Barbell Shrugged - [Menopause] Exercise and Nutrition Tips for Menopausal Women w/ Dr. Abbie Smith-Ryan, Anders Varner, and Dr Andy Galpin #690

Episode Date: April 12, 2023

In today’s episode of Barbell Shrugged we chat with Dr. Abbie Smith-Ryan from the University of North Carolina at Chapel Hill to discuss training, nutrition, and supplementation considerations during menopause. Menopause is a natural transition in a woman's life, but it can come with many changes to the body, including hormonal fluctuations, changes in metabolism, and changes to bone density. In this podcast, we'll be discussing exercise, nutrition, and training tips for women in different stages of menopause. Exercise and nutrition myths and misconceptions for women in different stages of menopause Supporting the body through exercise and nutrition during menopause The importance of strength training and weight-bearing exercises for bone health during menopause Strategies for managing weight and maintaining overall health during menopause The role of nutrition in supporting bone health during menopause, including specific nutrients to focus on. Menopause is a natural transition in a woman's life, but it doesn't have to mean a decline in health and wellness. By prioritizing exercise, nutrition, and training, women in all stages of menopause can maintain their overall health and well-being. Dr. Abbie Smith-Ryan is an exercise scientist who specializes in sport nutrition and metabolism, and is currently a Professor and Director of the Applied Physiology Laboratory at the University of North Carolina at Chapel Hill. She has published numerous research articles in scientific journals, and has received several awards for her work, including the 2013 President's Council on Fitness, Sports and Nutrition Community Leadership Award. Dr. Smith-Ryan is also a certified strength and conditioning specialist (CSCS) and a registered dietitian nutritionist (RDN), and has worked with various sports teams and individual athletes to optimize their nutrition and training. She is a member of several professional organizations, including the American College of Sports Medicine, the National Strength and Conditioning Association, and the Academy of Nutrition and Dietetics. To learn more, please go to https://rapidhealthreport.com Connect with our guests: Dr. Abbie Smith Ryan on Instagram Dr. Andy Galpin on Instagram Anders Varner on Instagram Doug Larson on Instagram

Shrug family, this week on Barbell Shrugged, we have Dr. Abby Smith-Ryan from the University of North Carolina at Chapel Hill. She runs the Exercise Physiology Lab. And today on Barbell Shrugged, we are digging into all things menopause. That's right, ladies. You might not be the largest chunk of our audience,

but we got you today. We have tons of clients that come into rapid health optimization many of them being females that are approaching this menopause window in their lives and and looking for the best solutions training supplementation nutrition lifestyle recommendations on the best ways to get through menopause from premenopause mid menop, really the whole perimenopause timeframe postmenopause. And today we walk into or today we look into many of the considerations

that you should be taking specific to your training, your nutrition, supplementation, things you can think about when it comes to intensity in your workouts. And Dr. Smith Ryan is one of the leading researchers on this. So very excited to have her on the show. She's actually like down the street from me, which is very cool. Trying to get her to move to my neighborhood. So I have more meatheads in my neighborhood, like lifting all the weights and talking about physiology. As always, friends, make sure you get over to rapidealthreport.com. That is where you can see Dan Garner and Dr. Andy Galpin breaking down lab readings, lifestyle, and performance analysis. And you can also set up a call with me. It's over at rapidealthreport.com, rapidealth rapidhealthreport.com friends let's get into the show

welcome to barbell shrug my name is andrews varner dr andy galpin no travis mash no doug larson today doug is actually down in brazil trying to choke out people in the homeland of brazil to see if his black belt is going to be able to withstand the pressures of the white belt in Brazil, where his favorite sport of jujitsu was invented. So hopefully he makes it back. We're not 100% sure. But today on the show, we have Dr. Abby Smith-Ryan, and we are going to be talking about menopause. The reason menopause is so interesting to me is because I work with women inside Rapid Health Optimization all the time who are starting to feel their bodies change somewhere around their early to mid 40s. Or they have come into the program in their 50s,

maybe a little bit into the later 50s, and all of a sudden they are asking me questions about something that I have never experienced, can never experience, and only have very small sample sizes of people that we've worked with and helped on how they can deal with nutrition, supplementation, training during menopause and the best way to get through it. That is why we brought Dr. Abby Smith Ryan on the show today. Welcome to the show. Thanks for having me here. Happy to chat with y'all.

And this is a fun topic for me, particularly because it's glad, I'm glad to even hear women are talking about it too, because so much of, you know, especially for the longest time, women don't talk about menopause and perimenopause. And I think that's part of the problem. And so just even having the conversation, even if it's, I don't know. But to me, like the biggest thing when we think about is that your body doesn't shut down. It's not a disease. It's not a disease. It's not allergies, I think.

Every March when the pollen kicks up. Yeah, it's just probably. They may feel similarly. But yeah, let's make some space for that, that your physiology is changing and everyone feels a little bit different, but essentially the way that like why perimenopause, which is the transition to menopause is such a big thing as it can last for up to 10 years. And the best way to think about it is that your hormones are on a cycle, like, or they're not on a cycle there. It's, it could be one day you feel great, the next day you feel like shit. Whereas before perimenopause, women have more of a cyclical, kind of a predictable pattern.

Perimenopause becomes very unpredictable and everyone's experience is very different. And so I think a lot of women first start to say like, oh, why it takes them a while to figure out what's happening with hormones and those effects. And then it's sticks around for a long time. And then post menopause is just a single point in time, the time at which after 12 months, a woman no longer menstruates. And I think that's, you know, sometimes confusing. It's that time where menstruation becomes irregular is perimenopause. And that can last, like I said, up to 10 years. Yeah. In preparation, as your body's starting to kind of change into this, as far as just considerations on training, nutrition, lifestyle, like, what should people, what should women be doing to prepare themselves for this process?

