← The Neuro Experience
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- [00:00]
A
We are failing women because they think that they can put on a weighted vest or they can do two sets of goblet squats twice a week, and they're going to build muscle fast. You cannot Amazon prime your muscles.
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Women over 40 are being dismissed, misdiagnosed and misled about their hormones. For decades, women have been denied hormone therapy. Why has medicine failed women here? And what do you think the cost is?
- [00:23]
A
For so many years, women were told you just have to basically suck it up, buttercup. And no one got a Tochar for 20 years. And now sometimes the response to that is the extreme, like, everyone should do it. And that's not necessarily true either.
- [00:39]
B
We're told weight gain is inevitable. Muscle loss is just aging, and brain fog is something to tolerate. But what if it's all wrong?
- [00:46]
A
Your muscle tissue. As you age, we see a change in volume, but you also see a change in quality estrogen. When we're thinking about this in the context of body composition changes, the way that we distribute fat.
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B
Today I'm with Dr. Stephanie Esteama and we're going to break down the lies, the science and the solutions every woman needs to know. I want women to understand why you can't use walking alone as exercise. You should spend more time weightlifting and.
- [01:16]
A
Sprint training and there's, you know, strategies and action, items that we can implement in midlife and maybe ideally before that is going to help you age well.
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B
By the end of the conversation, you'll know why. Losing muscle isn't about strength, it's about survival and how your hormones and brain depend on it. I'm Louisa Nicola and this is the Neuro Experience podcast. Hi, Stephanie.
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A
So delighted to be here.
- [01:42]
B
Me too. It's been so long. We've been friends for a number of years. This is the first time we're meeting.
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A
We've been Instagram besties for.
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B
For God knows how long.
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A
For a while. Yeah.
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B
And I love it because you provide me with so much insight on muscle health and everything in between, which is what we're going to be speaking about today. And I'm going to first start off with this and tell me if I'm wrong. Right. For decades, women have been denied hormone therapy. Why has medicine failed women here? And what do you think the cost is?
- [02:11]
A
Starting off with the easy questions. Right. I would say that in 2002, we had the Women's Health Initiative. The problem with the WHI was that there was an overgeneralization, that hormone therapy was terrible for all women in midlife, irrespective of Age, irrespective of individual risk. Even though after that fallout, there were, you know, age stratified reanalyses showing that women who started hormone therapy within 10 years of the onset of menopause. Most women start, you know, enter into menopause around the age of 51. That's the average age. So before the age of 60 actually shows quite a bit of benefit for some of the very common symptoms that we see. Things like the vasomotor symptoms, the hot flashes, the night sweats, mood disorders, bone, which is. Which I'm very, very concerned about, and even just the urogenital changes that we see for women, things like atrophy of the clitoris, the vulva, the vaginal wall, the pelvic floor in general. So for so many years, women were told, you just have to basically suck it up, buttercup. And a lot of our mothers were denied a lot of that hormone therapy. And I think that the consensus now in 2025 is that hormone therapy is generally recommended for vasomotor symptoms, for helping to slow down bone loss. And there are other lifestyle factors that we can pull into that. And I know we'll talk, we'll talk a little bit about that today, but also for the urogenital symptoms that a lot of women experience. So I guess to answer your question, yes, I think women have been denied hormone therapy. I think that we are getting better at it. I think there's more advocates now. Women who themselves are going through perimenopause and menopause and are not willing to suffer with the symptoms. They're not willing to suck it up. And then there's. So we have sort of that medical arm to it. And then there's other people like myself who have, you know, degrees in the neuromusculoskeletal system. And there's system and there's, you know, strategies and action, items that we can implement in midlife and maybe ideally before, but even if you're new to the game in midlife that is going to help you age.
- [04:24]
B
Well, let me get this straight. So we had obviously the whi. Now a lot of that has been debunked, but it scared a lot of women out of taking hormone physician therapy and physicians. Correct. And now we're seeing this big, this rise in hrt. We've got a lot of people on social media talking about menopause and estrogen, estrogen's role for brain health, muscle health, heart health. We've also got progesterone and something that we're not really Speaking a lot about testosterone, which we'll get there. So we've got this rise and I think more people are becoming acquainted to it, especially if they're listening to this episode. For me, because my primary area of research is Alzheimer's disease, I gotta tell you, right now I'm a bit Switzerland. I'm writing a meta analysis. So I'm going through so many studies. And what I'm seeing is that, is it hrt, like specifically estrogen and progesterone or just estrogen alone? Is that what is aiding in better cognitive health because we've got estrogen receptors on the brain, or is it because it's simply helping the vasomotor symptoms, which are helping cognitive health? So I don't know where I sit right now in that. In terms of that, I don't know what your take is.
- [05:38]
A
I tend to be a bit Switzerland like you as well, because I think that there was this swing one way where it's like no one gets HRT and no one got a to try for 20 years. And now sometimes the response to that is, is the extreme, like, everyone should do it, everyone should do it. And that's not necessarily true either. I think that there is a tendency in medicine to marry ourselves to the benefits and divorce ourselves from the risks. I typically think when it comes to hrt, certainly every woman has, I think every woman has the right to have a conversation with her primary care provider in terms of whether or not this is an option for her. And so HRT may be on the table, maybe it's not. But what's on the table for absolutely everyone is some of the lifestyle levers that you can pull. So prioritizing protein, which we'll talk about, strength training, sprint training, some of these things that can augment and prevent the atrophy of type 2 muscle fibers, sleep management, stress management. So these are things that I think every woman, irrespective of hrt, should be thinking about. And if you are on hrt, the other, you know, the one thing I'll say is it, it is very well established that this is going to help with, as I mentioned before, the vasomotor symptoms, the genitourinary syndrome of menopause, it can help prevent bone loss and mood and all of that. And HRT is not going to build a plate for you. It's not going to lift the weights for you. It's not going to set boundaries with your mom. You know, like you have to do those things. So there's a marriage, I think, to be had with medicine and some of these lifestyle factors together to help women, you know, the way that they choose to and the way that they want.
