Mind Pump: Raw Fitness Truth - 2430: How Women Can Slow Aging & Improve Hormone Balance With Dr. Stephanie Estima

Episode Date: September 23, 2024

Dr. Stephanie Estima Her story and background. (2:31) Why has women’s health been left behind? (5:49) Why has she changed her opinion on fasting? (8:37) Using your menstrual cycle as a vital sign of good health. (14:50) Getting women to lift weights more. (19:49) Why women should bulk. (22:55) Strength training is the preferred form of exercise to balance hormones. (24:35) Nutritional interventions. (34:15) Explaining hyperthyroidism and its prevalence in women. (37:13) Leaky brain = leaky gut. (41:44) Can premenopausal women get lean through strength training? (43:43) A trainer checklist for premenopausal clients. (49:10) Her thoughts on GLP-1s. (55:06) It’s a privilege to age. (58:26) Practices or exercises to find what makes you happy. (1:02:37) The currency of attention. (1:05:03) Physique competitors and disordered eating. (1:09:56) Exploring the concept of ‘junk volume’. (1:18:19) Her current strength training routine. (1:20:17) Skinny to strong. (1:21:35) The investment in building muscle. (1:23:45) Related Links/Products Mentioned Visit Entera Skincare for an exclusive offer for Mind Pump listeners! ** Promo code MPM at checkout for 10% off their order or 10% off their first month of a subscribe-and-save. ** September Promotion: MAPS Starter | Starter Bundle 50% off! ** Code SEPTEMBER50 at checkout ** Cardio Bunny to Muscle Mommy: Strength Training for Women with Sal Di Stefano A COMPLETE GUIDE TO FAT LOSS & METABOLISM with Sal Di Stefano Mind Pump #2345: The Muscle Mommy Revolution Mind Pump #1565: Why Women Should Bulk In Gerald Shulman’s Lab, Work Focuses on Reversing Insulin Resistance in Diabetes Mind Pump #2410: How to Maximize Fat Loss & Preserve Muscle on GLP-1s (Introducing MAPS GLP-1) The Betty Body: A Geeky Goddess' Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex – Book by Dr. Stephanie Estima Mind Pump Podcast – YouTube Mind Pump Free Resources Featured Guest/People Mentioned Dr. Stephanie Estima (@dr.stephanie.estima) Instagram Podcast  Website David Perlmutter (@davidperlmutter) Instagram Peter Attia (@peterattiamd) Instagram

If you want to pump your body and expand your mind, there's only one place to go. Mind pump with your hosts, Sal DeStefano, Adam Schaefer, and Justin Andrews. You just found the most downloaded fitness, health, and entertainment podcast. This is Mind Pup. All right, today's episode, one of my favorite people on social media, Dr. Stephanie Esteemah. She's a functional medicine practitioner. She understands women's health very well. In fact, that's one of her specialties. But she also lifts weights. In fact, she competed back in the day, I believe, as a figure competitor.

So she understands strength training. She understands fitness, and she understands wellness to an incredible degree. In today's episode, we're talking all about female-centric health, hormones, balance, strength training, you name it, it's in this episode. If you're a woman, you want to get more fit and healthy and balanced, you're going to want to listen to this episode. By the way, she's also a host of an incredible podcast called Better with Dr. Stephanie Esteemah.

You can also find her on Instagram at dr. Stephanie Estima. So dr.stephanie.estima. That's her Instagram. You can also find her online at drstephanieestima.com. Now this episode is brought to you by our sponsor, Intera Skincare. These are peptide-based care products and hair restoration products. So these are the real deal peptides. Things that really do make things different.

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Prime and the Intuitive Nutrition Guide. That entire bundle is also 50% off. If you're interested, you go to MAPSFitnessProducts.com and then use the code SEPTEMBER50 for the discount. All right, here comes the show. Dr. Esteema, welcome to the show. I'm thrilled to be here. I'm so glad we were doing this. This is awesome. So I met you, I was on your show and we totally hit it off. I loved the way you were doing the interview, the questions you had, that conversation we had. Then I looked at your content and I thought it was phenomenal.

So I wanted you to come on our show so we can introduce you to our audience. Those people who don't know who you are. Introduce yourself first, kind of tell us about your background. And then there's some stuff I'd love to ask you. Sure. Yeah. So first, thank you for having me your background and then there's some stuff I'd love to ask you. Sure, yeah. So first, thank you for having me.

It's an honor to be here and you've been on the show twice. The first time you came on, I think it's still in our top 10. I think it hovers around four or five. I have to check the number. Wow. I don't like not being number one. I wish you'd do good for us like that.

Stop. Stop. Yeah, so my background, I'm trained as a chiropractor. I did my undergrad in neuroscience and psychology, and so I've always just had this love affair with the brain and the neuromuscular skeletal system in private practice for 19 years before retiring it and moving more into the online space. And I focus now on women's health because even when I was in clinical practice, really noticed we would run nutrition programs and physical fitness programs.

Uh, we'd run stress management programs, the whole gamut and would notice a very different prognosis even in a husband and wife. So same environment, they're living in the same home, they're eating the same foods. And they would have different results, let's say, if they were following a certain protocol, a certain diet together.

We, I think it was maybe 2016, 2017, we had started trying a ketogenic diet, so more of a pulling back on the carbohydrates, moderate protein, a higher fat diet, and we would have men coming in after two weeks saying, doc, I feel great, I've lost 20 pounds, my libido's back, I'm sleeping the way that I did 20 years ago, and then the woman, the wife,

would sort of be dragging her feet behind him, saying like, I've lost maybe a pound, we're eating literally the same things. So that was sort of my first clue in terms of looking at how we can modulate dietary interventions for men and women and how those might be different. Certainly my thinking around keto has evolved quite significantly, particularly in the perimenopausal

and menopausal space, which I'm sure we'll talk about today. But that was sort of the beginning and my own story, you know, my own personal struggles with my menstrual cycle for years. I always would look to men in the fitness space and sort of try and copy what they were doing and never really had the same results for myself. So my own sort of end of one and then my patients in clinic over the 19 year tenure that I was practicing sort of led me to really focusing on female health because I think that it's getting better in terms of the amount of the conversations that are happening now. I think perimenopause and menopause are sort of having a bit of a moment, which is lovely.

And I still think that there's a lot of gaps in women's healthcare that I'd like to seal. Why do you think that is? Why do you think women kind of got left behind on the conversation? Why did we focus so much on men or what's your opinion? I think that it's a combination of things. I think first, when we look at the literature, so any clinician with their salt is going to combine, you know, when we think about

evidence-based medicine, we're going to be thinking about what's available in the literature. We're going to combine that with our own clinical experience and the desires of the patient, right? So if we sort of think of those three circles, overlapping, an overlapping Venn diagram, let's say, the literature is very much lacking. It's getting better now, but it's very much lacking in terms of female specific content. And if you look at a lot of the literature up until about 2017, it was usually, you know, university

guys signing up for a study because they were broke and they needed money to fund their university life. And so we have a lot of data that is titrated, sort of looking at women as maybe a smaller archetype of a man with just pesky hormones. We sort of never really considered this idea that a woman is really different every single week and really every single day of her month.

And so I think that there's a gap in the literature and then that translates to sort of a gap in clinical expertise because you're drawing on the literature and you're trying to play with it a little bit and that takes a little bit of time. So I think that, I don't know that it's mal-intent. Certainly, I know of online doctors in the online space who I just feel are filled with vitriol and don't listen to women when they speak up and tell their stories and they're dismissed. And I'm sure

that that happens in clinical practice as well. So I think it's a combination of those things. It's a lack of the literature, which is now getting better. I think in 2017, the NIH mandated that women be, you know, you can't exclude a woman because she has a menstrual cycle because that used to be considered a confounding variable. So you can't do that anymore. It seems so ironic to me because if you were to just randomly pick 10 men, 10 women and ask who's more likely to even go to the doctor, I'm imagining that women are even more likely to go and talk to a doctor.

So it's weird that we would exclude them in so many studies and stuff. That's weird. Yeah. And I think that there's a bit of a societal conditioning aspect to that as well. It's more acceptable for a woman to ask for help versus, you know, sometimes you'll, and I would see this a lot in practice where like the woman would be a patient first and then she would drag her husband in.

She's like, this guy's back, like I can't deal with the back pain that he's dealing with, I can't deal with him talking about the back pain anymore. So I think that there's a bit of a, there's some, some cultural norms in there as well. Yeah. Yeah. You know, as trainers, we work with individuals, but you start to notice trends, um, you know, when it comes to men and women, the biggest ones that I initially noticed were really just in preferences, uh, types of workouts

that they would, you know, gravitate towards things that they would want to do. And not want to do. Yeah. You know? Um, so it was really around that. And I didn't notice big physiological general differences because I was always looking at the individual. So to me it was always like, well, this is Mrs. Johnson.

This is Mr. Smith or whatever. But I noticed that the first time was with fasting. When fasting became kind of this popular thing, because when I first started fitness in the late 90s, fasting was, that was like the weirdos fast. Nobody fasted. Everybody eats every two hours. Then fasting became a thing and everybody started trying it.