I think that's the million dollar question. But, you know, a couple of things that I think is important to say, like most women in this age will say, my body's changing. I've gained weight. I'm not sleeping the same. And all of that is true. But I think part of it is we and that means physiologists and even healthcare, we've done a really crappy job of saying like, it doesn't have to be that way. So when you look at

the natural physiological progression, yes, you likely are to gain more fat, lose more muscle, and gain more fat around your abdomen. But I would say like, it doesn't have to be that way. If we look at lifestyle behavior changes that support body composition, particularly muscle, those are going to be the best things we can do to prevent those body composition changes, just like you would tell a young man or a young woman. But if you think about this age group, and it's really the average onset of perimenopause is 42 and the onset of postmenopause is about 52. So if you look at women, 42 to 52, think about what we're telling them.

We say exercise more and eat less. And when we even say exercise more, like go for a walk, like walk a couple hours, like of course you should be calorically restricting. And I would say we are doing them a total disservice. That's exactly opposite of what we should be calorically restricting. And I would say we are doing them a total disservice. That's exactly opposite of what we should be telling them. I would tell them like how, and even you Anders, like think of it this way. Like we want to put them in the best position to gain muscle. And that is what will help support their metabolism and prevent the fat gain and them feeling so terrible. Yeah. Maybe this is just me

because I think that strength training solves like 99% of people's problems. When it comes to specific exercises, training programs, high intensity training, there's a billion things that people could do. Are there recommendations on what is likely a better route to go? I'm assuming strength training is going to be a large chunk of that, but are there other, other things that they should be taking into consideration?

Um, so that they don't add weight and which, which just leads to a host of other, other things. I mean, absolutely. I think the, we can avoid the intangibles. So if we go back to this age group, 42 to 52, I'm not there yet, if anyone's thinking that, but it's literally when women are at the peak of their careers, or they're taking they're like at the peak of their child rearing years, they're putting everyone in front of themselves. And so I think one thing of the intangible is yes, you can tell a woman to go lift heavy weights, but there's a lot more barriers for her than you were to tell like a middle-aged man. And the motivators aren't quite the same because that's not what we're told our whole lives. And so it goes back to your question. Are there other things that they can do? 100%. And should they do 100%? Because it's not just muscle and heavy

lifting, which is very important. But the other piece is that we see this significant rise in cardiovascular disease, that weight training is not going to target. And so obviously, this is my biased opinion. But we study a lot of high intensity interval training, not because it's the best, but because it's very time effective, it impacts the muscle and impacts the mitochondria and metabolism very effectively. So I'm a huge proponent of that, especially for this age group. Yeah. Yeah. There's the, there is, if you look at, uh, say a perimenopause woman and a 20 year old man, there's still a Venn diagram of overlap of best health practices. Like it's, I don't know how big it is. It's probably quite big. So some questions on the end of those things. So when someone is either in

perimenopause and maybe you can tackle this as peri or post up to you, um, are there any things to like generally avoid or things that tend to not be effective or things that, Hey, if you haven't been doing this yet, try to put this in, you know, eat more of this, do more of this type of training. So is there anything on the outside skirts of either one that you want to apply for people? Shrug family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com. When you get to rapidhealthreport.com, you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization

on programs for optimizing health. Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach. So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep. Then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the most severe things concerns. And then we're going to also build out all the programs that go into that based on the most severe things first.

This truly is a world-class program and we invite you to see step one of this process by going over to rapidhealthreport.com. You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over

to rapidealthreport.com, watch the video of my labs, and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidealthreport.com. And let's get back to the show. So is there anything on the outside skirts of either one that you want to apply for people? Yeah, I mean, 100%. I think it goes back. So if we look at the Venn diagram, when we look at training principles of the Venn diagram, they're a lot largely going to be the same. But the delivery and the impact will be quite different. So if I look at it broadly, one thing I would say is don't intermittent fast and don't skip meals. Whereas, you know, there's some cases you might want to do that. But for a perimenopausal woman, that would, that would be something like I would avoid, whereas a young man would be more resilient against that. I think the other piece, one thing to tie in it, maybe not

second priority, but is the cognitive impact. And we can't under value that, like, there are a lot of cognitive changes, anxiety, depression, even just fatigue, that I think we could target both exercise and nutrition that would help them feel a lot better. That would then increase motivation and consistency that I probably wouldn't target as much for a young, a young man. And then we know that just, or what we're growing data is that women's muscle is likely more anabolic resistant earlier. And so it just goes back to, yes, we tell everyone they need to eat more protein, but for a woman that's, you know, aging, it would be even more important, particularly kind of evenly spaced throughout the day because they're not going to use it as much.

Can you just explain really quickly what anabolic resistance is with aging? Yeah. I mean, you probably could do a better job, but really it's the best way to describe it is your muscles don't use the amino acids the same, the proteins the same for muscle building. So we essentially need more. This happens with older people. We know that very, you know, like prevalently. It happens around surgery and injury or immobilization.

And what we have identified, it actually happens in a pretty big, like a lot of times we think pre-peri post is pretty linear when in reality, we're finding that it's not. It very much is pre, big drop to peri and then post. And so it's just this bigger justification that these women need to prioritize their health now. And it's going to have lifelong impact supposed to, we know a lot about postmenopause, but, and you can still change the body still changing, but just this perimenopause is so, so important. One last thing, like to me, as a scientist, there's a few big projects I still want to do before I like think about what I want to be when I grow up. But one of them is perimenopause. Is it linear? We don't know. Is it, you know, this big drop and then, you know, continues to go down or even stabilized? Or do we need different recommendations

for early peri versus late peri? And what does that look like? Okay, I have two big follow ups on that. I think one would be very quick. Someone identifies, Oh my gosh, I'm just, I think I'm in menopause. It's starting for me. Great. What is that? Yeah. Start the right. Sorry. Um, start what is that protein target? Is it a gram per pound? Yes. At least. Um, you know, obviously if they're under consuming to begin with, that bump would be higher. I like to say like, try and get 30 to 35 grams at each meal, at least, you know, three to four times a day.