- [07:27]
B
That's so smart, the way you said that, because that's how I describe supplements.
- [07:32]
A
Yeah, right.
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B
And it's, you know, this is how I was describing 15 years ago. Yes. Believe it or not, 15 years ago, we were taking, you know, whey protein, and I was trying to explain this to my clients. I always used to say to them, just because you're having whey protein, you still need to lift.
- [07:47]
A
Right.
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B
It's like a supplement. It's not going to do everything for you. Just like creatine is not going to do everything for you. Still, at the end of the day, have to lift. And that's a really good segue into what we're about to speak about. The reason why I opened with that is because we now know that women in midlife start to see a change in their hormones, mainly estrogen, progesterone. And this is what I could build a thousand episodes around, because there's so many things that happen. And one of the things that happens is we lose type 2 muscle fibers. And that's across the board, both men and women. But women experience so much more when, you know, insulin resistance, osteo, osteopenia, we go through so many things. And I want to talk about sprint training, because you mentioned it today. I posted a reel on Instagram about walking, and there's so many. You said, the walking brigade came after me. There's so much nuance around walking, and I'm the first one to say, I love it. I live in Manhattan. I walk 20,000 steps a day. That's not my exercise, though. And I was thinking about. And I thought, I want women to understand why you can't use walking alone as exercise. And I said, maybe, you know, if you want to get the biggest bang for your buck.
- [08:54]
A
Right.
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B
If you think about a woman who's around 48 years old, maybe she's 49, maybe she's got a husband or a spouse, she's got kids, she's working, she's going through day to day. That's you. So you don't have, you know, endless amounts of hours through the week to exercise. So I was trying to pinpoint, this is what you should do. You should spend more time. Walking is great. You should spend more time weightlifting and sprint training. Can we start with what your thoughts are on that? And then let's just talk about what happens to us physiologically, in terms of Muscle and bone health through those, through those years.
- [09:33]
A
I would start off by saying that I completely agree with everything that you put in that Instagram reel. I think that sometimes social media is like, it's a funny neighborhood because they don't have to come up to you in person and be like, louisa, I don't like what you said and this is why. But people can read that. And I was saying to you off air before we started, they can be. If they identify as a walker, or maybe they're wearing a weighted vest and they're walking, or maybe they have a walking group that they're a part of and you say, hey, walking is not the optimal way to build muscle. Instead of hearing what is just fact, they start to get in their feelings a little bit. So people can get insulted and say, I can't believe that you are insulting my lifestyle. Like I said, walk. This is what I love to do. And in your message, I didn't hear or I didn't see the message, don't walk. It's make sure that if you are limited on time that you are making sure that the strength training is happening somewhere between two to four times a week. You're sprinting maybe once a week, maybe twice a week. And if you're, by the way, if you're short on time, sprint training, one of the. It's your in and out, like you're one and done in like 16, maybe 20 minutes, you know, tops. So I think that these are excellent ways, especially if you're short on time, to preserve muscle tissue. Because your muscle tissue, as you age, we see a change in volume. So you see a decrease. Generally, if you're not being strategic like doing the strength training or the sprinting, you will see a decrease in volume of total muscle as you age, but you also see a change in quality of the muscle. So there tends to be, as we age, we tend to be a little bit more sedentary. And even though you might be walking, you're still more sedentary than maybe you were when you were 25 or 35 or 45. There's fatty infiltration of the muscle. So now the. One of the. I mean, there's many functions of muscle and we can get into it. But one of the, One of the benefits from a metabolic perspective is that it is a very efficient glucose sink, meaning that it will, almost like a sponge, sop up extra glucose from the plasma. If you've consumed carbohydrates or, you know, you've. You've just had a really Big workout. For example, like your, your muscles have the ability to take up glucose in both an insulin dependent and independent way. Like this is really what's cool about muscle is the presence of insulin does, is not required. Your muscles can take up glucose, insulin independently and dependently. So as your quality of muscle changes as there's a fatty infiltration, let's say through being more sedentary and not strength training, your, the amount of insulin that needs to be secreted now in order to shove literally glucose into the cell is much higher. So it is very important that we are engaging in activity that directly impacts and we can talk about the difference between type one and type two muscle fibers. But for women we lose. And this is true for men too. We lose type 2 muscle fibers first. These are our fast twitch muscle fibers, the slow twitch or the type one. These are the, you know, when you're going for a walk or maybe you are gardening or you're doing housework, like these are the muscle fibers that are active in sort of lower level or lower intensity activities. And so these are going to be primary. You know, they go through, you know, they will use beta oxidation. So they're primarily using fat as their fuel because the intensity is quite low. So they can afford to dip into your fat stores, break that up through beta oxidation and then, and you're able to do your activities that you're choosing to. When you are doing things like strength training. This is an explosive style for, you know, you get down into a squat, you have to find a way to get back up. So you are utilizing these type 2 muscle fibers. Same is true with sprinting. It's an incredibly explosive activity. And so if you're not careful, starting even in your early 30s, you start to lose like 3 to 8% of your type 2 fibers per year.
- [13:38]
B
And let me tell you, I feel it mid-30s. But I can't box jump anymore the way that I used to right when I was 21.
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A
Right.
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B
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A
Yeah, so the carbohydrate will break down, you cleave all the carbon bonds, it turns into glucose, and then your muscles are able to essentially sop that up. So they're able to bring the glucose into the cell and then the cell is able to now use glucose as a precursor for energy. Right. So producing ATP. So this on, as I mentioned, insulin in muscle, with insulin or without insulin. Right. It's like the U2 song, like with or without you. Right. Which is really lovely because as we age, we just as a natural function of aging, we become more insulin insensitive. So the pancreas has to, has to continuously pump up more or pump out more and more insulin in order to get the glucose to move into the cell.
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B
Yeah.
