The Food Medic - S4 E4 - Women Are Not Small Men

Episode Date: May 29, 2020

On this episode, Dr Hazel sits down with Dr Stacy Sims - an Environmental Exercise Physiologist and Nutrition Scientist specializing in sex differences. She is also author of the book ROAR: a comprehensive, physiology-based nutrition and training guide specifically designed for active women. In this episode they cover:*Training around your period*How women compare to men in exercise performance - and in recovery*Fuelling training throughout the lifespan*Supplements*Gut health Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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exclusions, and terms apply. Instacart, groceries that over-deliver. Hello, and a very big welcome back to the Food Medic Podcast. I'm your host, as always, Dr. Hazel Wallace. So on this episode, I sit down with Dr. Stacey Sims, well, virtually sit down. And Dr. Sims is an environmental exercise physiologist and nutrition scientist specializing in sex differences of heat and altitude stress, recovery, genetics, and nutrition to moderate adaptive responses for performance. She's also author of Roar, which is a comprehensive physiology-based nutrition and training guide specifically designed for active women.

And it was her book that really introduced me to the work that Dr. Stacey Sims is doing. And I was really interested to read about the things that she was writing about and also just how different women are compared to men in terms of exercise performance and recovery, how we should be fueling supplements, etc. So definitely sit down and enjoy this podcast. It is jam-packed with information. Just as a little reminder, of of course we are still recording remotely also Dr Stacey Sims is not in the UK so we would be recording remotely anyway but the sound quality may not be great in all parts of the episode but I promise you the content is. First of all Stacey it'd be great for the people listening to get a bit of an insight into your background, kind of in both

research and training, so we know a little bit more about you. Yeah, so I started as an athlete and had a whole bunch of questions that didn't seem to be answered. And I think the crowning point was when I was an undergrad and was in the exercise physiology, kinesiology department and in metabolism and doing experiments where I would always be the one that volunteered to do like the running trials or the cycling trials or whatever it was. And my results were always anomalies because I'd be compared against some of the guys that were in the class. And I'd always ask, well, why are these anomalies? And I'd get the answer, oh, we don't know enough about women. And this is often the case where women are so different from men, but we just roll it in or we discard it.

And so they weren't appropriate answers for me. And at the same time, I was rowing competitively and started seeing things like within the athletic world that didn't make sense either. So both of them kind of merged at that one point and it kind of pushed me forward both as an athlete and as an academic. In my athletic career, I went from, you know, being on the crew team to getting more into triathlon. I raced at a high level for Ironman and then picked up road cycling and raced the World Cup circuit. And every encounter that I had within my athletic career still had all these questions. So I'd start to implement sports science research into some of my training mechanisms and it wasn't

working. So it was still that drive of why is this not working? Why don't we have these answers for women? And then when you start really getting into the upper echelons of doing your PhD, getting into the literature, doing a postdoc at Stanford, rolling into a clinical science position and really being able to be at the top of the top and looking at the discrepancies and seeing the scientific design and seeing how women aren't included, or if they're included, it's in a poor methodology, and just going, what the? So both of them kind of drove each other, which brings us to now 20 some years later, where people are finally catching on. And we get to have these conversations about how women have been excluded in biomedical research and how we need to address scientific design and what are

the appropriate methodologies for actually getting to the crux of what it means to be a woman with a menstrual cycle. So yeah, that's kind of how I got to be here. Amazing. I think it's definitely getting more airtime in recent years in terms of how women are kind of physiologically different in addition to physically different to men. And one of your famous taglines how women are kind of physiologically different in addition to physically different to men. And one of your famous taglines is women are not small men, which is so true on the basis of your book Roar. So obviously there are certain physical and physiological advantages to being male. They're heavier, they're often leaner, they don't have as many hormone fluctuations and surely there's gender biases that exist from a young age that determine whose athleticism is honed and whose is ignored but