Got it. Okay, cool. Second one is you actually had a nice differentiator there between post there. I don't think a lot of people realize there's actually a decent amount of literature on postmenopause. And the reason is, please add here, it's easier to control because of exactly what you've explained, right? When you're going through perimenopause, it could be a year, 10 years, it could be like all these things. And so a lot of

work has been done as pre and post, but almost nothing on actual perimenopause. Is that fair? Absolutely. And I think the other piece is post is considered aging. Aging is a really hot topic. Perimenopause, it's, I mean, try telling, you know, a 42 year old woman, like she's aging. I mean, like we know it, but you know, it's a different group. And I'll even be honest, like a lot of times I get comments on grant reviews of like, how will you recruit this population? You would never say that about a middle-aged man. And I've even been said like, oh, you have to put childcare as a cost of participating. I'm like, oh my goodness, like, is this 2023? So I think there's these intangibles that are causing barriers as well.

Yeah. Yeah. So if you could, I know you're doing actual lot of research in this population and are planning to do more and things like that. So I guess the first thing is you said, all right, I'm walking into it. I'm started protein target. I never really paid attention to that's your first stop. Is there another like absolute first action step they should probably take maybe from the exercise or nutrition or anything else? Oh, gosh, where do I start? So definitely protein, something to load the skeleton, I think a huge down, this goes back to this idea of postmenopause, we know bone density and postmenopause is pretty bad. But partly, it's because that's the only time insurance pays you to measure bone density, think about if we got it perimenopause. So if we can stop that loss, then and so that loading the skeleton, obviously lifting heavy weights, some sort of weight bearing activities, and then hand in hand like that alone isn't going to work if you're under fueled and have not enough, you know, micronutrients. So vitamin D, calcium, I would say vitamin D would be most important.

So like, think about skeleton at that young age. I think 42 is young, you know, 40 is the new 30 is that what they say yeah so those things is what yeah those kind of load the skeleton would be another key priority all right i just heard you say two things um i actually never thought about this way i feel like when you typically talk about or talk to people who are going through perimenopause uh it is they're most concerned with a couple of things. One is symptom. This is how I feel in my sleep, things like that.

Two is the changes in body composition, et cetera. You actually mentioned two that probably most aren't aware of, which is your bone mineral density is crashing, right? Two, your skeletal muscle is wasting or becoming anabolic or resistant. I want to go back and talk about like symptom stuff here. There's a lot. But is there any more things to add that list of like, hey, these are you mentioned cardiovascular risk.

That was the third one, actually. Is there anything else? It's like, yo, this is not just about actually managing your symptoms or keeping you lean. It's about you're setting the pace for your next 50 years of aging. Anything else you want to add to that list? Yeah. I mean, I think within that, I would just take that one step further. I think that's what we've been doing all wrong. We're not building the skeleton from the base in, you know,

we're worried about how we look on the outside when I would argue it, we would look better on the outside if we targeted the bone and the muscle first. And within that, it's also this is a little nerdy, I wouldn't say it quite like this to a woman. But what we've done is, you know, we want to kind of modify our mitochondria, we want to be really inefficient. And so I don't want a woman to go walk several miles without eating, I want them to be fueled and I want them to do exercise that modify the mitochondria and make us less efficient. How I would translate that is do exercises that you suck at because you're born burn more calories, do things like interval training and high

intensity resistance training. That's lower volume, lower risk for injury. And it's your, your mitochondria will be modified in a good way. You won't be so adapted. Those would be the key things that I would think about it. It's really the same, saying the same thing, but we're, we're looking at it a different way because that really sets us to be able to meet our, our body composition goals. The other piece I want to really talk about, or just kind of at least think about is that brain piece. So many women are like, wow,

I feel terrible. No one else feels terrible. Like, you know, I have brain fog, I can't concentrate. And, and that has a big impact then in our ability to sleep, our ability to stay consistent with our diet and our exercise. And I think why I want to say is that there's some really good things that can help us target our brain health that aren't whether they be pharmaceuticals or nutraceuticals that people aren't thinking about. Like what? Any ones you can share? Yeah, I mean, I think the science here. I mean, you know, we're all our own kind of lab rat. But the brain fog when you tie in, I don't know if you guys have seen this, like the science, that impact of like social media and just the COVID had on on our science of concentration I think nootropics are

so powerful um just the ability to target brain fog so like what I would say is the rhodiolas phosphatidylserine um I think there's some interesting data with ashwagandha, you know, like there, bacopa, there's like some blends that, that I like to experiment with, because the brain fog is real. And then it, it so impacts everything. And it, it's not just like, I think so many women are worried about like, oh, you know, like, it's a me thing. Or, you know, or we get joked, oh, it's that time of the month. Like, it's, it's more than that. It's physiology.

And I think if we open that up to say, like, what are your symptoms? Are you having a hard time concentrating? Are you overwhelmed? Are you worried? Like, those are like physiological outcomes that could be treated, even if we take the benefits of exercise. And that ties be treated, even if we take the benefits of exercise, and that ties into sleep, right? So one of the best ways is if you actually can consistently exercise, that doesn't mean you have to go, you know, be the best squatter. But it at least

provides some consistency that supports better brain health and brain function, and sleep. Why? Oh, God, sorry, Galvin. I was just going to say, Anders, how many people have come into Rapid complaining of brain fog and that is now gone? Yeah. A truckload of them. Unbelievable number.