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A
So when you are strength training or sprinting, literally within hours, you are going to change your, your muscle's capacity to soak up that glucose, bring it into the cell and make energy. And that lasts for, you know, depends on how well trained you are, but something like 24 to 48 hours. So you can very quickly do a little bit of rough math and say, okay, so if I'm strength training two to three times per week and I have a 48 hour post exercise rise in my capacity to dispose of glucose and I'm three times a week, it's like I've got myself covered for the week. Right.
- [18:08]
B
And that goes back to the walking because when you're strength training, you're also increasing bone mass. Right. Bone density.
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A
So yes.
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B
What actually. So women lose bone mineral density as they age because we have estrogen receptors on the bone. Correct. And that. Yes. So obviously as we're weight training, you're pulling on the muscle, which pulls on the tendon, which pulls on the bone, which you create stronger bones. Which is, by the way, what we need if we're building for, you know, let's just say we're building muscle for. And bone for when we're 80 is going to help us get up out of a chair, be more mobile and prevent us from falling, which is, I think, what the number one cause of death over the age of 80 or the second.
- [18:50]
A
Yeah, yeah. I mean it is, it is a major category for sure for not being able to live independently anymore. And I think just as a point of clarity, when we're thinking about estrogen and its, and its function on bone. So estrogen is generally an anabolic hormone, so it's involved in growth just like testosterone. They're both anabolic hormones. And one of the things that estrogen does specifically when it comes to bone is it tampers down a certain type of bone cell called an osteoclast. So there's two types of bones. There's an osteoblast, which is a bone builder, and an osteoclast which resorbs the bone so it breaks it down. Estrogen will almost like hammer down osteoclastic activity. So in midlife, as we start to lose Our estrogen, the hold, the chokehold, if you will, that it has on osteoclasts, begins to weaken. So we start to see a general increase in osteoclastic activity, which is now when we think about the balance between osteoblasts and clasts, we start to see, you know, the scales tipping unfavorably for us, which is why it is so important. This is one of the things that one of the benefits of hrt. Right. So when we are taking estradiol or estrogen as hormone replacement therapy, that can help augment or slow down bone loss. The other thing that I think is really important to pair that with is impact. So as you mentioned, the strength training pulls on the muscle, which is the muscle turns into a tendon and the tendon attaches to the bone and we pull in the bone. We have fibroblastic growth fact, all these things that are going to help positive bone turnover. And our bones are like full body scales. When you are doing box jumps or sprinting, let's say on a track or on a treadmill or something, your bones can feel that weight and they will pause. They will naturally upregulate osteoblasts. So the bone growing cells. This is why we need impact as well. So you can't do impact every day. Right. This is not. We're not guys. Women are distinct in many ways from men. And we want to be thinking about at least something like once a week where we are thinking about impact. So that might be a weighted vest. If you are a walker with your weighted vest, that might be jumping with your weighted vest.
- [21:20]
B
Now, do I have to jump with weights? Because there was a really great study that I actually put out there which showed that women who were osteopenic just jumped. I don't know how they were jumping, but it was calisthenics. It was not probably just low body weight. And so women who jumped three times a week for 10 minutes went from osteopenic to normal bone mineral density.
- [21:42]
A
How fantastic is that?
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B
Yeah.
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A
How amazing are our bodies? So you don't need to jump with weights. So I would actually. So I would say generally, if someone's listening to this, like, oh my God, now I gotta sprint with a weighted vest. That's not what I'm saying. We always wanna think about, and this is true for weightlifting as well, form first before load. You always want to think about executing whatever activity you're doing, whether it's jumps, sprints, box jumps, squats, lunges, deadlifts, whatever form has to Be pristine. And then we progress to load. Then we can put some weights in your hands, then we might put a weighted vest on, et cetera. But you can, as you just mentioned, with your own body weight, you can completely change the trajectory of your bone mineral density.
- [22:28]
B
That's so interesting. And that's what I love, because I want. What I really want as a prescription for health, especially brain health, is two times a week is minimum. Like, you know, you don't have to. You don't have to go crazy. It's two times a week doing your compound movements, your squats, your deadlifts. Obviously, if you can get a trainer, do that would be great. Or you can follow people on apps. Then you've got your. Your jumping. Where do you sit on VO2 max and zone two. So I. I have this. I've been really crazy, I think, the last few months, but as I read more and become more aware of midlife women and time is really of the essence, I put out a statement saying that stop doing Zone two. I didn't say it because I want everyone to stop walking or stop, you know, going at that low zone, but I really spoke about the fact that Zone 2 is really marketed. It's marketed for everyone, but it should only be really marketed heavily for men.
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A
Right.
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B
And, you know, Inigo San Milan has been on the podcast, and we know that Peter Attia is a huge proponent of Zone 2, and they are men. So why do you think women should not ditch Zone two? But maybe, you know, what's. What is it about Zone two that isn't, you know, in their favor? And it does have to do with mitochondrial density, right?
- [23:46]
A
It does. And there's gonna be. What I'm gonna say now is probably going to upset many people, but we. So this one thing is the individuals that you mentioned, I have a lot of respect for them and the research that I do, but they are also men. So they are doing protocols that have. Where there's a robust amount of data for men. Zone two is attractive because it's easy, of course.
- [24:11]
B
Like, walking.
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A
Yeah. Like. And I'm not. I love walking. I walk. I walk. So I walk as well.
- [24:17]
B
Stephanie walks.
- [24:18]
A
Yeah, I walk. I'm not saying not to walk. The one thing that I get really riled up about, and it's probably one of the hills I'm gonna die on, is this idea that women are not putting in the appropriate intent and intensity to their work. And this includes strength training. Like I was saying to you, the name of the doctors, it's. It doesn't matter. But she had put out an Instagram post saying, I'm gonna quickly build muscle and this is how I'm gonna wear my weighted vests. I'm gonna do some kettlebell swings and I'm gonna do. What was the other one? It was like goblet squats and I'm gonna do two sets of goblet squats a week. And I have a 20 pound, or maybe it was a 40 pound kettlebell swing. And I think that the women are so confused because they have someone like who has an MD behind her name saying, here's how you can build muscle quickly with things that are not going to build muscle at all. So we can talk about walking. Weighted vests do not build muscle. They're great for an increased caloric burn, increased metabolic benefit. For sure. They're not going to build much muscle. There's no evidence. And I did a whole series on weighted vests because I love weighted vests. But there's a lot of misinformation about them. So weighted vests are not going to do it. If you're doing goblet squats or kettlebell swings one to three times a week at a set because you have that one kettlebell in your home. This is not progressive overload. Muscles do not. You need to continually challenge your muscles. They are organs of demand. So the more demand you make of them, the bigger or stronger they will get. They are not. You will adapt. So you will have a certain adaptation to two times, you know, two sets of whatever was that she was saying 20 kettlebell swings. But then you gotta jump it up basically.
