← The Revive Stronger Podcast
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- [00:01]
A
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B
if you're listening to this podcast, you are probably a man because the vast majority of listeners are male. But you very may well coach women or at least you have a mother, potentially sisters. You have friends who are women who are going to go through eventually in their lives menopause. And that's probably something everyone has heard of. But I personally, obviously not obviously necessarily, but I had very little experience with it and I didn't really know too much about it. I started doing some research to try and find who in the kind of evidence based space who I know, know and trust have looked into this. And Bill, you're one of those people that came up and there's so much noise actually online. As I started looking on social media, I saw various posts coming through of just like almost like menopausal kind of influences at this point. And I was not pleased with some of the stuff I was seeing. And I think it was leading to a lot of confusion for a lot of people. And you seem to be cutting through the noise. And that's really what I want to do today is kind of look at what actually changes during the menopause. What do women need to be aware of? What do we maybe as men need to be aware of to help others? And first of all, I guess, Bill, you're also a man. What led you to kind of looking to investigate this further and kind of. Yeah.
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A
So thank you for the, for inviting me on. I think this is my second, third time on the podcast, so I'm very excited. Yeah, yeah, at least. And I think I've always enjoyed chatting with you. Menopause was the furthest thing from my mind and your mind. So a lot has changed for me professionally in the last few years. But just as a note to all the noise online, I've heard it described that menopause is kind of like a gold rush. And it just people are jumping into this area for financial reasons and I can see that because middle aged women tend to make purchasing decisions. They have higher income at this stage of life. So I wouldn't doubt that the more sinister elements of predatory products services have flocked to this. So not surprising, sad, but not surprising in terms of what got Me interested in this. Let's just go back 10 years or so and I'll start with again. Four years ago, this was the furthest thing that I was interested in. I mean, I probably would have rather studied injury rates with toothpick use than study menopause. It just, I had zero interest in it. But going back 10 years, I've always been a fat loss researcher. So I started my fat loss research career as a grad student. We did a lot of research. My entire doctor doctoral studies were funded by a fitness company who served women with obesity. So that company was called Curves for Women. So I had done literally probably in the thousands of DEXA scans on women with obesity, fitness assessments, drew blood. I did it for like four years during my PhD, just a lot of obesity research. My true passion was bodybuilding. So when I got out and started my own lab, I still stayed in this fat loss muscle building realm, but I wanted to study female physique athletes. So that's what I did. I did a lot of resistance training studies in females and a lot of case studies or case series studies in women. So I've, I've tested as an example top level Olympia bikini competitors, like in my lab doing body composition metabolic rate assessments. So in my career I've spanned women with obesity to literally top five Olympia bikini competitors, studying fat loss, learning about how they maintain muscle, etc. So I have all of this fat loss context. And on and off throughout my career I would do what you do professionally. I would coach people. Now I never did this professionally with bodybuilders, so my career started as a personal trainer. So I did that for a few years. So many hours in the gym, you know, just personally training people, but working with bodybuilders as a coach again. And the reason I did it, I often didn't even charge people because I just knew it made me a better scientist. Like I, I want, I want to know what questions I should be asking. And that has served me very well. So one of my clients, if you will, was my wife. And she wasn't really a client, but throughout our marriage she has wanted to lose body fat sometimes. And I would always help her. My wife's pretty fit, has always lifted weights, so she, you know, she would gain five pounds and want to lose it. So I would be the one to write her program, workouts, diet, and just like you would expect, she's in her 30s, she loses weight every time we put her on a deficit. 40s, early 40s, no problem. And then she's starting to go through menopause. I didn't know this. She didn't know this, but she couldn't lose weight. And she's like, hey, can you help me? I'm like, yeah, of course. Like, we've done this before. And I, I vividly remember getting her calories down to about 1100 calories, which was pretty low for her. And her body would not respond. Now that's an end size of one. That doesn't mean that I throw out. Oh, calorie deficits don't work. I don't believe that today. But I was like, this is very, this is shocking to me. And as I reflect back on that time, I can't tell you, most of my followers historically have been female. For whatever reason, women just love me. I know you're not surprised by that, but now I, I just, I've always had more women as followers, even though my research, you know, wasn't solely focused on women, but, but more so. And there were many, many times that I disregarded women who would reach out and like, hey, you know, this isn't working like it used to. When are you going to study menopause? Like, things are different. Like you, you say all this stuff, but, you know, and it used to work for me, but now it doesn't. And I just didn't take it seriously. But then when it happened to my wife, it's literally staring in front of me. And then I started to talk about this publicly about just the, what I, what I would call weight loss resistance. And as soon as I started talking about it publicly, it is literally like an avalanche of women. And I've had thousands and thousands of conversations online about, hey, I used to diet, would lose weight predictably, and I cannot do that now. So there's a very long answer with as much context as I can give to your very short question about why I'm, why I'm interested in this.
- [07:53]
B
I think that background's great though, because it, it shows how much experience you have with fat loss and with various populations. And now it's like a very, I say very niche, but it's not really a niche because I mean, any women kind of later in their lives, like 50 plus are going to be in this. Well, I guess they're going to have gone through the menopause out and perimenopause. So it's interesting now, I guess your kind of life just took you in that direction and this weight loss resistance. And obviously as an evidence based practitioner, we kind of know the law of thermodynamics and calories in, calories out. And obviously we also understand how much more complex it is than that. And so it's definitely an interesting area. And to hear, hear that your wife, obviously you had coached her and nothing like she'd always lost fat very simply. And then suddenly, all things being equal, apart from she's now older and then going through some of those hormonal changes, now she's suddenly not able to lose the weight. So it feels like something there is going on. I guess it would be useful. I think this might be useful, especially for those less of the know of these things. Difference between perimenopause and menopause or for the business.