I remember there was a dramatic difference between how men and women fasted. I would have women that would fast and they'd come to me and be like, my hair's falling out. Why is my hair falling out? All these over-stress symptoms, whereas the male clients I had didn't necessarily see that. And when I saw it enough times, I started wondering, I wonder if men and women generally have a different response to fasting or to physical stress or to nutrition.

What are some of the big different general differences that you see when it comes to, I mean you mentioned keto for example. What are some of the big differences and then why, are they just hormone based? Is that where those differences come from? Yeah, I think there's, I think it's a little bit of everything. Fasting is another area that I've changed my opinion on. And I think when fasting was sort of this premier topic in

healthcare, uh, you saw a lot of women adopt, adopting the 16 hour, the OMADS every other day, you know, the 72 hour, the 96 hour fasts. And I think what, again, coming back to this idea that women are just not smaller archetypes of men, you would see women adopt almost these maladaptive behaviors. So with keto, I saw this as well. So both keto and fasting, they would see a drop

in water weight, right? You reduce your carbohydrates they would see a drop in water weight, right? You reduce your carbohydrates, you're going to drop water weight, right? So, uh, people would feel better on it. And that's all great. Uh, maybe you're sensitizing yourself to insulin a little bit, but one of the things that I had trouble with, with the, with the

ketogenic diet and with fasting is actually moving them away from that therapeutic intervention. Like they just wanted to stay in Ketoland forever. I see. To the point where you're, you know, where you're saying my hair's falling out, the, you know, the outer third of my eyebrow has, you know,

has fallen out. So now we're starting to think, okay, is there any sort of thyroid issue that's coming in? And women are exquisitely more sensitive to nutrient intake than our male counterparts, especially in our fertile years, because we are, you know, the mitochondria in the ovaries are constantly scanning the environment to see,

is this a safe environment for her to become pregnant? Irrespective of your desire to become pregnant, your oocytes, like the cells in the ovaries, are always looking, is this safe for her to become pregnant? And so when you're fasting for 72 hours or 96 hours, or even if you're just fasting every single day, you don't eat until 1 p.m.,

you're not sending a safety signal to the body. And you do see things like the hair loss, you start to see more anxiety, you start to see sleep dysregulation, mood and affect changing as well. And then you also just, you know, the metabolic adaptations to reducing, to having an extreme and aggressive caloric restriction over time. I mean, you know, I was listening to, I listen to your podcast all the time and you've talked about bulks and cuts, Like there's only so far and so long you should

be in a cut, right? In a caloric deficit. And of course the magnitude, the magnitude of the caloric deficit is also going to matter. If you are consistently under eating, your body is not stupid. Your body is going to be adapting to the substrate or lack thereof that you're giving it.

So you're going to dial down your BMR, you're going to dial down, your digestion is going to slow down because your body now is trying to extract every single molecule of food that you might put into it. So you're going to see all of these different adaptations for women and so I, where I stand on fasting now is, we all of us men and women, we all fast every night, right?

So we all sleep, hopefully somewhere between eight and nine hours. If you want to extend your fast, if you feel good when you're fasting, if you're someone who is still in their fertile years, so you're still menstruating regularly, you might be more receptive to a longer fast in the first half of your cycle. So that would be in the follicular phase, so bleed week, so the week that you have your period and then the week before you ovulate. But even then, I would say, I mean, I can say for me personally, I don't really fast

more than 12, 13 hours maximally. So I'm usually like 12 to 12, like I'll sleep and then maybe I'll wake up and I eat almost immediately upon waking and that's just a muscle preservation strategy as I'm in my mid-40s now. And I tend to finish eating like a couple hours before I go to sleep. And that's how I feel best doing that. And based on the stories that I have had with many women,

when we are extending the fasting window for a long period of time, it's like, where are you going to go? You know, like how much longer are you going to fast? How much more aggressive are you going to try and use this as a tool for weight loss? And I found, you know, I was saying before, I find the same is true with the ketogenic

diet as well. They feel good. They lose the water weight. And then when it's time to reintroduce carbohydrates in the form of vegetables and fruits and sweet potatoes and rice and oats and all the things, they're deathly afraid of carbohydrates, which I think in both cases can

really lead to disordered eating. And women, I think, because of our culture, like, always be skinny, always never age, and always look this way, I think that we are much more susceptible to that disordered relationship with food. Yeah, and you know, you have, one of the things I like about your perspective, you have a unique perspective because you have a great relationship with strength training. You've been strength training for a long time. You at one point competed as a figure competitor, which is like a natural bodybuilder essentially. So you understand the

benefits of it, but women, and you see this, it's less now than it was when I first started. It was really bad when I first started. But still they're so afraid of the scale. They're afraid of the scale moving. It's the only metric in some cases that matters. Yeah, so I often tell people don't even weigh yourself because you could gain weight on the scale and get leaner. A lot of people don't realize that. 100%. As a percentage.

You could take creatine and gain weight on the scale. And you actually become leaner as a percentage of your body weight. A lot of people don't, a lot of women don't realize it and then they look, muscles look rounder and fuller and it's like, that's what you want. But the scale is a big enemy. Enemy, one other thing that I noticed

and I love your opinion on this is, well first let me ask you this, is your menstrual cycle, is that a great, is that a sign you should really pay attention to when it's starting to get off? When you're skipping periods, when your period's longer than it normally is or it's not like you, is that a great sign that maybe something's off? 100%.

Yeah. It is a vital sign for women. It is basically every month you get a hormonal report card, how well you manage your stress, what the balance of progesterone and estrogen was, every, and you can look at the quality, I don't know if this is TMI, I was going to get it. No, no.

You can look at the quality, I don't know if this is TMI, I was going to get a squeezy one. You can look at your blood and look at the quality. Is it, does it start very dark and then over the course of the week, does it sort of lighten up? Is there a lot of clots in the blood? If so, how big are they? So you can really extrapolate a lot of information from the blood in your bleed week in terms of, do you have too much estrogen?

A lot of women who deal with excess estrogen, you know, conditions like endometriosis, adenomyosis, I've cared for many of these women who when we first started and I would ask them about their menstrual blood, it's like it's all clots. It's all, it's just all sort of clumpy, it's not liquid in any way. So you can derive a lot of information from the menstrual cycle. That's interesting. Are there common ones that women just tend to ignore in relation

to that? Like they just think that's normal. Like, oh, that's normal. We talked just recently, I know this is a terrible analogy, but hang with me, of like, you know, people having like these disgusting farts that they do and thinking that it's normal, right? Oh, it's just gas. But it's like, no, listen, that's your gut trying to tell you that's like, yeah, the paint is not supposed to peel. So are like in the same regards, is there similar things that women just go, oh, I'm supposed to bleed or supposed to be like that, like as far as the flow or the things that

they ignore. Like the length of the bleed is important. So for, you know, and there's bio individuality here, so I'm going to talk about normal ranges, but of course there can be, there can be, uh, you know, there's area for, there's wiggle room, but typically a bleed somewhere between three and seven days is considered normal.

Like I mentioned, bleeding in the beginning, having a heavier flow in the beginning and then having it, um. Taper off. Lighten, taper off towards the end of the week is very normal. The color of the blood should also change. So normal colors of the blood in the beginning, typically a very dark plum color, and then it

should sort of taper off to more of a lighter color. You can even see some brown at the end. Um, that's usually just oxidized blood. It's just been like blood that's usually just oxidized blood. It's just been like blood that's just been exposed to oxygen. If it's, it usually should not have, if the color of the blood is orange or black or gray,

you know, we could be looking at BV like bacterial vaginosis or some type of infection. And then the clotting that I mentioned. So there should, some clotting is normal. I typically will tell women, you know, if it's about the size of a dime or smaller, that's considered normal. If it's a quarter or bigger,

then this is where we start to think, okay, maybe there was unopposed estrogen in the second half of the cycle, where we should see sort of progesterone and estrogen, I like to call progesterone, she sort of brings in her ninjas and beats the crap out of estrogen, with the, down regulates the estrogen receptors, down regulates estrogen production, you should see that in the second half of the cycle. So there's a lot of clotting in the blood that tells me that there's unopposed estrogen in that time of her cycle. And are these like signs,

now are these signs of imbalances, hormonal, stuff early signs or does this mean this has probably been going on for a long time? Like can the, will the body start to tell her that, hey, this is going on? Almost immediately. Okay. Sounds like just a good metrics.

Yeah, it's so, it's so wonderful because you can really go from having terrible periods, terrible PMS, youMS, requiring medication to get you through the second half of the cycle to within a couple of months really seeing that turnaround quite aggressively. I've seen that in patients hundreds of times over. For women who exercise regularly, who watch their diet and they start to notice these changes, is it typically because they're doing too much, overstressed?

Is that what tends to be one of the common culprits? I think there's a lot of type A personalities, I'll call myself out on that as well, where we are always concerned about achieving, achieving, achieving, achieving, achieving. And you can also overdo it in the gym, right? So when last time you were on the show, I was saying, you were talking about junk volume and I was like, oh damn, I feel like I'm being called out here because I totally can move into that junk volume territory because I really enjoy it. And I think that a lot of women can also get caught up in that. But I think that it's very hard for a woman, I've seen it, but I think it's more common for a woman to overdo it on the cardio side than it is for her to

overdo it on the weight training side. I've often, whenever I've sort of evaluated a woman's strength training program, more often than not, if strength and hypertrophy is the goal, she's usually not working out hard enough. Like lifting heavy. It's either lifting heavy enough, she's not working close enough to failure. You don't need to, certainly heavy weights is one way that you can drive muscle hypertrophy as you know. I think for a lot of women, particularly these, I'll use your course name, your muscle mommies, right?