- [26:06]
B
Cardio.
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A
Yeah, well, it's cardio. But then, but even if it does provide you some muscle building benefit, it's going to level off relatively quickly. Like you need to increase either the weight, so the load needs to increase, the reps need to increase, the sets need to increase. The time that you take breaks in between your sets needs to decrease. Like these factors of progressive overload I think are really missing from women. And this is where I still think that women, we are failing women because think that they can put on a weighted vest or they can do two sets of goblet squats twice a week and they're going to build muscle fast. And I was saying this to you in, you know, before we got going muscle building. You cannot Amazon prime your muscles. You need to really. This is a long day.
- [26:48]
B
I wish we could because I'm, I'm on. Every time I go into my apartment, my doorman's like your Amazon boxes have arrived every single day. And if. I wish I could do that.
- [26:57]
A
Yeah, me too. I wish it was that easy. But muscle, you have to really work hard. Yeah, it's hard work. And so a lot of women will pick up the same £15, the same three sets of 15 that they've done for the past 10 years and they're like, I don't know why I'm not building muscle. It's just, maybe it's not just for me.
- [27:16]
B
Maybe a bit of a personal question. And I'm sure you're strict on your protocols. I'm sure you're writing in a diary.
- [27:22]
A
You have an app. Yeah.
- [27:23]
B
Yeah. Okay, You've got an app that's writing in a die, right? I know, I'm so old. Old school. So can you just walk me through maybe not yours, because you, maybe you're a bit more advanced. Walk me through What a typical 45 to 55 year old female should like. What is a good set or what is a good lower body workout for you to say? That's great, you did well.
- [27:47]
A
Fabulous question. One of my favorites. Okay, so I would say first of all, you can get fantastic results with two to three times a week of weight training. For me, lower body, again, intent and intensity. Maybe the most intense days of my training is legs. So keeping that in mind, I would say an ideal workout for a woman if she's just starting. Assuming that we have her body weight form like Chef's kiss, pristine, she can do it. There's no ankle mobility issues. We have no knee osteoarthritis that we're dealing with. We don't have any, any discrepancies left to right or if there is, we've been working on that to correct it. I would say some kind of squat where you are maybe utilizing. I really like to utilize tempo, so I like to get down in the squat and hold it there for a moment because it's the hardest part of the squat is not at the top.
- [28:46]
B
It'S at the bottom. Would you say some kind of squat? Are we talking barbell?
- [28:51]
A
It could be a machine. So there's machines where they're. And actually for a beginner, I would, I would never put, I would never start a beginner at the, at a barbell. Oh, yeah, it's way too complex for her. I would say starting her off on a machine where there's a predicted line of motion that's going to happen and she can toggle the weight with the sticky thing. Yeah, the pin. Yeah, we Would start there, I would say, some type of squat, a pause at the bottom so we can actually train the weakest. So your glutes and your hamstrings and your quads at the bottom of the squat have to work the hardest because that's where they have to contract to get you back up. There's really no work being done when your legs are straight in a squat. So some type of squat, three to.
- [29:34]
B
Five reps.
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A
Depends on the goal. So if we're talking about a power or strength goal, three to five reps is wonderful. So that's gonna be. At three to five reps reps, you're going to be probably 80 to 90% of your one rep maximum there. If you are not comfortable with that, because that also can have. At least initially for a beginner, there potentially could be higher risk of injury there because the weight necessarily has to be heavier. 3 to 5 reps, you might start off at a 10 to 12 or a 12 to 15. The only thing I care about is if it's 5 reps or 25 reps or 30 reps, I don't actually care.
- [30:16]
B
Oh, wow.
- [30:17]
A
The only thing I care about is that you're within one to three reps of failure. And when I say failure, that means that you can no longer do full range of motion anymore. The velocity of your repetitions are slower. So rep the last rep that you do, you struggle to actually complete the full range of motion and at the same speed that repeat rep1 was done at. And then I would also say subjectively, the weight feels a ton heavier at the end of the set than it did at the beginning. And the research is pretty clear. Five to 30, it actually doesn't matter in there when we're thinking about muscle growth specifically. So strength is a different conversation. But muscle growth specifically, 5 to 30 reps, as long as the set is taken 1 to 3 reps from failure.
- [31:04]
B
I love that you must be friends with Stu Phillips for you to say that. So, okay, so let's just. Okay, rep side. So then what about sets? And we're looking at around three sets or four sets.
- [31:15]
A
Three is. I would actually start everybody usually at three. And then if you want to progress. Right. So once three becomes relatively easy for you, another set would be appropriate.