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A
And one other note about my wife, when this was happening, we were so ignorant. She didn't know she was going through menopause. I didn't know she was going through menopause. So we had no, no, I don't want to say biases. Like we just knew something was off. And I also want to say her in a. She gained weight. She probably gained 12 pounds or so, which isn't a lot, but when you've been fit your whole life and you gain 12, 10, 12 pounds, it's a lot of weight to that person. Um, the. And again, I'll just say that what was just what, what really made me stop was, why can't she lose this fat? And again, so I'm now bringing my work home. I'm like, this is, this is odd to me. So pre menopausal, you're typically going to be premenopausal on average until your mid-40s. The transition from being premenopausal to post menopausal, it's highly variable. Maybe as short as one year, maybe as many as 10 years. But that's the transition where hormones and I'll define them and what happens to them in a moment. But that's the transition from going from pre to post menopause. Now, postmenopause means that actually happens on a single day. The day that you become postmenopausal is when you have not had a menstrual cycle for the previous 12 months. So if you have not had a menstrual cycle for 12 months, congratulations, you are now postmenopausal. This period before this, we would define as perimenopausal. And there is no blood test, there is no objective measure on perimenopausal status. It's very frustrating because when I first started studying this, I'm like, okay, what I need Black and white, because that's how my mind works. And studying this whole topic area, there is very little that's black and white. One thing is you're postmenopausal. When you haven't had a period for the last 12 months, I would love for there to be a blood test. So let's just talk about what happens hormonally real quick. So what typically happens is estrogen tends to be high throughout your reproductive years. And as you start going through perimenopause, estradiol levels start to go down. And then when you're postmenopausal, they're just low indefinitely. Fsh. Follicle stimulating hormone does the opposite. That tends to be relatively low. And then as you're going through the menopause transition or perimenopause, now that's high and that remains high when you're in post menopause. So that's, that's the, the main two drivers of hormonal changes. And the reason that we can't just say or that we can't just do a blood test is because those hormones are high, low, high, low throughout this phase of life. If you do blood work, you might be testing it on a day that your estrogen is high. And then it looks like, oh, yeah, you're not even close to menopause. But if you had waited four days, now it's really low. It's like, oh, yeah, you're borderline postmenopausal. So that's the very frustrating part scientifically, about trying to get blood work to define what stage you're in. Now when you're in post menopause, you can easily do this. Your estrogen's very low, your FSH is pretty high. So very objective post menopause. But the transition is, is, is very, just highly, highly variable. Now, do you want to go into what happens to their bodies? Is that where you want to go? Do you like to go there next? Or do you.
- [12:52]
B
Yeah, I just wanted to touch on the fact that your, the perimenopausal period could be years. It's like you said, it's highly variable and it's, it's something that, it sounds like it almost can creep up on you. You might not even really notice it. And then suddenly you're kind of in the mix of it when you start googling maybe some of your symptoms. And is that also where most of these symptoms occur that people talk about in terms of the hot flashes, night sweats, sleep disruption, migraines? And is it, do they continue. Once you've gone through the menopause, do they continue?
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So it's exactly right. So those are all, they call them vasomotor symptoms. Those are all signs of hormonal fluctuations or hormonal changes. And a lot of what happens with these does, does it does not continue the rest of your life. So even the body composition changes tend to level off, which we'll talk about them in a little bit. But the side effects, the hot flashes once you're postmenopausal. And now again, I'm going to say generally speaking, because there are going to be women who have hot flashes into their 60s or 70s, but generally speaking, yes, you kind of get through the turbulent perimenopausal phase and then even a few years into post menopause and then things tend to start to level out.
- [14:15]
B
Yeah, yeah, that makes sense. So, yeah, I think at least the way I always heard about it was people talk about the menopause and really they're talking about the perimenopausal like that time. Not that, I mean, it's just different words really, but just from my understanding, like you said, it's black and white. When you've gone through the menopause, that perimenopausal period is a little bit more complex. And that's where you're seeing most of these people talking about how not fun at time it is. At least that's always the framing I get. It's never framed as, oh, this is super fun going through this. So, yeah, I guess I think you were going to talk about some of the kind of the fat gain. Is it inevitable, some of this sort of thing? Why might be that occurring? I don't know where you want to start specifically, but I'd love to dive
- [14:59]
A
into that area and just to give a little context to this. The body composition changes are also highly variable. So what I'm about to say, I'm going to speak on averages. Some women will not experience the changes that I'm going to explain. Some women will have worse body composition outcomes. Also, one more note about my wife and this is going to be true for I think a lot of women. Her worst effects of going through this were not body composition related. She had other problems and she tried to hide this from me. We have two daughters. She didn't want us to know, but she was really struggling on just anxiety, depression, maybe not depression, but just not herself. And again, didn't really know what was going on. All I knew was, hey, I can help you lose body fat. But as it turned out, I was struggling in that realm. So I'm a fat loss researcher. So of course my focus is on this. So that's where my expertise is. But that's not the only change that is happening during the menopause transition. So what we know most, what, what is most likely and predictable is body fat gain. So, and you'll appreciate this, it is very hard to determine how much of the changes are occurring because of age or because of the menopause transition, because you can't separate getting older from a menopause or a perimenopause transition. And if you're going through menopause, you're getting older. If you're getting older, at some point, you're gonna go through menopause. So it's very hard to parse these out. And a lot of the science nerds, I'll just call them Internet scientists, cause they're not people that actually study this, but they have strong opinions. They will say it's only age and not menopause specific. And I think that that's a, that is an argument that you can make. And depending on what research you look at, you could defend that. And the research that I think is weaker is cross sectional studies where you have, you know, a hundred premenopausal women, a