It's not that complicated to fix, actually. Like it's fairly straightforward. I think the complicated part is not using the same ingredients every day, even though you're tired is not always brain fog um and totally and then also making sure you hit it before it happens you know like having like a it's being aware that this does exist and that there's solutions and nobody knows that they just think oh i should have slept more well sleep is not always the solution to brain fog. Now it makes it worse, but yes,

it's it. Yeah. You know this, but it is being a little bit strategic. Yeah. Yeah. There's a lot of levers you can pull. You just got to know which ones to pull at the right time. Yeah. Um, why is bone mineral density? Uh, why does it reduce in this time period so much? Like there isn't a single female that I talked to, um, coming into the program that isn't concerned about this. And then they go to their doctor and they can see numbers when we run the DEXA scans and they get it, like immediately turns into this,

this high level thing that they think about nonstop. What, what is causing bone mineral density, even people that are working out to reduce? Well, there's a lot of things, but most, I mean, most specifically it's the drop in estrogen and changes in progesterone. And I would even argue like testosterone and growth hormone that changes over time. But it doesn't have to be that way. I think it's, it's our practices. So if you think about a woman, she doesn't think about bone density until she hits

postmenopause. And then that's all their doctors talk about when is if they would have started practices in their 40s, or arguably in their 30s, bone density isn't that big of an issue. But it's when we don't address it that then okay, oh, shit, it's postmenopause. Yeah, my bones are pretty weak. But doctors to they're throwing HRT at people the same way they're throwing TRT at men in the same age group. As far as what's right and wrong and kind of how do you, how do you feel about the HRT really being introduced in this? Yeah. I mean, I'm not a medical doctor and you need to follow your doctor. You're smart. You have opinions. You have opinions. Yeah. So one thing I will say is that there's very little research on the impact of HRT on

some of these physiological outcomes. But more so, I think it would be so great if our healthcare providers also talked about lifestyle changes because pharmaceuticals are great, but also how can we start this before we need HRT? And so that is what I, like, I do think that's like the next step. Let's understand what's happening in perimenopause a little bit more specifically. And then what happens when you add in different levels of HRT? There are reasons that you would do that. And this goes back to Andy's question about symptoms. Some women are so miserable and it still blows my mind that we have no solution for them. Is HRT the only solution? Absolutely not. But why spend our money on other things to understand if it is? And that to me, so like

we've done some exploratory stuff and other groups are too, but you know, some of our initial data shows that vigorous exercise is more positively associated with fewer symptoms. And, and there's a big debate about this. Is it because now if I've done vigorous exercise, I know what I like, I can deal with sweat. You know, like I can deal with some of the fatigue, like I know what does it change my adjustment, or is I'm doing more vigorous work. And now I sleep better. And that helps with some of the things. The other thing that I was surprised, like I was convinced that if we had better muscle mass, higher quality, more muscle, it would lower some of the symptoms

just based on some of the physiological spot kind of sources of those. Our pilot data has not shown that I'm not totally convinced I'm wrong yet. But what it did show was that higher symptoms were associated with higher body fat. And so to me, that's a little disheartening, because I don't want all these women to think like they need to lose body fat. But I, I'm not done yet. Like, I think part of it is some of those things associated with higher body fat, like what if we change the lifestyle factors that then impact it. So for example, like most people with higher body fat also aren't doing a lot of high intensity exercise or like which impacts sleep. So all that to be said, I guarantee

you there should be some lifestyle changes that help with some of our symptoms, but there's so many symptoms and women's experiences are so different. I don't think we have like that key outcome yet. Is there a piece of this on the stress side of things where this is an issue that they've never dealt with in their life? Then all of a sudden their life is completely flipped upside down and they don't kind of really understand all the changes that are happening, why they're happening. How is the stress management playing into this? And, you know, what can people do? Well, I would say stress, but also coping. So this is probably a bad example. And I am not in perimenopause. But I think one of the things that comes up most is hot flashes. And so like, this is TMI, but like, I get sweaty just talking to you, you know, like teaching like it, we're

used to like part of active people like you have that adrenaline response that has that that hotness. And there's so much data, even I'm sure a lot of your your clients, like night sweats, that that's very common in active people. And so if you take that into perimenopause, I think it gives us different coping strategies. If I'm having a hot flash, I'll just go get sweaty or like, okay, you have a night sweat. Well, there's some really interesting data that some of that it's a real link to hypoglycemia going into bed. So instead of stopping eating at seven or intermittent fasting, let's, you know, tweak some things. So now we have a lot of solutions for that. We deal with it all the time.

Yeah. Yeah. Pretty easy to fix um you sort of while we're on the hrt stuff i think one thing that's important for women to understand they don't already is that they actually don't have any testosterone whatsoever in their body uh that's only a male related hormone is that correct or is there any testosterone what are you trying to say like what are you trying to say i'm gonna debate this but where i feel like you andy does this nice job of always trying to teach us something andy teach us something no i it's uh i think it's important for women to understand that um this is not a male hormone right and the reason is i think if maybe you can share what's it look like when women

have really low testosterone during these issues. And so can you just sort of explain the difference between both sides here and then what it actually what role it's having in the female cycle, because it's not just about estrogen and progesterone and women, there's testosterone is important as well. Absolutely. So I think the things that matter most to women, like a lot of women have low testosterone based on sedentary behavior. It's and even not getting enough food, like it's linked with low libido, no energy, not responding to training. And just on the opposite, I think the biggest difference is just because I'll take, you know, responsibility just because I'm telling you to lift heavy weights doesn't mean you're going to have these dramatic increases in testosterone. But if you feed yourself,

and you lift heavier, you'll have these natural rises in testosterone that increases the libido increases energy like helps you sleep. And so speaking to what you're you're saying is that yes, we have testosterone as women, it's not as much as men, which means we won't be, you know, we won't gain large amounts of muscle. But you need that testosterone to build muscle and to build bones and to build hormones. Yeah. So one thing that it's important to pay attention to as you're going through major symptoms, is to pay attention to that number. If you're getting a test that your doctor and ask, and that is something that if you want to, if it is low, unnecessarily low, and you can elevate it even without hormones or hormone therapies, this is probably going to be a very good thing. You're

