The GLP-1 Warning No One Is Giving You: Dr. Stacy Sims on Muscle Loss, Birth Control, Perimenopause & the Female Physiology Research That Was Never Done

Summary

Podcast Summary: Mayim Bialik’s Breakdown

Episode: The GLP-1 Warning No One Is Giving You: Dr. Stacy Sims on Muscle Loss, Birth Control, Perimenopause & the Female Physiology Research That Was Never Done
Date: May 19, 2026
Host: Mayim Bialik (with co-host Jonathan Cohen)
Guest: Dr. Stacy Sims, Exercise Physiologist and Nutrition Scientist, Author of ROAR

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Episode Theme & Purpose

This impactful episode dives deep into overlooked truths and emerging science about female physiology, particularly reviewing the risks and misunderstandings around GLP-1 weight-loss drugs (like Ozempic), birth control in adolescents, perimenopause, and the historical gender data gap in health science. Dr. Stacy Sims brings cutting-edge research and practical advice, challenging both mainstream trends and the persistent tendency to base women’s health advice on male-centric data.

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Key Discussion Points & Insights

1. The Missing Research on Female Physiology

• Historical Data Gaps:

  • Most clinical research historically focused on men, or added women as afterthoughts, generalizing male results to female populations ([06:33], Sims).
  • Biological differences (like hormonal cycling) made it “inconvenient” to study women, further perpetuating male-dominated data ([07:42], Sims).

• Consequences:

  • Conditions like endometriosis and PCOS remain poorly understood ([07:42], Sims).
  • Drugs and guidelines (e.g., for aspirin use, osteoporosis treatment) are based on studies in men ([07:42], Sims).

• Quote:

  • “Instead of actually using women, they use men and try to create an environment that was similar to a woman’s body. It’s like, that’s ridiculous.” – Dr. Stacy Sims ([08:56])

2. Sex Differences Begin Before Birth

• XX vs. XY Resilience:
  • XX (female) fetuses exhibit more resilience under stress; X chromosomes can “rescue” defects ([09:58], Sims & Bialik).
  • The cultural narrative of male dominance flips on its head biologically ([10:54], Sims).

3. Birth Control, Brain Development, and Anxiety

• Oral Contraceptives in Teens:

  • Early OC use during brain development (ages 14-16) can cause irreversible changes to the amygdala, increasing risk of anxiety and fear; adult brains are less affected ([18:47], Sims).
  • “There is not as robust development of the amygdala in either group... the 14 to 16-year-olds tapered off, there were no changes.” – Dr. Stacy Sims ([18:47])
  • The “default” prescription for period irregularity (which is often normal) may have lasting consequences ([20:45], Sims & Bialik).

• Social Implications:

  • Women routinely face health choices men are never asked to consider.
  • Cultural and systemic reasons for these shortcuts are deeper than “just” misogyny ([07:42], Sims & Bialik).

4. Body Image, Diet Culture & The Rise (and Danger) of GLP-1 Drugs

• GLP-1 Weight-Loss Drugs (Ozempic, Wegovy, etc):

  • Up to 40% of weight loss can be from muscle, not fat ([32:30], Sims & Bialik).
  • Loss of muscle mass accelerates sarcopenia and increases risk of metabolic rebound—often leading to worse health upon cessation ([30:17], Sims).
  • Cardio-metabolic risk factors worsen after stopping the drug without lifestyle intervention ([30:17], Sims).
  • “For every ten pounds that you lose on a GLP-1, up to four pounds can come from muscle.” – Mayim Bialik ([32:30])

• Muscle as Longevity Strategy:

  • “If we are muscle centric and think about what we have to gain... we have the capacity to gain a higher quality of life... at any age.” – Dr. Stacy Sims ([37:10])

5. Strength Training & Female Health

• Why Heavy Lifting, Not Just “Toning” or Cardio:

  • Mitigates muscle aging and loss of estrogen, supporting cognitive function and health span ([40:35], Sims).
  • Heavy lifting trains the neuromuscular system and helps prevent dementia and osteoporosis ([41:00], Sims).
  • “You have to work really, really, really hard to get bulky... If you just want to tone up, do some heavy lifting—you will, and you’ll get all these benefits.” – Dr. Stacy Sims ([41:00])

• Young Women at Risk:

  • Modern teens/20s/30s are not reaching peak bone or muscle mass due to sedentary habits, compounded by misguided weight-loss approaches ([37:10], Sims).

6. Fasting, Diets & Micronutrient Deficiency

• Fasting:

  • Women’s circadian rhythms are more sensitive; skipping breakfast or long morning fasts can disrupt metabolism, increase cravings, and phase-shift circadian rhythm detrimentally ([45:27], Sims).
  • “If you have to have a small calorie restriction, it's better to front-load your calories and not hold your fast till 11 or 12.” ([48:16], Sims).

• Micronutrient Deficiency:

  • 2 billion globally are deficient, primarily from eating ultra-processed foods and insufficient variety.
  • Symptoms: fatigue, lowered immunity, cognitive issues, risk of other diseases ([61:20], Sims & Bialik).
  • Aim for “30 different plants a week” ([57:05], Sims).
  • Supplements are less effective than whole foods; test first before adding supplements ([59:09], Sims).

7. Hydration Myths

• Water Isn’t Just Water:

  • “All the water in the body is not just plain water—it’s a solution of primarily sodium and glucose.” – Dr. Stacy Sims ([76:10])
  • Drinking plain water in large quantities leads to “peeing it out, not actually hydrating.”
  • Add a pinch of salt to water for better absorption, especially outside of meals ([77:21], Sims).

• Structured Water, Fruits & Veg:

  • Water from food counts toward hydration but shouldn’t replace fluids entirely ([79:38], Sims).

8. Peptides and Supplements

• Peptides:

  • Unregulated, often contaminated, and minimally researched—risk outweighs benefit at this time ([51:19], Sims).
  • “Let other people biohack and see what happens… I’m going to keep pushing people to look at other alternatives like heat exposure or cold exposure.” ([54:02], Sims).

• Creatine:

  • Choose high-quality, plant/water-based forms (Creapure/Crea Vitalis).
  • Particularly beneficial for women ages 18–60: improves muscle, bone, cognition, stress resilience; helps address shift work, circadian rhythm disruptions, and possibly ADHD ([68:58–74:12], Sims).

9. Menopause/Perimenopause Action Steps

• Top 5 Strategies:
  1. Prioritize sleep – foundation for all other changes ([81:54], Sims).
  2. Increase fiber – preserve gut microbiome, counteract hormone shifts.
  3. Movement – focus on strength training over cardio.
  4. Community – social support is crucial for mental health.
  5. Tailored pharmaceutical support (HRT/MHT) – only as needed for severe symptoms; not a “must” for all ([81:54], Sims).

10. Sauna, Heat, & Cold Plunge—What’s Actually Evidence-Based?

• Sex Differences in Thermoregulation:

  • Women do NOT get equivalent benefits from ice/cold plunges; optimal for women: 55°F (14–15°C), not lower ([92:02], Sims).
  • Women respond robustly to heat/sauna and benefit with improved cardiovascular health, neurotransmitter balance, and reduced hot flashes ([93:32], Sims).

• Practical Protocol:

  • Heat: 10 minutes, 3x/week at 80°C ([95:57], Sims).
  • Cold: 14–16°C, not “ice bath” extremes for women ([92:02], Sims).
  • Perimenopausal hot flash management via controlled heat exposure ([96:32], Sims).

11. Technology & AI Bias

• Wearables & Data Lakes:

  • Most health tech is normed on male data—producing false “alerts” for women (e.g., ovulation being flagged as illness) ([99:40], Sims).

• Urgent Need for Representation:

  • AI and medical advances risk perpetuating the gender data gap without conscious correction ([99:40–100:13], Sims).

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Notable Quotes & Memorable Moments

• On Health Trends:
  • “We are now in a time in history where there are so many people that are overfed and undernourished.” ([61:20], Sims)
• The Cake Analogy (on shortcuts):
  • “If you’re not taking care of your foundation, why try to use something to create enhancements? If the cake is bad, the buttercream can’t save it.” ([50:14], Sims)
• GLP-1 Dangers:
  • “For every 10 pounds that you lose on a GLP-1, up to 4 pounds can come from muscle.” ([32:30], Bialik)
• On Contraceptives & the Amygdala:
  • “We see that there was not as robust development of the amygdala in either group. When the 14 to 16-year-olds tapered off, there were no changes.” ([18:47], Sims)
• On Hydration:
  • “Just add a little bit of salt... and you end up drinking less and being more hydrated.” ([77:36], Sims)
• On Fiber:
  • “Fiber is the food for our bacteria in our gut... focus on 30 different plants a week.” ([84:11], Sims)
• On Female Physiology Research:
  • “I want to close that gender gap... AI is perpetuating the problem.” ([99:40], Sims)

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Timestamps for Major Segments

• The Data Gap & History: 06:33–11:58
• Birth Control Effects on Brain: 18:39–25:57
• Body Image, Diet Culture, GLP-1 & Muscle Loss: 27:51–37:10
• Muscle/Longevity, Strength vs. Thinness: 37:10–44:14
• Fasting & Circadian Health: 45:27–49:39
• Peptides & Supplement Quality: 50:14–54:51
• Micronutrient Deficiency: 55:28–61:20
• Hydration Myths & How to Drink: 76:09–78:16
• Menopause/Perimenopause Top 5 Tips: 81:54–84:11
• Protocols for Sauna, Heat, Cold Plunge: 92:02–97:38
• Wearables, AI, & Women’s Data Bias: 99:40–100:13

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Practical Takeaways

• Women’s health research remains years behind—advocate for inclusion and question generalized advice.
• Prioritize muscle mass and strength for health, longevity, and cognitive well-being at every age.
• Exercise skepticism about “miracle” supplements and weight loss drugs—protect foundational health first.
• Be conscious of hydration habits (add a pinch of salt to water; don’t overdrink plain water).
• Address micronutrient needs through food variety—aim for 30 plant sources per week.
• Women should approach fasting, training, hormone therapy, and even wellness tech differently than men—trust your physiology, not the default settings.

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This summary captures the rich, myth-busting, and nuanced tone of the conversation while delivering actionable insights and timestamped, attributed highlights for listeners and non-listeners alike.

Transcript

[Jonathan Cohen]

Mind Breakdown is supported by Helix Sleep.

[Mayim Bialik]

Spring is in the air and so are all of the allergens that come with it. Spring allergens means you need more sleep, but there are a ton of factors that can prevent us from getting a good night's rest. Night sweats, back pain, Feeling the person next to you when they roll over a million times. We were so excited to hear that Helix wanted to partner with us. I've had my Helix mattress for about five years now and I have been sleeping so much better and Jonathan and also our kids love their Helix mattresses and all of those issues. Night sweats, back pain, motion transfer. Those things are significantly better with a Helix mattress. Helix delivers your mattress right to your door which is so much fun. With free shipping in the US they have a 120 night sleep trial and limited lifetime warranty plus their happy with Helix guarantee. Rest easy with seamless returns and exchanges. The Happy with Helix guarantee offers a risk free customer first experience designed to ensure that you're completely satisfied with your new Mattress. Go to helixsleep do for 27% off site wide. That's helixsleep.com breakdown for 27% off sitewide helixsleep.com breakdown with Verbocare help is always ready before, during and after your stay. We've planned for the plot twists so support is always available because a great

[Jonathan Cohen]

trip starts with peace of mind.