- [31:25]
B
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- [34:31]
A
And if just before we move on, I would love to say that if you want to look at biomechanical geniuses, go to a playground and watch a 2 year old get down in the sandbox. They will just get down in a full squat and they'll observe the sand, the bugs, and they'll stay there forever. So. So we all are born with this ability to do a full atg, ass to the grass squat. But we lose it once we start putting our children and we start school right. We're sitting for eight hours a day. There's one hour of recess when maybe it should be the reverse. Maybe it should be eight hours of activity and then one hour sitting. But that's neither here nor there. But we are all born with that biomechanical ability to be in a full squat. So I'll just say that. So squat. The next thing I would say is some type of hip hinge. So that could be a deadlift. I love deadlifts. They are, I think they're such a functional movement. We are always reaching down to pick up something on the ground and lifting it to the counter. We're getting our groceries and we're, you know, and we're bracing and we're moving it into the home. So I think deadlifts are a wonderful exercise for us to master. Again, like the squat, very technically difficult. It is a full body, just like this one. It is a full body movement. Like you have to engage your lats. Like the lats have to lock and load in order for you to hold a bar. If you're doing it on a barbell, you have to be able to think about elongate. Like your knees. You know, there's many different types of deadlifts. If we're talking about a Romanian deadlift, your knees are going to be slightly bent. I always say, you know, push your butt back as if you're closing a car door, right? So pushing your, like being able to elongate again, again, lengthening the glute, lengthening the hamstring. This is more of a posterior chain and then being able to, with those muscles bring you back up again. So you're not moving the compensation, you're not compensating and moving it into the back. So hip hinge. I actually Love. So both of those exercises are examples where the movement is hardest when the muscle is lengthened. Another one, especially for lower body would be a hip thrust. So this is oh my favorite. They're so great. There's such ego boosters.
- [36:49]
B
Yeah, I love it.
- [36:51]
A
You can lift multiples of your own body weight, but this is a very, this is very much targeting the glutes. So if you are looking to build glutes, this should be a mainstay in your program.
- [37:01]
B
It's the non surgical bbl.
- [37:03]
A
That's right, yes. It's like you can do surgery if you like, but you can also naturally build it in the gym. And this one is the hardest part is when the muscle is shortened. So when you are coming up. So if you have a barbell or you're maybe you're on. There's lots of machines now. So like a glute drive type of machine, the hardest part is actually when you're squeezing at the top. So you start off with your butt on the floor and then you lift the barbell or the weights all the way up. And now we have contraction and shortening of the glutes. So I would say again, to make it harder, a little squeeze at the top. Right. So that's an example of a work, an exercise where the hardest part is when the muscle is short. And then I love unilateral work. So I think that this is where we can actually tease out compensatory.
- [37:55]
B
I love that. Because it's good for the brain, right?
- [37:57]
A
Yes, it's good for the brain. And then if you're doing, let's say a lunge or a Bulgarian split squat, you can play around with where the load is. Right. And work on anti rotation as well. So.
- [38:05]
B
Yeah, so that's not hard at all.
- [38:07]
A
No, there's four exercises and you do that once a week, twice a week. And you've got glutes that walk out two minutes of the room after you do.
- [38:14]
B
And the stronger the legs, the stronger the brain, right? Yeah. So everyone should be doing that. You've really like solidified why you've called muscle a silent flex. So I love this. I want to now get out of that and actually move on to some nutrition because it's always, you know, it's something that I always struggle with.
- [38:36]
A
I think everybody does.
- [38:37]
B
Yeah. Especially midlife when by the way, again, how much like how many different opinions are we listening to?
- [38:45]
A
Right.
- [38:45]
B
You know, we've got the, we've got the vegans, the ideologists, we've got the omnivores, we've got the carnivores, we've got the. What do we do?
- [38:51]
A
It's like, we've got. The kale is going to kill you. Oats are for people who have no money. You know, it's like, yeah, yeah.
- [38:59]
B
So instead of what to eat, I took a poll and this was on Instagram, and I get this question. So many women say, I'm eating the same, I'm moving the same, but my cholesterol is climbing, I'm gaining belly fat, I feel insulin resistant. What is actually happening physiologically to these women and why do we see this trend, this upward trend in LDL if we're doing the same thing as we always did?
- [39:25]
A
This is probably the most common comment that I get as well. It's like I'm. I'm doing the same program that I do when I was 35 and I'm 45 and now I have a belly. And I don't understand why if I'm the same calories, I'm doing the same classes, I'm doing the same. Couple things are happening. So one, we talked, we touched on it before, but I think it's worth mentioning we have body composition changes that are being driven hormonally and there's also the lifestyle component. So the hormonal part of it is we have a overall decline in midlife in estrogen. And of course, when you're menopausal, it is a sharp, you know, we go down to 1 to 2% of what we once had. And so estrogen, when we're thinking about this in the context of body composition changes, the way that we distribute fat. So when we are putting on fat, when we are perimenopausal or younger, typically we favor subcutaneous fat. So, and for women, we tend to put fat on in the lower half of our body. So bum, tum, thighs, all the areas that we have a general disdain for, like, we're like, we have to just reduce our fat. It's usually you're talking about your thighs, your butt, your stomach, okay, when. Or your lower stomach. When we start to lose that estradiol, we tend to start accumulating what's called visceral fat. So this is fat now that's not sitting underneath the skin anymore. It's actually piling on top of the organs. This is where a woman is going to say, I'm losing my waist. Like, my waist is thickening, so I'm starting to get thicker through the middle. This is the belly fat. That everybody doesn't want the muffin. Like, there's so many derogatory sort of ways to describe it. But generally, women will say, I've lost my waist. I feel like there's this midline thickening that's happening. And what's happening here is we have. With that decline in estrogen, this is, by the way, I should say, independent of aging. So your loss of estrogen, it doesn't matter if you're 47 or you're 52 or you're 55, it's the loss of estrogen that's driving that ectopic fat distribution, that central adiposity that I'm describing.
- [41:32]
B
So it's solely driven by estrogen, estrogen loss.
- [41:37]
A
And this is where some HRT can be helpful in terms of. Of redirecting or maybe slowing down the accumulation of visceral fat.
- [41:49]
B
I just want to point out something that Dr. Vonda Wright said on the podcast, which I love. She said there is three inevitabilities that women, every woman on this earth, will go through, and that is death, taxes, and menopause. So no matter what. And when she said that, I was like, right, so no matter what, we're all females. We're all going to go through this phase, and then we're all going to have this redistribution of fat. That's scary.
- [42:20]
A
It's scary. And it's a yes. And so we have this change. And you can help you with the lifestyle levers that we've been talking about with the strength training and the.
- [42:32]
B
But it's just going to get harder.
- [42:33]
A
Okay, so what.