probably going to have a huge improvement in symptoms because I feel like women just tend to ignore or get told to ignore that number, which is like a really bad strategy if symptoms are pretty gnarly. Well, and I would even argue um you know i have a big birthday this year and i'm turning 40 this year oh sick when so we're gawping and i um what's that you are too yeah both of us when's your birthday we're both in april we're ready seriously yeah what happy fucking birthday uh i don't even know galpin you're soon i'm at the end of the month okay well i'm younger than y'all i'm in like uh six days okay happy birthday i'm not till october so all right you're so wrong you're so wrong um but what i was gonna say is like i

i i'm gonna get like a baseline blood panel of all of these things that you normally wouldn't. So if we speak to testosterone, like, it'd be really great to know where you are as a woman before going to perimenopause. It's more it's giving like women should be asking more questions about themselves and taking which is sad, like more ownership of their health, but it really allows them to know then, oh, all right, let's here we are five years later, no wonder I feel really terrible. Or like here is okay, my testosterone looks pretty good. But my progesterone is is terrible, you know, like it just helps us get a better feel or maybe my hormones look the same, but my vitamin D is really low. Like, oh, I've been forgetting to take that. That's like an easy fix. Yeah. I would strongly encourage even as soon as you're probably early thirties.

Oh yeah. Getting a full panel for females. Even if you do nothing with the action right then, just to know, again, when you start entering menopause, like what happens? Is this actually normal for you? You feel terrible, but this is the same. Super, super important to know, especially if you're then going to go on any sort of hormone. But you also have to advocate that, which I think is crazy. Like usually if you go to the doctor, they're not going to recommend any of those things, but I would even say something like your thyroid hormone, like getting some of those baselines. Yes. Every few years, obviously,

if you're healthy, you don't need to do it every year, but getting those will, and you'll have to ask your physician and you might have to pay for some of it, but it's very much worth your health in the long run. Yeah. Yeah. Is there a, um, so I, in thinking about kind of like the timeline of this from paramenopause to postmenopause, um, and then all the things that we've kind of talked about from bone mineral density, muscle mass. And if, for example, you are somebody that has been going to the CrossFit game since you were 25 years old, and now you're in the 40 and over age group, you're staring down 42, 43 years old, and all of a sudden, like your body starts changing. Are you in a much better place as far as bone mineral density, kind of the speed of decline of those, of the muscle mass?

Is there something that if you're 25, 30 years old, listening to this right now, that you can start preparing for this? Because we want to have like a, I would imagine we want to have a longer ramp in this period than just this like steep decline that just happens overnight. Yeah. I mean, I'm convinced it doesn't have to be this pre to Perry steep, and maybe I'm in denial. But I think it's because like, I mean, chronic exercise has a huge impact. So it doesn't have to be we know that physiologically, there's so many things we can do. So yes, the earlier can start the better. And we see that like, you don't have to look, It doesn't have to be all of this.

But what I want to say is also women, if you take that elite level CrossFitter or very elite level. Any athlete, yeah. Yeah, I think the issue is you'll have to do some things differently to maintain the same physique. Or they're going to at least see the differences more. And I think those are the women that I also worry about, because it's the women that like, oh, they are trying their hardest, they're dedicated, they're taking care of themselves, and it's still not working. But that's why like having those baseline hormones, those smaller tweaks being a little bit more evidence based can have those changes. And then also saying, like, I always ask,

do you need to be the same that you were like three years ago? Like, what are your new goals? And so, you know, I think like those women have a very high standard of themselves and see those changes, but then also what, what is happening. And that's also the benefit I think of measurement. So like, let's say I do a lot of body composition measurement that women don't want to see. But if you take that elite level woman, like how much is actually changing? What is changing? And is it really that much? Or are there other things that we can do? Is it more of this anxiety about our bodies? Yeah, because I just kind of like, logically walking through it, if you have the bone mineral density, the changes can't be that much because you just continue

living, living your life, there are going to be some hormonal changes to it. And there will be some sort of, um, decline that goes along with it, but it will be a much smaller percentage of the, of the whole, assuming you're not coming into it from like today, we're going to learn about strength training and we're doing it because you have haven't done anything in 30 years. Absolutely. And you can always build more bone. It just takes longer the older you are. Yeah.

Yeah. So I actually have a question about that. I assume very few people listening to this are 43-year-old females who have never lifted weights. That's probably not a huge percentage of this audience. But you probably have a bunch of coaches who are coaching those people so can you give them some ammunition abby of they have somebody come in who's is perimenopause and their bone mineral density is down or maybe their early post-menopause and it's like whole crap and we've been told for forever and nothing you can do about that if you don't especially if you're a

female if you didn't build your bone mineral density when you were nine, you don't have it now. What does the data, what does the science look like on improving bone mineral density for perimenopause and postmenopause? And then any specifics of like actually what to do, what to take, what do we got here? Yes. Yeah. Okay. So like a couple of key points. One is, and I go back to fueling, making sure that they're eating enough around their training, because that is a thing we're seeing the incidence rates of eating disorders in women this age is significantly higher and growing. And that's because of this discontent. So like recognizing like bones may be changing because of lack of fuel. Bone takes longer to turn over. And so just that heavy loading is one of the best things you can do. But you'd want to periodize that you don't want to just throw a bunch of weight on a woman.