[Dr. Stacy Sims]

We are now in a time in history where there are so many people that are overfed and undernourished.

[Mayim Bialik]

Billion people worldwide have micronutrient deficiency.

[Dr. Stacy Sims]

Eat a wide Variety of foods 30 different plants a week.

[Mayim Bialik]

30 different plants a week.

[Dr. Stacy Sims]

There is an endemic happening osteoporosis risks GLP1 the loss of bone density, the loss of muscle mass.

[Mayim Bialik]

For every ten pounds that you lose on a GLP1, up to four pounds can come from muscle.

[Dr. Stacy Sims]

When people are talking about weight loss, what do we have to gain with putting muscle on? We have more control over what we're eating. Better sleep, better immunity, better blood glucose control, better cognitive function. We have the capacity to gain a higher quality of life whatever age you are.

[Mayim Bialik]

Dr. Stacey Sims is an exercise physiologist and pioneering nutrition scientist.

[Dr. Stacy Sims]

My frustration of being an athlete and a researcher in academia, noticing that there was no real representation of women, I want to close that gender gap.

[Mayim Bialik]

What happens to the amygdala when you give oral contraceptives at a young age?

[Dr. Stacy Sims]

We see changes that are not reversible. That increases the capacity for anxiety, fear.

[Mayim Bialik]

Tell us five things that every woman should be doing for her health. Hi, I'm Mayim Bialik.

[Jonathan Cohen]

And I'm Jonathan Cohen.

[Mayim Bialik]

And welcome to our Breakdown. Today we're going to be tackling some of the biggest myths and trends in the health and nutrition industry, specifically as they relate to female physiology.

[Jonathan Cohen]

And if you're thinking I'm not a woman, maybe I'll turn this episode off. Stay tuned, because we cover things that totally blew my mind. From the huge dangers of GLP1s to the real truth about creatine, the biggest mistake people are making, and you're likely drinking water. Totally wrong.

[Mayim Bialik]

This episode also covers things that many of us take for granted, like our understanding of why people go on birth control, why people lift heavy weights, how to protect your brain, how to live a longer and more vibrant life. These are things that impact men and women differently. But understanding the differences in physiology can make a huge difference. And we're speaking to Dr. Stacy Sims, the author of Roar, a really, really fantastic book. Match your food and fitness to your unique female physiology for optimum performance, great health, and a strong body for life. But as we said, we're not just going to be talking about how these things impact women. We're going to be talking about the differences in male and female physiology and how so many of the trends that you might be following you're actually approaching in the wrong way. We're also going to talk about a deficiency that impacts 2 billion people worldwide. And when you hear the list of symptoms you might be surprised to find may be at risk for this deficiency. This episode is also in honor of Women's Health Month. We could not think of a better guest to have for this very special episode than Dr. Stacy Sims. So without further ado, let's welcome to the Breakdown, Dr. Stacy Sims. Break it down.

[Dr. Stacy Sims]

Thanks for having me. I'm excited.

[Mayim Bialik]

We're very excited to talk about roar and I'm really like your target audience for this book and this message. And I noticed that on page 50 there is a crushing it as a 50 year old vegan. And I thought, Stacy, you didn't need to put me in your book. That is so embarrassing.

[Dr. Stacy Sims]

Well, maybe, yeah, you know, there you go. There's lots of us who are 50 year old vegans, so why not?

[Mayim Bialik]

I wonder if you can talk about sort of the why of this book. What is special and unique about what you are helping everyone but women in particular understand about their bodies?

[Dr. Stacy Sims]

Yeah, I mean, it stems from my frustration of being an athlete and a researcher where as a researcher in academia and first learning it and Then trying to actually do it, noticing that there was no real representation of women. And if women were included, they were included in studies that were with men just to bulk up. How many people are in the study? Or they're very small and they're only in like one phase of the menstrual cycle. So there really wasn't that much there. They just generalized stuff. And through my racing career, people would always ask me questions and I was like, okay, well, I'm going to go to lab and answer this. And the book stemmed from my co author who saw me at USA Cycling, and she's like, no one is talking about this. And to me, I was like, why are we not talking about this? I've been researching this for at least 15 years because we need to do a book. So we had collabed on. She was a journalist, we collabed on a whole bunch of stuff. And every time we talked about the menstrual cycle, women needing different recovery, how we respond in the heat, differently hydration, everyone was like, oh my gosh, this is so interesting. So that was the birth of the book.

[Mayim Bialik]

One of the things that I think it's important to talk about, you know, and this is really true for every aspect of research, you know, whether it's biology, whether it's neuroscience, whether it's medication, whether it's any aging. The reasons that studies tend to be historically all male is not just because of systemic misogyny and all of the reasons you can give, but one of the complexities of the human body for women and the physiology of women is that we have a very special monthly cycle that is really not ideal for a study where you're trying to reliably track basic physiological metrics. And so the solution has been to only do studies on men and treat women like kind of an extrapolation of what we find in men. Can you speak not only to your field, but to the general reason that we shouldn't just dismiss it as, oh, the patriarchy is just trying to, you know, screw women with research. It's a lot more complicated than that.

[Dr. Stacy Sims]

Absolutely. I mean, I always say start with it's a historical perspective. Right. We know the patriarchy and who was in the room was men. That's how scientific design started. And I don't think people really grasp onto that and how endemic it is. But we know that it's not just the menstrual cycle and sex hormones. It's also specific sex differences. We know, like when you're looking at stress and environmental stress For a woman who is pregnant, there's a higher incidence of spontaneous miscarriage when they're carrying an XY rather than an xx. So, so we look at, you know, and people don't know that. I was talking to a well known OB and she's like, we never learned that. How do you know that? It's like, because when you look at sex differences from birth, you start to see all these things that happen in utero and then go through, but no one really says anything until like puberty and they're like, oh, the girls are going through this crazy stuff. And look, my boy is getting so strong and lean and yeah, he, he doesn't talk, but you know, that's kind of the aggression. And then we get to like our reproductive years and it's always that taboo that time of the month or oh, I need to go on an oral contraceptive pill because my periods are really heavy. And so it's just kind of been this dismissive and I always sit back and go, how does this really affect women? It's like it's 2026. We still don't know why endometriosis happens. We don't know why PCOS happens. We look historically at research on like aspirin and heart attack. That whole cohort was men generalized to women. We see the original osteoporosis research was done on men that were like supplied estrogen to see how it would instigate bone growth. So we see all this stuff that instead of actually using women, they use men and try to create an environment that was similar to a woman's body. It's like, that's ridiculous. Like, come on.

[Mayim Bialik]

If only we could make men act more like us and understand us by giving them a little estrogen. But it's actually not that simple.

[Dr. Stacy Sims]

It's not that simple at all. Target tissue and a whole bunch of other things.

[Mayim Bialik]

I feel like we need a little more attention to what you just mentioned in terms of sex differences and in terms of spontaneous miscarriage. Can you explain a little bit what that is and what it means? Even though it's a little bit off topic, but I don't want to pass that by.

[Dr. Stacy Sims]

Yeah, so when we're looking at they call it the fragile XY because the XX is actually the more dominant kind of genome. And the reason why we have differences is there are certain, when you have a double X, there are certain things that are turned on and turned off according to the two X's, but with XY you don't have that capability. So we see that the fetus who's an XY actually is more fragile. So when you start looking at what's happening under high stress conditions, the XX becomes more stress resilient. There's actually some epigenetic changes that are occurring within the growth and development that is making the female fetus more stress resilient. And that leans into being more stress resilient from immunity to mental capacity onward through, through life. So when we start talking about the dominance of the male culture, I'm like, but you're the weaker sex, so to speak.

[Mayim Bialik]

Well, and I think yeah. And sort of in, in genetic terms, the notion is that if you have two X chromosomes, which women do you have an X chromosome that can rescue anything that comes up. That one chromosome kind of throws out there. If you're missing a little bit, if there's some micro deletion, the other X chromosome is like, we got this, like, we're okay. And you don't have these maternal autosomal recessive. We don't have those issues. Whereas with an xy, if something goes a little bit different on the X chromosome, there's nothing to rescue it because the male chromosome is very different. And it's funny, I don't know if you remember, you know, back to biology class, right, The Y chromosome is actually very, very teeny tiny, you know, compared to the X. And obviously it does all the things it needs to do to create a male. But when people talk about this sort of default fault being female, it's because it's the Y chromosome that actually signals, hey, we got a boy here and, and puts into motion, you know, the, the changing of the ovaries into the, the testes and all these sorts of things.

[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

Make 2026 the year you finally start sleeping again.

[Mayim Bialik]

You talk a little bit about sort of the differences then, you know, as we sort of view women and as we view men, it's not a competition. But there's so much that's different that really deserves its own kind of arena.

[Dr. Stacy Sims]

Yeah, I try to get people to understand that it's not him versus her. It's like you said, we're uniquely different. Women have smaller hearts, we have smaller lungs. It's not because we're weaker, it's just that's the sizing. We look at muscle morphology. Women are born with more of our endurance type fibers. So what does that mean? That means that we have a greater capacity for using fat at rest and during exercise. We also have more robust mitochondria and the proteins within mitochondria to help with fat fatty acid oxidation as well as improve oxidative responses and antioxidative responses. We also see that women's bones, we see that there's a difference. Like there's a difference in the schematic of our biomechanics. Very similar. Until puberty and then the epigenetic exposure of estrogen actually causes a shift where we start to have our hips widen and our shoulder girdle widen to accommodate for those wider hips. Why? Because it's reproduction. Right. So how does that affect things like gait? How does that affect the way that we carry ourselves? Our center of gravity is different. We have more predisposition to ACL issues and soft tissue issues because we're more quad dominant. We don't use our posterior chain very much. And then when we start to look at developmental, like from a brain standpoint, we see that there is a difference in the way that the brain regions develop. And I'm sure you're very well versed in that with your background. Right. See this difference? And one of the things that I really try to get moms of young girls to understand is if they're having irregularity in their menstrual cycle. And the answer is an oral contraceptive pill. Hold on. Because you're putting that in a system that is developing. And we see inherent changes in the amygdala that are not reversible. They're reversible when you're older, but not during those developmental years. And then that increases the capacity for anxiety and fear. That's never an issue with boys because they're never given that oc.

[Mayim Bialik]

I would love to double click here. What happens to the amygdala when you give oral contraceptives at a young age?

[Dr. Stacy Sims]

There were a couple of studies that came out maybe a year and a half, two years ago that were really looking at functional MRI and trying to understand what was going on, because I think Lisa Moscone was coming out with all this evidence, right. About estrogen and estrogen receptors. So then they're starting to look at. Okay, well, if we're looking at the younger set. So they had two groups. We had 14 to 16 year olds and we had 20 to 22 year olds. They were put on OCS and followed for two years. And they saw that there was not as a robust development of the amygdala in either group. And when the 14 to 16 year olds tapered off, there were no changes. When the 20 plus group tapered off, it changed back to the way it was before, which meant that it was adequately developed and we had more volume of the amygdala.