They're like, they've gone from the cardio bunny, now they want to be the want to be the muscle mommy. Um, there's a lot of apprehension in terms of starting to lift heavy because now all you hear is like lift heavy weights, lift heavy weights. So a lot of women are really worried about getting injured. You can still drive an incredible amount of muscle hypertrophy just by working the, there's a couple of different ways. So heavy weights is one of them, but if you don't have the

neuromuscular integrity, if you don't have the neuromuscular integrity, if you don't have the motor patterns, like you all know more than anyone, exercise is a skill, right? It's a motor skill that you practice every time you're in the gym, you practice it over and over and over again to become more sufficient and more proficient at it.

So women who train, and I don't want to poo poo on like women's magazines or anything, but let's poo poo on women's magazines. It's like you often see them in a plank and they're doing a row. It's like, what are you doing? So now we have- Donkey kickbacks. But if you're in a plank with a row,

or like the one I always see is- A squat press curl. Squat and a press. It's like that's working. So the weight is neither going to be sufficient enough to work the legs, because you're holding probably five, eight, maybe 10 pounds. squat press. Squat and a press. It's like that's working. So the weight is neither going to be sufficient enough to work the legs because you're holding probably five, eight, maybe 10 pounds.

Like that's not sufficient enough for a squat, for your leg muscles, some of the biggest muscles in the body. Right? So you're maybe going to approximate failure with an overhead press with the shoulders, but it's a waste of time. So just do the barbell squat, do the front

squat, do the sumo squat, whatever. Get on the Smith machine if you want a predictable line of motion and work the muscle to one to three reps of muscle failure. I mean, you guys, I mean, preaching to the choir, right? Like you don't need to go. Yeah, but it's so good to have you say it though. I know, better when you say it than we say it. I want to know too, because I mean, the two hardest cells, and you're bringing one of them up, which is like to get women to kind of focus on lifting heavier and making that a priority.

The other one is to eat more and to be in a surplus and go through a phase of that even. And like, how hard is it for you to convince or even talk women into doing that? It's hard. Even with the creatine, you know, the creatine, people are like, aren't I going to get bloated? It's like, no, the water is not, the water is in

the myocyte, it's in the cell, it's plumping up, it's rounding out the, it's rounding out the shoulder. It's going to make your booty more, more plumpy. Yeah, it's going to pop. That tends to have more definition. Yeah, exactly. So I think that there, it's really, I think for anyone, I know that you, a lot of trainers, a lot

of coaches listen here. I think that the first thing that you have to do with your clients is develop rapport. Like they have to trust you. Yep. If you just go right out of the bat and you're like, you're going to, you're going to be eating in a caloric surplus and we're going to,

we're going to take you away from the circuits and we're going to move you right into. See ya. They're going to just slowly walk backwards to the door, right? So we want to slowly develop rapport and trust with our clients, with our patients, and explain to them the process.

I think a lot of women also, a lot of people don't take the time to explain why. Why is this so important? And I think for people, especially like me, if I were to ask you, why is this important? Why do I need to take creatine? What is it gonna, if you explain it to me, then I can intellectually understand that.

And maybe I haven't emotionally bought in yet, right? But there's part of me that understands what's happening. And then if there's trust in the relationship between the trainer and the client, then over, you know, a delta, you can start to see, you can start to see some results from that. Yeah. You work with a lot of women too, to help them balance out their hormones. Yeah.

Is strength training the preferred form of exercise? Yes. Now why is that? Why is... So I didn't know this early in my career. I was early on, I was just kind of meathead trainer. I knew exercise is a new technique, but when it came to hormone balance, when it came to overall health and wellness, I was just deficient. But I was lucky to work with a lot of really smart individuals and some of them were functional medicine practitioners. And I remember them, the reports they would give me on their patients who did strength

training as a primary form of exercise versus others. In one particular, I remember him saying, oh, this is the way that I have people work out now because they seem to balance out their hormones much faster and effectively with strength training. What's going on? What is it about strength training that helps with the hormone balance versus other forms of exercise? This is such a good question. I'm so happy that we're here.

So there's many ways that strength training balances out a woman's hormones. The first, when we think about muscle in general, muscle typically serves, when I talk to women about muscle, it serves three functions. So it serves a mobility function, right? So our ability to walk and pick things up. And I was just recently in Italy with my husband, we went to the Amalfi coast. And if you've ever been there, it's gorgeous.

It's very hilly and there's no elevators, right? There's no, you have to take the bags off the train, onto the platform and then roll it up the hill and all that. So there's a mobility function to muscle, serves a mobility function. The second is a metabolic function. It's the primary site for glucose utilization, for glucose storage, for fat utilization.

Your muscle metabolism is largely going to dictate what your blood glucose levels are and what your blood lipids are going to be. And so for women, a lot of women actually in perimenopause will say, I don't know what's happening, I'm 45, I'm doing literally the same thing I was doing when I was 25, 35, and now my triglycer, I have more triglycerides, my total cholesterol

is creeping up, my LDL, like I have no idea and I'm doing the same thing. Part of that is the degeneration of muscle metabolism, if you're not strategic about lifting weights. So it has a metabolic function, which will balance out glucose and insulin, of course, right? It's like muscle can take up glucose in an insulin

dependent and independent manner. So there's a metabolic balancing in terms of some of your metabolic hormones. And then there's also a menstrual benefit. So testosterone, we know that testosterone is famous for libido, but it's also really famous for maintaining muscle mass, for maintaining bone density, for heart health. And depending on how fit you are, every time you train,

you're gonna have a transient rise in testosterone. So the more fit you are, you know, you have a smaller effect because there's less muscle turnover, but anywhere from 10 hours to about 48 hours, you're gonna have a transient rise in testosterone. So how great is that for women who, uh, you know, in perimenopause, for example, we see a

lot of changes in mood, we see a lot of changes in, we see a lot of the sort of decrease in their muscle mass. Um, so that transient rise in testosterone, and that's also very important for brain health as well, because testosterone and dopamine are very closely related as one lifts, the other one tends to lift as well.

So as testosterone's rising, your dopamine levels tend to rise, which is gonna make you more likely to pursue things that matter to you and you're gonna be chasing your goals and your dreams. And then the other piece to that, of course, is when you're lifting for a woman, it tends to have a balancing effect.

It tends to promote a progesterone to estrogen balance in the second half of the cycle. So if you're a woman who's still in her fertile years, including perimenopause, because you're still menstruating, albeit maybe more irregularly, what we see over time as just a natural consequence of aging is we see this stepwise decline in progesterone. There is an overall decline in estr decline in progesterone. There is an

overall decline in estradiol, the main estrogen. There's three estrogens, estradiol is the main one and estradiol in our perimenopausal years can oscillate quite like it can be up one month and then down the next month. So when we're training, it tends to promote a better progesterone-estrogen balance. And for women who experience dysmenorrhea or premenstrual symptoms, if they're going to feel any type of symptoms at all, it's going to be in the second half of the cycle. So all more important for you to be training all through the cycle. And I often talk about this idea of training to failure know, to failure, whether that's with heavy weights, you know, anywhere between like five and 30

reps, the literature suggests is appropriate for muscle growth. As long as you feel like I could have maybe punched out one or two, maximally three more in that set. That's a proper progressive overload, or that's a proper way to train. Yeah, so, I mean, you mentioned a lot of things there. One of them that stuck out to me was how muscle affects insulin.

Is the relationship between insulin resistance, even in the early stages, before we can identify it as let's say, pre-diabetes, is the relationship between that and estrogen and progesterone, is when insulin starts to go off, do we start to see those imbalances cascade or continue down the line? Yeah, so insulin resistance starts

at the level of the muscle, right? As you, I know you've talked about this before on the show. And again, you don't just wake up in your 40s or your 50s with type 2 diabetes. Like this is a decade long process. And in some cases, you know, Dr. Gerald Schulman and his work has really elegantly showed

that you can, like the insulin resistance starts as early as your 20s. Like you can have euglycemic level. You can have healthy blood glucose levels, but your insulin, like your, you know, the beta cells of the pancreas are just like pumping out insulin to try and keep that blood glucose in that normal range. So that's sort of the first thing.

Your second comment around estrogen and progesterone is certainly well noted because when we are more insulin resistant, if you are pumping out more higher levels of insulin, you will have lower levels of something called sex hormone binding globulin, which is just basically a protein that binds sex hormones like estrogen and testosterone. And when it's bound, it's not useful. It's not useful, right?

It's like basically, yeah, it's in your... It's like testosterone or estrogen that's like locked up, now you can't use it. Exactly. Okay. So the higher your insulin levels, the lower your SHBG levels. So there's like an inverse relationship between the two. High insulin, low SHBG.