how do women compare to men in exercise performance and are men really better athletes when we compare them and are there any sports where women are outperforming men? That is a very big question, but I'm hopefully, hopefully we can pick that apart. I'm like, that's a loaded question. No, just kidding. So there's a lot of sociocultural aspects that come into play, as you alluded to earlier, like my daughter is seven and I've seen just the changes in the past couple of years of her doing pickup games of soccer with the boys to now just doing monkey bar stuff, because that's what her female friends want to do. But she has a very close guy friend and they play pickup games of

soccer and cricket and all sorts of stuff. So that's where it starts. It's not necessarily a sex difference and more of the perception that girls aren't as fit as boys, but it has to do with that sociocultural aspect of what they're doing in their day. But when we get to puberty, this is where we have the true sex differences. And this is where we start to see things that really implicitly explain why guys are fitter, faster, leaner, when compared to a woman who's doing the same sport. And it's the epigenetic exposure of testosterone that changes like the lean mass development and the ability to have stronger bones and ability to recover faster. Whereas if we look at estrogen, it's the primary epigenetic causation for the widening of the hips and changing the Q

angle and making girls put on more body fat. And that's the dichotic switch right there. And then we start getting to the sociocultural aspects of girls drop out of sport. They're not taught to pedal their bike efficiently or swim differently because of these body changes. So you start to see all that happen. And then when we get down to the actual XX versus XY aspect of are men better athletes than women? If we were to take the top tier and look at like the Olympic athletes, and we see that there's like a timing difference. Yeah, we can say that because men have larger hearts, larger, long, greater hemoglobin capacity and oxygen carrying capacity from testosterone, that those physiological aspects do make men the better

athlete. When we look at endurance, and we're talking about the ultra endurance, women are catching up. And this comes down to an inherent sex difference within the muscle fiber of women have more protein for beta oxidation. So we're better at fatty acid utilization. We are better at that long, slow stuff. So we haven't really seen what the outcome can be because women in the history of sport haven't really come into sport and been able to have the generation upon generation of training and sports science behind them to progress them as fast as the men have. So I think we're right at this cusp of being seeing women catch up at different sports. For the power aspect and the sprint performance, women are still going to have a bit of a lag time compared to male counterparts because they have a

wider hip angle. They have less of the enzymatic activity and proteins for that fast twitch fiber. And those are inherent sex differences. If you're looking at a recreational athlete and you're taking two ultra runners, then they could be very similar, cyclists, very similar. So it just depends on which population you're looking at. And are you going to head a age group athlete male versus an age group athlete female, or are you talking about the top tier? So in a roundabout sort of way, I guess it depends on what sport and the training history and what level. And then that could be the determining factor of if a male or a female is going to be the top of the sporting game in that sport. Yeah. And like you mentioned, endurance sports seem to be an area where women are beginning to excel. And I think in your book,

you talk about swimming and how women are physically built for that type of sport. Yes, exactly. Yeah. Okay. So next topic, which is hugely important and relevant is training around your period or your menstrual cycle. I think before we get into this, it's important to highlight to listeners that research in this field, as in everything in kind of female athletes is pretty dire for a few reasons, low sample size, lack of blood testing. But if we pool all the evidence together, whatever we do have, what advice do you have for women when it comes to programming their training around their

menstrual cycle? I think this is important also for any coaches that are listening, especially male coaches who may not want to touch on this topic. I think it's something that we do need to be factoring into programming for clients. Yeah, so there is some really robust evidence that's come out in the past couple of years looking at the strength component of menstrual cycle phase training. And so when we look at phase-based training, so that's looking at, you know, how are you training in the low hormone phase versus a high hormone phase? We see that not only because of the menstrual cycle phase and the lower hormones in the follicular state or the low hormone state, we have a better ability to push power and push that neuromuscular zero to six rep range and get significantly mass

gains. But we also have to look at the immune system that overlays it. So when we're in the low hormone state or the follicular state, we have a different response than when we're in the high hormone state. And this impacts inflammation and recovery. So when we talk about the layers of the menstrual cycle and how do we train, we talk about it as in a typical 28 day cycle, which isn't really that typical because there's lots of different factors that affect the length of the menstrual cycle. But for talking purposes, we'll say that 28 days. Day one is the onset of bleeding up to around day 13, 14 around ovulation or your low hormone state. And when you have the estrogen surge right before ovulation, some women feel super flat for about 36 hours and other women feel bulletproof. So you can take that