[Mayim Bialik]

I mean, that's. That's kind of. It's kind of mind blowing. And I think it's a good place to sort of, you know, start and then continue this conversation because there's so many things that we take for granted or that we assume we have to listen to because a doctor says so. And for so many young women, I was one of them when I started having hormonal swings and complexity. That's what they jump to. Even if you're not sexually active yet, you know, this'll regulate you, this'll calm it down. Or if you have irregular periods, which is actually not abnormal as you're just starting the kind of solution. And I really don't necessarily fault, you know, kind of the medical system that I was raised in. It was built for efficiency and seeing the most people it could in an hour for the least amount of money. You know, the way to get people to not kind of keep coming back with problems is let's try and just kind of neutralize everything. Let's just, you know, put you on a hormone system that at least you'll be regular and that should do it. But can you talk a bit about sort of what that framework does for the way that we're treating not just women's health, but health in general?

[Dr. Stacy Sims]

Yeah, I mean, I find it really interesting because I don't live in the US I now live in New Zealand. And there's a more of a socialized health care. And when you look at the difference of when you have a for profit system like the US Everything is kind of compartmentalized unless you have the money to pay for innovation. So we're looking at the lack of robust education. I again am not faulting doctors or the medical school. It's just the way that it's been defaulted. So when someone comes in and they have, you know, irregular periods, there's not a lot of education in women's health unless you're having a baby. We don't see much in menopause, we don't see much in reproductive issues unless they specialize. And it's a very small amount of women or women or men, male doctors that actually specialize in it. So a young girl comes in, her mom is not aware that irregularity is normal. She sees her daughter suffering with really bad cramps and heavy bleeding, which is also not abnormal at the start. So what's the solution? Well, okay, well, let's give you this OC because that's what we've always done. And not knowing as a mom, well, I know and most people don't know, is that it down regulates your natural ovarian function. It kind of makes it stop. So if we're thinking about giving someone an exogenous hormone to stop an endocrine function that still hasn't developed. What's the forefront? Right, we have longitudinal research that says, yeah, it's fine, when you get off it, things go back to normal. But then there's a subset of people who are like going and using the depot. No one knows that you shouldn't be on the depot for a year, no longer, because it affects bone density. I've had a couple of people who've been on the depot for 25 years and they come off it and they have no bone density, like very low bone density, osteopenic, they don't have their ovarian function, come back and they're in their early 30s and they're like, what is going on? So there's so much of a misinformation. And the ramifications of the type of contraception that you use can be massive. We know just in a typical oral contraceptive pill, there are different doses of estradiol and there's different generations of the progestins. Each one of those can have a different effect. And then for looking at like the iud, is it a copper or is it a low dose progestin? Not as much of an issue as systemic, but it's still going to affect. And the younger we are and don't let the whole body develop the way it should, what are we doing? Like, how, how is that interference actually playing in the development of an endocrine system in the brain and bone density?

[Mayim Bialik]

And I think also, you know, we'd be doing a disservice to women and to all of the, you know, incredible advances that the women's movement has, you know, brought us to a moment of, in terms of, you know, I also understand that for women who don't want to get pregnant, many are willing to also take on a certain amount of risk in terms of other things. And when you're young and, you know, you feel like these things are so far off, right? It's like, oh, I'll be fine, I'll go on it, I'll get off it. And for a lot of people, that is the story. So I think it's important, you know, and obviously for the work that you do, it's important not to sort of have one solution for everyone. But, you know, no one's trying to be a feminist downer in saying, wait a second. The way we've been approaching things actually may not be ultimately the most supportive, you know, and the fact is, you know, men have this 24 hour cycle, right? And sure, they have fluctuations over the months and, you know, it's very important. I'm not dismissing it. But if we were to say to men, every single day, we're going to disrupt your natural, like, hormonal circadian rhythm every day. We're going to do it every day because that's when we have to do it. I have a feeling, Right. That it would have been approached a little bit differently. So I think it's important to kind of cater that as well. Do you want to comment?

[Jonathan Cohen]

I'm just saying, if the side effects were, your testosterone is going to be totally messed up, your bones may not develop properly and you're going to have a high level of anxiety, it wouldn't happen, right? It's not going to happen. No.

[Dr. Stacy Sims]

Yeah. But I love the way that it started. Like, hormonal contraception was developed at Stanford. There's actually two women that one was the money behind it, the other was a scientist. But they actually couldn't go into the lab to develop it. They had to have male science scientist colleagues develop it. And they were all in the, we want to give women control. And it was part of the feminist movement. And I love that. So now it's like, there's so many options. Everyone needs to be educated about it, of how it's going to affect them now and longer term down the pipe. Because now we're looking at research that's just coming down the line that it's taken so long and people are like, why didn't I know this in advance? Like, we actually didn't have the research until now and now that we do, we need to be able to talk about it and spread it so you can make an individualized choice that's appropriate for you and your situation and what you need it. But if it's just for health reasons, there could be other things that we can consider rather than just blanket saying, go on. Exogenous hormone.

[Jonathan Cohen]

I do wonder how. What is the overall connection between that and the massive spike in anxiety that we're seeing across the culture?

[Dr. Stacy Sims]

Yeah. I mean, it could have a tagline, but we also know that the isolation and social media stuff has a massive effect. I mean, you know, if you're consistently seeing and getting a dopamine hit when you're a young age, it's like, how is that also affecting the brain? Been watching the whole no social media for 16 and younger. That's happening in Australia. Yeah, there's some loopholes, but now the kids are actually going out and doing puzzles and card games because, like, I said, wait, that's how we grew up. It's called the landline. Hey, want to meet up? Sure. So it's just taking them out of what was considered the norm and giving them the opportunity to find something else, which is reducing those anxiety levels.

[Mayim Bialik]

Well, and I, and I also, I mean, the, the spike in anxiety and depression in particular for girls and unfortunately this has spread to boys as well. So much of the focus, and this is kind of where I want to segue, you know, so much of the focus is about body image, right? It's, it's about what we look like. You know, there was a period where body positivity seemed to be a thing, but now it's not a. And we're kind of back to, you know, at least sort of in kind of public arenas of beauty standards, right. We're seeing a swing back to very, very, you know, thin. And, you know, we have these GLP drugs which are incredible and can be life saving, you know, for people who need them medically. But a lot of people are, you know, using them, I guess, somewhat cosmetically. I'm curious if you can talk about even when you started studying, you know, when you were working towards all of your degrees, you know, what was your kind of perspective as an athlete on what health looked like for women? And how has that changed?

[Dr. Stacy Sims]

Oh, it's changed. I mean, when I first started, it was still the calories in, calories out exercise for a really long period of time to lose weight. And when you start looking at metabolism and not putting it into the context of what it actually means, that was still very pervasive. So the general recreational person, when you go into like the university gym back then, everyone's on the StairMaster. Like no one's in the weight room.

[Mayim Bialik]

Not all of the women. Some of us were weightlifting, some of

[Dr. Stacy Sims]

us were weightlifting or, you know, you're looking at that. And then how it's changed over the years is people started doing more research in the strength training. I mean, I do have to credit CrossFit for bringing it into the mainstream of lifting weights is fine. So as you're starting to get more research into strength training, we're seeing this huge, massive shift in the whole fitness industry where they're getting rid of more and more of the cardio and bringing in the lifting platforms. But now that might change because of the GLP1 things that are happening. And that makes me angry because I've spent so much time with, you know, I have a daughter and she's just now 13 and we spent so much time with her and her friends to not have diet culture in and around our household and her soccer team. We've always been, let's be strong, let's be fast, let's be powerful, let's fuel for what we're doing. And they still say that, but then someone will come in with Instagram or TikTok and they have a different image now. It's like, what are we doing? What are we saying? It's like, no, that is not a picture of health. So I explain what's going on. And the loss of bone density, the loss of muscle mass, we don't know the long term effects of it. And I'm pretty sure the people who are at the Grammys with the camera on them cannot do corner kicks and sprint down the field like my daughter and her team. So I just keep bringing it back to in the moment. We need to be strong and powerful. And for the general woman, being strong and powerful, I mean, you sit up straight, you walk into a room, you have confidence even if you don't have confidence. And that comes from being able to be strong in what you are doing. So, yes, I've seen the evolution and I don't like the way it's going backwards.

[Jonathan Cohen]

Can we talk for a moment about the risk of lack of a loss of muscle with these GLP1s? What are people actually doing to themselves?

[Dr. Stacy Sims]

Yes. So I've been following this because we get asked this all the time in this, the fitness world. Like, what does this mean? So JAMA published a review and it was a systematic review of all the papers that were looking at the individuals that went on it and then went off it. So they were comparing that to the literature that was based on the Biggest Loser, the, you know, and they were like. So they found that it's very similar. You lose all this weight and then you have this massive rebound, but it's not muscle and it's not bone, it's fat. And all the metabolic control that you got with the GLP1 reversed and got worse. Cardio metabolic risk factors went up. So when you're looking at that for us in the fitness world, we're like, you have to put that lifestyle intervention in play in order for someone to make the decision to come off. They already have these good habits and they have really strong bones, they have strong muscle. Because if you're thinking about what is muscle, it's an active tissue, it's a glucose sink, it is a cardio metabolic health profile and it helps you age well. And not be decrepit. And we see that the sex difference in health span and lifespan is completely real. And we see a longer amount of time of women living in a poor state of health. And part of that also is Alzheimer's and dementia. So if we look at some of the ways that we can attenuate that dementia and Alzheimer's risk, it's through not having sarcopenia, it's by doing strength training, it's by doing a whole bunch of things that are going to create increased neuroplasticity and neural connectivity in the prefrontal cortex. And we see that happens with heavier strength training and building that muscle. So when I look at this population, all I can think about is Wall E, the movie Wall E, where everyone was floating and he fell off and he couldn't stand up because he didn't have the capability of standing up. And I'm like, oh, my gosh, what is going to happen to the healthcare system in 10 years with all these people who have been on it for either cosmetic reasons or other health reasons, but haven't been given the lifestyle intervention that they need in order to progress?

[Mayim Bialik]

Well, and I think one of the, you know, ways to kind of practically think about this is, you know, what it looks like from some of these large studies is that, you know, for every 10 pounds that you lose on a GLP1, up to 4 pounds of that can come from muscle, which means almost 50%, and that's a reduction in that lean muscle mass. So the reason that you're so skinny is that your muscles no longer exist. They're just falling off your body and they carry weight. And so now you weigh less and you're thinner and clothes fit differently. But I think, you know, what I've heard from just, you know, anecdotally from friends of mine who have been on it, when you go off it, it's as if nothing changed. Meaning the voices come back, the all of those patterns, behaviors, you know, all that stuff comes back. And this is not, not for us to say, don't go on a GLP1. But there's. There's definitely. This is not as simple as I think it's been made out to be, especially in all those commercials.

[Dr. Stacy Sims]

I mean, it is not simple. I mean, you can look at some of the lifestyle programs that are in the obesity clinics, and they're really careful to also include cognitive behavior therapy, other methods that people can actually practice and lean into when they are on the GLP1 because of the silencing of the voices. So again, it's giving the tools that you can have if you need to or want to come off the drug. But the pharma companies don't want us to say that because they want everyone to stay on it forever.