So what can happen there is now that sex hormone binding globulin can't sop up, can't like bind the testosterone and the estrogen. So now testosterone is sort of free to wreak havoc, estrogen is sort of free to wreak havoc in the, you know, to the cells that it's, you know, that it's affecting. And this is where we see for women PCOS, or polycystic ovary syndrome.

That's right, because it's connected to higher free testosterone. Yeah, yeah. Oh wow. So you see excess androgens in a woman with PCOS, but whenever we see high T, whenever we see high testosterone in a woman, it's almost always not because she's just inherently producing these super physiological levels of T, it's usually

something else. And with PCOS, I think it has its roots in insulin resistance, which if you go a level deeper is poor muscle metabolism, right? So she's probably not using that contractile tissue on a regular basis so that the muscle is well versed in sopping up that excess glucose in the system that's driving up the insulin.

Is this the anabolic resistance? Is that what we're talking about right now? Yeah. Yeah. And it's more common, is it becoming more common now than it's been before? I would imagine because of the loss of strength that we're noticing. Yeah, I would, PCOS in particular is the most common hormonal

derangement that we typically see. By the way, symptoms of that, can you go over those? What are the symptoms of PCOS? It's irregular periods. Like so it's amenorrhea, it's infertility. So inability to get pregnant and stay pregnant. You'll typically see in extreme cases, you'll see things, something called hurt suism, which is just male pattern hair.

So you'll see, uh, hair on the chin. You'll see hair, um, on the chest. You'll see male pattern baldness. So like along the temples, you'll see loss of hair. Uh, a lot of these women also, if you look at their labs, you're going to see dyslipidemia, you're going to see, you know, high levels of triglycerides, high levels of total cholesterol.

And then you'll also, you'll also see mood and affect changes. She may or may not tell you that, and that depends, again, on your rapport with your patient. But depression, anxiety, some of these issues are rampant in women with PCOS. And one of the best ways that you can overcome that is to have her strength train on a regular basis. So we're getting that contractile tissue, that muscle is the main sort of glucose disposal agent that we have. So the more that she's training, she's going to be

able to pull in that glucose, which is there, you know, has this knock on effect of like lowering insulin output from the pancreas, which is now going to help all systemically the cells of the body sensitized to insulin. And it's also going to raise SHBG. Oh, wow. Now back to kind of what Justin was asking, I'm curious to like, with when it comes to like getting women to bulk and eat more, how important is it that they're also

eating a sufficient amount of protein and calories while also trying to do this? Or do you just see positive benefits just simply by getting them to strength train? Can they see that from that alone? You can see, of course, yes. Just from that alone? 100%, yeah.

I think that I don't know that there's any intervention that equates strength training. Across the board, I know we're talking about PCOS right now, but across the board when we're talking about metabolic syndrome and dysfunction, type two diabetes, cerebral vascular disease, cardiovascular, all of the sort of big killers that we think about, I think that exercise should be the number one intervention.

In terms of nutritional interventions, I'll preface this by saying there are therapeutic interventions of nutritional therapies and then there's sort of what you follow when you're healthy. are therapeutic interventions of nutritional therapies, and then there's sort of what you follow when you're healthy. So in the same way that if you contracted some bacterial infection and you went to the doctor and they wrote a script for antibiotics, you would take it for whatever it is, 10, 14 days,

you wouldn't continue taking the antibiotics for the rest of your life, you would just take it as that therapeutic intervention to get rid of the bacterial infection that you had. The same is true for nutritional therapy as well. So if you are someone who, if we're continuing the example of a PCOS patient, she has high levels of insulin, you know, it would be a good strategy for her to think about how we can lower blood glucose.

One of those would be maybe a transient, underline, double underline, bold, transient, temporary reduction in carbohydrates, along with the protein. So this is where I've kind of, again, sort of changed and I've said this, I know a couple of times right in the show, like I've changed my view on this and that.

It's like, I hope that any doctor changes their, or any trainer or anyone sort of changes their mind with time. If you have someone who's still talking about the same thing, it's like, sell peach diet, you know? In 2024, it's like, run. So, I'll just say that. But I think protein, you know, incredibly satiating, of course, it's going to chemically stimulate muscle protein synthesis,

which is like kind of the goal again. We're trying to get more of that lean muscle for that woman with PCOS. So protein does play a big role, I think, across the board, irrespective of the hormonal issue. I think women need to be thinking about protein, not as this, you know, I think protein is, I think it's traditionally looked as like man fire barbecue meat, you know, but meat is just as much and,

and good quality protein sources are just as important for women as they are for, as they are for men. Now, yeah, I had kind of a, I guess, a personal question. It's, it's, I'm just curious because I've seen a commonality with a lot of clients that I've had, women that all shared hypothyroidism and my wife as well.

And I'm just curious, besides genetic factors and why do we see this kind of common, it's commonplace I think a lot of times and too, like have we always, has this been around for a long time or is this like a new trend, upward tick in hypothyroidism or is this? I think that we're seeing more and more, so hypothyroidism obviously is low functioning of the thyroid, which you can sort of get from the name of it, but most women with hypothyroid, if you're testing their labs, they're also produced,

they're already producing autoantibodies, right? So they're already on the spectrum for Hashimoto's thyroiditis or the autoimmune condition that attacks the thyroid. In terms of prevalence, I don't know if it's more or less, I don't know if it's more or less common. My guess would be more. I think our diagnostic capacity is better. I think that there's more we have, we've sort of expanded.

You know, I just said to you like hypothyroidism, you're already sort of on the spectrum for autoimmune disease. So I think that our inclusion criteria has also expanded. We're a little bit more inclusive now. And then we're also seeing a lot of women take to social media to come, like to, I can't tell you, we have this in our help desk, in our email system almost every week. My doctor is refusing to look at my auto antibodies or just screening for TSH. So I think that there's, it's crazy to think that you might just look at TSH, maybe T3 and T4 and

not look at reverse T3 and not look at the auto antibody. Like it's crazy to me that we're still there, but we get emails at, you know, in our help desk, like at least once a week we have someone, you know, wanting, we have a lab guide that we, um, that we've put together for, for women to download with like optimal ranges and, um, and

when you should test your thyroid and, and that kind of thing. And we, we're constantly getting that feedback that the sort of allopathic or maybe more traditional, um, route for thyroid care is very lackluster. Is there a connection between, I've always read that gluten seems to be connected in many cases to antibodies in the thyroid, is that?

Yeah, I'm wondering like environmental factors, all that kind of stuff, like what's out there in terms of knowledge of what might be contributing. Well, gluten is interesting because it's the protein, the gliadin, it's the protein in the gluten that resembles the thyroid, right? So what happens- I see, you're building an immune reaction to that

and then by- And then your immune system's like, wait a minute, that thing right there, that's the gliadin, go get it, right? So there's your meat is like, wait a minute, that thing right there, that's the gliadin, go get it. Right? So there's a morphology, there's a similarity in terms of the morphology of the protein. Interesting as well, cerebellum also very, if you

have like a leaky, you know, we always talk about a leaky gut, but there's also leaky brain, like the blood brain barrier, if that's sort of open as well. You can also have- Is there a correlation between the two? If one's leaky, the other one tends to be? Always. Yeah.

So the cerebellum also morphology is very similar. So you can also have, you know, over a long period of time, you can sort of develop things like ataxia and all these different, because your immune system is now attacking the cerebellum as well. So. Wait, wait, wait.

What are the symptoms of that? The symptoms? Well- Crazy wife. I mean, yeah. So the cerebellum is sort of the coordinator What's that? The symptom? Well- Yeah. Crazy wife, I don't know. I mean, yeah. So the cerebellum is sort of the coordinator of all of your motor movements, right?

So you'll have the motor cortex and the ephairns that are going down to the body will go through the cerebellum and then vice versa. So there's like a smoothing. That's when, you know, if you ever stopped, not that you guys would ever be stopped, but if you ever stopped for drinking and they tell you to walk the line and they tell you to do this, what they're testing for is the cerebellar's ability to sort of clean up those movements because what will happen is you'll miss, or it'll be shaky. So the cerebellum basically cleans up our motor movements.

Wow. So motor movement changes would be a sign, especially if you have gut issues, like uh oh, I might have leaky brain. Balance issues would be there as well. When you walk the line, it's like one foot in front of the other. Is leaky brain like leaky gut used to be? I remember in the late 90s, early 2000s,

like I said, I've worked with some, been lucky to work with exceptional individuals who were ahead of the curve. And I remember when they would bring up leaky gut, the doctors that I trained, traditional doctors, surgeons, they would overhear the conversations and they'd roll their eyes at me like leaky gut. Now of course it's established, we call it,

what do they call it, intestinal wall hyperpermeability. Is leaky brain like leaky gut used to be? Or are they- It's the same thing. Are they saying, in other words, is the medical establishment like that doesn't exist? Or are they saying, oh no, this is the thing? That's it, are they, in other words, is the medical establishment like that doesn't exist or are they saying, oh no, no, this is a thing? Oh, that's a, you know, I don't know what the feelings are in the medical establishment

around it. I would- Like if I go to my doctor, I'm like, I think I have leaky brain. Yeah, he might give himself a lobotomy with how hard he rolls his eyes. I would say, you know, a really good person to talk to about this is Dr. David Perlmutter. I don't know if you've had him on the show. Yes, I do. No, I haven't, but I know he is. He's fantastic.