hundred perimenopausal women, and 100 postmenopausal women. They're all different women, all at different stages. And from that research, from observational cross sectional data, you could easily come to that conclusion. But I think the better science to rely on is longitudinal data where, and there's not, there's like a handful of these studies, but they started tracking women in their 40s when they're premenopausal and they track them for 5, 10, 15 years. And you're keeping your, your every year, you're, you're assessing the same person as they go through this. And what that data shows us is women are gaining fat as they get older, just like men do. But there is an accelerated rate of fat gain that occurs during the perimenopausal years. Now again, cross sectional research will not, you can't identify that. But if you know exactly when a woman has reached postmenopausal status and then you look back 1, 2, 3, 4 years when she was likely perimenopausal, most of this longitudinal data is capturing this. So there's, I would say the best science suggests that women will gain body fat during menopause. And in relation to that, it is not an equal distribution of that fat. Instead, it's an uneven distribution such that most of this newly gained fat is deposited in the midsection. We know that there is very consistent, is an increase in visceral fat and even subcutaneous abdominal fat. So there's a fat, we call it like male, like fat patterning because males tend to have more fat in the midsection. That's exactly what happens to women during menopause. Less fat is deposited in the lower body, more of it in the abdominal visceral region. And then let's look at one other compartment here, the lean mass, fat free mass, lean mass. This one is a little more nuanced in my opinion. Some of this longitudinal data, well, almost all of the longitudinal data, I'm going to say five out of the six studies that I'm aware of that at least track the same women over time will report a loss of lean mass during the menopause transition. One out of those studies says, nope, there's no loss here. Just like men, we're not going to gain lean mass when we age. So is it possible that the loss of lean mass is that aging, is that menopause? I don't know. I, I believe that it's. First of all, it's not massive. They're not losing lot, lots of muscle. So it's, it's, it's marginal loss. If I had to estimate based on the research, I, I would say, I think clearly aging is part of it, but I think the menopause transition is also part of it because I believe that estradiol is anabolic, especially for females, and you're losing that anabolic hormone or you're, you're having lower levels. So again, that's based on other randomized controlled trials. So I'm just trying to piece all of this together now. One more thought. Everything I'm saying from the moment I started this, the research is, is in, I, I'll just say normal, likely sedentary women. We do not have any research on women who embrace a fitness lifestyle. And that is what my lab is focused on, obsessed with. We want to study women who lift weights, who have lifted weights, who track their food, who do their conditioning, track their protein. And as they go through menopause. What is happening now, some of these women would say because they have more muscle. I think the claim is anecdotally, I've lost a lot of muscle. That, that may be true. And the, the, the potential reason is, well, they had more muscle to go into this phase. So that when their estradiol levels decreased, they now had a stimulus to lose more muscle. But again, this is my opinions not based on science yet. And, and when I say there is no research on women embracing a fitness lifestyle and menopause, I don't think there is any. And let me just for your listeners who are nerds like me, correct me, send me the studies because this is what I want. So everything I'm saying, how does it change for fitness women? And the one answer is they're much more sensitive to these changes because they've been fit and their body's changing. If you've never lifted weights, if you're not living a fitness lifestyle and you gain six pounds, I don't, you might not even notice that your performance might be going down. But guess what, if you don't train, you don't realize your performance is suffering. But fitness women do. So there's that, that's also needed context.
- [22:54]
B
Yeah, really well said. And I think it's just always important to understand the limitations of the evidence that we have generally. And that's a thought that came into my head with regard to this in terms of the actual like scientific body of literature that we have generally. I know women like notoriously understudied as it is. How the, with the research that's there and available at the moment, Bill, like how strong can we kind of put our thoughts towards that? Do we need much more research to say anything very strongly with regards to what has been researched so far?
- [23:27]
A
Well, let me just say globally speaking, nothing changes about the, the solution to these problems. Like okay, so you're going to gain body fat, you might, you may lose lean muscle. Well, what do we do about it? Well, the same thing that you and I do every day or that you work with, you live a fitness lifestyle. Which to me means the foundation of your fitness lifestyle in my opinion should be lifting weights. But you should also have a cardiovascular component. I like power and agility training because that, that goes down quite severely during this transition as well. So a well rounded fitness lifestyle, the foundation of which is resistance training. And I don't know if that answered your, did that answer your question? Like the, the solutions or the, the, the, the prescriptions aren't going to change. Now there are some, I do have some deviations on some fat loss strategies that, that may be best for this phase of life, but maybe not like I'm still, still. This is what my lab's actively studying right now.
- [24:42]
B
Yeah, I guess because I think like I know there's you've probably seen a McCante et al. 2026 was like a narrative review and I was essentially saying when you adjust for fat free mass, energy expansion doesn't seem to drop uniquely due to menopause. Just kind of saying, hey, your total calorie burn is like you're not seeing your metabolism damage or downregulate because you're going through menopause. Which then you could extrapolate that and think oh, it's maybe it's just like it's nothing. Regardless of menopause, it's other things that are impacting energy balance such as, I don't know, people are underreporting the amount of food they overestimating how much activity they do down regulations and non exercise activity, thermogenesis, I guess all the downstream effects of poorer sleep and what impact that would have on everything you're trying to do. So I guess do you feel that the changes that women are experiencing are less related to the hormonal shifts and maybe more due to the symptoms and the downstream effects that that might have on their kind of fitness lifestyles and their personality?
- [25:48]
A
Yeah. So that, that is the argument that is the crux of the discussion. Now one thing, you mentioned that study and you said something very telling. And I don't think I'm going to say, I don't think anybody approaches that data with what I'm about to tell you. But after I elaborate you're like well yeah, that makes sense. You said a word or a phrase. It was. Did you say lean mass adjusted? What was the.