But consistently overloading the skeleton is going to be a really important part. And then, I mean, obviously, I'm a research nerd, but some sort of tracking to know what's happening. So bone takes, you know, every couple years, get a measurement or just see. And then, you know, you even if you load the skeleton and are inadequate in your vitamin D, calcium, protein, that it's going to take longer. There's also some really fascinating data. I mean, I you know, I'm a supplement nerd, like creatine with resistance training has shown to significantly increase bone, particularly in women. And so it's really just maximizing your training, overloading the skeleton. And that's where that goes back to that Venn diagram. I would highly recommend some key supplements for women

to help, you know, maintain bone for many things. Yeah. And this is important to flag here. More recent findings suggest that creatine amount has to be higher for this to occur in bone residency. Is that true? And so how much? Yeah, I mean, I think we need more data, but like a 10 gram dose and not even so much for bone. But if we increase the 10 gram dose, the biggest thing with creatine is that it's got to be paired with resistance training. And then the higher dose, we have a secondary benefit of the brain health, particularly in this group. And so that slightly higher that 10 gram dose versus a five gram dose, probably better to target the cognition, the anxiety,

depression, which is very prevalent in this group. Yeah, so it's not unrealistic to think if you start strength training, and you start eating that gram per pound uh ish you spread that over 30 or 35 grams of protein per meal uh go on a 10 gram dose of creatine make sure your vitamin d is sufficient check and on calcium concentration so that one gets a little bit tricky you may not just want to throw in calcium supplementation um but if those steps alone and then you give it four years like you probably will have a noticeable change in your dexa scan like two years like something like that it's not going to be a six-week transformation yeah um that timeline is that correct that timeline's super important um i one of the very first clients i ever started training

that or coaching that had osteoporosis i didn't even realize they only check it like once every two years if you're following your insurance plan. So you give somebody like a two year goal, that sounds like an eternity when they come to you and they go, can I fix this problem? But having a much longer mindset to it and understanding that this thing takes a long time to change, but it does work. Well, and I would even say, like four years, that's like, that's a really hefty timeline, two years, even like what I like to look at is every nine months. And that doesn't mean your bone is going to dramatically increase, but it will allow you to see is my muscle increasing or maintaining because if you have strong muscle that's pulling

on the bone, it's going to make it stronger. And that also helps women stay a little bit more or anyone stay a little bit more motivated. Like, no, this isn't changing, but all your hard work is working. Um, and even regional specific, like, oh yeah, your, your legs, your arms. Yeah. Um, can we transition this a little bit into the injury recovery and nutrition considerations? Absolutely. I love it. I have a nice transition for you. Okay. I love it.

Well, I was going to get into. Take it away, your show, Abby. Well, this goes into it. The less I talk, the better for everybody. So fantastic. I don't think that's the case, but I think,'s true um women will go into training they think all right i'm not gonna eat or like i'm busy and then they they train and like often they'll get a post workout but some of the initial research in our lab and others is showing that women might be

better off having something before exercise what yeah right like why would I do that? And so it like, I always tell women, like, well, one never fast, you're not going to burn more fat, you're actually going to burn less, and you're going to feel like shit. So having a small amount of protein, not carbohydrates, like that doesn't mean don't eat the carbs, but prioritizing the protein before exercise has been shown to increase more muscle mass, increase fat oxidation, and increase the amount of calories you burn. Like, why wouldn't I want that? And so I think it goes back to like, what am I supposed to eat before exercise? And that's, to me, where some of the dietary supplements come in, just because you don't need to eat a chicken breast. But even

things like yogurt, some sort of protein base before exercise, that would be also if we transition that into like rehab injury, that's going to prevent some of those injuries, accelerate recovery. And that particularly in that in that female group. Yeah. What's your what's your stance on collagen for this discussion? I think you have a strong stance. I mean, a strong stance in like, it wouldn't be the first supplement I would have a woman buy. If, if, if we're talking about like someone who's just had a surgery and has the financial means, I would first prioritize a whey protein, like an isolate, because it's a complete protein. And then if yes, if you are having some sort of joint pain or surgery, then collagen would be a good option

as a supplement to a whey protein. I would very much put our money first in like a complete protein. Yeah. On the injury recovery side, where is protein really like the big thing? Is it an energy balance thing that we should also be looking at

as far as how that's divided up? Should they be eating in some sort of surplus just because there's going to be an additional demand? How would you kind of structure that for people? If someone's in a like surgery, like if someone has a large wound, it increases our caloric need. And yes, then I would prioritize that caloric surplus, especially because usually we're taking some sort of pain meds, and we're more sedentary. So we have no appetite, no recognizing calories matter. And yes, protein amino acids matter. But it's the timing of some of that it's more of preventing large times in between meals. And if you are stimulating the muscle via therapy your way, you know, it really depends on the scenario, making sure you aren't fasted in either

of those time points pre or post. What about from a supplementation perspective, anything else outside of the, obviously the technique way, I didn't count ways to supplement though. Like when I say supplement, I don't count it. Well, it depends what people buy, right? Yeah, no, I would. Yes, of course, I would recommend supplements if I had to do it in order. Gosh, you know, depends on the point of surgery or rehab. Let's not go in order. Let's just go on one I would recommend. HMB would be one for sure in this group. So HMB has been shown not only to prevent muscle loss, but to help with muscle building. And it really is not effective in a large amount of people, but it is in a scenario of, you know, turnover rehab. So I would recommend that three grams a day in divided doses.

And HMB is a quick in divided doses. And omega- HMB is a quick little amino acid. So it's one of the important ones for muscle building. So you can get that isolated itself. And it's different than just whole protein. Well, and it's not in a lot of adequate amounts in like a whole protein. And we really have, with all of these supplements that I recommend, it's just really hard to get through food.

So prioritizing food, but we just can't eat enough. It's particularly good at flipping on the switch of muscle growth. And preventing muscle loss, which is the unique piece of it. Yeah, probably the better actual way to explain it, because it's not really going to be helpful for a normal person to grow muscle mass in normal situations. But in this particular case of muscle wasting and muscle loss, that's when it starts to matter. Yeah. And I would take that one step further. Even if you have someone that's been injured and returned to the gym, I always give the example of, you know, like in COVID,

if you didn't have a great squat rack, like Anders does before you, and then you go and return to squatting, like you can barely sit on the toilet or walk up the stairs. It's a perfect time to supplement with HMB, those transitioning back to high volume to help with the muscle loss, prevent muscle loss. I look forward to those days now. Oh, I did something yesterday. Free fall. Oh my God.