I have been, he's phenomenal. So he talks a little bit about this as well. Often when we look at, um, immunologically privileged sites, like the brain has a sort of its own immune system. We have the astrocytes and everything. Like that blood brain barrier we used to think it's like impenetrable.

Nothing can get in there, but, uh, it's, uh, it's not, it's absolutely withenetrable, nothing can get in there, but it's not. It's absolutely with poor diet, with poor, you know, when we see metabolic syndrome, when we see inactivity, poor stress management, all of these things over time can like nick away, if you will, it's sort of a crude, like it sort of can nick away at that impenetrable

layer between the brain and the body. Does working on the integrity of your gut also simultaneously then work on the integrity of the brain? Absolutely. Yeah. Wow. What another, so the reason why this is blowing me away, I mean, I guess if I thought about it, it sounds logical, but what a great, another great way to sell why you

should focus on gut health. It's not just about your gut. It's about your brain, not having that integrity. Very interesting. That's fascinating. So what are your favorite things in the space right now that you're learning that are just, what do you like to talk to most or what do you find most of your questions revolving around right now? I think for me, I talk a lot about strength training and fitness for women. So the questions that I get most often, I'm sure

you guys also get this as well, is like, can I lose weight and build muscle at the same time? How do I train without injuring myself? That's a real issue for my perimenopausal ladies who are now wanting to get into the gym, that are kind of nervous about lifting heavy weights, they don't necessarily have the integrity or the, you know, the motor patterning,

uh, to sort of figure that out. And then I think just what to do. I think that I get a lot of questions around, uh, what does heavy lifting even mean? Like, how do I know that I'm approaching muscle failure? Like what are, how does that, what does that look like, feel like? Is it harder for a woman in perimenopause or menopause to get leaner because of the changes in her hormones? Is that a real thing? Because I've heard women, I have, okay, so I'll give you a personal story.

My aunt, who I've been trying to convince to strength train now for 10 years, and so we constantly go back and forth, and I love her to death. She's wonderful. But she's like, you don't understand. Suddenly I gain body fat around my midsection. Suddenly I'm pre-diabetic and nothing changes except for my hormones and I'm always trying to tell a little strength training, I think that'll,

but I hear that a lot, I hear that from female clients too, like all of a sudden, like everything just changed. Is it harder and if it is, are there anything that they can do specifically to get their bodies to get leaner and fit that may be different than someone who isn't in that place. Yeah, your aunt, very astute observation with the belly fat.

So that is something that we see in terms of the phenotype of fat or the type of fat that we typically produce changes as we age. So usually women will, even though we have a general sort of disdain for it, we will typically put on weight in our bums, thighs, sort though we have a general sort of disdain for it, we will typically put on weight in our bums, thighs, sort of lower

tummies, right? And that's under the influence of estrogen. As estrogen begins to wane in our forties and then eventually going through that menopausal transition, you know, for most women's 51, 52 years of age, we will start to accumulate visceral fat. So that goes back to the insulin resistant

conversation that we were having before. will start to accumulate visceral fat. So that goes back to the insulin resistant conversation that we were having before. When your muscles are not sopping up that excess glucose, you have now a higher systemic output of insulin and now your liver is going to be more, your liver will continue. What happens when there's, you know, the liver has been exposed to insulin over a long period of time is now your liver will continue what happens when there's, you know, the liver has been exposed to insulin over a long period of time,

is now your liver will continue to produce glucose, even in the presence of glucose, right? So there's this gluconeogenesis that's happening when it should be shut off. And the other thing that happens is the fancy word is, you know, de novo lipogenesis, which is just like new fat, right? So your liver is now, there's a hepatic output of new fat.

So we will see fat that now accumulates in and around the organs on the liver. We've all heard of NAFLD, or non-alcoholic fatty liver disease. And we see the spilling now of triglycerides and the cholesterol and things like that into the blood. So our cholesterol and we sort of have this atherogenic dyslipidemia.

So we see this change in our blood lipid levels that are more atherogenic in nature. So your aunt is correct in that she's like, I don't understand, like I'm doing the same thing I always was and now I have, like my waistline is expanding. Um, that is because in part of A, the insulin resistance, uh, and B, declining levels of estrogen.

So for her and for many of the perimenopausal women, maybe they're listening to the show, there's sort of a beautiful marriage that can happen with the strength training that we're talking about. And then the pharmacology of hormone replacement therapy, where they might consider either taking, you know, this is obviously a very individual discussion with your provider, but you know, maybe if you've already gone through menopause, you might consider estrogen, you might consider progesterone, you might consider testosterone as well. So she's not wrong and there's a lot that's within your control, right? So she's not wrong in that she's noticing ectopic fat, we call that ectopic fat distribution. So like that fat

distribution that's not typical for a female. Uh, it tends to actually look more of like male pattern, like the way that men typically distribute fat, they'll typically distribute fat through the, through the midline. So there's a lot within our control, strength training being absolutely one of them.

Um, and then your, and then your diet. So when we think about, one of the beautiful things about strength training is I know for years we used to talk about like spot reduction and like, I would just love to lose like, you know, whatever. You can't do that, but you can certainly direct your training to gain and like, if you wanted to

grow a booty, like you could do lots of squats and lots of deads and lots of all of that. And the same is true when we're thinking about visceral fat. Visceral fat also very positively responds to lowering your particularly ultra-processed carbohydrates, fructose and things like that because that will bring down in a very short period of time the visceral fat that you're either accumulating or that you have. So in a sense, you could affect the type of fat distribution in your body by improving insulin sensitivity, changing your diet, or at the very least,

reduce that switch that happens as you go into paramanopause or menopause. Stay right here. Okay, you're already starting to do something that I wanted you to do, which is cool. Like for my trainers and coaches, right, because we have a lot that are listening, and I remember that if I were to look back at all the clients that I train,

that this is probably where I was challenged most was women going through menopause. I just did not, I didn't have the education, the experience around it. And if there was ever a client that I felt the most challenge, it was, was helping them. So if I was a trainer and you're, you were helping me as a trainer years ago and you'd like, here's your checklist, Adam, like, you know, ask her about this first, then address this, then address, could you give me like your top five, like here, here, here, here?

And that's controllable, right? Obviously we can get hormone intervention, but the things that I'd want her to control first herself before we even go that direction, what would that look like? I think for, and I guess it's gonna depend on her level of fitness. If she's new to the gym, certainly I'd be wanting to start off with like proper, like range of motion. I loved what you said on my show. You said a range of motion that you

can own, right? So a lot of times women, they might have some sort of arthritis, maybe it's an OA or an RA or psoriatic arthritis or rheumatoid or something like that, where that's precluding them from having full range of motion. So you want to understand where their, um, uh, where their deficiencies might be. And you want to work on a range of motion that is full for them and pain free for them.

And if it's possible, um, you know, increase that range of motion with time. Okay. Sometimes with our, like with a rheumatoid, let's say, which is a destructive autoimmune condition of the joints, you can't necessarily improve the range of motion, but you can preserve it through, you know, and you're not

focusing for someone with RA, you're not necessarily focusing on heavy weights, you're just focusing on like, let's just get them to move something, just like an overhead, like let's just get them to have that mobility in the shoulders so they can fully, you know, bring the arm all the way up or as much as they can. So it would be range of motion and joint health, in the shoulders so they can fully, you know, bring the arm all the way up or as much as they can.

So it would be range of motion and joint health. Can they tolerate, can they axial load? So can they put, can they do a barbell back squat? Can they do any type of deadlifting, that kind of thing? And then I would be looking at where they are in the menopausal transition. So, are they still menstruating, albeit irregularly? Okay. Um, if they've already transitioned, I mean, menopause is just like one day in your life, it's just, you qualify for the diagnosis of 12 months without a period, that's all it is. Yeah.

But if you're past that day, then the management of that client is much easier because in some ways clinically or in practice, if you're a trainer and you have a perimenopausal client, a perimenopausal client in some ways is clinically more challenging because she's so variable, right? She's kind of a moving target until she really goes through that transition. So I would want to know, is she still menstruating?

Do we think she's in like early stage perimenopause goes through that transition. So I would wanna know, is she still menstruating? Do we think she's in like early stage perimenopause where she's still menstruating regularly? Maybe she skipped a month or two or has it been several months and she's just kind of in the waiting room now figuring out like have I gone two months? Okay, this is good because I mean, shame on me.

I would have lumped everybody just under menopause and that almost the same protocol applies to her as it does if she was just coming in. So there's actually a different protocol. Okay. Yeah. And even injury risk, right? So we see women who are in their fertile years, there tends to be the type of injuries that

they sustain is different than a menopausal woman. So in some ways, a menopausal woman, and I don't mean this in a derogatory sense at all, but in some sense, she's more male, right? Because she has lower levels of estrogen. So she's not gonna have as many, let's say, she might not have as much muscle strain, or she might not have as much tendon injuries as someone who is younger and still cycling. So that's something to consider.