[Mayim Bialik]

We love to say the things that the pharma companies don't want us to say.

[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

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[Jonathan Cohen]

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[Mayim Bialik]

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[Jonathan Cohen]

Important to reiterate the importance of muscle mass for overall health as well as longevity because it can you I think we're saying you could be thinner. That doesn't mean you're being healthier in all regards, but you're thinner. Talk about the importance of muscle mass as you describe it for overall health as well as longevity.

[Dr. Stacy Sims]

Yeah, there is actually an endemic right now that's happening in our teenagers through 20 and 30s where they're not reaching peak bone mass. And part of that is also not having enough muscle. Because we know that when you have pull on the bone, you also have, you know, you develop your muscle, you're also developing the bone. And when we're looking at the rates of sarcopenia, that's happening in an earlier standpoint, which means that you don't have high quality muscle and the osteoporosis risks that are coming because of the sedentary lifestyle and all the things that are happening in Western world, then if you're adding GLP1 onto that, it's like, okay, wait a second, we really have to take stock because what does muscle do? It's not just holding your skeleton together. It is responsible for so many processes in the body. So if we want glucose control because we don't want diabetes muscle because it is a huge glucose sink, we want to be able to walk up the stairs without being completely out of breath. You need muscle, you need to train that muscle. We see that we want more brain development for innovation and having capacity to be stress resilient muscle is associated with that. So it's not just about looking lean and strong, it's about actually being strong. And when people are talking about weight loss, I really like to lean into Gabrielle Lyons idea of let's be muscle centric, let's not think about what we have to lose, but let's think about what we have to gain. So if we are muscle centric and thinking about what do we have to gain? If we are putting muscle on and bone on, we have the capacity to gain a higher quality of life. And that holds true for whatever age you are. And this whole rhetoric of we need to be thin or we need to lift light weights, and there's just this disconnect. It's like, no, we want to really focus on who the person is, what their needs are, and really build from the inside out. And so I'm always pushing people to think about. If you are focused on weight loss, what do you have to lose? You have a whole bunch of things to lose. You might lose some fat tissue, but we are losing our quality of life. We're losing our ability to make wise choices. Because now we're, like, concentrating on the fact that I can't eat, that I can't eat this. Sleep gets interrupted because we see a lot of people who wake up with hypoglycemic spikes, which comes up as little awakenings during sleep because they're actually not fueling well enough. And for a lot of women trying to do calorie restriction or fasting and having these large periods where they're not eating rebounds, they put more fat on and they get micronutrient depletion. So if we switch it and say, what do we have to gain with putting muscle on? It actually flips the switch. We have more control over what we're eating. We have better sleep, we have better immunity, we have better blood glucose control, we have better cognitive function. So this is the pushback that I'm having right now against everyone who's like, oh, thin is good. It's like, no. We lose so much more than just what we look like. We lose so much more when we're looking at health and stress, resilience capacity.

[Jonathan Cohen]

There's three points here that we need to expand on. The fourth first is speak to the person who's like, I just want to be toned, but I don't want to bulk. Why is it so important to lift heavy?

[Dr. Stacy Sims]

So for women, we see that as you get older, there's an aging discrepancy in the way our muscle functions. So if we think about the actual contractile proteins, so if we think there are two key contractile proteins, we have actin and we have myosin. Actin grabs onto myosin and they come together and they become very strong in a bond. And then when they get the signal from the nerve to let go, they let go. Myosin becomes dysfunctional, it changes its form. So the isoform of myosin becomes a little bit less apt to be able to grab on to actin. So if we're looking at why are we lifting heavy? We want to have a neuromuscular connection that is telling myosin not to become dysfunctional. The other capacity about it is estrogen is tightly tied to the way myosin functions as well. So as women get older, not only do you have this aging discrepancy, but you also have a change in our sex hormone, especially estrogen, it becomes even more dysfunctional. So if we're looking at lifting heavy, it's that neuromuscular connection to create that strong and powerful contraction, which we know is a significant predictor for really good health span. We also are getting neuromuscular connection which helps with prefrontal cortex cognitive decline attenuation. And you don't get bulky. Like that's a myth. You have to work really, really, really hard to get bulky. Being in the gym for days on end, for long periods of time, having appropriate periodized program, eating a lot. So if you're like, I just want to tone up, do some heavy lifting, because you will, and you'll get all of these benefits. And it's a very short, compact time frame, so it doesn't take a lot of time.

[Jonathan Cohen]

Amazing touch on this idea of disturbed sleep from not fueling enough. That's fascinating.

[Dr. Stacy Sims]

So it comes a little bit from what we were seeing in our female athletes who had low energy availability. They were having really poor disruptive sleep and not recovering well. So we put some CGMs on them and we saw all these variations in the blood glucose profile across sleep. And most of them dropped into hypoglycemic time periods that corresponded with awakenings on their wearable. So then we put them into a sleep lab to make sure that the awakenings were true and not just a wrist movement. And it was the same thing. So then we're like, okay, we know that you're not eating enough in the day, so we could look at where you're eating through the day to work with your circadian rhythm in your training. And then if we see that you're still having these awakenings, we're going to have a bolus of protein before bed because that's going to kind of mainstay slow digestive aspect, and it's going to help maintain your blood glucose. And then they were sleeping really well, sleep architecture changed and they woke up Feeling amazing.

[Mayim Bialik]

What would you give them? A bolus of what?

[Dr. Stacy Sims]

So it was really just a half a cup of non fat Greek yogurt because you have casein and whey and that is the two proteins. That one is a fast digestive way. It's fast digestive case. Insulin is slow. It's not a massive amount of food. So your body doesn't go into I'm going to digest instead of rest. So it was really 20 grams of protein from yogurt that helped significantly. Yeah. And so we translated into like recreational athletes and people who are having difficulty sleeping and are trying to follow like a fasting schedule or, you know, so we just kind of have to rejig it all to let's, let's fuel for what the circadian rhythm is doing. And then if you're still having awakenings and we'll look at having some yogurt before bed.

[Jonathan Cohen]

How long before bed? And what's the vegan alternative? Is there one?

[Dr. Stacy Sims]

There is a vegan alternative, actually. Pea protein isolate. And if you're like, huh, that doesn't sound so great. Right before bed we would take some unflavored pea protein isolate and put it into some coconut yogurt. So it was similar to yogurt and hit all the notes because pea protein isolate is very similar in amino acid profile as yogurt. And it worked the same. And we're looking an hour to 30 minutes before bed. And again, it's not a lot of food. It's only a half a cup. So it's not that much.

[Jonathan Cohen]

You've been prescribed. You've been prescribed.

[Mayim Bialik]

But I'll be like, what if I add some sunflower seeds and what if I, you know, make it a little party and that's.

[Jonathan Cohen]

What if I put some granola and chocolate peanut butter?

[Mayim Bialik]

Okay. No different message.

[Dr. Stacy Sims]

Wake up. But maybe, I don't know, a little drizzle of cacao nibs for a little bit of chocolate crunch because it doesn't have caffeine in it.

[Jonathan Cohen]

So yeah, this leads us to fasting and the difference in fasting, especially time restricted eating that. How do men and women respond differently to that? Should they be thinking differently about it?

[Dr. Stacy Sims]

Yeah, I get a lot of pushback on social media for this because I'm coming from it from a physiological and chronobiology standpoint standpoint. I'm not coming from the fitness world. So when we look at it, really paying attention to the sex differences in our circadian rhythm. So we know that men's is a little bit longer than women's and women's is tightly tied as men's. As to our hormone perturbations throughout the day, we know that women have a higher peak for their cortisol awakening response. And with that is a peak in what we call our acylated garland, which is our active form of our hunger hormone. And also peptide yy or pyy. If we don't eat within a half an hour or so of waking up, that cortisol stays elevated and keeps that acylated ghrelin elevated and peptide yy kind of just kind of hangs out and it doesn't do the thing that it's supposed to do. By stimulating the hypothalamus, say there's some nutrition, we don't have to be hungry. So when we're looking at holding it fast, we end up having more of a wall lean. In the afternoon, we don't have as much incidental movement throughout the day. And we see there's this big craving for simple carbohydrates in the afternoon and a significant drop in energy because what we've done is we effectively phase shifted as if we were doing night shift or we're jet lagged because it interferes with the normal hormone pulse throughout the day, which also includes our appetite hormones. So the brain is perceiving this as what's. There's a little bit of a dysfunction here. So it becomes a disconnect between what it means to be hungry and what it means to be nourished. When we look at men's, it's not as tightly tied to that because the baseline for dysfunction is different. When we see women who drop below 35 calories per kg fat free mass end up with dysfunction. For men, it's 15. So if we're thinking about that baseline set point, the idea of not having as much nutrient density is not as severe response to men's hypothalamus as it is to women's. So when we talk about time restricted eating versus fasting, if you're looking at how we work with chronobiology, if you wake up and have some food within a half an hour or so and then you're fueling throughout the day, then you have dinner, you don't have anything after dinner, unless you have to have your nighttime bolus of protein, then you can end up with a 12 to 14 hour overnight fast.

[Mayim Bialik]

We used to just call that sleeping.

[Dr. Stacy Sims]

Right. That's how we grew up.

[Mayim Bialik]

Oh, it's a 12 hour fast.

[Dr. Stacy Sims]

It's called I slept right exactly Exactly.

[Jonathan Cohen]

I ate dinner, I didn't snack all

[Mayim Bialik]

night and then I didn't stuff my feelings down with food and then I slept. And I didn't wake up in the middle of the night and eat a sandwich.

[Dr. Stacy Sims]

Exactly. But the world has become very strange because calories are available all the time. Then we have this whole like the clinical world is different from the fitness world, but yet so much clinical stuff gets pulled over without saying if it's actually generalizable or not. Because you see that fasting and holding and calorie restriction, holding food is very appropriate in the obese and some other populations. But it's not. When you're looking at the health and fitness world, when people are trying to maximize what they're doing from an exercise standpoint, maximize their sleep. So if you have to have a small calorie restriction, then it's better to front load your calories and not hold your fast till 11 or 12. That's when you start to see dysfunction in both men and women. There's population research that shows that both men and women having a late break of their fast end up with no improvement in metabolic control or cardio metabolic risk factors.

[Jonathan Cohen]

So if you do fast end earlier versus starting your eating later in the day.

[Dr. Stacy Sims]

Exactly.

[Jonathan Cohen]

And if I can just reflect back what it sounds like is at an overall body fat standpoint, men can drop to a lower body fat before there starts to be metabolic issues and hormone disruption where women need that additional body fat percentage. And if you start to reduce that too significantly, you're going to have issues.

[Dr. Stacy Sims]

Exactly.

[Jonathan Cohen]

You brought up peptides, which everyone is talking about right now. There's a ton of people who are absolutely pushing them as the world's greatest thing. Other people who talk about how they're unregulated and unproven and there isn't the data. Where should, how should we be thinking about this, especially for BPC157 that promises to have this faster recovery time. Other people who are, you know, supercharging, injecting with NAC or others, how can we start to understand the risks and benefits of peptides?

