at just piling another thing into the backpack. Right. It's like, yeah, okay, I got it. I gotta do it. I like, this is what I gotta do to make it through. But just really recognizing that you have this physiological change that we're describing and you have these life. These really big life changes as well, all sort of coming, you know, to butt heads at the same time.
- [13:16]
Dr. Stacy Sims
Yeah. Oh. So when we're talking about it, like in our more high performance environments, we talk about the allostatic load and we try to make people understand, not only is it the training stress and the recovery from the training stress, but let's look at all the other stressors in your life. Because if you are overrun with daily stressors, then the exercise isn't a positive use stress. It is actually becoming more of a distress. And I know so many women are like, well, it's my time to decompress and to have my own time and space. But then we have to really look for, from the physicality standpoint of what kind of extra stress you're putting on.
- [13:56]
Dr. Stephanie Estima
Yeah. Okay, so we have progesterone affecting our sleep. Estrogen also eventually affects our sleep as we see estrogen trending downward. Of course, estrogen has a big role in REM sleep.
- [14:05]
Dr. Stacy Sims
Yep.
- [14:06]
Dr. Stephanie Estima
Talk to us a little bit about how sleep is generally different from men, and then what are some optimal strategies that we can be thinking about if we are so you've, you've mentioned already, like, cool, you know, cool, dark room. You know, we've all sort of heard of sleep hygiene hacks or strategies like that. What are some habits and action items that you like to counsel women on in midlife who are having trouble sleeping?
- [14:31]
Dr. Stacy Sims
The first thing is I want women to understand their circadian rhythm is different than their male partner. So our circadian rhythms really work on a different cellular and like day, night rhythm than what our male partners do. And women tend to have a melatonin rise and sleep onset need earlier than our male partners. Which means women also tend to wake up earlier than their male partners. And often we see in households where you finally get the kids to bed and you want a little bit of time with your partner and you're sleepy, but you fight through it because you want to stay up with your partner and you've passed that wave of sleep and then you can't get to sleep and you have interrupted sleep. So this is the very first thing I want bring attention to for a lot of women that are listening and a lot of the women that I work with is finding where you have that drive for sleep. Where is that melatonin rise and that sleep onset coming? Cause you might find it's at 9 or 9:30 and not 10, 10:30. So being able to wind down and get into bed when you are able to capture that circadian rhythm, shift into sleep and sleep onset is the very first step into being able to have a better and more restful sleep. When we look at people who are doing shift work or can't navigate that whole sleep onset, then we start looking at, okay, well, what are the things that we need to do to one, be able to work with circadian rhythm, and two, really kind of tell the body that we are ready to bring core temperature down, we're ready to allow melatonin to come up and for us to get into this parasympathetic engagement. So one of the first things is we are not taking melatonin because the dosage over the counter is often not appropriate for women, it's often too much. If you can work with a specialist who knows how to microdose it, then that's fine. But when you're just buying something over the counter as a sleep aid, it again can fast forward to changing your body's own natural production as well as circadian rhythm. So we look at other things. We look at L Theanine, we look at ashwagandha, we look at cold tart cherry juice A half an hour before you wanna go to slee. So all of these are going to help drive parasympathetic and our hormonal neurotransmitter responses in the brain to say, yep, okay, we're ready to get into that rest and digest. We see something as easy as cold tart cherry juice half an hour before bed. It increases your body's own melatonin production and rides the wave, which means that you have more melatonin available to instigate sleep and sleep patterns. And the coldness drops your core temperature. And this is one of the things that we find in perimenopausal women is there's such a temperature fluctuation that instead of being able to dip low into a sleeping temperature your body's used to, it oscillates right at awake temperature. So we see a natural progression of sleep. As your core temperature drops by about a degree Fahrenheit, it stays low and then it starts to come up as a natural waking cycle with cortisol. So if we can drop our core temperature and get down into that sleeping stage by using cold or icy fluid before bed, then this really does help you get into a faster sleep onset and helps you set up more of that delta wave sleep.
- [18:06]
Dr. Stephanie Estima
So I love that. I've never heard of cold tart cherry juice. That is something that I'm going to look into myself. What about now that we're talking a little bit about adaptogen? Shashandra, would that be something to help with the parasympathetic response?
- [18:18]
Dr. Stacy Sims
Chandra tends to wake people up. It gives them really good focus. So when we're looking at some of the adaptogens that are good for sleep, we can see rhodiola and ashaganda are the two big ones. Some people do have a stimulant effect with rhodiola. So you want to try it out first. Like take it on a day where you don't have a lot going on and see if it makes you sleepy or wired. And then you'll know if you can use it before bed.
- [18:44]
Dr. Stephanie Estima
So if we have a, we'll say a phasic shift in our melatonin production, would that also implo. Would that also have implications in terms of when we should have our last cup of coffee as well?
- [18:56]
Dr. Stacy Sims
Yes and no. It depends on more genetic factor. If you're a fast or a slow metabolizer. If you're a fast metabolizer, it's not such a big deal. It doesn't have such an impact on our Melatonin and you know, are sleeping. But if you're a slow metabolizer. Definitely.
- [19:14]
Dr. Stephanie Estima
Yeah.
- [19:15]
Dr. Stacy Sims
Caveat is when we get into perimenopause, we find most women become more sensitive to caffeine. Why? Not sure. But we do see that there's an interference or maybe a change in dopamine and adenosine receptors that caffeine is so tightly tied to. So we're seeing all the neurotransmitter changes that are happening in perimenopause. It makes sense that people become more sensitive to the effects of, of caffeine. So that's still an area of research that is being investigated because, you know, menopause is supposedly new to research.
- [19:51]
Dr. Stephanie Estima
Right. It's never happened before.
- [19:52]
Dr. Stacy Sims
It's never happened before.