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B
Yeah, when adjusted for fat free mass
- [26:20]
A
was the word to me that's very telling. If you have a hundred units of muscle and you have a hundred units of calorie burning, so you have a one to one and you lose 10 pounds of muscle and your metabolism now goes down 10 units one to one. It's fat free mass adjusted. Your metabolism hasn't changed at all. It's one to one. That is not true. Your metabolism has gone down 10 units. So that makes that fat free mass adjusted negates or disregards. Did they lose lean mass during this phase? Now the research suggests probably not a lot depending on which longitudinal study you want to look at. The best one that I've ever read, the most comprehensive in terms of time and precision of the annual assessments, that was the greatest amount of lean mass loss. So I'm not so quick to say lean metabolism's not going down because you're adjusting it for fat free mass, which is good. That's a Good thing. But that creates another interpretation problem.
- [27:39]
B
Yeah, that makes sense. Women are losing muscle mass during this period of time on average. And therefore of course their metabolism would downregulate along with that, which is going to have implications. So whilst their metabolism isn't damaged, it has adjusted down with accordance of the loss of fat free mass, which like you said, would happen for men too when we unfortunately have a sock.
- [28:01]
A
And what I just described, no scientist has ever mentioned. I don't even believe me. People try to argue with me and I don't, I don't even waste my time arguing, but nobody has bothered to approach that type of data. And a lot of longitudinal data on metabolic rate is corrected for fat free mass. And again, it's not a bad thing, but it does create. It also raises another question.
- [28:34]
B
Yeah, that's, yeah, very well said. I think, I guess you mentioned, I guess talking about women's ability to grow muscle during this period of time, you said with estrogen going down, they're a little bit less like hypertrophic for those who haven't already had a training lifestyle. So they haven't got much muscle already and then they try and grow muscle. Could they kind of negate some of this metabolic loss or negate the muscle loss? I'm assuming they might still be able to grow muscle.
- [29:04]
A
So just like when you're, you know, know, very elderly, 80s, a resistance training stimulus is a stimulus for muscle growth, for lean mass growth. So yeah, absolutely you can gain lean mass from resistance training optimized with adequate protein intake. I think though, the real question here is for women who've already been lifting for 10 years and they don't really change their workouts, do they? Are they able to maintain their lean mass? And this is where I'll rely on some other research. These are randomized controlled trials and I can send you the pmids or whatever you want for your audience if they want to check up on this. They had one study, I'm going to summarize two studies, but one study compared to early postmenopausal women, to premenopausal women. So I think it was like mid-50s to early-40s. And one group was clearly postmenopausal, but early, they hadn't. Within a few years they gave them the same resistance training program. And at the end of eight, 10 weeks, I don't remember the details, the younger women gained significantly more lean mass than the early postmenopausal women. So now it is. Well, yeah, not surprising. They're older. So it's Aging could be. Or is it the fact that menopause, the hormonal change, impacted that. So that study alone doesn't tell us much. So I'm gonna. Now I'm gonna go to a completely different study. In this study, they had two sets of early postmenopausal women. One group of women got an estradiol patch, an estrogen patch. The other group got an estrogen placebo, put them on the same resistance training program, and the group getting the estrogen patch gained significantly more lean mass than the placebo group. So that tells me estradiol was clearly anabolic in a randomized placebo controlled trial. I use that to inform me of that. Of the first study, I said, well, there probably is not just aging is involved now. It's one, you know, two studies. I'm using one to interpret the other. But yet these are not. Again, a lot of people will look at cross sectional studies and say menopausal women can gain just as much muscle mass as premenopausal women. Well, when you're looking at cross sectional, nutrition isn't controlled, length of program. Like, there's just so many things that aren't standardized or controlled. So I put a lot more weight of the evidence on these randomized controlled trials. But I appreciate if you don't. If you don't do that and you're looking at cross sectional data, you will come to a different conclusion.
- [32:11]
B
Hi, guys. Steve here. Just wanted to take a moment of your time to remind you of our online coaching service. At Revive Stronger, we pride ourselves on providing personalized service that will take your physique and knowledge to the next level. If you're interested, check the description and sign up. Makes sense. Actually, it's made me think of talking about estren and its impact and whether or not it's anabolic. And I don't know where I stand with this completely. And I just would be interested. I'm throwing this as a bit of a wild card at you, Bill. But within natural bodybuilding, which is like the sport, I do.
- [32:45]
A
I know where you're gonna go. I know where you're gonna go, I think. And it's gonna be very contradictory, but go, go, see. Let me see if. I think I know where you're gonna go, so.
- [32:55]
B
Yeah, let's see. So I have some clients, as we spoke off air, who are coming to this age, and I have one specific client comes to mind where she's gonna. She competes at a high level. She's a. A pro within the OCB and figure and she has this thought of, what if I need to go on HRT or that's the best thing for me to do for my health, I then can't because it's a banned substance within natural federation. She can't then compete anymore. And I just think it's an interesting, perplexing situation. And I don't know what the best solution there is because, I mean, ultimately natural bodybuilding, the way I view it is trying to support people's health, well being, all of that sort of thing. And it's a natural thing for women to go through, but at the same time, it's a banned substance. And I don't know if there's. There's a solution here, but I don't know if that was what you thought I was going with or what your thoughts are on that situation for kind of test competitions and women who are potentially of benefit going on hrt.
- [33:58]
A
And when you say hrt, were you, Were you meaning estradiol, estrogen or testosterone or both?
- [34:07]
B
I think I didn't have one in mind particularly, but either or. I think both would be off, like band.