I have to go and stand on campus in front of donors for like two hours today, and Dan Garner blew my calves to smithereens three days ago like i woke up all night going like she just like touched my calf with her hand i was like get off me get off like i was just like screaming just tell yourself that's pure muscle growth. Just think about how big your calves are going to be. They're still big.

They're still so swollen right now. They're just rocks right now. I'm like, Dan, 10 sets of 6, Dan. Great idea. They'll be great. We could have prevented some of that with some appropriate nutrient timing and some HMB. We used a lot of resveratrol. There was a lot of resveratrol there. If that helps.

Post-workout red wine goes great too. That's exactly what I recommend. Oops. We have some polyphenols in there. All right. Okay. What else is on your list there? Omega-3.

But I would withhold omega-3 for like the 24 to 48 hours right after a surgery or a major injury to help just normal inflammation come up uh but omega-3 up you know up to three grams a day is a good starting point to help with inflammation yeah um vitamin d Yeah. Vitamin D. I would also personally recommend creatine. The literature around creatine is not like it's going to prevent a lot of muscle loss, but it helps someone recover much faster, kind of like get past baseline more quickly once they return. Those would be my like key ones to start, I would say like my low hanging fruit. Even now, like if someone I know has a surgery or is like injured, I prioritize essential amino acids over like a whey protein just due to the absorption and kind of in between meals, it's less of like a, you know, a full protein versus

more of like a juice type drink is the best way to describe it. Yeah. The nice part about everything you mentioned too, is they're all very low risk in terms of they don't do much else of anything else. So you don't, other than cost, of course, there's no real harm to kind of toss any things in there. When a lot of them aren't super high cost. And that's why like, I do think cost matters. Every time I say that right now, people burn me for saying creatine is cheap. Well, it's a little bit more expensive than now yeah than it is yeah well let's just i like to juxtapose it this way you can either take and take your teaspoon of creatine or you can go buy six extra chicken

breasts a day like that's gonna be way more expensive than anything not to eat a plain chicken breast again in my life it's just more costly too like everything costs more right now which is unfortunate yeah i think it's like creasing is like something like a a dollar a serving rough plus or minus like it okay gosh come on here come on here friends this is not a health care cost no creatine uh creatine seems to be something that you've really recommended for the entire podcast that people go on. Do you have general recommendations? We could start kind of like going back to the perimenopause and then if there's some, you've recommended the 10 grams for the injury recovery stuff, but is there something in the paramenopause that you would recommend people? Is it based off body weight? For creatine? Yeah.

I mean, it is and it's not. I would still say about 5 to 10 grams for women. There's really no risk of doing that. Could we dial it in a little bit more? Maybe, but it's not worth the time or money to study it. Five to 10 grams. There's no risk in overdosing. No, I mean, the best way, and we actually have done some really cool data.

So usually at a higher dose, like a loading phase, which is 20 grams in four divided doses, four or five gram doses, it pulls more water into the cell. And so sometimes people see more like whatever we call it weight gain, it's just water in the muscle. But women don't see it as much. And interestingly, we looked at it across the menstrual cycle, particularly in the luteal phase, which is women when women hold more water, and found some insightful things where it actually is beneficial. It helps more of the water stay intracellularly versus extracellularly. So a lot of women feel puffy or right before they menstruate. Creatine actually helped it stay in the muscle, which would

be good for preventing dehydration, which is higher risk during that phase. There was actually no weight gain. There was like a little bit like less than half a pound, which was the same as our placebo group. And so for whatever reason, it's probably a number of things, but women don't seem to see the weight gain even with that 20 gram dose. And I would almost say for women, this is probably an unpopular opinion, but kind of swayed more towards a higher dose because of those cognitive benefits that you might not see on the lower side of the dose awesome yeah you you don't really uh like honest the honest reality is when people mostly take creatine it's sort of like you just take

your scoop yeah yeah it is what it is like it's totally fine yeah we're at you know after we interviewed uh darren kandell there was like a week where i was giving it to my one-year-old and my five-year-old and then my wife looked at me and she was like maybe not i was like yeah you're cool but that guy said it was awesome for everybody so i want my kids to be jacked you just want them to have hair no totally kidding that that's all they need i'll do that we're're going to go backwards. I know, I know, I know. I just keep daring a hard time.

But actually, they now have creatine gummies. And so I give them to my kids. And I do think there's a value in it. It's not something I would do every day. But yes, as they are more active, the benefit on bone, ligaments, brain, it just is, I would rather do that than make them metabolize a ton of chicken breasts, like or like kids don't eat that much. So yeah, it's a it's not a bad thing. And honestly, even the data, this is not what we're talking about. I'm gonna tell you anyways, during pregnancy and postpartum, it was like, something that I always did.

And I continue to recommend as the literature grows, but also, again, the prevention of postpartum depression, the prevention of hypoxia during like kind of birth issues. There is very little risk and so much potential benefit. OK, so to really clarify, you're saying there's actual data on women taking creatine during pregnancy and 100 and then it is safe and effective absolutely during at the same dosage five to ten ish grams or so 100 and i would say it becomes even more important postpartum because of that risk of of um postpartum depression and think about when you have a baby, like you have hardly any time to eat. So it's even more important. You wouldn't happen to know anybody offhand personally

who's ever tried that, would you? No, only with two children. Yes, I recommend creatine and titrating omega-3 higher doses throughout, kind of tracking the brain and growth development and into postpartum. Yeah. And you guys had no issue with that? No. Like personally, it was fine.