- [19:54]
Dr. Stephanie Estima
Yeah, just the whi was the first time that anyone ever heard of it.
- [19:57]
Dr. Stacy Sims
Yeah, exactly.
- [19:59]
Dr. Stephanie Estima
I get that feedback too. I hear a lot of women, they're like, coffee, love it. But I can't have it anymore because it just, I feel, it gives me the jitters and I just have this sense sensation of energy. I have this sensation of panic that I didn't necessarily have before. So that is interesting to, to sort of unpack and understand what's happening there. Research, you know, hopefully will, will tell.
- [20:20]
Dr. Stacy Sims
Hopefully, yeah.
- [20:22]
Dr. Stephanie Estima
Okay, let's talk about something super important. How your digestion changes in perimenopause. If you want more energy, better focus, less stress, and to stop bloating after each and every meal, this starts in your gut. When your gut is out of whack, just everything feels off. Your mood, your digestion, your sleep, everything. And this is why I use and I love the Just Thrive probiotic. Most probiotics never make it to your gut alive. They are dead on arrival. But Just Thrive is clinically proven to arrive in your gut 100% alive and actually do what it is supposed to for you. That means less bloating, better immunity and that steady feel good energy. To tackle your day, here's my challenge for you. Try the Just thrive probiotic for 90 days and it is 100% risk free. And just see how much better you feel. Head over to justthrivehealth.com better and you're going to save 20% on your first time order and start your 90 day just thrive challenge today. If you don't love the way you feel, if you don't see any changes in your gut health, you can ask for a free full product refund, no questions asked. So again, that is justthrive health.com better talk to us a little bit about when we're thinking about recovery from the gym specifically. I mentioned I have asynchronous splits I don't have, like Monday's not always legs, Tuesday's not always back, etc. It's like I sort of work on a 8 to 10ish split just based on in 8. In 8 days, I'm trying to get in 3 to 4 workouts. And then I will also structure or schedule in, I'll say deloads as well. Like days where I am reducing volume by like 50% or I'm just not going to the gym at all, which is the one that I usually opt for because psychologically it's very hard for me to just go and do 50%. So I'm like, all right, I just need four days off. I need a week off the gym. So talk a little bit about active recovery. One of the things I have found to be incredibly useful, particularly with leg day, is walking. So I feel like walking maybe is my favorite, you know, active recovery. But I also have found just in, you know, my own background and talking with other friends who are in, you know, the mobility space, like just mobility work is so, so much more crucial for me in midlife. Even as a practitioner who spent, you know, 19 years in private practice talking about mobility and the importance of mobility, I would skip it. Like, I would, you know, just putting myself, like, I would skip it in lieu of other, other things. But now I find as a, a woman in her, you know, mid to late 40s, I'm like, okay, I can't. I have to do, I have to do mobility work. Like, my ankles are not like this ankle mobility is not going to fix itself.
- [23:11]
Dr. Stacy Sims
Right.
- [23:12]
Dr. Stephanie Estima
I. I'm right. So talk to us a little bit about what your views are maybe on active recovery days, what active recovery looks like deloads. And then also your thoughts on, on mobility too.
- [23:23]
Dr. Stacy Sims
Yeah, we have a joke here where we feel like we spend more time mobilizing than we do actually training, but it's neither here nor there. So we're talking about active recovery. Like I was saying earlier, when we're exercising, we're creating that stress. And part of that stress is the tear down of muscles, increasing inflammation, increasing oxidation, putting stress on the bone. So we need all of these things to recover. And as we were talking earlier, it takes a little bit longer because of things that are happening. So when we talk about active recovery, going for a walk, going for an easy aqua jog or an easy swim, anything that's going to create low amount of stress with increased blood flow to the muscle. Because if we're talking about blood flow to the muscle, that's our nutrient transporter. It's the way that we bring more nutrition to all of the working muscles and tendons and bones. And it's a way we can take away some of the waste product. So walking's great. You're getting some movement in and around all the joints. You're getting more blood flow to the muscles and the tendons. Your looking at, you know, being able to get through a range of motion that is easier than what you would find in a heavy squat. And so it really does facilitate more of a metabolic recovery. And this helps with all of our tissue repair as well as our ability to adapt. Because if we're increasing reparation, then we are increasing our ability to adapt to that training stress. And it tends to be something that people forget to or like neglect. Right. Because everyone's in this mindset of go, go, go, I gotta go to the gym, it's in my schedule. And like you're talking about with deloads and having a change in your split so you're asynchronous is really ideal when we're talking about the stress that the body is under when we are in perimenopause. Because if you're planning on doing heavy squats every Monday, your body most likely won't be able to do heavy squats every Monday. Because we have central nervous system that we have to take care of, plus all the tissues that we have to take care of. So doing asynchronous is fantastic. If you are looking at training blocks, maybe you're talking about angle mobility. And we see a lot of uptick in soft tissue injury and joint instability when we're seeing a change in our estrogen progesterone. Two of the most common injuries are plantar fascia problems because of a change in the tendon and tendon responsiveness, but also a weakening of our calf muscles. We see frozen shoulder as well, and it has to do with estrogen and it's change changing its tendon and fascia, I guess, ability to be responsive to stress. So this is where mobility comes into play. So mobility is super important, not just for increasing our range of motion, but to create enough stress within the joint capsules and against the tendons and ligaments to keep them able to be responsive to different stressors. So if we're thinking about pulling and opening up the joint capsule of the hip, then we're going to get more synovial fluid going in there. We're going to be able to keep more lubrication going, encouraging blood flow. And that way we keep our range of motion, which enables us to have a better movement technique when we're looking at being in the gym. Mobility is super important and it's also a really good way to come back from an injury. So if you are looking at plantar fascia problems or tight ankles or torn meniscus or something to this effect and your range of motion is compromised from those injuries, there's only so much a physio or physical therapist can do with regards to manipulation or giving you exercises. If you're using heavy resistance bands to get into a tighter or the end range of that motion, you're able to come back from that injury without as many biomechanical issues as you would have if you didn't use the mobility aspects.