[Dr. Stacy Sims]

Okay, so I'm, I'm going to bring you back to an image of a really badly made cake coming out of the oven that's kind of lopsided and burnt. And then you try to put a beautiful buttercream on it, what happens? The buttercream melts and becomes a mess. So that's what peptides are. If you're not taking care of your foundation, then why are you going to try to use something that's supposedly supposed to create enhancements, but only that when we're looking at how people are approaching this, there is not a lot of robust research. And when you're looking at the formulations that are coming through, they are not regulated. I think the New York Times did a deep dive and showed the lead qualities that were in all of these things. And the way the companies get around it is they say, research purposes, full disclosure, I've used them after I had a significant hamstring tear and knee injury because I was desperate, but I didn't see any difference. And then I started doing investigation into like, what was actually in it. And I'm like, oh my God, I can't believe I injected myself with that stuff.

[Mayim Bialik]

What's in it?

[Dr. Stacy Sims]

Well, you see a high level of different metals because it's not regulated. So the way the process of breaking down and creating these peptides, in the process, you're getting a high amount of lead, we're getting some mercury and some of these other, like, noxious metals that shouldn't be in any of the peptide products because they are not purified and regulated.

[Mayim Bialik]

It's derived from like gastric juices.

[Dr. Stacy Sims]

I know.

[Mayim Bialik]

What does that actually mean?

[Dr. Stacy Sims]

I know. What is it? So if we think about peptides are parts of proteins and gastric juice is an acid and it also has a molecular structure of some proteins in it. So for some reason, someone decided that was a really good thing to extract. And the reason why it's in gastric juice is because if you have some kind of intestinal leakage or stomach leakage, you don't want that acid getting out and causing damage into the body. So if it does get out of its normal place, then it's protected. So they're extracted because they're like, hey, look, it's protective. But it hasn't been done in any kind of real human studies.

[Jonathan Cohen]

Obviously they are not regulated to the way that we need them to be. I assume that they're not all like that. Some are like, that depends on the manufacturer. It's imp. It's impossible to know.

[Dr. Stacy Sims]

Yes. So I look at it as like, they're banned in a lot of other countries and they're on the waddle list as a banned substance as well, because the efficacy isn't there and the risk to benefit ratio leans into the risk is greater than the benefit. I mean, we just don't have the research yet to support the marketing behind it. It doesn't mean it's not coming. It just Means that right now I'm going to let other people biohack and see what happens until we get they can be their own lab rat until we get more evidence. And I'm going to keep pushing people to look at other alternatives like do all the things. But then let's also look at using heat, heat exposure, like controlled hypothermia from cool water exposure and hyperthermia from controlled heat exposure. Because those two things create a cascade of responses that are beneficial. We see greater anti inflammatory responses, we see increase in heat shock protein production, which means that all your extra little cellular bits are going to be repurposed and picked up. So it's protective. We see a slight increase in ovarian function and controlled hyperthermia. We see better endocrine function in both cool water and in sauna exposure. So those are the things that I would push people to do first before trying to do any kind of injection.

[Mayim Bialik]

Peptides, like from, you know, like chemistry and biochemistry, are just short chains of amino acids. So are people using this general term peptide to mean a variety of different things? Because I keep hearing people say peptides, Pepsi, but that's just a generic term. What are we actually talking about?

[Dr. Stacy Sims]

The different molecular structures. So you have like TB500, which is a certain set of amino acid, and then you have BP157, which is another set.

[Mayim Bialik]

Okay. So they're literally short chains that are being isolated to perform the function that they may naturally perform in the body. But it's a way to sort of, you know, try and accentuate their impact by injecting them directly. That just doesn't sound like a real thing.

[Dr. Stacy Sims]

I know. Isn't it strange? It's like we know that this works if the stomach acid leaks out, but if you're going to inject that into the body, is it going to do the same thing?

[Mayim Bialik]

Yeah, I don't know. It feels like we needed a scientist to weigh in before people just started

[Dr. Stacy Sims]

doing this, but I know, I know.

[Jonathan Cohen]

I want to get to saunas and cold plunges. The benefits, the protocols. But first, you mentioned micronutrient deficiency earlier. Are people at risk of that? Should we be just eating more variety? What is the risk of micronutrient deficiency?

[Dr. Stacy Sims]

Yeah, so it is a pretty widespread when we're looking at the different ways that people are restricting food, but also the generalization of what food is available, especially in the US with ultra processed foods and all the things that go with. If you go to Safeway, you know, like it's a whole store full of stuff that I'm supposed to eat, but I can't eat any of it. Right. So if we look at micronutrient deficiency, most people think about iron, but we also see copper, selenium, trace elements that go with that that are very important for things like collagen and collagen development. And we are seeing a decrease in some of our fat soluble vitamins because people are eating a lot of fat, but it's from not a natural source. So they're not like an avocado. Yeah, you have fat soluble vitamins in there because there's fat in there and that they work together synergistically.

[Mayim Bialik]

But that's not the same thing as a cake.

[Dr. Stacy Sims]

Exactly, exactly. Right. So when people start thinking about micronutrient deficiencies, it's because they've heard it or they feel awful and so they want to go get all these panels of tests done. And it's definitely a real thing in coming up. And we see that a lot of the collagen and tendon dysfunction that's starting to occur, especially in women who are approaching 40, it is a lack of copper. And it's like, okay, how much copper do I need? Just eat a wide variety of foods, especially our leafy greens and things like that. Because if we are aiming in general for 30 different plants a week and having protein and fiber at every meal, you're going to cover those micronutrients.

[Mayim Bialik]

Did you say 30 different plants a week?

[Dr. Stacy Sims]

Yeah, it sounds hard, but it's not. Because you're thinking about our herbs, our spices, plus the typical nuts, seeds, sprouted grains, fruits, veg.

[Mayim Bialik]

But basically what you get these kind of micronutrient deficiencies is when people are eating a lot of foods not in their natural state, I think is a way to kind of think about it, meaning over processed or highly processed foods, which I know like the some large food organization that's, you know, funded by the government came out and was like, there's no such thing as ultra processed, everything's fine. But if you eat a food that has very little semblance to something that actually grows naturally, that's going to have. And you can do it once in a while, but that's not going to give you all of these things. Like, honestly, if you had asked me if I'm eating copper, I don't know. But apparently it's in leafy greens. Also, leafy green seems to be the answer to just about everything, doesn't it?

[Dr. Stacy Sims]

And spirulina, have you tried blue green or blue spirit oh, yeah.

[Mayim Bialik]

Yes. Everything. Everything green.

[Dr. Stacy Sims]

Yeah. No, if you use the blue spirulina, it doesn't taste grassy, it doesn't smell funny, and it has a higher amount of protein and iron than green spirulina.

[Mayim Bialik]

And you can put that in smoothies. If you're blending something up, it makes

[Dr. Stacy Sims]

it for a beautiful unicorn smoothie. Love it.

[Mayim Bialik]

Unicorn.

[Dr. Stacy Sims]

Well, but the other thing about the micronutrient deficiencies, when you start looking at people who are fasting and they only have a very small window of time to eat, they actually aren't able to consume everything that they need in that small window.

[Mayim Bialik]

No. I knew a woman who only ate for two hours a day.

[Dr. Stacy Sims]

Oh, my gosh.

[Mayim Bialik]

And I was like, what do you even mean? She was eating candy. She's like, whatever I want. I'm like, that's not. You're not. It. This doesn't make sense.

[Dr. Stacy Sims]

No, different story. Yeah.

[Mayim Bialik]

She was losing weight, though. And I said, yeah, because you're not eating because you're starving.

[Jonathan Cohen]

If you may think that you have a nutrient deficiency or you're not getting that variety, obviously nothing replaces getting it from natural foods. But should someone be considering a trace mineral supplement or that and a multivitamin like. There seems to be mixed reviews, so

[Dr. Stacy Sims]

get tested first to see. And then we try to do it through food. Because if you're looking at the supplementation type thing, there tends to be almost no effect. Like with iron. Yes. If you're doing it right every other day, you can absorb it, but you have to be specific about that because if you have too much iron, then your body upregulates the hormone that's going to prevent iron absorption. So we start looking at. When you're using supplementation, it can be too much. So we need just very small amounts to slowly saturate and build up over time, which you do with food. But people are so pill happy because we are in that society. It's like, you need this. Here's the supplement. And there's not a lot of efficaciousness around taking a high dose. We also see that a multivitamin is pretty much just peeing out money because it's not readily absorbed. Often cheap forms because they have to work together to be in a small tablet. And if you look at the back of one, it says calcium and iron together. Then you know that someone who put that formulation together doesn't know what they're doing because calcium and iron bond together and are excreted. So it's just better to try to do it through food. And there are really fantastic high amounts in natural foods. It's just kind of outside the scope of what medicine practices, because that's not what they're taught.

[Mayim Bialik]

Well, it's outside of the scope also. I mean, Jonathan a little bit rolls his eyes at me and I understand that, like, it all comes down to also, like a capitalist system and you know, the class, the, you know, race, class and gender. Like, it comes down to like, we're talking 2 billion people worldwide approximately have micronutrient deficiency. Like, this is. And, and the symptoms, in case you're wondering, are everything you have, if you are a human woman in particular between the ages of 35 and dead, fatigue, lowered immunity, you know, having like cognitive issues, brain fog, at risk for other diseases. That's like, literally everyone may be walking around, right. With micronutrient deficiency. This is a global problem.

[Dr. Stacy Sims]

And we are now in a, in a time in history where there are so many people that are overfed and undernourished and the discrepancy of calorie availability, so many calories available in the Western world, and they're not actually doing anything to improve population health.

[Mayim Bialik]

And also we have, you know, this whole movement of make America healthy again. Like, it's actually not that. I mean, I noticed from. It's easy for me to say from here, but like, it shouldn't be that difficult. You know, these are some basic needs that, you know, even the notion of what we feed kids in schools. Right. I mean, I remember when people lost their ever loving minds about meatless Mondays in schools. Right. How can you not feed a child that weird, that weird hot dog or hamburger? I did like burger days. It was Thursdays at my elementary school.

[Dr. Stacy Sims]

We did love it Tuesdays.

[Mayim Bialik]

That's right. But I'm saying, like, you know, there are things that also, we can do for populations also that have no one speaking for them. Right. To be able to say on a larger level, he's rolling his eyes.

[Jonathan Cohen]

No, I'm stuck on overfed and undernourished.

[Dr. Stacy Sims]

Yeah, yeah, yep.

[Jonathan Cohen]

We're just consuming, consuming. We're eating everything out of plastic containers that have been sprayed with fire retardant and we're wondering why we're hungry and don't feel well.

[Mayim Bialik]

You could apply that also to our psychological state. We are overfed with labels and boxes to put ourselves in and social media telling you that this one's a narcissist and you're getting triggered. But in terms of like, the nourishment we actually have about what are the lifestyle changes we can make that can impact our mood. Right? Get off your phone for eight hours a day and watch, you know, how many changes happen over the course of a week or a month.

[Jonathan Cohen]

Here's a challenge for everyone. How many meals did you cook at home this week?

[Mayim Bialik]

Oh yeah,

[Jonathan Cohen]

congratulations. That's amazing, right?

[Mayim Bialik]

Like everybody's like, she lives in New Zealand, there's no stores and she's in the mountains.

[Dr. Stacy Sims]

Like she's out in the middle of the whop waps. There's no place to buy food.