- [42:35]
B
Because you're like, we can mitigate that. But you know, with the strength training. But I can only imagine, because I'm really looking right now, now on a flywheel. But then the loss of estrogen really means that everything gets exponentially more difficult because you're having fluctuations in sleep architecture because of the loss of estrogen, that sleep then impacts next day. The way that you're going to turn up to the gym and how you're.
- [42:58]
A
Insulin sensitivity.
- [42:59]
B
Insulin sensitivity. And it's this cycle. So everything is really going to get harder. I've got to savor the years that I'm in right now, huh?
- [43:06]
A
And dial in your strength training and your sprint, because these are both anabolic. So the more muscle you have, again, it's the volume and the quality of the muscle that you have can also help mitigate that. So what we find generally is individuals, women who have been strength training using the principles of progressive overload. Like we've been talking about one to three reps of failure. Maybe they're doing something anabolic like strength training, sprint training, I should say, tend to have less of the derangements. Not to say that they're completely not there. But some of the vasomotor symptoms tend. It tends to be blunted. So we do see there is a direct impact. Like one of the things I just want to mention very quickly, if I can just to sort of pull this in, is every time you strength train, you are going to, again, depending on how well trained you are, you are going to unlock your own endogenous pharmacy of, I mean, myokines, which is something that maybe we can geek out on, but also your own reproductive form hormones. So you in order when you are building new muscle. By definition, you'll need to have more testosterone when you are strength training. There has been some studies that have shown that it positively affects the progesterone estrogen balance in the second half of the cycle if you're a woman who's menstruating. So you have these anabolic effects that take place somewhere between, you know, 10 to 48 hours after a training session. If you're more trained, you get less of it. If you're, if you're untrained, you get more of it. So the more well trained you are, the more often maybe you can work out in order to reap some of these benefits. But somewhere between 10 to 48 hours after your training, you're also unlocking your own capacity to produce some of these hormones. So I'm not saying that you should only do this or it's not only lifestyle, it's not only hormone replacement therapy. I think for the loss of estrogen, that, that change in body fat distribution, certainly the hormone replacement therapy and the weight training.
- [45:07]
B
Now, I said at the start, but I kept cutting in that we also see a rise in LDL cholesterol.
- [45:13]
A
Right? Yeah.
- [45:13]
B
Why is that? Is that because of also estrogen?
- [45:17]
A
It's the visceral fat. It's the visceral fat accumulation. Right. So the liver is now working harder to clear. So we will start to see this aberration in lipid for sure.
- [45:29]
B
That's interesting because we know that, you know, ltl when that goes up, I'm sorry, but we do see different parts of the brain that do get affected, which is why I always say that APOB and LDL are two of the things that you really keep at bay and low. If you're optimizing for brain health and trying to Stave off cognitive decline.
- [45:50]
A
Yes.
- [45:51]
B
All right. I'm going to move on to something that I hate talking about. Okay. I really hate it because maybe I just don't know too much about it, and that's fasting. I know you know something about fasting. Are you on the bandwagon of fasting is good for women?
- [46:05]
A
I've really softened my opinion of fasting. So I, many years ago, maybe circa 2017, 2018, was a bigger proponent of fasting. I have really softened my.
- [46:17]
B
Oh, me too. I'm so over it because of the so. And I know that there's. There's other people out there who really love it for women, but if you.
- [46:25]
A
Look at it, I don't love it for.
- [46:27]
B
Is that because of cortisol?
- [46:28]
A
It's a bunch of things. I think that generally. I will just make this comment that I think there are, again, many experts in the space, typically men, although there are some women who talk about fasting. Certainly, for sure. But I would say generally, men can do things. They can go low carb for longer, they can fast for longer. They can do more HIIT trainings in a week. They can be more aggressive with some of these protocols and be totally fine and actually thrive. Right. We see testosterone going through the roof. Their body composition changes. And women who try to imitate that. Most women, and I say this from a clinical lens, most women fall flat. And part of that is safety signaling. So when we don't, Women are very. We are much more sensitive to nutrients or lack thereof. And that can set off a cascade. And certainly you're gonna be able to speak to this more than I for sure. Around. Your hypothalam is going to essentially freak out, and you may lead. That may lead to menstrual aberrations. You may have cycles where you're anovulatory because your ovaries and your hypotheyour brain. Ovarian access is always talking to each other. And if you don't have enough food, your ovaries are gonna be like, this is a terrible time to get pregnant. We probably should not release an egg this month, because if she gets pregnant, there's no food, the baby, and maybe she will die. So.
- [47:52]
B
So there's a word for that. It's not amenorrhea. It's hypothalamic amenorrhea, I believe.
- [47:57]
A
So. Hypothalam. Yes.
- [47:58]
B
Is that the correct term?
- [47:59]
A
Yep. Yes, that's right.
- [48:01]
B
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- [50:54]
A
When there is lack of nutrients so we can see some of these menstrual cycle aberrations. You can also just as a general comment, because you're not getting in enough calories, your body is not stupid. So it will first for sure you can dip into your fat stores, but then eventually she's going to dip into bone, she's going to dip into muscle, she's going to dip into organ weight. And you don't want to to dip into bone or muscle or brain or any. You definitely want those things to be as heavy as possible, as dense as possible as we age. And this is actually a really big issue for women in general, in sport for sure. But I would say even just the menopausal perimenopausal woman, she's grown up like my cohort, let's say of women we've grown up in the 90s that gave us heroin chic and thigh gas and eating disorders.
- [51:48]
B
You know, we would starve. Starve yourself.