- [27:32]
Dr. Stephanie Estima
Yeah, I love that. And I also think for women who are now where we're seeing this big shift from cardio bunnies to muscle mommies, where they're like, okay, I am now, I'm going to. Yes. It's like, yay, finally, you know, we're moving into the weight section of the gym. If you don't want to get injured, which is a, a, which is a reasonable fear because you don't have that neuromuscular skeletal pattern, you don't have that motor learning, it, it is reasonable that it is reasonable to assume that if you go too heavy, too fast, without good technique, without full range of motion, as you're saying, that likelihood of being, getting injured is also higher. And as a perimenopausal woman, like, you can't, like that is, you know, you can not that injuries always suck. They always suck. But if you are 20, you are going to bounce back much faster than if you are 40 or if you are 50. And you just really can't afford the degradation that happens while you're off in midlife.
- [28:27]
Dr. Stacy Sims
Right, Exactly. I mean, I have an injury that I've been trying to come back from since February and it's very frustrating because 10 years ago would have been a non issue, but now it's like, okay, now I have to really look at how am I loading, how am I maintaining muscle, how am I also so rehabbing? And it's much better not to become injured.
- [28:50]
Dr. Stephanie Estima
Yeah, yeah, I, I, yeah, I, I, I love that you're saying that. And thank you, thank you for sharing that. Because psychologically, when you get injured, you're like I'll be back in like a couple days.
- [28:59]
Dr. Stacy Sims
Yeah.
- [29:00]
Dr. Stephanie Estima
Eight. Eight months later. It's like my AC joint. Still not where it should be or whatever.
- [29:04]
Dr. Stacy Sims
Right. Yeah, exactly.
- [29:06]
Dr. Stephanie Estima
Okay, so let's, let's move on to. Let's talk a little bit about heat and cold for women. I've heard you talk about this a lot. This is something that I wanted to make sure that my Betty's, my community opinion on. I think we are very aligned on it. But I wanted your thoughts on cold plunges. We have all of the bros love them. We love our bros. Right. But they're all doing like cold plunges. That's what they do. Fasted every morning at like 3 in the morning. And then they do their, whatever they're doing, fasted workout. Then they come back and they have a black coffee. But cold plunges is usually part of that sort of, you know, biohacking, let's say, protocol. How is cold plunging different for women? First question and then the follow up question is if a woman does want a cold plunge, because I do think that there are some benefits to it, how can we strategically time it so that we are not interfering with adaptations, let's say from the gym or for whatever exercise you're doing, and then how might we adapt it for. For the female body?
- [30:05]
Dr. Stacy Sims
Yeah. So I laugh because I think I created an international shitstorm when I was talking about how women shouldn't do cold plunge. Drawing on science that's been around for quite a few decades and keep contributing to it, where we see that men can get all of our parasympathetic and metabolic and other kinds of responses from ice water. But when women get into ice, because we have sex differences in thermoregulation, it creates such a strong sympathetic drive and vasoconstrictor response that it's too much of a stress for women to get those same adaptations. We see that women can garner some of those metabolic and parasympathetic and endocrine responses. If the water is 10 degrees Celsius or around that 45 degree mark, we're talking about Fahrenheit. So it does not need to be ice. Ice is too cold. If we talk about cool water, then we're onto something for women. So if we think about what is cool water immersion, we have to divide it up. Are you looking to use an environmental stress like cool water as a way to help with training and adaptation, or are we looking at it for all of the health benefits that in some regard exercise gives you? Anyway, if we're Talking about metabolic and endocrine and parasympathetic help. But when we get to perimenopause, a lot of women are again looking for some way to increase parasympathetic responses. So cool water can help with that. But if we're looking to use it for health and training, we can't put ourselves into cool water right after training because this dampens a really necessary response within the muscle for the body to understand what inflammation is, to overcome that and understand what oxidation is and overcome that. So you want to look at cool water five hours after you finish a training session. Session minimum? Five hours minimum.
- [32:07]
Dr. Stephanie Estima
Yeah, yeah.
- [32:08]
Dr. Stacy Sims
So then that also can become part of your health strategy too. The caveat on that though, is if you are doing a really heavy event, so maybe you're doing a CrossFit competition, or maybe you're out racing and you've done a really heavy, heavy competitive session, getting into cool water right after you finish is beneficial to enhance acute recovery. Because women tend to or don't tend to, we vasodilate first. So that means all of our blood will go to our periphery where men will vasoconstrict first. That means all the blood will come back centrally, and that's what you want. Because if blood is coming back centrally to the heart, then it gets pumped back out to facilitate recovery. So if women get into cool water right after really heavy, heavy trainings or race or other competition, then it will cause that vasoconstriction to enhance central return. But you don't, again, you don't want to do it all of the time because that cold water does not help with facilitating the muscles responses to inflammation and oxidation.
- [33:19]
Dr. Stephanie Estima
Would you recommend doing cold water before a training session?
- [33:24]
Dr. Stacy Sims
Not if we're looking at doing a heavy muscular load. Because you do need the tendons and the ligaments to warm up with the muscle. I do have some of my open water swimmers get into cold water before they get in for their swim to get over a vagal response. Because if you have cold water immersion of the face, it is such a strong central nervous system survival response to drop heart rate and get into a very parasympathetic type condition so that everything slows down because the body's like, oh, I'm in really, really cold water and I need to be able to survive this. So I'm going to turn down my heart rate so I can conserve everything that's there as a survival. Because if you get into that state, then you can't race, you can't Bring your heart rate up. It takes a really long time to come back from that. So it's just more of a dose response to stimulate that, get out of it, warm up and then get back in. Because you just need that kind of dose response.