to advantage. You get a really strong training stress. But then as you start to get into the high hormone phase or after ovulation, when you have immune system changes, you have uprise of estrogen and progesterone that affect every system of the body. This is where you need to be a little bit more careful and specific about what you do. We know that in that early luteal phase, right after ovulation, you can stand to do a little bit more of your VO2 work in your steady state, just around or above threshold work. When you're looking at resistance training, this is where you're doing every minute on the minute type stuff or more of your six to eight rep range. And then when you get into the few days before your period starts or that high hormone phase, this is where a lot of women are affected by premenstrual

syndrome, where there's the bloating, there's the brain fog. We also know that estrogen, how it affects the brain, reduces reaction time, affects cognition, affects balance. So this is where we typically say it's a deload week. So if we're looking at a deload, you can either look at it as dropping volume and intensity, or if you're in a very technique oriented, like Olympic lifting or some other technique oriented sport, you can actually use that deload week to work on technique. And there's been some pushback on that where people are like, wait a second, this is where women are more quote clumsy. They don't have great reaction time,

their cognition's off. But if you're dialing technique in the state where your body is perceived as being quote tired, you take that technique into the next power phase, which is that low hormone phase, then you get significant gains in the fact that you're taking that tired, learned pattern and putting into an untired state. So you're nailing that technique. So if we look at it from, you know, the strength training to the traditional micro and macro cycles, it's the low hormone phase or the first about 12 days, you're doing that high intensity power-based stuff. Around ovulation, you need to be a little bit careful because there's a greater predisposition for ACL injury, but you can still hit it really hard there and get a big training stress that can be significantly

overcome by that anabolic stimulus of estrogen that happens. And then we look into the last two weeks after ovulation where you have that steady state or the lower neuromuscular but higher cardiovascular stress into that deload. Yeah. And in terms of tracking, apart from kind of counting the days in between your periods, what types of different measures do you suggest that people should be tracking around that in terms of their diary? Yeah, so a lot of women don't even know what it means to track. I mean, there's various apps out there, you have the wild AI app, that's more artificial intelligence oriented, you have a fitter woman app, that's a little bit two dimensional, what gives them a little bit of tips around training. You

have the Garmin menstrual cycle app. So there's so many ways of tracking your cycle, but the very best way to really dial it in is using basal temperature. So you're taking your basal temperature in the morning, plus an over-the-counter ovulation predictor kit. So then you can really see where you have that surge and dial that in. Then you can start tracking. And by tracking, you're just keeping track of the days, but also writing in mood and sleep. But the biggest thing really is the perception of how you feel. Because once you start tracking and putting training in how you feel over your menstrual cycle, you'll start to see some patterning. And when you understand that patterning, then you can put interventions into place that will allow you to maximize the days you feel

fantastic and can take a big stress and minimize the days where you feel low. And it gives you the answer of, instead of I didn't get enough sleep, I'm highly stressed. It's Oh, well, for the past three months that I've been tracking four days before my period starts, I feel awful. So I'm not going to schedule a big training session that day. I'm just going to back it down. And I think giving that objective data really allows a woman to dial in her training and feel good about her progress. Because so often we're like, what's going on?

What's wrong with my fitness? Last week, I was able to do X, Y, and Z. But this week, I can't. What's going on what's wrong with my fitness last week I was able to do xyz but this week I can't what's going on yeah absolutely now kind of discussing menstrual cycles one of the most common complaints I hear from women who are mostly avid gym goers or runners or athletes is that their period is either irregular or it's disappeared and while there's loads of reasons why that might happen let's chat a little bit about why that happens in sport and the concept of relative energy deficiency in sport, which I know is getting a bit more airtime lately, which is really important. Yeah. So relative energy deficiency in sport is the big syndrome and it still needs to be