No, I think it's the best. I view birth as the most athletic event you'll ever do. And I was a collegiate athlete. But when you train for labor, like an athletic event, it, it makes sense, right? You're using every muscle in your body and it accelerates recovery. It's my understanding that childbirth is equivalent to a show about a man having a cold. Is that about, okay. Yeah. I'll give you that. Since you said it, I'll sign off on that. We'll get one of you on that paper after the show. I got two quick things for you. If you don't mind. You have a wonderful, very short paper on supplementation specific for female athletes and includes dosages and timings and things like that.

Could you just tell people where to find that, of course, but we'll kind of walk through what is in that little guide. It's very easy for the first normal person to read. Yeah, well, I mean, we have the original publication in sports medicine that's open access. And I think it's called like active ingredients for or nutritional ingredients for active women across the lifespan. And then there's a quick more like even lay summary on the GSSI. So Gatorade Sports Science Institute with more pretty pictures, that's also easy to kind of absorb. And that differentiate there's there's

there's recommendations for a couple of different recommended what are the different groups that are included in there? So we have one paper that specifically looks at kind of active women pre-peri post and those using, you know, we kind of bring up contraception. I have another paper that's a little bit older. of our peri or our pre-menopausal women kind of luteal follicular and luteal things that happen across the menstrual cycle that we might want to tackle with nutrition and supplements cool so it's a pretty like you could plug and play guy you can grab it look what phase you're in and then dosages timings all that stuff is laid out pre and post workout all that stuff is included for people to go do it's pretty awesome we have one other other paper to talks about nutrition around rehab and into surgery. And I and I those three papers, what I've tried to do now that you know, like, I don't have to play the game is

actually give people information that you can look at a picture and know what to do. And that's what those papers do. Like you can say, Oh, like, here's a good meal example, or here's how it relates here, the dosage. And so even if you're not a scientist, there's pieces in there that you don't have to be a scientist to understand. Yeah, it's super, super valuable. The only other thing I have for you is you've mentioned several times now, we've sort of

forgot at the very beginning to tell people kind of what you're doing and what you're working on. But is there anything else that your lab is working on right now that people would be interested in the research you have planned that can follow along with you or any other cool findings that you got to tell us about? I think it's cool. Yeah, we just finished. I think everything your lab has ever done is cool. Well, you know, I'm not very good at social media, so we don't, it's hard to get it out there. I'm doing better, But we just

finished a really cool study trying to understand the impact of hormonal contraception IUDs on things like performance. And one of the key outcomes is protein turnover. There's a lot of data around Oh, like the luteal phase women are, you know, all these different things. We are looking at that as well as how hormonal contraception impacts that because 65% of women in the U S use some sort of hormonal contraception. So those should be coming out soon. Um, and then another study that we're in, um, in the process of just starting having, having some chats with Andy is looking at, I have this big question about women are more fatigable or less fatigable, more fatigue resistant. It goes back to the cold thing, like we can handle colds and a lot of other things.

But how does that impact then how we recommend training and kind of work to rest ratio for them? And so trying to understand how different work to rest ratios impact recovery and performance across the menstrual cycle, which to me is honestly the foundation for then going ahead and doing a training study in different phases of the menstrual cycle. So there's all these questions about cycle syncing when there's really only one paper, the rest are meta analysis, but why do that study? If we have baseline data to show, there's no need to do that study. And I, and I, to me, that that's

the building blocks of what we're trying to do, because then the next step is, should we apply those concepts to our perimenopausal women that don't have, you know, those hormonal, like, do we need to train them differently? Yeah, research takes too long. But those are our progression. Well, the reason you suck at social media is because you spend your whole time doing actual science, which is very difficult. Finding funding for all these studies is extraordinarily difficult because you're, again, what people don't really realize is you can get money for studying really young people. You can get money for studying really old people, but it is very challenging to get studies to do anything in the middle age. So you're out there showing most of your life probably trying to just get money to do anything in the middle age. So you're out there showing most of your life, probably trying to just get money to do these really interesting studies.

So if anybody's listening out there and you or yourself or your clients want to support this stuff, I'm sure Abby would be happy to take that call because this stuff is very, very hard to fund and a lot of cool stuff. So. And it has direct impact, I would argue. You all have moms, wives, sisters. And we need to do better for them. Yeah. Funding is the number one thing. Yeah. I think about this stuff all the time.

As my wife, she's not at 40 yet, but we're getting there. All this stuff is coming. And it will help us. Even like now, right? It will help us, Galvin. If we can manage these things, this is, Hey, I'm looking at beyond on board,

but I'm on board. Sold. I'll write the check myself. Thank you for coming on the show. Abby, where can people find you reach out about anything? Any questions? I'm on Instagram,

Twitter at a Smith, Ryan. I do have a puny website and I love education. So speak all around lots of different places, but those are the best places. And then I do work at UNC. We at university of North Carolina have a general web website there that tells us more about the research that we're doing. If is that a, if they just Google you somewhere,

is there a way to donate to the lab or anything like that? Oh, but I need to add that, I guess. Patreon. What are you doing? Is Patreon still a thing? Yeah, yeah. It's still a thing. We can circle back, Andy. Get your IT people. Yeah.

You know me on Instagram and Twitter, and if you need to get in touch with Abby, email me. I will give you her personal phone number. Only if you're going to donate her money, though. Or teach her how to use her website. Sorry. GPT website builder. We'll hook you up. We got you. I'm Andrew Varner at Andrew Varner. We are barbellstruck. Make sure you get up at the rapidhealthreport.com. That is where you can find Dr. Andy Goffin and Dan Garner doing a full lifestyle lab and performance analysis, which everyone will receive once you get into rapid health optimization. That's over at rapidhealthreport.com. Friends, we'll see you guys next week.