- [51:51]
A
And we would see these magazines where women would just be absolutely pummeled, like demolished. Their appearances would be demolished. Anyone remembers America's Top Model, that show where everything all about their body. So there's so many women that are my age that have grown up thinking skinny. Like I need to be skinny. Skinny is the goal always, always and forever. And so we really need to move the needle for these women in that we wanna be thinking about. And I know your question's about fasting, but if you will just allow me on my soapbox for one more moment. We have to be thinking about when we're looking at our diet and fasting can be a part of that. We need to be thinking about not what are all the things that we need to get rid of, but what are all the things that we need to include so that we can thrive and we're nourishing ourselves. And fasting can be and is abused, I think because it is essentially you're not eating. For some proponents, we'll talk about days on end where you're not eating and your bones and your muscles like those are going to be sacrificed at the altar of weight loss. So I think that it's really important that we reframe fasting. I like a gentle. We all fast, by the way, every day when we sleep. So we're already, everybody's already fasting about eight hours. Ish. If we're doing it right, somewhere between seven to nine hours, we're already fasting. So if you want to extend that a little bit on either end, maybe you want to augment your sleep so you cut off your eating window two to three hours before you go to bed. That's fine. Oh yeah, that's wonderful. So that's going to help your sleep. No problem. It's the 16, 8s, it's the Omads, it's the every other day stuff. I think that for, especially for women in menopause, I, I don't like it because it's very unlikely that you're going to be in an omad situation or longer. You're going to be getting in your protein targets, you're going to be recovering appropriately from the, if you're sprint training, you need to eat in it like before and after the sprints. Before and after the training you need to eat for performance. So it's very unlikely that you're going to be able to put all of those pieces together on a 16 hour fast.
- [54:03]
B
I, I believe so too. And I think on that note, I think a lot of women just don't know how or what to eat. I can't tell you that my, even my close group of girlfriends, they wouldn't even understand what I meant if I said, are you having 100 grams of protein per day? So I think that's another, that's a whole other segment where, you know, people don't even know how much they're eating. I speak to my mom about this almost every day and I'm like, did you have protein? I had chicken for dinner.
- [54:30]
A
Right.
- [54:31]
B
You know, it's like, that's like, how much? Maybe 30 grams of protein right there.
- [54:35]
A
40 if she's gotten 4 ounces.
- [54:38]
B
Do you see what I mean? So it's under fueling as well. I think that's another thing. Under fueling.
- [54:42]
A
It's a, it's a huge issue. And I think for many women, especially in midlife, when they've done these crazy diets or they fasted for like, your hunger signals become altered so you may not feel hungry even though you need food. Right. So you have this metabolic adaptation when you've calorically restricted for years and years and years, you might not actually feel hungry in the morning when you technically should feel hungry when you wake up because you've gone for many hours without eating.
- [55:09]
B
I'm actually not hungry when I first wake up. I can't stomach anything, but I do, I do. Now that brings me to my next point. Ozempic, Tirzepatide. Now we have a tripeptide, I forget the name of it. So this is on the rise. And look, I really believe that this is doing wonders for metabolic health. We've seen advancements in Alzheimer's disease. I think it's all because it's fixing Parkinson's. Parkinson's. Well I think it's because it's fixing insulin resistance. Obviously obesity epidemic probably going to go down. That's a risk factor for all of these diseases. But we do also have a problem of under fueling and getting somewhat skinny fat. Have you seen in your practice, have you seen women who have taken this?
- [55:51]
A
So I have thoughts on Ozempic. I think, I think to everything you just said, I'm 100% aligned with that. I think that as a society, I mean all you have to do is just if you're in a car or you're walking down the street, just look at how many fit people you see on the sidewalk. It's a rare event. And I think that the Ozempics, the Mounjaros, the Tirzepatide, all of these medications are incredibly useful here. And it's another yes and so yes to the Ozempic. And you are gonna lose fat when you are on these medications. And if there's a mismanagement, let's say there's a dosing mismanagement and that's usually a practitioner issue. You absolutely will sacrifice lean tissue as well. So we have to make sure that. And this is where the strength training is so important and the protein targets are so important like above all else when you are on some of these medications, like get on the medication if you need the medication. Like there's some really cool research on like the regenerative properties of them as you mentioned for brain health. And you need to be strength training. You need to put, you have to put this tissue under mechanical tension. So you're signaling to the brain. We need to keep these muscles, these muscles are important. Look how often she's working them. We're going to preserve them. You're going to do that through activity and you're also going to do that diet like from your diet where you're going to be consuming protein. So the protein I would. And if I can, I'd say protein and fiber. Protein and fiber targets. But more for muscle, for talking but just about muscle preservation. It really just is making sure that you're Getting your protein targets, you definitely want to prioritize that above everything else.
- [57:31]
B
I want to just stay on this for a second because I think I'm at the stage in my life where I actually need an app to help me understand how much protein I'm having. Right. And I used to do this way back in the day with myfitnesspal, but now I've realized that there is, like, there's AI versions of this app. So what's the best way a woman can track and measure her nutrition?
- [57:55]
A
I think it depends on the individual. So I will say that tracking is going to be very data driven and it's going to give you the best information. And for some women with histories of eating disorders and restrictive eating, this can also sort of bring up a little bit of that. So I have found, even in my own practice, when I have counseled patients to use apps, they start to get in their head a little bit. So I would say that if you don't have a history of an eating disorder, I think apps would be a great place for you if you are worried about that or if you're just like, I'm not gonna take a picture of everything I eat and I'm not gonna weigh everything on my counter before I eat it. You can also also generally look at a plate and say, is half of my plate vegetables, a quarter of it protein, and the other quarter of it maybe is a carbohydrate. That's one way. The other way is you can just use your hands. So this is about a cup, right? This is about a tablespoon. So you want about a cup of vegetables or two cups of vegetables. This is about a protein serving, like about 3 ounces. You can maybe go sort of the entire, including the hypothenar and thenar muscle. Like, this can be a protein serving. And then, you know, a tablespoon of, you know, olive oil. You know, the distal phalange of the thumb.
- [59:13]
B
The distal phalangea of the thumb. I love that. I want to know, what is it that you think we're getting wrong and what makes you so passionate about female health? Like, what is it that we're getting wrong when we separate? By the way, I never used to do this. I was a triathlete. I was racing with or training with men. Obviously, I was racing with women. So we didn't know that there was a difference between men and women 15 years ago, 20 years ago. But what do you think we're still getting wrong?