- [34:14]
A
I thought you were gonna say, being in the bodybuilding space, I'm aware of some female bodybuilders taking estrogen blockers to lose more fat and,
- [34:27]
B
oh, no, I'm actually not.
- [34:29]
A
And it kind of goes. And again, this is a different area. So we have these changes in women. Well, how does hormone therapy, how does it impact this increasing body fat? And again, very frustrating for somebody that wants to study this. It's so variable. I can give you almost as many studies showing that estrogen therapy as women go through menopause causes them to gain body fat. There's other research saying that it causes them to lose body fat. And then there's research that says it has no impact. It is so variable. And anecdotally, because I spend way too much time communicating to these women over Instagram, it's the same thing I see just in my normal conversations, oh, I gained all this weight when I started estrogen. Another woman will say, oh, I lost six pounds within the first two months. All fat. It's so variable. And it's so variable that it's very frustrating because when you study, my earlier career was resistance training and protein. Everything's predictable. But it's not predictable with hormones or hormone therapy and body composition. Oh, the one thing I'll say, I don't think I've seen any studies showing estrogen declining lean mass. It's either always improving lean mass or having no effect. And once again this is where I say but we don't have any data in women who are also lifting weights. So that also that's. And that hope that needs to change and hopefully my lab will be on that.
- [36:17]
B
Yeah, yeah. And I guess in regards to what you've said there, that makes sense why it may be banned because it does seem to have some kind of protective effects against muscle loss which then would give someone a competitive advantage. And ultimately when you, you consider again, natural bodybuilding is meant to be like, I don't know where it's a specific list of substances that you can't take according to that natural federation, but is an unnatural kind of substance or potentially a performance enhancing drug. So I kind of understand it from that perspective, but it's a challenging decision for some women to kind of go through and I guess that's a good opportunity to talk about hrt. I know there seems to still be a fair bit of fear surrounding it because there was that study that I think was probably misinterpreted from the Women's Health Initiative surrounding kind of the increase of breast cancer risk. Whereas actually it seems like that's not a concern or it's more of a myth that's just continued to be out there. I don't know how if in your chats you've seen that still people seem to be a bit against going on it and how helpful HRT is if every woman should look to kind of consider it. I'd love any, yeah, I'll start with
- [37:30]
A
the, with the end and then I can give a little bit of my education in this. I think every woman going through menopause, if she's a candidate for hormone therapy, it should be considered. Now that doesn't mean every woman should take means if you don't have a contraindication. So historically like genetic predisposition to breast cancer or things that would make it a, that it's not a good choice. I think it should be considered. And then if you choose not to. And again that decision is between the patient, the woman in this case and her evidence based physician. Great. And the reason I have that is I just know a lot of women just outrightly just say it's not an option. For me, I don't want to do it. And they don't really know why they don't want to do it. They just don't want to do it. And I think a lot of it is without them saying is they just want to do it naturally and that's great. But I wish that they would have the conversation or spend a little more time about the potential benefits before coming to that conclusion. Now, in terms of that women's health initiative, what's funny about that whole study was it totally changed the trajectory of women's health for decades. Literally decades scared women to consider taking hormone therapy. So hormone therapy, prior to the publication of that study, I believe it was 2002, hormone therapy prescriptions were very high and then they plummeted almost overnight with the publication of that study. If you read the study, there was not even a statistically significant increase in breast cancer outcomes with the. And I won't even say estradiol because it was, it was synthetic estrogens used in that study. Conjugated estrogens is what they used. So even the types of hormones that are much more prevalent today were different. But the. Yeah, it wasn't even a statistically significant finding. And then I've read, you know, there's been books written on, on this because a lot of people think this was a crime to women's health. The way that that study was handled, you start to get into a lot of. And again, I wasn't there, so I don't know. But I have read books on it. The researchers involved set out to, they already had the end in mind of wanting to say hormones are not good. I've heard, I've read this multiple times, they published the paper without all of the co authors even agreeing to the final published paper. And that's a, in my world of publishing, you can't do that. You have to get people's permission. So there was a lot of, let's just say, questionable ethics or non scientific normative behavior around the publication of that even at the time. And now looking back, it really brings into question some of the motives of some of the researchers on that paper that did the research.
- [40:54]
B
Yeah, that's really scary, especially because I think it got completely blown out of proportion from my understanding, from I guess, media outlets and I guess it brings us back to the start of our discussion in terms of the kind of menopausal influences out there that are just predicating upon people's insecurities and troubles and concerns just for financial gain or they've got a particular motive like with this, which is, I guess the media outlets just wanted to get more eyes on their paper on, on their marketing or what have you. So yeah, it's, it's scary in that regard and I guess to talk about what some of these social media influencers might be trying to shill any supplements that are at all evidence based to help with this transition for people.
- [41:40]
A
This is where I just rely on what we already know about bodybuilding optimization. So optimal protein diet. So historically research reports midlife women, they are under consuming protein. So just correcting that. So one study, I'm thinking of randomized controlled trial, just increasing protein, nothing else. So one women just here's extra whey protein, they lost a significant amount of body fat and they gained a significant amount of lean mass just by correcting their protein. And they were eating like 0.9 and they went to like 1.3 or something, not even up to 1.6. Now again they weren't resistance training. Another study also I think this was 50 to 80 years old women, they were dieting but they added more protein into the dieting calories. So they were actually dieting less. Same outcome, maintain lean mass better, lost more fat even though they were eating more calories. So in terms of supplements, that would be one. Let's, let's, let's, let's start with a macronutrient and then again we can get that from food doesn't even have to be a supplement. One thing I've been very happy is the women in my community. So my lab did the largest ever menopause fitness survey. We haven't published it yet. We have one's under review and we're starting to write the second one. So this survey was for women who embrace a fitness lifestyle. Again, nobody's ever targeted that population. We had a body composition and weight loss resistance section. We had a large fitness section of the survey, a nutrition section and a hormone therapy section. So right now we're working on the body composition, weight loss resistance, but just looking at the protein intakes and I analyzed this before the study was over. So this would be preliminary data. The subjects in the study were doing very well on protein. I think it was like around 1.6 grams per kilogram, but not surprising because these are women who lift weight weights. So it was, that was good to see. So in terms of other supplements, I know there's a lot I don't want to say peddled because that's, that's making it look like they're all scams. I, I just haven't put my focus on menopause specific supplementation. I know there's arguments that inflammation goes up during this transition. So fish oil again I, I, I take fish oil and I'm not a menopausal woman. So that, that would be another one. Urolithin a yes. Yeah.