And then in terms of diet, if you're a trainer who's consider. And then in terms of diet, if you're a trainer who's working with your client in terms of diet, again, prioritizing protein for these women. Back to the anabolic resistant conversation, there's two ways that you can stimulate muscle. It's mechanically in the gym and then chemically in the kitchen, right?

So we wanna be driving MPS, muscle protein synthesis, as much as we can. And we do that through consuming more protein. Where I like to counsel women to think about, especially in perimenopause and menopause, with their protein, is to stop thinking about protein as a percentage of your total calories.

So, you know, sometimes with a diet, you'll say it's like 30% carbs and 40% protein and 30% or whatever. That zone. Yeah, yeah, whatever it is. Or keto is like 70, 20, 10. And think about it as a gram target. Yeah.

So pull the protein out of the percentages. It's a gram target. That's the first and most important priority in your diet. And then you can back in the calories, the rest of the calories that you're consuming, the carbohydrates and most important priority in your diet. And then you can back in the calories, the rest of the calories that you're consuming, the carbohydrates and the fat, based on your preference. Some people like higher fats, some people like more carbs,

and you can sort of make a diet, you can create a program for them that they're gonna more likely stick to over a longer delta. Yeah, awesome. So great hearing you say that too, because that's kind of, I mean, that's always the protocol that we say first, like when we get somebody.

And that's, you're talking about a very specific situation, but I feel like that's such great advice across the board for someone. It's like, stop looking at it as a percentage. Like, here's my goal body weight I want to go after in grams of protein. Totally. And then letting the other stuff fall into place.

You'd be surprised how much just that alone changes so much for everyone. Women have, I find, I don't know if you find this, if you get this feedback, but I have a lot of women saying, oh my God, that's so much protein. Oh yes. Oh yeah. That's why it's such a, I feel like it's such a

important thing to address first because in my experience, almost every client I ever trained was under, especially my female clients were under eating protein significantly. Yeah. They misunderstand what high protein is. It's like, I had two eggs for breakfast. Yeah.

Yeah. You need to have 120 grams a day. So, how do you feel about GLP-1s? How do you feel about some agglutide, trisepidide, and these new interventions that are now huge, hugely, in my opinion, hugely going to impact our space and just in general culture. Are you working with them? What are you seeing?

I'm not working with them. I am very interested to see how this is going to pan out. I think that in terms of when we're thinking about this in obesity medicine, I think that this can be a lifeline for some women and men. We don't all have the same levels of ghrelin, right? So some people just have this like hedonic hunger. And even, you know, coming back to our beautiful menopausal women, those menopause munchies, like you just, some women, they just, they're always hungry, they're always hungry,

they're always hungry. So we can, we do see GLP-1s tamper, certainly tamper that. I would like to see right now, like the safety profile, like they've been around for a long time. I know that they're super popular right now, but they've been around for like 20 years. So the safety profile of them is really great. profile of them is really great. What I would like to caution or maybe have people who are considering it or who are on it take note of is that you also have to major in the majors on the

lifestyle side, right? So you still have to be majoring on, you still have to be getting the gram target of protein. You still have to be mechanically stimulating the contractile tissue, your skeletal muscle. You still have to be managing your stress. You still have to be mechanically stimulating the contractile tissue, your skeletal muscle. You still have to be managing your stress. You still have to be sleeping well. These things all matter. And I would say the same is true with hormone replacement therapy.

You just can't jump to estrogen replacement therapy, testosterone, and think that that's going to be, you know, it's going to wash away a multitude of sins. Like you also have to do the other work. I honestly think you're hitting exactly why we're seeing the negative press on it with the amount of muscle loss and the thing that's happening is people are purely using it

as a way to just cut calories. They're just eating what they did before and just eat less. Yeah, yeah, yeah, right. But I don't know that... I've seen some data that suggests that while you can increase, like you can increase sensitivity of insulin sensitivity. Oh, they're muscle preserving.

But what's happening is people are just eating less. Exactly. And I think those cases are the cases of people majoring in those things and actually focusing on the core stuff. Yeah, I love asking this question because the way you work with patients is very much like a coach. Like you coach them, you work through behavioral, you and I have talked that, you know, I hear a lot

of what you say sounds like behavior modification. This is where I see some of the biggest potential benefits. Which is not an outcome, right? It's like stop thinking about the outcome and start thinking about the behaviors that lead into the outcome that you want. A hundred percent.

So this is where I see some of the potential benefit because if a GLP-1 is allowing you to not engage in this behavior over three, four, six months, 10 months or whatever, we can weaken those neural connections between you and that, whatever that behavior was. And then maybe replace it with another behavior and use it kind of as a bridge. That's where I can see the potential for people like us in using these things.

But you have the exact right approach. You could tell you've worked with a lot of people, like real people, and not just said, here, take this and come back and see me. So that's great. So when you're, first off, how long have you been working with patients now? Class of 2003. So that's awesome. Where are we? 24. So it's one, I mean, I retired from practice at year 19, so where are we now, year 21? Yeah.

That's awesome. Are you seeing any trends? It feels like more people are taking what you're saying. Like, it doesn't sound as radical as it did 10 years ago. It's so funny. When my first book came out, and even just talking about, like even just talking about menstrual blood,

like all the men would just sort of, just like hold on for dear life. So, I think that that conversation is now more out in the open. I think perimenopause and menopause, like I said, is definitely having a moment. I think that the women that came before us had to sort of suffer in silence, like the hot flashes, and it's just like, suck it up, buttercup. And this is just, you know, what happens when you're aging and we're seeing more and more women really embrace aging well. We're sort of, and I like to think about, I know that there's a big anti-aging,

like I want to look good, you know, like I want to look good in my dress, I want to look good as long as I can. But I also very strongly believe that it is such a privilege to age, it's such a privilege to become a father as some of you have been, to become a mother. I hope one day I'll be indicted into the grandmother club. So I think about what are some of the things, and I borrowed this a little bit from Peter Attia, because I know he talks about, I think he calls it the centenarian Olympics.

Where he's like, what do I want to do as a centenarian? What are the things, when I'm a hundred, I want to, and I don't remember the metrics that he's lined out, but he wants to be able to bench press this and squat this and what have you. And so I've taken that because I love that concept and I think about what is it going to

mean for me to be like a kick-ass grandmother? Right? Like when I have, I me to be like a kick ass grandmother, right? Like when I have, I want to be able to get down on the floor and play with my grandchild. I want to be able to pick my grandchild up. That means that I have to have a certain amount of proprioception and leg strength and glute strength and quad strength and balance and all

of that to be able to get back up off the floor. I want to be able to run after that toddler. If I take, you know, my grandchild to the park, that means I have to have a certain VO2 max. I have to preserve my type 2 fiber. So these are some of the things that I'm starting to think about now in my 40s. And maybe that's just, hopefully I'm getting wiser

and I'm starting to think a little bit about what the real meaning of life is. And for me, family is very important to me and taking, savoring and finding joy. I was on my recent trip to Italy, I was talking to my husband and we came up with this term. I haven't really talked about it publicly,

but I'll just sort of, I'll tell you guys and I'll see how you can give me some feedback. I love the term offensive joy. And often when we think about offensive, usually it's like something that's like an insult or something is offensive to you. But if you think about it in a sports context, there's offense and there's defense, right?

So when you're on the offense, you're being proactive about something. And I think for women in perimenopause, as I am, or in menopause, it's in some ways, it's a second spring. It's a way for us to reevaluate. We've spent many decades serving other, we've been mothers to children and wiping up the snot and taking them to soccer and all the things.

And it's a time of our lives where we can get back to who we are. So understanding what are some of the things that really bring me joy? Like how can I be proactive in creating joy and pleasure in my life? Because I think that so many women, maybe your aunt feels this way where she's stressed, like there's so much chronic stress, and it's like, is it that you're stressed

because you're doing too much, or is it because you're not doing enough of what you love and you're not balancing out the need, the have to do's and the get to do's? I love this conversation and it also, there's some parallels with men, men that retire, go through something similar where they're just like, their whole life was provide for the family, do this,

and it's like, oh, I couldn't wait till retirement, then they get there and they're depressed. So staying in this topic, are there things with clients that you exercise or practices that you give them to try and find that? Because sometimes when you've been serving others for so long or this focus on this goal, then you get there and you realize like, I'm not happy. I'm not doing what's, you don't even know how to find what makes you happy. I mean, is there things that you recommend that they do to try and figure that out? Because I'm sure someone's listening right now is like, oh my God, that's me.

Like, I'm done being a mother now and now I'm like just supposed to be living for me. I don't even know where to start. I think the first thing is, this was very useful for me is writing out a desire list. Like, what are the things that you desire? Because so many times we're rushing through our day, we're rushing through our to-do list, we don't even think about what are some of the things that make me happy.

And it doesn't have to be this sort of hedonic, like someone's fanning and like feeding you grapes, right? It doesn't have to be that, but it can be a cup of coffee, you know, out, you know, by the window or, you know, in nature, you can go outside and sit if you have a balcony or you have a porch. It can just be taking a quiet repose and having your cup of coffee in the morning. It's finding the little pieces of sweetness through the day. And then really getting in, sometimes I'll ask women, I've run clinics with women before

where I'm like, okay, we're going to write a list. And everyone's like, what is she talking about? I understand the language, like it's English, desire. I know what that means, but I don't really know what I want. And if you just create some quiet space, some of the smaller little delights will come up, like the cappuccino or being able to walk, taking an evening walk with your family or, you know, whatever.