[Mayim Bialik]

I appreciate that, but I always kind of come to the, you know, the assistance of the theoretical woman in my head who is not only now working, right. Since World War II, more and more women are in the workforce, but in, in many cases when women are the primary breadwinner for their family, they are also bearing the brunt of childcare and of care around the house. So there's so many other factors here that like women are, are, are overworked, you know, under supported. And for many people, especially if you are a single woman, a divorced woman, a widowed woman, the last thing on your mind is being able to figure out how to cook a healthy meal at home while managing all of the humans. It's, it's, you know, I mean I saw my, my mom do it, you know, when she was working. She was also still cooking three meals a day for all of us.

[Dr. Stacy Sims]

Hard. And I think they call it the invisible woman syndrome where the extra load that's not paid and it is hard. And when you're thinking about having to do all of the things in a day and then it's like, okay, I can barely take care of myself, how am I going to cook? And I mean you go back to the whole you get your hellofresh or your blue apron delivery, which is kind of helpful, but it's expensive. So how are we going to get rid of food deserts? How are we going to improve? Because in New Zealand, the reason why we cook at home all the time, it's really expensive to go out. Like you're paying 20 bucks for a taco. It's like just not feasible.

[Mayim Bialik]

But is it a good taco?

[Dr. Stacy Sims]

No, I'm kidding.

[Mayim Bialik]

I do want to get back to some of these kind of more fitness and you know, kind of health related differences between men and women. I was really surprised, you know, in terms of oxygen use, right. And you know, for me in my head, when I think about where I wish I was or where I'd like to be, I feel very intimidated by like, lady on the COVID Do you know what I mean? Like. Like thi. This sort of intimidates me because I feel like when I look at the chart, right. Of maximum, like, oxygen capacity, I'm like, yeah. That's why I cannot do what men do, because statistically speaking, generally speaking, our bodies are different, our physiology is different. But I think one of the scary things in our culture, especially when we have, like, this fantastic emphasis on strong women and how that's beautiful and that's powerful, it sometimes can make us feel like we're still not meeting the expectation, because many of the women that we're supposed to compare ourselves to are outside, I think, of the middle of that bell curve, meaning it's like, oh, like, name of female athlete, you know, Gabby Reese. I think that was, like, a popular person, you know, when was young, right? And it was like she was on the COVID of Everything. And I was like, there's no way. I'm not six feet tall. I don't have that capacity. How do you sort of balance that when you're, you know, making suggestions for women so that we can also feel like we don't need to be like men, but we also don't need to be like those women who are closer to men in terms of their physiological capacity because of amazing genetics or they're Olympians.

[Dr. Stacy Sims]

Right? And I am really. I've been following the VO2 max thing in the. In the sphere of things, and as a sports scientist and research scientist, I'm like, why are they putting that metric out there? Because there is a discrepancy not only of maximum oxygen carrying capacity for women versus men, but the way women use oxygen. Because we can work at a higher workload for a longer period of time as compared to men, but all the metrics are being compared to men. So when we're looking at what does that mean? It's like, don't think about those absolute numbers. What we want women to do is work at a point where they feel like, oh, my gosh, I'm breathing really hard, and I can feel my muscles.

[Mayim Bialik]

We're there right now, Stacy. I'm in it. I think I'm at maximum capacity right now.

[Dr. Stacy Sims]

And then you recover and bring your heart rate down, and then you go back up. It's about pushing yourself outside of the norm. So if we think about all the classes and stuff that are out there, they're never really polarizing. They're not telling women to go as hard as you can and then really recover, because then that doesn't fall into how we grew up of you want to get a really hard, sweaty session and come out feeling smashed. That's actually not what you want to do when you come out of cardio session. You want to feel elated and tired because you push yourself really hard, but you had the opportunity to recover so that possibly push yourself really hard again. And it's not about how long it is, but it's about the quality. So it's a very short period of time where you're pushing yourself way out of your comfort zone. So if you usually go for a walk and you go by a hill, push your pace a little bit up the hill, get out of breath, start to really push yourself a little bit. Because I don't think women have ever been encouraged to just push a little bit more. Push a little bit more.

[Mayim Bialik]

I ask him to push me when we get to hills.

[Dr. Stacy Sims]

Okay.

[Jonathan Cohen]

It's a great workout for me.

[Dr. Stacy Sims]

Well, now you just have to reverse it so you can push her up the hill, but then she has to push you while you're going downhill so that she has to walk backwards and have the load going down.

[Mayim Bialik]

That's. That sounds like fun.

[Jonathan Cohen]

That's great.

[Mayim Bialik]

I could do that.

[Jonathan Cohen]

Okay, I have a very hard question, because everything out there on it says it's the most researched supplement in the. In the world. It helps with everything.

[Dr. Stacy Sims]

Creatine.

[Jonathan Cohen]

Creatine, exactly.

[Dr. Stacy Sims]

Yeah.

[Jonathan Cohen]

The news now is, and it's coming from very small pockets of the world, is that it's from a synthetic source. It's. It's created as a byproduct of. Of a petroleum output. I don't know enough about it, and I feel confused. Where should everyone be on it or should they not? And are there risks associated with it that may not be in the studies yet?

[Dr. Stacy Sims]

Okay, so I will explain how it's made first. Yes, all creatine comes from the lab, but there are two ways of doing it. One is derived from formaldehyde and petroleum products, and it's washed with an acid.

[Jonathan Cohen]

That doesn't sound good at all.

[Mayim Bialik]

No one should eat that.

[Dr. Stacy Sims]

No one should eat that. And the other is a patented way of producing it with a water wash that comes from more organic material. So it actually comes from, like, formulating certain things within the lab that come originate from plant sources. So you're good if you're vegan. And it comes through water wash.

[Jonathan Cohen]

So no petroleum, no formaldehyde. From plants and water.

[Dr. Stacy Sims]

Yeah. So when we're looking at the cheaper forms of creatine monohydrate come from the formaldehyde and acid wash. The more expensive forms. You want to look for a business, business brand or B2B brand on the back of the creatine label that says Creapure or Crea Vitalis. It's a German brand that has a patent on producing it from a water wash. So they supply more the high end supplements. So when we're looking at what's the difference? Yes, go for a little bit more of the expensive one because you know that there isn't any formaldehyde, petroleum, acid, anything in general.

[Jonathan Cohen]

I try to limit formaldehyde in my diet.

[Dr. Stacy Sims]

Yeah, me too. Yeah, and probably petroleum too, especially the cost of it. At the moment when we're actually looking at what does it do. We see that your body does produce one to three grams a day from your liver, but it's involved in every fast energetic in the body. So you think about brain metabolism, heart, lung, bone building, muscle building, every cellular process, because It's a very 0 to 20 seconds of all kinds of every fuel in the body uses creatine. If we're looking at how much our body stores around 70 to 80% of our muscle is actually saturated with creatine. Because we use so much of it in a day, we start seeing how using a supplement can benefit. We see it benefits brain and brain function and brain metabolism because it relies more on creatine because the nerves and everything that are conducting are so fast. So it uses a lot of creatine. We see that the mucosal lining of our intestines, it gets eroded pretty quickly. If we have more creatine on board, then that mucosal lining stays and it reduces IBS symptoms, It reduces issues that women have when estrogen fluxes as well. We see it's beneficial again for bone and bone density because it's involved in all the energetics, first creating bone and then of course muscle performance. There was a systematic review that came out and the reason why I know all these things because I've been on planes reading, trying to fill in time. Systematic review came out two weeks ago that looked at all of the studies that were done outside of muscle performance, health and fitness on creatine. And the group that benefited the most from using creatine supplementation were women 1860. So we look, it's just a very small dose, it's 3 to 5 grams and that's over the course of three weeks. Fully saturates all tissues in the body and it just brings your body up to another level of stress resilience it helps with cognition and brain fog and everyone benefits from that, men and women especially. In this era of lights and everything on all the time, we're just bombarded by stuff. So it just allows your brain to have a little bit more stress relief, resilience.

[Jonathan Cohen]

What about the notion of taking, you know, the higher doses? I've heard it, you can bet, you know, recover or function better if you've had a poor night's sleep or two if you have to perform. What. What about the 10, 15, 20 gram dose?

[Dr. Stacy Sims]

So that one's interesting. Darren Kandao is one of the lead researchers and he's out of California. He's been looking at this and he's like, initially, yes, but the problem is it takes longer for creatine to pass through the blood brain barrier. So an acute dose doesn't necessarily help right away. So if you've, if you're a shift worker and you know, you have three days on and then other days off, it works significantly to help and reduce carbohydrate cravings because the brain doesn't feel as tired. So you end up having better metabolism and glucose control. We see it helps with jet lag too, because of it's a circadian rhythm shift. We also see in early studies it helps with individuals, adhd, because ADHD is also a circadian rhythm shift. So all the things that have a circadian rhythm shift benefit from having the higher dose. And I think it's what, 0.38 grams per kilogram, which ends up being around 20 grams for 130 pound person.

[Mayim Bialik]

I'm sorry, circadian rhythm for ADHD. Can you repeat that?

[Dr. Stacy Sims]

Yes. So they're looking at things like sleep and melatonin and issues with adhd and they found that it actually is a circadian rhythm shift. So for individuals with ADHD who are trying to get better sleep, and they're looking at things like melatonin and other sleep supplements, you want to take it three to four hours before you need to go to bed so that it allows your brain to. We're microdosing with these things, so allows your brain to settle back into enormous circadian rhythm.

[Mayim Bialik]

I want to get into some of the kind of perimenopausal and menopausal concerns that some of us might have. But there was a part in the book that kind of stopped me cold. Can you talk about hydration? Can you talk about kind of like everything relating to this chapter is kind of interesting to me. I'm a person who loves salt. Like everything has to have salt. Like salt salt. Like I will salt it before I taste it. I do all the no no's Right. And I also am quite thirsty. But you talk a lot about, you know, should you drink, obviously, before you feel that thirst. Yes, But I didn't know how many problems people can have from hydrating inappropriately. Can you explain, like, what we actually should be doing?

[Jonathan Cohen]

That's your nickname, Inappropriate hydrator.

[Mayim Bialik]

I am an inappropriate hydrator in both directions because also sometimes when I'm just giving you all my problems, sometimes when I get to a me, I cannot be the only person who has this. Sometimes when I get to finally sit down and eat a meal, I am so thirsty that I drink so much water and then my stomach hurts and I swell up like a mushroom. He calls me mushroom belly. I swell up like I've ingested a mushroom because it's all bloated and I don't know if I'm drinking too much or at the wrong time. Like what's happening with hydration for digestion.

[Jonathan Cohen]

Right. Explain it to us.

[Dr. Stacy Sims]

So we think about all the water in the body is not just plain water. It's a solution of primarily sodium and glucose. So if we look at just drinking plain water and we see people walking around with their Stanleys and they're drinking liters a day, they end up peeing it out, not actually hydrating, because the plain water is not absorbed very well because the body's like, oh, I have to dilute this. No, I don't need to dilute it. I need to add stuff to it. It maybe I don't. So we're talking about hydration. There's a very tight amount of pressure that the intestines can withstand, and it likes an ideal pressure. If we look at having something that's just plain water, it doesn't exert enough pressure. So the body has to bring in some sodium and some glucose from other places in order to absorb it. If you have too much sugar, like all the Cokes and Powerades and stuff in there, the body has to take water from other places in the body to dilute that in order to absorb it. So we talk about hydration. If you're drinking water, you just add a little bit of salt. So it might be a 16th of a teaspoon in 25 ounces. So it's just a very small. It's about 200 milligrams of sodium.