- [59:41]
A
I still think we're getting wrong. Calories. I think women are deathly afraid of food. Still. I have a coaching program that I run and when we talk about when we have them calculate their total daily energetic expenditure, they're floored. They're like, there's no way that I am burning 2400 calories a day because I'm only having 1100 calories a day. It's like, that's the problem. That's the problem.
- [60:07]
B
So women need to eat more.
- [60:09]
A
Most women need to be eating more. What I have found over and over and over again is when you're smart about it and you can maybe slowly start to increase the calories that you are consuming, women end up losing more weight, the weight that they want, and recomping like the body composition goals that they have when they're actually consuming more calories. So I do want to just, I think that we're getting the calories wrong. And then the other piece that we're getting wrong is the intensity in the gym.
- [60:40]
B
Oh, that's the biggest one.
- [60:42]
A
I think you have to be moving close to failure. If you've done the 3 by 15 with the like 3 sets, 15 reps. Reps, the same 2 pound, 5 pound, 10 pound weight for the last 10 years. Like you're not doing anything anymore. You're, you're regressing, you need to, you need to progress, you need to lift either heavier weights, you need to do more sets, you need to do more reps. Like something has to change. I always say jokingly to my friends, but I'll share it with you and, and your audience. Like, if you're not making sex noises when you're, when you're training, you're not do, you're not working hard enough. So, so, and I joke when I say that you don't have to, but.
- [61:18]
B
You know, I love that. But there are some people at the gym who are so aggressive and they throw their weights. And I tell you what, I get so angered when they do that.
- [61:27]
A
Yes. Or if they don't put their weights away after they're done with a machine, it's like, that is rude.
- [61:33]
B
I just want to end with your take on supplementation. We speak a lot about omega 3 fatty acids, of course, creatine, vitamin D. I attack it from a brain health perspective. Other than whey protein, what are the supplements that you would recommend that can help with muscle building, muscle architecture?
- [61:55]
A
Creatine. 100%.
- [61:56]
B
Yeah. How many grams are you having?
- [61:58]
A
I probably have about 10. Yeah. I had Dr. Darren Kandel on the show and he convinced me. So I was taking five before he came on the show. I was like, for muscle benefits. He's like, okay, great. And if you take 10 now because it has a harder time getting across the blood brain barrier now, you're gonna start experiencing some of the brain benefits. So I take 10 grams daily, but just start off with five and you can, you know, play around with what you. I think 5 grams for most women you're going to get some of the muscle benefits, but brain benefits start at about 10 and even I've actually had a couple of friends playing with higher doses, like 20 grams daily. So I don't know if I'd go that high. But 10 is where I am.
- [62:36]
B
Yeah, they've dosed NFL athletes pre game with 20, 25. And that's really to stop the, you know, the post traumatic insults. It acts as a neuroprotective agent. But they're getting hit at really hard velocities with really heavy helmets.
- [62:52]
A
Soccer players probably too for heaviers. Yeah.
- [62:55]
B
I think if you're a female and you're doing it for first and foremost muscle health.
- [63:00]
A
Yeah, but you five, you need five for muscle.
- [63:02]
B
Muscle, yeah. And then if you want to get the cognitive benefits, I think 10 and you can separate it, you know, you can do five in the morning, five at night.
- [63:08]
A
That's what I do. I don't take 10 all at once. I do five in the morning and I do five in the morning, in the evening or after late afternoon. So I would say creatine. I think that every woman should be taking an omega 3.
- [63:18]
B
Yeah. Why?
- [63:20]
A
Systemic anti inflammatory benefits. I'm sure you can speak to the brain benefits again more eloquently than I can. But I think systemic cardiovascular protection, again, biggest killer in women. It's not breast cancer, it's CVD cardiovascular disease. So Omega 3s somewhere I take 2 to 3 grams of a day. That works for me. So I would say 2 to 3 grams of omega 3, I would say at least 1.2 grams of DHA in there as well for the brain benefits. So omega 3 creatine, vitamin D I love for women, magnesium and then the other one that is a bit of, I wouldn't say it's not part of my foundational stack. But maybe once you have, you know, you're taking the omegas, you're taking the creatine, you're taking the vitamin D and the magnesium. I would actually look at urolithin A.
- [64:10]
B
Oh, I just posted about this.
- [64:13]
A
Yeah, I love urolithin A. Yeah. So really cool.
- [64:16]
B
Really.
- [64:16]
A
I actually think in a couple years, urolithin A, we're gonna. The way that we talk about creatine now for all these systemic benefits, I think we're gonna be talking about that.
- [64:23]
B
With urolithin A, I just think the compound is phenomenal.
- [64:26]
A
Super cool.
- [64:27]
B
Yeah. It helps with mitochondrial health and it's one of the biggest, greatest compounds right now. Studied in longevity but sourcing. And by the way, I tell everyone this. Sourcing your products from high quality manufacturers and where you get your products from is what counts if you're just getting it on Amazon.
- [64:45]
A
Never buy any of your supplements on Amazon because we don't actually know where they're coming from. There's a really poor quality. I know it's super convenient. You can get a T shirt while you're there as well. But I would say if you can buy it directly from the companies that you trust to your point. Because who knows? I mean, who knows where they're coming from? Quality control. There's a lot of fraudulent supplements there that are saying, oh, we're this company, but they're really just some random factory in China. Like, we have no idea.
- [65:15]
B
Yeah. And they've done a study on that, which is quite scary. You've given us so much to think about. Me especially. And I love how you connect biology to empowerment because I think that's what we all need. You've really inspired me. You actually do. I watch you every day on Instagram and I'm like, oh, she's. She films herself. You, Everyone should follow her. We'll link everything below your coaching community. But I follow you because you actually inspire me. I'm like, damn, I gotta go to the gym. And she's always looking great when she's doing it too. I'm like, how, how do I look this good in the gym? It's so lovely to sit down with you in person. Thank you for being part of the Euro experience.
- [65:49]
A
Oh, thank you. It's been a blessing. Thank you. And Doug Limu and I always tell.
- [65:59]
B
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A
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B
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A
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B
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A
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