- [44:36]
B
Your general health.
- [44:37]
A
Yeah.
- [44:38]
B
Health supplements are wise. Creatine, your vitamin D potentially if you're not getting your sunlight. Those sort of things. Nothing, nothing special or like specific towards the menopause. At least as far as you're aware that you've spoken to people. There's, there's much bigger levers to pull
- [44:53]
A
up on creatine if you're living a f this lifestyle. Creatine makes sense anyway. Protein makes sense anyway. Vitamin D makes sense. Fish oil. So yeah. And I don't want to say there aren't any supplements that, that, that can help with menopausal symptoms. I, I just, I'm, I haven't done enough work to, to speak in an educated manner about them.
- [45:19]
B
Yeah. It makes me. Actually are the creatine because of all the potential sleep disruption and then there's been some research showing how creatine can potentially buff negatives of that. Imagine that's even more, more of something that might be.
- [45:31]
A
Let me ask you, I'm kind of getting towards the end but this weight loss resistance phenomenon. So I have so much respect for you. You're an elite, one of the world's best coaches and I think you mostly work with men. But. And I don't. I would say it doesn't matter. Do you know or do you believe if somebody is under a lot of stress in their life, does that make it harder for them to lose fat? What's your experience with that?
- [46:06]
B
First, Unbelievable kind words. Thank you so much. I appreciate that a lot. But huge stress can absolutely make or break that situation going on more than people would realize. Often like, I don't know how to say it any differently than it can put the brakes on completely on fat loss.
- [46:27]
A
I thought you might say that, but I wouldn't have been shocked if you didn't. But I have a pretty vast network of coaches like yourself who I learn from and almost all of them have said the same thing. If stress levels are high, it's almost. Well, here's how I teach my students, my university students, and I'll rely on what you just said to add to this evidence base. In fact, you probably told me this in the past when we talked. But I tell my students, if you're working with a fat loss weight loss client and you know they're in a particularly stressful time in their life, it's probably a good idea to have the conversation. This is not the best time to go on a diet. And we always say like, what would those situations be like going Through a divorce, recently having a baby, maybe a big career change. So anecdotally I get this from the coaches that I respect the most. Now let me ask you, what is stress? What's the mechanism? How is it. Because I'm trying to learn about weight loss resistance. We know that menopausal women have likely have more stress just because of lack of sleep. We also know that the phases of life, they have children that may be leaving the house, they have parents that rely on them more. Divorce rates are higher at this phase of life. So I'm making what I've, I'm trying to make the link from what I learned from bodybuilding coaches about stress and just simply saying, okay, it may exist here, but as a scientist there's no mechanism. Is there anything you can think of that would be like, oh yeah, no, there is, Bill, it's this.
- [48:27]
B
No, you're completely right. When you were just talking me through there, I was like, I can't actually think of a mechanism apart from hey, I mean. And it's not stopping fat loss. But obviously stress leads to kind of inflammation and like one of the first things the body does is holds onto water and so you can just look like a hot mess. You see this if I'm peeking a person to stage and I've got someone competing, I want to reduce stress as much as possible for an inevitably really stressful time because stress can just make you look terrible. Does that get in the way of fat loss? It doesn't, but it might make the scale do some funny things. And I guess like you said, the stress just, we just have learned so much about how important sleep is. It's the fundamentals to everything and it can impact your ability to lose body fat, in fact even in similar, like for like calorie deficits. So I imagine the stress having a knock on impact to the sleep is probably a huge part to play for that. But it's for sure it's. I guess that's the thing you're trying to identify a little bit more of is is it the symptoms caused through the perimenopause? And then it's a case of managing those as best as possible to try and allow for less muscle loss, less fat gain during this period of time, that sort of thing or inevitably, I guess from your experience of talking to women, are they having to diet on lower calories as well? I think it's, you sound, it sounded like your wife was having to push her calories even lower than what she typically.