Those are some of the things that I like to do every day. But then it can also be some of the bigger things, like some of the bigger dreams, like maybe you want to learn a language, maybe you want to travel, maybe you want to take a class or a ballroom. I had someone on my Instagram the other day saying, I just want to take ballroom. I posted about pickleball because this is like my new obsession. I'm obsessed with pickleball. And she's like, oh, I want to do ballroom dancing, but my husband doesn't want to go. And it's like, just go.

Like they're singles. Like they have, you know, you could just be a single, you'll be paired up with someone. But if ballroom dancing is going to bring you happiness and joy, and that's like the favorite hour of your week, like Tuesday night or whatever, when you go to your ballroom class, absolutely find time to make that happen. Yeah.

Dr. Stem, how much of that is also maybe like ignoring media, social media, the world, because it glamorizes what it can sell and what it can often sell is sex appeal, youth, you know, like the things that the market tells you is valuable. But in the reality, it's not everything that's valuable. And I think that's maybe one of the reasons why older societies seem to look at people as they age in prestige and they give them so much honor, whereas these newer societies,

not so much where it's kind of like you're supposed to disappear. Because I know you coach people through lifestyle. Do you ever tell people like turn off your social media, like stop looking at that stuff because it's just telling you the wrong. Yeah, the news never reports on the planes that land, right? It's like they're always going to be trying to pull, steal your attention, right? Here's the new drama, here's the new drama, here's the new virus, here's the new war, here's the new whatever. And I think that that keeps us, you know, there's different currencies that we pay in, right? So, the most obvious one is money, we pay for, we go for your coffee, you pay for your coffee, whatever. But there's also attention. That's also a currency. And so, when you're attention,

when you are constantly spending your attention on social media, it takes away from your own goals, your own dreams, your own desires. And so you can, you know, wake up at 45 and say, I don't know what my desires are. It's like, well, stop doom scrolling and have, create some white space, create some time for yourself. And those desires will come up because they're, you know, I don't have, for example, I, whenever I've had this conversation with women, I know, you know, I'll say, I'll give them the example, like, I don't have a desire to play basketball, right, because that's

not meant for me. I'm not meant to play basketball, but I do have a desire to speak many languages. I'm very attracted to, you know, Italian and French and Greek and Arabic and all the, you know, all the things that sort of delight me. But that's because those desires are meant for me and I've been quiet enough to allow those things to sort of bubble up. And so you don't have to be a polyglot, like that doesn't have to be your desire, but giving yourself some space and maybe a social media fast, that's a fast that I'm happy to promote. Like you can do a 24, 48, 96 hour fast. That's a great fast. And funny enough to my, we were talking before

we started recording about my children, my 13 year old, this is probably going to be the biggest regret of my life, but he has a phone. All of his buddies are on Snapchat and I can tell when he has been on his phone, his mood, he's angry, he's quick to snap, quick to yell. And so we do the same thing with him. It's like you can't be on your phone.

Like you have to put your phone away, we're going to have sort of a family fast and we're going to go for a walk, go for a bike ride, play basketball or whatever. I have two, I have four kids, but they're huge age gap. And my older two, 19 and 15 soon, they had, well, especially my 19 year old, unfettered access to the internet. I was young when he was born.

I was working a lot. This is when it kind of was a new thing. So I really didn't really- And we didn't really know. I didn't think about it much. So we just had tons of access. My younger ones, it's going to be very restricted. And the way I look at it, it's like, as a access. My younger ones, it's going to be very restricted.

The way I look at it, it's like as a health and fitness expert now, I wouldn't allow my kids around just all kinds of different garbage food and then say, hey, guys, regulate yourselves. They don't have the ability to regulate themselves. The internet, it's like they don't have the ability. They have access to everything. Everything. And we are their substitute frontal lobe. Like they're, even though my 13 year old thinks he knows more than his mom who's 46, you know, it's like, I love that you are 13 and you know more than me already, honey.

And I am your substitute frontal lobe until you're 25, because we see, that's when the brain matures, right? It's at the same time as a skeleton, it matures around 25-ish. So I have to be the person who is putting in those boundaries for him because he's unable to do that for himself. And even when we take him, we go play pickle ball,

we do the basketball, we're playing soccer, whatever, he feels so much better and he'll say to me, he's able to articulate, I feel so much better when I'm not on my phone all the time. He's still going to fight you over it. But then he goes back to it, right? Because he just doesn't have that, you know, that brain maturity to be able to inhibit some of those lower brain centers

that are getting that dopamine hit every time he's. I literally just got an argument with my daughter this morning. She's like, why do I have time limits? Because we put time limits on apps and stuff. Why do I still have time limits? I get good grades. I do this, that and the other. Yeah, you're not 25. Yeah, we're still having on apps and stuff. Why do I still have time limits? I get good grades, I do this, that, and the other. So we had all- Yeah, you're not 25.

Yeah, we're still having a discussion about this. But I notice such profound improvements in her mood and our connection. And sleep, right? So many kids, especially over the pandemic, so many kids were up all night on that thing, because they had no other form of connection. So yeah, yeah.

I wanna talk to you because you have experience in the competitive world. And I found that, I did that later on in my fitness journey and was really fascinated by what I saw. And I'm curious if you experienced something similar, you know, leading up to that, I had over what, 15 years of training normal clients. Of course, I've seen all kinds of different relationships with exercise and food. And when I got in the competitive world, I was really excited.

I thought, oh my, this is going to be the brightest minds. And like when it comes to nutrition and exercise, I can't wait to learn. Even being with the experience I had, I went into it with the idea of like, I could learn so much. Yeah. What I ended up finding was more dysfunctional relationships with exercise and nutrition that I had seen in the general population. Totally.

This blew my mind. Did you experience it? A hundred percent. Wow. And I had a coach. So the first time I was, I'm going to get a coach. They're going to help me with my nutrition. They're going to help me with the dieting down and peak week and all that and peak months, blah, blah, blah. And the food that she put me on. I was just going to ask you how quickly did you fire in broccoli or asparagus?

Yeah, it was like brickin'. It was like chicken and broccoli or it was cod, or it wasn't cod. Tilapia. Tilapia. It was tilapia and asparagus. Yeah, tilapia is a go-to. Yeah, cold it.

And to this day, I cannot have, I mean, asparagus is great, I can't have it. I had so, just the, I can't. You traumatize yourself. I traumatize myself out of a vegetable group. So I, yeah, so much disordered, eating, body dysmorphia, women would go like, you know, you're the leanest that you're going to ever be on stage, right?

And then as soon as you, you know, you're starving. So maybe you go and you have a normal meal or you have whatever. Binge. Binge, right? So, which is crazy. Oh, a 30 pound weight gain in a couple months, I would say.

Yeah, yeah. And then they would hide, right? They would feel so disgusting. They'd be so, so shameful because of course, leading up to it, everyone is, you're, you're getting all the social feed. Look at how good you look. You look so great.

You look so, and, and then when you're, then when you put on more, like you're holding more water because you're having carbohydrate, you're just eating like a normal human would. Um, I think that there's a lot of, um, desire to get back to that leanness. Yeah, so there's, yeah. You're obviously a very confident, intelligent woman, but when you competed, did that challenge

you? Did you feel yourself get pulled into maybe, oh, this might be dysfunctional? Or were you like you are now where you could kind of see it for what it was? Because that's a challenge, that would be such a challenging space. Yeah, I mean, if we're being completely truthful and the spirit of transparency and honesty, I was very hard on myself. So it was like, this is my first competition. I was like, I'm going to smash this out of the water. So I was very strict with myself.

It was difficult because you sort of find, you get into this, like, you start checking all the time. You're just checking, like, what does it look like? Am I, is my stomach, do I see my shoulders a little bit more? Like, how's the glutes coming in? What are the times? So, you start to, I would notice these thought patterns. I think, so I do think that I was affected by it for sure. Yeah. Yeah. And do you often recommend if you get patients who are like, I want to compete, do you often recommend don't?

There's, yeah, I think competing and one, I would love to go to the, I haven't gone to the Arnold yet. I would love to go and like just see the Arnold and see all the competitors there. But I think the idea of competing is inversely related to salutogenesis or, you know, just like health promotion, right? I think you are so unhealthy.

The moment that you were on stage, you're dehydrated, you're, um, you know, you're nutrient deficient, you're all of these things, um, severe caloric deficit, all, all of the things that happen in order for you to get stage lean, it is inversely proportional to health. So it depends on your goal. If your goal is to compete and you don't have, you know, if you don't have a longevity or a health goal and all you want to do is get up on stage, you know, I can certainly counsel you with that,

but my number one priority would be taking care of the psyche and like thinking about the intrusive thoughts, all the checking that happens, all the, you know, taking in kind all the comments that you will start to get, like, oh my God, are you a dancer? You look so beautiful. You're so lean. You're so this, like all just, that is an ideal

that is completely not sustainable and not healthy for women. Women should not, and, you know, kind of tying this back to menstrual cycles. So many women, myself included, lost, I lost my period for three months after I competed. Of course. Um, I, the last, I mean, I remember the check-in,

I forget the exact number, but it was like, I was at 10%, something like that, nine or 10% body fat, which for a woman is completely ridiculous. Like a woman should never be that lean, ever. Um, and so, uh, and in that sport, in, in the fitness, in the, you know, the competitive, uh, bikini and figure sport, like these women, like half of them don't have their cycles

regularly, right? And even at the top level of sports in general, it's very, very common. And sometimes it can be even reinforced by some of the coaches, right? Because they have this association with like the leaner that she is, the better her performance is going to be, right?