- [34:31]
Dr. Stephanie Estima
Yeah. With my boys, when they've been in tournaments, so there's, you know, on a weekend there's four or five, sometimes six games. They're cold, plunging, like it's. After they come home, they're in the bath and then they go back out for the, you know, for the next game or what have you. And I'm actually intrigued by what you're saying with the face. I wonder if we could also think about that for other extremities too. Cause I've always found when I get into, into cool water, and by the way, my cold plunge is 13 degrees. Like 10.
- [34:57]
Dr. Stacy Sims
Perfect.
- [34:58]
Dr. Stephanie Estima
I can't do 10.
- [34:59]
Dr. Stacy Sims
No, 10's too cold for you.
- [35:01]
Dr. Stephanie Estima
Yeah, 55. 13. That's. I can, I can get into that. But I wonder if extremity. If you were to. Because I've always found feet and hands are the ones that are the most difficult for me. And I'm sure that I'm not the only one. It's just, there's, there's nothing there. It's just bones. Bones and some ligaments. Could we also use face, hand and maybe feet immersion as a way to. If we didn't necessarily want to do like a whole body plunge, could we use those to mimic some of the, some of the benefits, like that parasympathetic response that you were, that you were describing.
- [35:32]
Dr. Stacy Sims
I don't know if the feet and hands would, but definitely the face. That sounds like an experiment that we should try.
- [35:38]
Dr. Stephanie Estima
Yeah. 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 500 milligrams, which is a clinically reference 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 checkout to receive 20% off today. Yeah, I wonder, because I know that there's some people that wear socks in cool water plunges or cold water plunges. So something to marinate on, something to think about.
- [37:20]
Dr. Stacy Sims
Yeah. Well, when we think about the palmar surfaces of hands and feet, and you have the AVAs, which are big shunts for blood. Right. So if you're having lots of constriction, then you are definitely pushing blood back. That's why you stick your foot out on a hot night and you instantly cool down because it offloads such a lot of heat. The complication there for women is Raynaud's. So if we're thinking about, you know, so it is. It's a nuance, but it does. Does warrant a lot of examination. I think. I think I'll pursue that one. That sounds cool.
- [37:53]
Dr. Stephanie Estima
Yeah. Awesome. Yeah. So cool. And I actually like calling it cool water plunges rather than cold water. I think that that's just a little easier. You know, we don't have to be as extreme in the same way that we don't have, you know, we're not. We don't need to fast for seven days like the guys are, or cold plunge at the, you know, in ice water, it can be cool water. And we can also be strategic about it in the way that you're talking about.
- [38:13]
Dr. Stacy Sims
Right.
- [38:14]
Dr. Stephanie Estima
Talk to me about heat. Sauna.
- [38:15]
Dr. Stacy Sims
My favorite sauna. My favorite, too. So women, again, because of sex differences and thermoregulation, tend to do better in heat anyway. So when we first get exposed to heat, we vasodilate and we try to offload heat and absorb some of the heat. Men start to sweat first. So when we are looking at the sauna in such an extreme temperature, your body equilibrates a lot faster and can withstand that heat more so than what happens with men, which is interesting, but I find it really beneficial because if you can stay in the heat for a longer period of time, it's a driver for so many cellular changes. Because we see heat shock protein unraveling and recomping. We see an epigenetic change in a lot of the way that your body uses and, and stores glucose. It helps with BDNF production. We see that it increases your body's temperature tolerance. So for hot flushes, we see that women who are more heat adapted, they have a greater range. So the hot flushes aren't as frequent or as intense. And from a health perspective, 10 minutes a few times a week in a sauna is one of the longevity hacks that does work for women in.
- [39:32]
Dr. Stephanie Estima
Yeah, I always find when me and my husband are in a sauna, like, we are in there for, I don't know, five, ten minutes, and he's like, I, I can't breathe. Like, I have to leave. I'm like, I'm, I'm fine.
- [39:41]
Dr. Stacy Sims
Yeah.
- [39:42]
Dr. Stephanie Estima
I haven't even started sweating yet.
- [39:43]
Dr. Stacy Sims
Sweating yet.
- [39:44]
Dr. Stephanie Estima
I love it.
- [39:44]
Dr. Stacy Sims
It's great.
- [39:45]
Dr. Stephanie Estima
Yeah. I haven't started. Yeah, it's so, it's so funny. So, yeah, I love sauna there. I mean, that. And maybe, you know, we have a, we have a sauna in the home. We use it, I don't know, probably three, four times times a week. And I can sit. I mean, I have an infrared sauna, so it's not a, it's not a traditional sauna. So it doesn't get as. It's not like 180 or 200 degrees. It gets up to about 160. But I can sit in there for maybe an hour, like 50 minutes. I can, I can stay in there. I'm reading a book. I'm fine. It's great.
- [40:12]
Dr. Stacy Sims
I love place because you can't bring any devices in there, right?
- [40:16]
Dr. Stephanie Estima
Exactly, exactly. And there's some, there's something also to be said about heat. So we've, we've talked about cold after exercise not being ideal because you're sort of blunting that acute inflammatory response. But there is, for lack of a better word, hyper. Hypertrophy. Like, you know, can you talk a little bit about some of the benefits of getting into. Yeah, yeah, right afterwards. Talk to us about that.