[Mayim Bialik]

Why did you pick the hardest measurements for me to understand? A sixteenth of a teaspoon in 25 ounces.

[Dr. Stacy Sims]

Okay, people like numbers, but here's.

[Mayim Bialik]

Okay, but that's like a. That's like a. It's a. A modest pinch, right?

[Dr. Stacy Sims]

There's a little pinch into your bottle of water, and then you get hydrated, and you end up drinking less and being more hydrated. Because if you're walking around drinking water all day and you're putting it on your tongue, it kills your thirst sensation. So people are like, oh, I don't feel thirsty until they sit down and they realize that, wait, I'm really dehydrated, but I've been drinking water all day. You've been peeing it out and not absorbing it. So just a little bit of salt.

[Mayim Bialik]

I mean, if we learn Nothing else from Dr. Sims is that I've been drinking water all wrong all this time.

[Dr. Stacy Sims]

Who knew, right?

[Jonathan Cohen]

I'm just thinking about how many people this affects. No one is doing this.

[Dr. Stacy Sims]

If you're drinking water with a meal, there's sodium in the meal. That's fine. But if we're talking about, like, the focus on being hydrated, which is. Becomes the thing, right? Everyone's talking about I need to be hydrated. And you see all these massive water bottles that people are going on a walk, and they're just using water and peeing it out, and they're becoming dehydrated, or what we call hypohydrated. So it's actually doing the opposite. So again, if we just put a little bit of sodium, you don't have to drink all those bottles of water. And you're not interrupting your biochemical processes either.

[Jonathan Cohen]

This has blown my mind.

[Mayim Bialik]

It's kind of blowing my mind, too. But now, because of the things that I know about pressure and also the stretch receptors, that's what bloating is. It's that you've disrupted the pressure, much like high blood pressure. Right? And what do we give for high blood pressure? A diuretic. Right. To pee it out. So basically, you're creating. Oh, that's terrible. That's exactly what's happening.

[Jonathan Cohen]

This is a little segment I like to call crazy hippie ideas that may have some scientific merit. So help me understand this. Someone turned to me and said, you know, our bodies need structured water. We shouldn't be drinking all this water regularly anyway. We should be getting all our water from fruit, because that's the way it is in nature. And I looked at him and I said, that's too complicated an idea for me to implement into my thinking. I'm going to ignore it. Can you explain if there's any merit in that?

[Dr. Stacy Sims]

Well, it does count as a water source, but it wouldn't be your only thing. Like, people are like, I need eight glasses of water. Well, that's from marketing. That was from a whole like ad campaign and people grabbed onto it. It's like if you're thinking about water and staying hydrated throughout the day, it's not about how many things that you drink drink. It's you have watery fruit and veg. That counts too. But it's not being exclusive in just drinking water or just eating fruit or just eating veg. It's like, okay, all the things that have hydration in it we can use to hydrate our, our bodies and ourselves. So there is a little bit.

[Mayim Bialik]

Well, and, and, and also, and you know, correct me if I'm wrong, the notion of kind of structured water means if, if water's being taken in through fruit, for example, or vegetables, it's processed differently than if you're sort of just inserting water. And it basically is just coming out of your urethra.

[Dr. Stacy Sims]

Yeah, kind of. Because as you're like looking at digestion, the water will be absorbed first while all the fiber processes are being digested. So the body is like, I'm mushing it up, I'm leaking it into the small intestines. 95% of your water absorption takes place in the small intestines. And then you further digest as you go down. So if you're having lots of watery stuff, that stuff gets absorbed first while the rest of it kind of dissipates.

[Mayim Bialik]

Can we move on to kind of this 10 year period called perimenopause and then menopause? But I think a lot of the focus right now is on, on perimenopause because that seems to be, you know, this place where so many women and the people who love them are noticing, you know, all of these differences and all of these changes. And I think I'd like to make this really simple for people because we hear so many different things we should be doing. And I kind of, I'm happy for you to speak to hormone replacement therapy, but I also am happy to set that aside for part of the conversation. If you had to tell us five things that every woman who is perimenopausal should be doing for her health, what would those five things be like? Make it really simple for us.

[Dr. Stacy Sims]

Sleep. Because you can't change anything without sleep. That's the, the first thing. Sleep. Looking at increasing fiber because we have a decrease in our gut microbiome diversity which exacerbates a lot of the body composition changes. Changes being very specific in the movement that you do. Putting an emphasis on strength training and not aerobic cardio stuff. If you are doing aerobic cardio stuff, you have to be very specific in intensities. So those are your big three, having support and community. So you have your buddy. Right. And having someone who you can vent to and who isn't going to try to fix things. This could be your partner. I've been talking a lot to men about how they can support their partners in this. It's like, just listen, don't try to fix things because it's a very confusing time. And then when you're looking at specificity of symptoms, like are you having severe brain fog, are you having severe mood swings? Like, then that's where we start looking at pharmaceutical options. If, if things like adaptogens don't work for you, then yes, menopause hormone therapy is definitely on the cards as a way of helping get women through this. What I don't like is the conversation. Every woman needs to be on it because that's not, that's not. We don't have the data yet to say what is the long term effect of this. And we look at the, you know, the Women's Health Initiative study that took it off the table. So many women. But at the same time, the UK Women's Million Women's study was going on and that's why there's a difference in the way that people approach it in the UK versus in the States.

[Mayim Bialik]

No, now they're saying like, as soon as you're 20, just go, what? No, that's really helpful. And also makes it a little more manageable, you know, I think to sort of think about, can you talk about fiber? Because like, I think of fiber bias, you know, as like something for old people to make sure they don't get constipated, you know. But I'm hearing more and more people talk, in particular for women with autoimmune conditions, like, what is up with fiber? And why is she being so sneaky late in life?

[Dr. Stacy Sims]

I know. So fiber is the food for our bacteria in our gut. Right? And we see that there are different phyla. For women who are in perimenopause, there's a significant decrease in the good gut bacteria. Unfortunately, this causes an overgrowth of the bacteria that makes you highly sympathetically driven, makes you crave simple carbohydrates, increases our visceral and our subcutaneous body fat. So if we're looking at fiber, it's all over fruit and veg because that is fiber. Like fibery fruit and veg, sprouted grains, whole grains, like real food. We're not looking necessarily at a fiber supplement unless there's a case where you've been sick, you've been traveling, you've had some kind of issue where you actually need fiber supplement. Not telling everyone you need Metamucil every day, it's like, let's just. That's where that whole 30 plants a week comes into play. Because it really does help increase the amount of fiber, but not a big wallop at once. And this helps with that gut microbiome diversity. And we see this decrease because of the way our sex hormones are now changing because we're not having as many sex hormones come in. There's not a second pass. Because when our sex hormones are bound up with sex hormone binding globulin, they're shot into our intestines through bile and then unconjugated by these gut bugs when we stop having as much progesterone or we start having different ratios of estrogen that kills off those gut bugs. So we really need to focus on fiber and diversity so that we keep producing the good gut bugs which then enhances things like brain derived neurotrophic factor bdnf. We see it helps with vitamin production, we see it helps with serotonin production, dopamine, all these other things that the gut bugs are responsible for. So that's why I keep telling women like it's about the nutrition and the fiber.

[Mayim Bialik]

Yeah, that's really, that's very helpful because you know, I remember after giving birth, right, that's the thing they tell you is like if you'd like to leave the hospital, you have to eat your fiber because you have to have a bowel movement, right? Because you're trying to rebalance everything. And I remember I was like, what do they mean? And they were like, let it this just, you know, but even that notion that we need those kinds of foods to keep things kind of functioning. And especially as we get into, you know, this, this kind of situation where sex hormones are behaving so differently. I wonder if you can kind of speak a little bit on, you know, for the people who say, and look, we've hosted, you know, many of these, many of these people, you know, who say that kind of we shouldn't ever not have the hormones we had when we were younger. And you know, estrogen is everywhere and it's, you know, it's in your brain, and it's in your gut. And so, like the, you know, all of these connections with cognition, with mood, you know, all of these things need the same level of estrogen. What does it look like to gently, you know, go through this phase of life? Is it possible to come out on the other side without that kind of supplementation?

[Dr. Stacy Sims]

Absolutely. Absolutely. Because one of the things that's not being described when people are talking about everyone needs these exogenous hormones is target tissue. We see each different formal form of estradiol and progesterone actually is absorbed and affects target tissue in a different way. So if you talk about bioidentical and micronized, yes, they're molecularly the same, but they don't affect the target tissue the same as if your body is naturally producing it. So when we start looking at receptors, and yes, we see that all the receptors in the brain light up when estrogen is going down, because, yes, they want estrogen, but do we need to feed it, or is that just a natural process and the body finds a new baseline? This is the research that's being done, but isn't done because we haven't done the actual investigation of how all of these things affect target tissue.

[Mayim Bialik]

Right. And there are plenty of women who kind of holistically are like, this is your age of wisdom. And, like, you go through this really rough period, but then you level out at a place where, you know, for. For, you know, quite some time. Women have weathered, and it is a different phase of life. I think Margaret Cho has a hilarious thing about the haircut you're finally allowed to get. You know, when you're through menopause, like, you just get a boy haircut because, like, that's all you can deal with. Right?

[Dr. Stacy Sims]

Yeah, exactly. I think a lot of the push for it is, is aesthetics driven because so many things happen with body composition. And people are like, oh, well, if I go on hormone therapy, then it's going to help me preserve my body composition. But it doesn't. There's no research to show that it actually does preserve body composition. It slows the rate of change. But you have to put in lifestyle changes to actually benefit.

[Mayim Bialik]

Right. And this is where it becomes a cosmetic conversation. Because, you know, I'll be super honest, I never heard women interested at all in the vulva the way they are now. Because the conversation is, sorry, Jonathan, cover your ears. Or you can listen. Everybody's talking about plumping. And I'm thinking, like, this is not a conversation I ever thought we'd be having. Especially when there are so many physiologically, you know, critical things also happening, you know, in addition to the cosmetic. But it's kind of like the conversation with GLP1s, right? Like. Like so much of the conversation because of the industry. Right. And because of what we're told to kind of factor in as the most important. It gets shifted away from some of these more, you know, kind of clinical conversations, which are so important.

[Dr. Stacy Sims]

Definitely you have a history, family history, or you yourself have a history of low bone density. Then, yes, it's shown that it does actually help with bone, and it helps with mood, but there are other things that help with mood. Vaginal dryness definitely helps with that, but there are other things help with that. So it's like you have the camp. The pendulum is swung from one to the other, but we need to settle in the middle because there are absolutely things that you can do. And, I mean, I used it very briefly when I had severe rage because it got to a point where my daughter was.

[Mayim Bialik]

I don't mean to laugh at your rage.

[Dr. Stacy Sims]

No, no. I actually share the story. I was like, yeah, my daughter will turn to me now and say, mom, When I was 4 and 5, I was very afraid of you because you had such rage. And that, like, breaks my heart. But I. I had a friend who pointed it out. She's like, you've done all this research on hormone therapy in menopause. Why are you not trying it? Because you are not the person that I thought you were. You were like. I was like, oh, my gosh, you're right.