- [49:57]
A
Yeah, so that's probably where my lab's primary interest is, is in the weight loss resistance. So. So again, I don't think you can make a good argument that women aren't gaining body fat during this phase of life. So the next logical action for a lot of these women is, okay, I've gained fat, now I want to lose it. And anecdotally, they're not losing it using methods that worked for them previously in prior years. And think about, for me, I've been one of the loudest champions of SECO energy balance equation. Now I've never been. I mean, my demeanor is, I'm not gonna mock people, I'm not gonna say you're lying, but my whole career has been you reduce your calories, you lose fat. So now I'm at a stage in my career and I think this is where we go back to where we started. I mean, I'm, you know, I'm into this career, 20 plus years studying fat loss across all different populations. It's what I read every day of the week practically. So it's, it comes across as being hypocritical. Oh, you can't lose weight when you're in a deficit. No, I'm not willing to throw away thousands of other studies that have documented weight loss from a caloric deficit. It, I think where I'm at now as I try to explain this or even just come to terms with it in my own head, is every, I'm willing to invest my career into at least validating if weight loss resistance is a thing. And when you look at research, published research, it's always on, it's always, the results are always published as group averages. That doesn't mean, and I have this in my own lab, that doesn't mean there weren't a few subjects that were not responsive to the diet or to the muscle building stimulus. So I think what I'm trying to do is, I think historically if there were people who had resistance to weight loss, they were never acknowledged or identified in group averages in weight loss studies. What if we collected just those people and we studied them? Because I don't think it's many people, but I think it's almost like it's the most likely time for this to happen. If, and that's, I'm saying if, if weight loss resistance occurs, the most likely phase of life is in a middle aged woman going through this phase of life. And then I think back to how many bodybuilding coaches I've talked to who've said this person will not drop fat. And we keep lowering. And so people who work in this space, they're very hard, as am I to say, yeah, calories in and calories out isn't validated. Of course it is. But we also know sometimes it seems like it's not or that you have to go, like you said earlier, you have to lower the calories so much. And I think that is what has to happen. So I define and this will be in the research literature soon. Weight loss resistance is defined as an inability to lose or a, a more difficult time losing body fat. Using strategies that used to work, such as a caloric deficit or increase in exercise doesn't mean you can't. But the level of a deficit or a level of the amount of exercise that you have to do is not sustainable and it's not healthy. And of course all of this is self reported. Maybe these women are all lying, they're overeating, they're skipping workouts. I don't think I believe that. But I also don't think that every person who claims, well, here's where I'm at. If you claim you're weight loss resistant in midlife, I would say I would ask, are you tracking your macros? Are you tracking every calorie that goes into your body? Are you tracking protein? And are you at least tracking your workouts like so? Most of the time the answer to those questions is no. So I'm like, okay, come back to me after you've tracked your calories for a few months. So that way we know. And again, let's assume it's accurate tracking. But what I'm interested in studying is the woman who has tracked her food for years, who's lived, you know, just former competitors in many cases. And I've always said I trust bodybuilders. If you're a bodybuilder and you tell me you're doing something now, you may not because you work with them professionally, but generally they know what a gram of carbs is, they know what a gram of fat is. So all I'm doing is trying to isolate the women who I think are doing all the right things and are claiming that they can't lose fat. I want to study them and who are fit.
- [55:28]
B
Yeah, that makes so much sense because I guess when we've talked through this practically for someone who isn't of that ilk and they're just a woman who hasn't really resistance trained much, hasn't paid much attention to their diet, and they're going through the menopause, you do all the things that you would do in anyone who wants to improve their body composition. Start resistance training. Consider your general activity, maybe tracking some steps, get protein intake, high sleep as well as you can, control calories, monitor body weight over time. And those people, they can see an improvement and they can actually stop that kind of fat gain and actually increase muscle mass during this phase. Because that's how powerful novel resistance training is if you've never done it before. But like you said, for the people that have already done that, and they've done that for years, they're now challenged in this situation. And I know you said you've done your kind of fitness survey lab and you also have a series of case studies, is that right? Where you're gonna compare some kind of quite extreme interventions. You talk about that.
- [56:29]
A
We did a case series study, have not published it yet, actually just finished it within the last few months. So under the, under this scenario of women who, who, who would do a typical caloric deficit and the body's just not responding, so 25% caloric deficit, that's kind of been like my lab's go to deficit to, to lose fat to maintain muscle with you know, 1.6 to 2.2 grams per kilogram of protein. If, if that's not enough of a stimulus to cause fat loss in these self reported weight loss resistant swimsuits. What I did was ask the question, okay, you're saying that what used to work is no longer working and that you have to go on really low calories to lose fat, which is not sustainable, not good, not healthy. My thinking on this, well, let's lean into this, let's not keep doing the same thing that hasn't been working. 20 to 30% caloric deficit, high protein. And let's go all the way, and I don't want to say starve, but let's prescribe an extremely low calorie diet. And we did this, we did this in a case series study. So that means it's just a handful of women. We actually had nine women go through this protocol. And the thinking is this, if you keep dieting for a long period of time, you're going to lose lean mass. If you lose lean mass, that, that sets a, a cascade of events which make it very hard for you to maintain your fat loss when the diet is over. And in some cases you're actually going to have fat overshoot where you gain more fat than what you had before you started dieting. So it's very important to me, my whole lab's philosophy we want you to lose fat, but we need to maintain your lean mass. If your lean mass is maintained, your metabolism is maintained and your likelihood for maintaining any fat loss is significantly higher in the weeks to months following your diet. So what I'm about to say seems counterintuitive, but what we did was we put them on a extremely low calorie diet. So approximately 3 to 400 calories per day of almost all protein. So it was 1.6 grams per kilogram. And we said, there's your calories, try not to have any additional carbs or fats. In addition to this, we said you're also going to walk six hours per day. So very few calories, high volume walking, no resistance training. Now here's the key. This was only a four day intervention and what we found in every single subject, nine, they all lost a significant amount of body fat and none of them lost lean mass. So why. Well, here's what I'm thinking. The extreme nature of this protocol is long enough that the body responds by losing fat, but it is not long enough that the body will start losing lean mass. So the timing on this is important. If that diet were were tried for 10 days, 12 days, I think there would be lots of lean mass lost. But because it's so short, it's been very effective. And I want to add a few of the women that were in this case series study, again not published yet. Actually we did present this data at a conference last summer only on seven subjects. But some of the women like nothing is working. My body's not responding well. It responded to this. And again, I'm not saying that everybody should do this, but it does seem like the threshold for some of these women to be able to move the fat loss needle needs to be more severe. And we just leaned into it.