- [40:39]
Dr. Stacy Sims
Yeah. So if you're getting into the sauna right after training, you are actually enhancing your training stress. Because if we think about the mechanisms of blood flow, one of the critical factors for being able to moderate your internal temperature is a shift of blood to the skin. So we have more hypoxia to the muscle, which is increasing a training stress. Your heart rate is elevated. So you're giving more cardiac stress, you're getting a stimulus to increase your total blood volume, and you're having slight hypoxia to the muscle because most of the blood is going to the skin to offload the heat. So again, if you're looking to increase hypertrophy effects or even central stress strength gains, and if you get into the sauna for 10 to 20 minutes after a hard training session, you're extending that training stress just by the mechanisms that your body is undergoing to thermoregulate if you're trying to adapt to a hot condition. So for someone like me, who is sitting freezing, even though you can't tell, it's like 30 degrees Fahrenheit outside versus you guys in the northern hemisphere, who's sweating today? Death. And I have to go to the northern hemisphere. I'll get into the sauna for nine days in a row to acclimatize. So I'm going to increase my blood volume, I'm going to shift my temperature sensation so that 60 degrees feels cold instead of 30 degrees feeling cold. And that's also going to give health benefits. So when we're looking at what are we using the heat for? If you're using it right after training, it can enhance our training stress, increasing our ability to adapt. If we're going to a hot environment, we can use it to acclimatize. And if we're looking for health gains, then you're going to get them in either way that you're using it.
- [42:25]
Dr. Stephanie Estima
And so do you have recommendations on frequency, duration, how hot the sauna should be, generally speaking?
- [42:33]
Dr. Stacy Sims
Yeah. So if we're looking at the typical finish dry sauna, we want to have it at 60 to 80 degrees Celsius, and you want to get in the sauna for about 10 minutes after training, and that enhances your training stress. If we're looking at heat acclimation or acclimatization, then we look at going nine days in a row, slightly dehydrated, around that 70 degree Celsius mark, and you want to stay in it for up to 30 minutes. But the caveat there is when you get out, you don't want to throw a whole bunch of water back. You want to slowly rehydrate because you want to prolong the viscosity of your blood or having less water in your blood so that you're going to get an incredible decrease in the partial pressure of oxygen at the kidney, which then stimulates more red cell growth.
- [43:30]
Dr. Stephanie Estima
Okay, this is fabulous. So when we get into the sauna. So finish sauna, Traditional dry sauna, 60 to 80 degrees CEL. So I, I apologize. My North American was showing. I switch. I think that's something like 180Fahrenheit, something like that, for about 10, 10 minutes. And we want to do that without hydrating in the sauna. So we want to be. If you've just had a training session, you want to be slightly, we'll say dehydrated. So you're not using, you're not, you know, throwing back a water bottle or whatever in the sauna. And then you want to slowly, after the sauna, after that, slowly rehydrate. So this is perfect because this is what I want. I wanted to talk about hydration with you. We hear all the time about electrolytes as well. So as we are, we've come out of the sauna 60 to 80 degrees Celsius centigrade. Do we add electrolytes into that water? Do we sip it slowly? Is it a glucose solution? Like how, how do we rehydrate?
- [44:22]
Dr. Stacy Sims
Rehydrate, yeah. So if we're looking at rehydration, there are two critical electrolytes you need, and that's sodium and potassium. Sodium works with the water to pull it through the intestines into the blood space. And the potassium works to rehydrate the interstitial spaces or between the cells. So you need both of those for rehydration. When we talk about electrolytes, quote replacement, that's a marketing term because if we're eating food throughout the day, we're getting sodium and potassium and magnesium. We are getting adequate electrolytes. The critical thing to think about when you're hydrating is what are sodium and potassium doing for fluid transport? So we know that every solution in the body is not plain water. You have a little bit of glucose, but also with food and rehydration, you're going to have adequate glucose available to then help with fluid absorption. So you really can look at water with a little bit of sodium and a little bit of potassium for rehydration.
- [45:33]
Dr. Stephanie Estima
And do we have like, I know that there are electrolyte supplements that are anywhere from 200mg up to a grammar up to a thousand. A thousand.
- [45:43]
Dr. Stacy Sims
What would be your ideal for rehydration.
- [45:46]
Dr. Stephanie Estima
And for women specifically?
- [45:47]
Dr. Stacy Sims
Yeah, so women tend to finish exercise in a training stress with normal blood sodium or slightly low blood sodium levels. So when we're rehydrating, we want to look for around 360 to 400 milligrams of sodium per 16 ounces. And with potassium you want half that amount. So around that 200 milligram mark of potassium and that's your adequate rehydration. If you've done something that's really long and intensive, so two, three hours, and you're really dehydrated because you've been out on the east coast in the humidity and the heat and you're completely tapped out, then you want to look at adding some maple syrup or some glucose and sucrose to that to really facilitate some rehydration.
- [46:36]
Dr. Stephanie Estima
Okay, so this is, you know, the, the 360 to 400 mgs of sodium that you're talking about. This is after a typical 60 minute, 75 minute training session.
- [46:46]
Dr. Stacy Sims
Yeah, 60 to 90 minute training session. Yep. Okay.
- [46:49]
Dr. Stephanie Estima
Okay, great. And then when does the glucose. Is that like after hydrox or something where you're training for several hours or.
- [46:56]
Dr. Stacy Sims
Yeah, yeah, yeah, yeah, for sure. So if we look at an optimal hydration solution, we're looking at 2 to 4% of glucose sucrose. So when I talk about in practical terms, I'm like, okay, we want to look for between 5 and 7 grams of carbohydrate per 8 ounces of fluid because that will give you a 2 to 4% carbohydrate solution. And that's what works optimally in your small intestines where all your fluid absorption takes place. Place. Because if we think about the small intestines, it's very temperamental to what we call osmotic pressure. So if we have a solution like Gatorade, that's 6%, it increases the pressure in the small intestines too much. So then water comes from other spaces to dilute it in order for it to be absorbed. If we have plain water with no sodium, then the body has to excrete sodium and glucose into the intestines before it can be absorbed. So when we're looking at a 2 to 4% solution with the 360 to 400 milligrams of sodium and around 200 milligrams of potassium, that works with the pressure gradients in the small intestines to maximally stimulate all of our different fluid absorption gates. So our glucose and sodium transporters, that will help pull fluid across. And if you get something that's too high, then you have water diuresis. So that means more water is coming into the intestines. If you have something that you have.