[Mayim Bialik]

He feels so validated right now. But I think you talk about it in the book, and, you know, for women who have not experienced this, I'm. I'm glad, and I hope you never do. But as you described it, and this was.

[Dr. Stacy Sims]

Was.

[Mayim Bialik]

This was my experience, about once a month, like, anything in my path, I would take a blowtorch to. And that. That meant the human in this vicinity, you know, it meant work. It meant, you know, everything. It really felt like, burn it all down. And, you know, for many people, it's very confusing. It's not healthy, you know, for kids. And, you know, we always joke, like, we just thought our moms didn't like our dads.

[Dr. Stacy Sims]

You know, the highest incident of divorce happens during perimenop. Cause.

[Mayim Bialik]

Yeah, and rage, apparently.

[Dr. Stacy Sims]

And rage.

[Mayim Bialik]

One more thing we wanted to talk about with you. There's so much conversation about temperature and body regulation, and you had kind of mentioned it a little bit, but this notion of cold plunge, you Know, kind of took the manosphere, you know, by storm. But I'm curious, like, is there a perspective you have, both for men and for women, about cold plunge, about sauna, about heat? What should we be looking to if that's something that's interesting to us and something that's available?

[Dr. Stacy Sims]

Yeah. So I think I caused an international shitstorm when I was like, women shouldn't be in ice because there is no data to support it. I was just looking at the science that's been around since the 1990s. There is sex differences, like XX versus XY, not hormonal differences. We look at thermoregulation. So if a woman gets into that 0-4-degrees Celsius or the ice water, it's such a sympathetic drive and survival mechanism that she doesn't actually accumulate the right kind of stress to create adaptation that you want.

[Mayim Bialik]

This is what I say when I've tried it, and people are like, oh, you need to breathe through it. I'm like, no, this feels like a specific. Oh, oh.

[Jonathan Cohen]

I'm gonna caveat by saying she's never been in 0 to 4 degrees.

[Dr. Stacy Sims]

No, that's true.

[Jonathan Cohen]

You've been in cold water.

[Mayim Bialik]

That is, once my bath got cold and I was really upset.

[Dr. Stacy Sims]

Yeah. So if you want to go down that route. For women, we look at about 55 degrees Fahrenheit, which is that 14 to 15 degrees Celsius. It's uncomfortable, but it's not as severe stress as ice. So you will get metabolic and endocrine changes that are beneficial, but they are still not as robust as male responses.

[Mayim Bialik]

Interesting.

[Jonathan Cohen]

What are the beneficial responses?

[Dr. Stacy Sims]

More parasympathetic drive, more focus, better serotonin and dopamine responses. Better metabolic control, so better glucose control. Those are the main ones.

[Mayim Bialik]

These sound like great things.

[Jonathan Cohen]

And that's at 55. What about 60? Like, what? What's the range?

[Dr. Stacy Sims]

So the research is always held tight. At 14 to 16 degrees Celsius, is it warmer? Well, then we start to see, well, is it cold enough to invoke a response? Well, it depends. Like, where I live, the seat temperature never really gets above 65 degrees. So if you acclimatize to that, are you going to get responses? The benefit for women is to get in the heat because we actually get really robust responses. When we get in the heat, we have a fluctuation of our internal temperature across our menstrual cycle anyway. So our body is really already primed for, you know, different threshold shifts. So if we go in the heat, women last longer in heat, we vasodilate first and then start to sweat. Men get in there like, oh my God, after five minutes, I'm sweating like a horse. I can't be in here any longer. So men have to kind of fight through. But we still get really robust responses, very equivalent to what men will get. So that means we have increase in our cardiovascular function because we increase our blood volume. We have better heat shock protein responses. So more autophagy that can occur. We see better blood vessel and blood pressure responses because it's a strong stress, so we get more vascular compliance. It also helps with our dopamine and our serotonin and our neurotransmitters. It also helps with our metabolic control. Just like the cold. But a lot of women will gravitate towards heat more so because it's not as, as a sympathetic like, oh my God, I'm going to die. It's like it's really hot in here, but can tolerate it because the body's used to shifting. So either one is fine. You just have to be, am I leaning into the cold but not too cold or do I want to lean into the heat? But they both give really advantageous health responses. We look at how much, which is always the question. If you're not trying to acclimatize to the heat because you're going someplace high hot. Then we look at 10 minutes, maybe three times a week because you're getting that robust heat exposure. But it has to be about 80 degrees Celsius. So you get in there, you're like, it's hot, sit high and then move low and then you get out. You don't have to be in there. I think Brian Johnson said till his core temperature got up to be 39 and a half and then he stayed in there. I was like, we poll people in the lab when their core temperature gets up to 39.5. You get benefit way before that. So it's not about keeping your core temperature up high.

[Mayim Bialik]

I do think that this is sort of the, the testosterone driven aspect of the fitness industry is like everything becomes so extreme. You talk about that in Roar. You know, you talk about, if you are interested, if that is your life is extreme temperatures and extreme sports and extreme fitness, like, great. But for most of us, yeah, it doesn't feel like doing 45 minutes in that kind of heat. Especially, you know, for women who are dealing with our own temperature regulation issues, which is like a real thing, you know, for many, many years.

[Dr. Stacy Sims]

Yeah. So when I was doing my postdoc at Stanford. I had the luxury of being able to work with one of the top complementary alternative medicine and thermoregulation research scientists. She came over from Columbia. We were really trying to quantify what a hot flash or hot flush was. So we had women sitting in a neutral room sauna without the heat on, and we were looking at the spikes and being able to predict what happened. And then we did controlled hyperthermia. So we'd expose them to sauna temperatures for 15 minutes a day, and we did that every other day for a week. And they would have severe hot flashes in there because it's hot. Right. But then after those five days, they would have less severe and less number of hot flashes. So then they're like, this is great. I can. They're controllable and it's, you know, the hypothalamus and is able to understand what that severe heat is and how to bring it down. So we can use controlled hyperthermia to help with hot flashes.

[Jonathan Cohen]

Is there a better time of the day to be exposed?

[Dr. Stacy Sims]

Not necessarily. It's like when you can fit it in.

[Jonathan Cohen]

You've done so many podcasts. You speak so much about health all the time. Are there any topics that you wish people would think about more that you're not being asked about?

[Dr. Stacy Sims]

That's a hard question, because my brain is always going in different directions, right. And so that's why I have all these different projects going, because for me, I want to close that gender gap. We have a new company that we're launching that's aiming to do that by going after AI Because AI right now is just perpetuating the problems of misinformation for women. When we start looking at the research, someone asked me, what's the one research study that you would want to do to help all women? I was like, there are too many. I can't actually specify one. So I guess questions that have been asked depends on what stream we're in. Like, if we're just talking about overall general women's health, I always talk about different things. So it's always interesting. If we're talking about the research perspective and what needs to be done. Well, we can look at every body system and we can go down that rabbit hole. But again, what I'm really pushing right now is we have to look at how AI is perpetuating this problem because it. It's an echo chamber in that bell curve. And who are the nuances in the information. The publication of women's health is lower than that of men because there are not as many studies. So those are the nuances. Ethnic differences and racial disparities. Those are the nuances. They're not being included. So as we're getting this upsurge of clod and anthropic and all those kind of data lakes, the parameters are set on male data. The human touch is still factored on male data. So a woman will look at her wearable and think that she's dying because the output says your core temperature is up, your heart rate variability is down, you're getting sick, when actuality, it's just she's ovulated.

[Mayim Bialik]

Am I dying or am I just ovulating?

[Dr. Stacy Sims]

Just ovulated. But the wearable thinks you're dying because you're not a man.

[Mayim Bialik]

Whoa. Dr. Sims, thank you. The book is Roar. Match your food and fitness to your unique female physiology for optimum performance, great health, and a strong body for life. We so appreciate our time with you. Thank you so much for sharing all of the research and experience you have with our audience.

[Dr. Stacy Sims]

Thanks for having me. This has been so fun. I appreciate it.

[Mayim Bialik]

Dr. Sims is one of those people that, like, if I were running the world, I would want her, like, advising on so many things just to help us understand things better, to help us do things better. Like, like to help us approach things in a way that really seems to work for optimal health. Like, I want her in charge of something new.

[Jonathan Cohen]

Health secretary nomination Stacy Sims. Also, think about the amount of water that you have not absorbed.

[Mayim Bialik]

I don't even know what I've been doing with my stupid water bottles.

[Jonathan Cohen]

Just a little pinch of salt.

[Mayim Bialik]

But you know what I'd like to remind people, when you see someone walking around with their giant water bottles, shake your head now. No, you don't know what's in there. It could be vodka. You don't know. Don't judge.

[Jonathan Cohen]

Could be salted water. It's okay.

[Mayim Bialik]

That's what I'm saying. It could be anything. You know, I don't envy Dr. Sims because she. She has to speak out on so many things that people just want to take for granted. Even the conversation about birth control and the amygdala. I'm like, I need to look this up. I need to look at what we think these medications are doing, but it may not be for everyone. And I think that's important to point out, too. We're not saying do away with. With birth control, do away with hormones, but everyone's experience is going to be different. Like, no two people are the same. And in particular, no two Women are going to have the same hormonal journey. There's so many other factors. Diet, you know, other pharmaceuticals, you know, the hormones in meat, in dairy, like all these things that people are realizing may have an impact. All those things have to be considered. There is not a one size fits all solution for all people and in particular for all women.

[Jonathan Cohen]

I also think a lot of people want to believe that there are these miracle cures in which she talks about the cake. If you're not working on the foundation, you can't just throw icing over it. You know, we have to be doing those fundamental things. There are no shortcuts and we are trying to get ahead. There's so much pressure, people are hustling. It's so much harder to cook these days than it ever has been before. And yet without that. But you're running towards a cliff.

[Mayim Bialik]

I mean, also, speaking of cake, like how about an avocado? Just that notion that not all fats are equal, right. And that having an avocado and getting those fats, it does, it processes all of those micronutrients differently than if you're getting your fat from icing on a cake.

[Jonathan Cohen]

That's not the best form of fat.

[Mayim Bialik]

That's the take home message here.

[Jonathan Cohen]

That's the take home message.

[Mayim Bialik]

I was also gonna say roar. It's, it's a really fun book because it has exercises and it has recipes and it has nutrition. But it's a really good guide. It's a really good reference. You can kind of look up everything that you're curious about and sort of tailor it to, to what you need. So really loved speaking to Dr. Sims. Hope you enjoyed it as well. Make sure to join the community over on Substack, our growing community of breakers. Go to my Ambiox breakdown on on Substack or go to bialikbreakdown.substack.com and we hope to see you over there. From our breakdown to the one we hope you never have. We'll see you next time.

[Jonathan Cohen]

It's Maya Bialik's breakdown.

[Dr. Stacy Sims]

She's gonna break it down for you.

[Mayim Bialik]

She's got a neuroscience PhD or two

[Dr. Stacy Sims]

and now she's gonna break down.

[Mayim Bialik]

It's a breakdown.

[Jonathan Cohen]

She's gonna break it down.