- [60:52]
B
That makes sense. Yeah. Kind of is confirming that calories in, calories out work, but it's not confirming that there aren't changes to how that setup is working, just. And it's kind of confirming that these women have had to go more aggressive. And I think I've seen through some of your communication on some of your posts, some talks surrounding the GPL1s and utilizing those in these situations. And I think I saw you say 75% of the women you've interacted with when they've gone for one of these GLP1 agonists, like a semaglutide or what have you, they found benefits and that's actually helped.
- [61:30]
A
I would say, yeah, I think about 80% just estimating, which to me is very intriguing because let's just talk this through. You have a woman who says I can't lose weight, dieting's not working. So you know where I'm going to go with this? Okay, so let's give you a GLP one guess what that's going to do. Well, that's going to suppress your appetite, so you're going to reduce your calories. And now that works. Well, that makes me think that you weren't necessarily dieting as much as you thought you were the first time. Now there are other mechanisms of GLP1s, but by far the weight loss stimulus is at the brain level suppressing appetite so that they under eat. Now again, that still leaves 20% of women that took these medications and it didn't help. So I guess once again I could say that's who I want to study. I want that population.
- [62:34]
B
Yeah, absolutely. And one final point with you Bill. Any differences between perimenopausal and like menopause? So post menopause, do the people post menopause seem to have the same weight loss resistance or is it more the people going through it?
- [62:52]
A
It seems that the body composition changes are are starting in Perry and last a year or two past post. And after that one to two years of being postmenopausal, you don't continue to gain excess body fat that plateaus. Whatever lean mass has been being lost, that has also plateaued at least the rate of the loss. Now again every decade you keep losing more lean mass. But we're talking about the rates of change here. So I would say parry into early post menopause is where a lot of the noise is.
- [63:40]
B
Okay, perfect. I don't think I have any other questions for you, Bill. I think you did a really good job of addressing kind of what the menopause is, what people on average are experiencing. There seems to be a unique subset of people, obviously resistance trained individuals who have been quote unquote kind of body living that bodybuilding lifestyle for years who are really struggling with it. If you're outside of that, there's a lot of just general fitness advice that we would give and prescribe to people who are trying to improve their body composition. That will work. But again, there's going to be a subset of people that have to try harder and are going to struggle with this a bit more. And you're not alone. Bill is continuing to try and study this and investigate it to find solutions. And actually as a final question to you, Bill, with your wife, did you have success in the end. How are things going on that front?
- [64:33]
A
Initially, no. So when she first started this menopause transition, once we realized, okay, this is something crazy going on, or once she was not being a bad wife and actually told me, hey, something's not right, again, trying to hide it from me. And a lot of women do that immediately I said, okay, let's look into hormone therapy. Let's look into this. And this is where that Women's Health Initiative study I think did a lot of harm. Because my thinking is, well, I know there's definitely an increase in breast cancer risk here. So me being a scientist, I probably spent way too much time reading and reading and reading and reading. So what worked great for my wife was she immediately got prescribed. Not immediately after, you know, probably a year of me reading. Started with progesterone. Actually, I wasn't even reading. We went to a doctor once, she said, hey, I'm not well, went to a doctor, and he prescribed her progesterone, which is another very. It's another hormone that changes throughout menopause that immediately changed, improved her quality of life, gave her more energy, allowed her to sleep. Awesome. Then all of my reading was more focused on estrogen. So we probably waited at least a year to a year and a half before I was like, hey, I think this is the right decision. Let's ask the questions. And I talked to multiple physicians. Like, I got multiple opinions. So she started estradiol, and in terms of her weight gain, I was hoping, okay, you're gonna start estrogen, you're gonna lose fat. Because some of the research says that some says you gain, but some says you lose. She didn't lose any body fat during that phase. And I would say she maintained her weight gain for three or four years during this, and over the last year is now been able to lose the weight that she gained. Was that the hormone therapy? I don't think so. I think it was exactly. You just have to get through the turbulence of menopause and then your body just settles down. That's what I think it was. So, yeah, it was not a quick or easy weight loss. Even with hormone therapy now, a lot of other women will have a different story and they'll say, it really did help me.
- [67:24]
B
Yeah, that's actually really kind of a bit of a nice wrap up in. It makes me think about what you said in regards to what you tell your coaches. If you're going through a really stressful, turbulent time, it's probably not the time to try and Drop body fat, which if you extra like extrapolate that, that could be the perimenopause. When things are really turbulent, it's a stressful time. It might not be the time to pressure yourself to go through fat loss. It might be the time to just focus on gaining muscle and maintaining good behaviors and habits and what makes you feel good. And then once it settles a little bit, as it did with your wife, that's when fat loss is going to be way more efficient. Similar to the person that, I don't know, has exams and that, that needs to pass. Or like you said, they've had a divorce and, or they have, they've had a baby. Let's put a more positive scenario in there. And they're in a good routine and with their partner, they've got kind of the sleep and wake all sorted, their sleep's in a good place, the baby's sleeping. And then you can attack fat loss, which is inherently a stressful thing. So, yeah, really nice closing story and I'm glad that your wife disclosed it to you in the end. And I guess that's also a good kind of poke or nudge to any women listening who maybe are hiding it from their husbands or similarly husbands or partners who have seen it in their, their partner kind of just kind of ask about it if they are nearing that age. Because it's an important discussion to have, as I've learned, and obviously you've learned too, Bill. So, yeah, thank you so much for spending the time. I look forward to keeping up to date with everything you're doing with your research, your lab, if people want to keep up to date with.
- [68:56]
A
And my handle is Bill Campbell, PhD.
- [69:02]
B
Fantastic. I'll make sure that's linked in the description. Thank you guys for watching and listening and we'll talk to you soon. Take care.
- [69:12]
C
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