- [48:30]
Dr. Stephanie Estima
To pull from somewhere else, right. You have to pull that from Somewhere. Okay.
- [48:34]
Dr. Stacy Sims
Yes. Yeah. So it's like an effective dehydrator. So anything that's high, super high in carb is going to do that. So, you know, a lot of these sports drinks are way too high in carbohydrate that it doesn't adequately hydrate you because the carbohydrate content in there is to support exercise. So rehydration is completely different than what you'd want to do during exercise. So rehydration, you can drop the carbohydrate intake relatively low to around that 2% with your sodium and potassium. And during longer exercise, you want to kind of boost it up to 3 to 4% so that you're not over taxing your small intestines. You're still working with the pressure gradients because during exercise as well, you have blood that, that goes to the working tissue away from your small intestine. So you have more kind of stress on the intestine. So you want to make sure that what you're drinking actually works with the physiological mechanisms of fluid absorption.
- [49:34]
Dr. Stephanie Estima
Okay, so this is phenomenal because this also in part explains why electrolytes become, or at least staying hydrated becomes more important in perimenopause. Because as we see that drop in estrogen, that's also gonna, that will also affect our electrolyte balance, will it not? It's gonna, or I should say it promotes. Well, estrogen promotes sodium retention. So when we start to lose estrogen, that our ability to hold on to that sodium declines as well. Which is why a lot of myself included, I take like, I typically work out, you know, every day in some fashion, like 60 to 75 minutes. I'll have, I have a little bit more than I'm probably having about 4, 500 milligrams of sodium. Y. Yeah, like I'm probably having about that. But hydration isn't just about how much water you're drinking, but it is how well your body is holding on to that water. And this is especially true in perimenopause and menopause because as our estrogen declines, so does our ability to retain key electrolytes like sodium. And then you add in exercise sessions and hot flashes and night sweats, and women in midlife can very easily get dehydrated and disrupt our mineral balance. This is one of the reasons why I love peak's deep hydration protocol. It is a synchronized day to night electrolyte protocol to restore your nervous system to keep you hydrated. And it has the added bonus of being Drinkable skin care. It strengthens your skin barrier and helps to unlock a luminescent youthful glow from the inside out. It's a two part electrolyte rich with. The first one is BT fountain. You take this in the morning to deeply hydrate smooth skin and fuel all day energy. And this electrolyte has clinically proven ceramides visibly to improve skin elasticity and reduce fine lines. It has the ceramides that support hair thickening, follicle strength, elasticity and shine. Hyaluronic acid which supports a youthful dewy glow. And of course electrolytes and minerals that provide that deep cellular hydration. The second part is re fountain taken at night and this helps to calm the nervous system down and promote, promote deep restorative sleep. It has magnesium, L threonate, glycinate and taurate. And this is going to help to calm your nervous system and your brain for rest and recovery in the evening. It's electrolytes and minerals that help to nourish hydration from the cells all the way up to the skin. So start your daily ritual today with 20% off for life plus a free gift. To elevate your routine, head over to peaklife.com Dr. Estima that's, that's P I Q U E l I f e.com-r e s t I M A this is hydration redefined. You're going to feel it and see it. Can you explain a little bit about the role of estrogen on sodium and potassium balance? So as we're losing estrogen now, what is happening to our ability to retain these, these, these minerals?
- [52:36]
Dr. Stacy Sims
So estrogen and progesterone both affect our fluid retention hormones. So we have arginine vasopressin which is avp, which stimulates our thirst, encourages water retention and estrogen is, is really tightly tied to that because we see what we call our plasma osmolality which is a driver for our arginine vasopressin release. Estrogen really kind of moderates that. So when we start to have a decrease in our body sodium and a decrease in our plasma osmolality, there is not really a drive to drink but more of a drive to have sodium because your body's like I don't want any more fluid retention, I want to increase my sodium. But the caveat there is as we get closer and closer to menopause, because we've had this dysregulation of our fluid absorption hormones, we have a muted thirst sensation. So we have to be very cognate that what we are drinking works with our physiology. And we're consciously aware that we have to drink.
- [53:39]
Dr. Stephanie Estima
It's just like appetite, what we were talking about last time.
- [53:41]
Dr. Stacy Sims
Right.
- [53:42]
Dr. Stephanie Estima
Women have a really funny. They're like, oh, I just worked out. I did a fasted cardio and I'm not hungry anymore. Or I did a fasted training workout and I'm not hungry. It's like, you definitely need to eat. You definitely should not push back your meal.
- [53:53]
Dr. Stacy Sims
Yeah, yeah, exactly.
- [53:54]
Dr. Stephanie Estima
Muted thirst. That is so important to know as well. Okay. Okay.
- [53:57]
Dr. Stacy Sims
Yes.
- [53:59]
Dr. Stephanie Estima
All right. So we talked about recovery. We talked about hydration. We talked, we touched on adaptogens. I also just. I'm just looking through my notes here. Oh, the other thing that I wanted to make sure that we talked about today was relative energy deficiency in sports. So I know this is just a little bit of a hard left. I went. We were just talking about hydration. But I think that this is so important for all of the type A personalities that, you know, the R word is recovery. It's like, no, I can do more. Like put me in coach. Like, I can keep going and I don't want to take any days off. Like, no days off. Right? Yeah. For me, what I would often battle against, at least with my teenagers that I cared for, is excessive dieting in these beautiful teenage. Like these beautiful girls that think that they're fat or they following some tiktoker or people who are modifying their photos online. You know all this stuff. Talk to us about relative energy deficiency syndrome and why this is so crucial not just for our beautiful daughters that we. That are coming up behind us, but also for the women in midlife, these type A. And I'm calling. I am that person. So that type A woman in midlife who doesn't. Who doesn't want to rest.