So you can have these sort of relationships that are even coming top down from your coaches that are sort of presented as normal and part of like, if you want to be part of the top percent, the top 1%, this is like the sacrifices that you have to make. So. This is the part that concerns me the most, and part of why I was asking this question is that what I,

not only did I- I would never compete again. Right, right. Yeah. So what I saw was, I saw the same, we saw the same things, and then there's this cycle of, you do your show, you get all this, you love it, you get in great shape, you eat up all the attention,

your Instagram grows, because you use all your imagery, and now people are asking you questions, now you become a coach and then now you're teaching other. And it's like we and we, and I feel like some of the most popular people in the fitness space are these competitors who are advising these people. And it's like, man, when, when I realized, oh my God, this space was just riddled with people with body dysmorphia, eating disorders, and these are now the people that are coaching our other people that are getting into fitness. And first time ever in my life or in my coaching journey of over 20 years, I started to see

the last decade, a lot of people just entering the fitness or just getting into working out and wanting to go right to a show because they follow so and so and she's beautiful and she's got all these followers and I want to be like her. So it's interesting to me and I'm also concerned on that we're setting so many people up for failure or the wrong direction, especially in relation to health. So that's right. In regards to body fat percentage around that, and I would love to know if I'm on point, but

generally when I would tell my fit, the body fat percentage I would say, or the range that I would give women that is a good fit, healthy lean, if you're consistent with working out, you take this seriously, would be like between 18 and 22% or so. Yeah, yeah, great. Am I, you agree with that? Exactly right. Okay. Okay, okay.

And another, we can look at body fat percentage, we can also look at FFMI, right? So the fat free mass index as well. So this is just what are the, how much of your body is metabolically active tissue that's not fat? So that's another, a lot of times people will look at, let's say BMI as more of an antiqu,

I mean, it's a measurement. It generally can be predictive of some things, but it won't take into account, let's say. Lean body mass. Yeah, it doesn't take into, so if you have a lot of. I'm obese, I have a high BMI because of my lean body mass. Yes, I mean, you look it, yeah. You look very obese, right?

Yeah, so, but if you were to look at your FFMI, that's a much better measure of your metabolic health and your health overall. Yeah, awesome. Yeah. You, I wanted to talk about something else that I heard you, you credited Sal for, but I don't think I've ever heard Sal say that. And if so, I want to talk about it. Junk volume. Oh, just do it.

Was that you? Is that yours and you gave him that credit or what? Because he's never said that. No, no, no. We were talking on the show. That's such a great topic. That's an old term. I don't know if I said it specifically, but we were talking about how much volume you need. Yeah, we were talking about what you should feel like after a workout.

Like you should feel really great. Like you shouldn't feel like you've run yourself off the ground. Although I will say that I do enjoy some of those sessions as well. But I think that what our conversation was around this idea of training too much, right? So are you in the gym, you know, four, five, six, seven times a week? Well, you're probably,

you're probably not rested and recovered from the previous training session. And we were talking about sort of moving into this like junk volume territory, like how long is a session? Is it 60 minutes or is it like four hours? You know, so, you know, after your 20th set, are you really, you know, what, you know, your fatigue has set in at that point. Like what is the, you know, what is the, you know, the ROI on that? I mean, I love that. I don't think we've ever used that term on our show

like that and talked about that because I also think another category that falls into junk volume because I was guilty of this In my early 20s is you know, there's obviously in order of operation of most valuable exercises And you know, I as a young kid not knowing what he's doing I'm doing a ton of just junk volume would spend an hour and a half in the jeans Yeah doing the lateral raises and little weird exercises and not squatting, not deadlifting, not overhead pressing these movements. And I wish someone would have guided me better. So I've never thought of using the term junk volume before. And I

can't believe we haven't. I do. I like that. Just because people are going to want to know what is your training look like? Now this is your fanatic, you're a I'm a team. I'm a team. I'm pretty. I do. I like that. I like that a lot. Just because people are going to want to know, what does your training look like? This is your fanatic. You're a fitness individual. I love training.

You love it. You love working out. It's your thing. What does yours look like? Right now, it's either four or five days. I train legs. Lower body I do twice. I find that it takes me, I usually train, it's Tuesday and Friday.

And I just need that amount of time in between to recover. Usually it's like my hamstrings that take me. It's sort of the linchpin that keeps me from training more often because my hamstrings get really sore. And then I'll do two upper bodies. So there's always going to be shoulders in there. I was joking with you, you know, all women want two things and I'm sure this is in your Muscle Mommy program, it's like we want nice big juicy glutes and we want delts that look like glutes as well, right?

That's true. So we want nice big shoulders, so I'm always working on lateral delts, delts in general, but you get like when you're doing back, you get a lot of, you get a lot of the posterior delt with your working chest, you get anterior. Um, and then, uh, if I am, so it's a shoulder workout and either a back or a chest. So it's either a shoulder and a pull or shoulder and a press. And then if I'm there for another day, then, um, I don't know, I probably, yeah, it's usually four days. Well, that's awesome.

Well, you obviously look like, uh, you know what you're doing. Have you noticed, this is one thing that I noticed as I've gotten older, I've been doing this for a long time. And so me and my peers, it was a little bit of a difference between us when we were younger, but as I've gotten older, I see my friends and I'm like, oh my gosh, like it used to be that I just kind of looked like I worked out and you kind of didn't. Now you're like, you know, I bro, I couldn't get out of bed for two days.

My back was hurting and, um, I just got put on this prescription. Like, are you noticing that with your? Oh, there's a bro, I couldn't get out of bed for two days, my back was hurting and I just got put on this prescription. Are you noticing that with your? Oh, there's a huge, I think that that tangent is like very slow in the beginning and then over time it really does widen for sure. And another thing that I was chuckling about when you were on my show was when you train and you're

in your 40s and your 50s, you wanna tell everybody your age. Right? It's like, you're like, I'm 46. And then you'll have people like, what, you're 46? You know, I had the biggest compliment. My 11 year old, his friends were like, he had asked, how old do you think my mom is?

I don't know why he even asked this question, but they were like, oh, she's like 30, 35. And I was like, I'll take it. Winning. Winning, right? I'll take it. So I think training, particularly strength training, like cardio, you're going to improve your endurance, you're going to improve your cardio respiratory fitness. But in particular, when we were talking about strength training, if you are a vain woman we're talking about strength training.

Um, if you are a vain woman, like myself, uh, you're, you know, it's, it is very good for your skin. It's very good for, uh, you know, obviously the way that you look. I think when you are, one of the things I would like to do in my, in my work over the course of my career is to, is to move, to reframe this like skinny, you know, and I think that

we're doing it. I think there's a lot of people who are moving the needle alongside with me, but moving from skinny to strong. Because when you're, when you're skinny and you're 60 and you're skinny and you're 70, that is no longer a good look. No, no, no.

You want to, you want to fill that out, you know, and you want to fill that out with muscle. So I think, you know, being skinny, I think has, you can probably get away with it when you're younger, but you really want to be reconsidering that as you age. How, as a woman, has it been for you for this? This is something that I've shared on the podcast that I've noticed now in my 40s that I find really cool. And I'd like to communicate to the younger generation that's just kind of getting started is that it does seem to have gotten much easier as I've gone because

I've invested in lifting for so long. I feel like, boy, I just got to kind of touch the weights and I can keep a muscular frame that is better than what I had done for the first five years of lifting every day, training consistently. Have you found something similar like the amount of volume it takes and like even what, you know, you would consider out of shape version of you is still probably way better than you, your first five. Like, I mean, I've noticed that.

Have you noticed the same thing? Yeah. I mean, you've put in the, you've, you have an asset now, right? So you invested in that asset and that asset has grown. I think that, I think that the estimate, if you, if you have the muscle, I think that it's, is it one third maybe or 25 to 33%? You need- Way less volume. Yeah, way less volume to maintain that asset, right? So you don't have to always be killing yourself. Like building muscle is a lot of work, but once you have it, maintaining it

is much easier. Yeah, for sure. I love to communicate that to the audience. It's a great selling point. It is because a lot, we have to remember, like all of us in this room are fitness fanatics. We like to work out with it, but not most people are like that. Most people are like, what's the least amount I can do to get the most amount of return from it? And letting them know that it's like investing.

You invest, so the more you put in now, it gets better and better because as you get older, you don't have to do as much to maintain what you've built. Compound interest. Yeah, I love that. That's right. So awesome. Well, thank you for coming on. I knew I'd love you on the show. Oh, thank you so much. It's been such a great time hanging out with you guys.

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