- [55:16]
Dr. Stacy Sims
Yeah, right.
- [55:16]
Dr. Stephanie Estima
Who doesn't want to. For in some capacity at some point in her life, someone told her the messaging that she internalized was, you're only enough when you're producing something. So how can we. How can we talk to her about eating enough? Because she's probably on some type of 1200. It's like I see like 1200 calories for 1300 calories for 10 years. Talk to us about the impact that that's going to have on. On performance, body composition, bone density of again, like puberty, sleep. You know, puberty and perimenopause. Like these two are almost like mirrors of each other. So talk to us a little bit about reds.
- [55:52]
Dr. Stacy Sims
So it starts with what we call low energy availability. So if we think about how much total calories your body needs in a day, and we're thinking about just lying on the couch watching Netflix, your body needs a more aquarium of around 1200-1400 calories just to exist. And this is to keep your brain going, your heart going, your gut microbiome happy, your muscles working, everything just being there to exist and do what it needs to do. As soon as you get up to start doing some chores, you need some more calories because you're activating more muscle, you're having muscle contraction, your heart rate's going up, you're producing more hormones to bring that heart rate up and down. And people forget this, they forget that their body isn't inert and it needs fuel. So when we start looking at women who are doing fasted training and they're delaying their meals because they have an appetite disruption and they're actually not physically eating enough, the body responds by downturning all of the unessential mechanisms. So that is building lean mass, including your bone, keeping your tendon and ligaments healthy, keeping brain and cognition going. We see a lot of dead end, like brain foggy kind of fatigue in midlife women who are in low energy availability, reaction time is slower. We see disruption in sleep. There's a lot of sleep awakenings because the body becomes hypoglycemic while we're sleeping. And if it's hypoglycemic, you wake up because the body's like, I need some food, I need some food, I need to forage. Yeah, right, exactly right. And the longer this goes on, the more you become entrenched in this low energy state. And that leads to relative energy deficiency in sport. So that's where every system of the body is affected. We see psychological issues with more anxiety and depression. We see more ppmd, we see more severe pms. We see the low levels of vitamin D that, that come with poor nutrition, which further exacerbates things like PMS and ppmd. We see gut microbiome changes where there's a decrease in diversity. If you have a decrease in your diversity, then your body is stimulating more body fat storage. We see a decrease in BDNF production when you're exercising, which is fertilizer for your brain. We see a decrease in bone turnover. So there's an increase in stress responses and stress reactions. Also a total decrease in bone density, which is really significant. Especially we're talking about our young puberty girls, right? When we're talking about peak bone Development. The other thing about the girls in puberty who are in low energy availability is when we're thinking about brain and brain development, we have things like your structural changes and the neuroplasticity of the brain. It's being muted because it doesn't have enough energy or carbohydrate to do what be to needs needs to do. So we see a decrease in the amygdala. So we have more fear components in women and young girls who are in low energy availability. So it's really a syndrome that you can't just take a blood test for. But we see it appearing in so many different symptomologies. Somebody might go in and say, I'm having really poor sleep and I'm really fatigued. Those then would be a red flag to start looking at. Okay, what's menstrual cycle function like? What is your blood lipid? Where are you storing your body fat? What's your dexa? So there are all of these things that come up because I'll see a midlife woman who is in a low energy state and on the outside she looks pretty fit, but on the inside her DEXA tells a completely different story. It's like she's in late perimenopause with increased visceral fat, low bone density, poor muscle quality. And these are things that on the inside are more important than what the aesthetics are. And it is a significant drain on your own healthcare system and budget because if you're in a subclinical low energy state where you're just kind of wandering along and just barely eating enough so you don't fully feel the effects, but yet you're walking around really tired, you have a short fuse, you don't have a filter, you don't have not sleeping well, you feel highly stressed, you're not responding at all to training. When you're going through the motions, body composition isn't changing. All of these things are really significant beacons of saying you're in low energy and low energy availability and the easiest fix is to eat.
- [60:30]
Dr. Stephanie Estima
Yeah. And so those are so common. So many women are like, I'm training but nothing's happening. I'm not seeing any changes in my body composition. Sleep is in the trash. And it's so, yeah, it's like, yeah, you and I have, I've had so many women that I've counseled where I've developed enough rapport with them for them to trust me just a little bit, to eat just a little bit more. And they're like, I can't believe it. Like, I'm. I'm like, it's so amazing, the gym, you know, all these PRs, all these PBS. And then they also lose more weight. They're like, I don't understand. I'm eating, eating more, and I'm losing weight. How is this. It's backwards land.
- [61:07]
Dr. Stacy Sims
I know. Because we've been so indoctrinated to calories in, calories out, eat less to become smaller. And that's absolutely not true.
- [61:16]
Dr. Stephanie Estima
Yeah, yeah. So how do we figure out what calorie. How many calories we should be eating? Like, I have like a general, you know, depending on the person's activity, their age, their history of fitness. Of course, all these things matter. Is there like a, you know, 15 times body weight that should be your calorie? Like, is there. Is there sort of a general recommendation that you can give if you suspect that a woman is. Would you sort of reverse. Would you sort of slowly increase their calories back up to a level that you'd be happy with? Like, how would you handle someone who is. Many of the women who are listening who are like, yeah, I've been having 1300 calories for, like, the last 25 years.
- [61:51]
Dr. Stacy Sims
Yeah, I know. And they're very afraid when they start increasing calorie intake because the weight on the scale changes. But we'll see this as an increase in glycogen, increase in fluid retention. So we do have to be very careful when we start adding it in. Right. Because we don't want them to say, this isn't working for me, and freak out and never try it again. So it's a slow phase in, like, you slowly increase. And the best way to increase calories with minimal effect on the scale, unfortunately, people are still tied to the scale, is fueling in and around training, because that's when your body will. Will actually absorb it, use it, and stimulate the brain and the hypothalamus that, yep, okay, there's some nutrition coming in. We can keep doing what we're doing. We don't have to downturn our endocrine system. If someone has been habitually eating 13 to 1500 calories and we see that they really need 28 to 3000 calories, we're looking at a slow implementation of increasing over a course of six weeks. Cause if you go all of a sudden you have to double the amount you're eating. It doesn't happen. So we look at slowly increasing, looking at first increasing protein and carbohydrate, then increasing some fat, because we also see that low carbohydrate intake presents as low energy availability too. So we have to make sure that we're getting enough carbs and we try by the end of that six weeks to have them eating around 40 calories per kilogram of body mass. Mass. So that's kind of, kind of a benchmark. So people ask, well, where do you get that equation from? And when we look in the literature, it was based on sedentary women to keep endocrine function going. Where it was 30 grams per kilogram of fat free mass was a, like a definitive point where below that we see significant endocrine dysfunction. We ideally want people up to 45 and people really are like, like, if you hit 40, then you're really good. 45 is ideal.
- [63:50]
Dr. Stephanie Estima
And is there, do we have different targets based on the goal of the individual? Like for me, my goal, even in my, you know, relatively hormonally deficient state, I'm 47. So obviously progesterone estrogen is not what it used to be. Testosterone, same thing. If my goal is hypertrophy, if I'm, I'm like, I want to maintain. So I want to maintain or improve my strength, but I also want to grow more muscle. Is that target now higher? How does that target change?
- [64:16]
Dr. Stacy Sims
Then we look at, we, it's the same, but then we look at the timing of the food, right? So we really have to maximize your protein intake in and around your training. Because when we lose those hormones, we also are becoming more anabolic resistance or anabolically resistant to exercise and nutrition. So we need to apply the nutrition strategies to the training to kind of double end it to instigate that hypertrophy.
- [64:44]
Dr. Stephanie Estima
Amazing. Awesome. Well, I'm so glad that we did this because I think that this is the second ha. This is the second part of the conversation that I think ties into our original one, which is, okay, how are we going to train maybe across the menstrual cycle into perimenopause and menopause? How are we going to eat across some of these different hormonal profiles? And then maybe, maybe more importantly for women in midlife, who is, who are, who is this audience? How do we recover and how do we actually prioritize recovery and lean into that rather than trying to, you know, white knuckle it and push through? Yeah, because it just, you know, it ends up in injury, misery, psycho, you know, and there's this whole myriad of, of things that can happen. So I'm so grateful for you and the time that that we got to spend again together. Thank you. Thank you.
- [65:30]
Dr. Stacy Sims
Yeah, thank you. And this has been great.
- [65:35]
Dr. Stephanie Estima
Welcome to the after party where I tell you what I really thought of this episode. I am just like, let me just first, I'm so thrilled that we got to do a part two because when Stacy first came on the show, we were doing nutrition and exercise and I was looking at the notes I had prepared. I was like, hot damn, we're already at. We're already at time. And I had, I haven't even gotten to recovery and hydration. So I'm so happy that we got to do this part two for you. Couple of favorite parts for me. I love, I mean, one of the things I love the most about this podcast is when I get to learn from my guests and I always learn from Stacy. So I have a new habit that I am going to be implementing, which is cold tart cherry juice. I have never heard of this before, but this was in the context, if you recall from our conversation around melatonin, how women actually have a phasic shift. We actually get sleepy earlier, so we like to go to bed earlier and we like to rise earlier than our male counterparts, which is important if you are happen to be sharing a bed with a male in terms of when you should be going to bed versus him and then when you should be waking up versus him. But she was saying that cold, the cold part decreases your core body temperature. And then the tart cherry also helps with melatonin production, which is fabulous. I love that. That is something that I'm going to be be implementing this week. Other things that I other highlights for me, obviously I want, I loved the reframe even it's just a slight reframe, but it makes such a difference psychologically to not call it a cold water plunge. Maybe we're just gonna, for women, we're gonna call it a cool water plunge. We're not gonna do it after working out. If you are maybe in a tournament, you're hydrox or something or you're a soccer player or you know, what have you. And it's you have multiple, multiple sessions in a very short delta. Sure, cool water plunges for the win, but generally you don't necessarily do a cool water plunge after recovery because you don't want to blunt the adaptations that are happening in the muscle. Loved that conversation. I also loved the when we were talking about salt, it did turn into a mini chemistry lesson, but I loved the conversation around estrogen and sodium retention and how women also might have a Muted thirst response. So if you recall from our first conversation with Stacy, we were talking about women and prolonged or having a muted hunger response. So you might, they might be fasted, they might go working out fasted. And the hypothalamus just is not. We just have muted appetite so we don't feel hungry. The same also might be true for thirst. So this is why it becomes, becomes important to make sure that you are hydrated and that is not necessarily a function of how much water you're drinking, but how well your body is able to hold onto the water. And then the last thing that I thought was a really great tip, which is the doing the sauna after a training session to augment everything that you've already done in your training session, whether that's resistance training or it's endurance, the adaptations that you're having are going to continue in the sauna and and pro tip that she gave, which was don't necessarily hydrate in the sauna or immediately after. Like slowly bring that blood volume back up, cause your body, force your body to, to produce to increase its own blood volume. So I loved that tip. That's something that I will actually be a bit more conscious of as well. Overall, I always enjoy my time with Stacy. We are so aligned. There's so many, so much serendipity and so much alignment in terms of our flavor philosophies for women. So it's a pleasure to speak to her and to be able to bring these conversations to you. So if you enjoyed this as much as I did, I would love to hear comments. If you feel like we are deserving of a five star rating on itunes or on Spotify, we would love that we read all the comments, all the platforms and until next time, I hope that you are well. 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 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.