buffed out a bit about immune system and all those things. But the underlying issue is low energy availability. So if we're not eating enough to support our life and our training, then we start to perturb cispeptin. So when we talk about cispeptin, it is the neuropeptide that's responsible for stimulating your gonadotrophin-releasing hormone, which in turn signals LH and FSH and estrogen progesterone. So when you start to perturb cispeptin, then everything gets downregulated. So you're not going to get the stimulus for releasing luteinizing hormone or follicular stimulating hormone. So you're not going to ovulate. If you don't ovulate, you don't get the upsurge of progesterone. So it becomes that flat

line. And when we look about how do we get out of this low energy state, if I were to take an athlete and say, hey, based on all of your data and your estimated energy expenditure, I need you to eat 1000 calories a day more than what you are, no one's going to do that. So what we do know from some of the most recent research is if you eat in and around training, and you stop that breakdown state, then even if you are in a lower energy state where you're not quite eating enough to support everything, you're going to attenuate all of the negative responses. Because we know that women who eat enough to shut down that catabolic state in one day, don't fall into the patterning of getting amenorrheic and thyroid dysregulation,

and the subsequent effects of relative energy deficiency in sport. So the biggest thing to do is look and say, am I fueling for my training and am I recovering from it? And we know that if you do that and you have a little bit of calorie restriction, maybe in the afternoon, that's not around the training. Then you can lose body fat, but not lean mass and keep yourself out of this low energy availability and relative energy deficiency in sport. And so when I see so many recreational athletes who are following like intermittent fasting or the keto diet, and not

seeing fitness gains, and they're putting on weight, they're getting tired, their performance is suffering. And then you start looking at how many calories they're taking in. And a lot of these diets, because of the higher fat intake, they tend to be full or satiated before they actually ingest enough calorie. So we have to start unpacking everything that someone's doing, even on that recreational gym going level, in order to get the woman to reach her performance potential. Yeah. And you mentioned a couple of diets there, which I definitely want to touch on because the low carb diet, you know, two, three decades ago was popular and it's come back again, even amongst athletes, whether it's paleo or ketogenic,

I guess the main premise of both of those diets is keeping carbs low. In your professional opinion, do you think it's wise for women to follow a diet that's that low in carbohydrates? And can they sustain it and sustain their level of performance? Short answer is no. Because when we come back to the whole kispeptin idea, so women have more neurons that are stimulated by kispeptin and receptors for it than men. And it's very sensitive to energy intake, in particular carbohydrate, because women need more carbohydrate for endocrine function, for brain health, and just general immunity as compared to men.

So when you start dialing back the carbohydrate and you start interfering with these feedback mechanisms that are responsible for endocrine health, you start to get either into a subclinical state where if you were to go to your general GP or internist, they'll be like, well, you're on the low end of normal, but you're still normal. So we won't do anything about it, which most likely is too low for optimal for that particular woman. And then when we look at like the ketogenic diet, and I'm very happy that there's more and more research coming out in female athletes on this, where there's a decrement to performance. There isn't any indication that it actually allows you to lose more body fat

and build more lean mass, which it does in men. The autophagy aspect of intermittent fasting as well is not as robust in women. It's better to exercise instead. You get the same benefits. So there's all of these little clinical diets that have been passed over and pulled into the fitness industry. And this is where there's the big misstep in the fact that these diets were originally for a particular clinical population that needed to lose weight for a particular surgery or blood glucose control. But then when you have someone who crosses a line and pulls it over to

the fitness industry and doesn't address the fact that the science hasn't been done, you'll have early adopters, you'll have some success, and that's what you hear about. And then when you start having science in that particular fitness area or in the elite athlete that's showing, no, actually, this is not beneficial for women. You get incredible backlash. Yeah, for sure. And even when I know like a lot of women are including carbohydrates in the diet, oftentimes they're not including enough, even though they really do think that they are, despite all of the activity that they're doing. For your recreational athlete, how many carbohydrates a day do you recommend in terms of a rule of thumb um so when we look at the basic physiology of women

the rough estimate is that the average woman needs between 110 and 120 grams of carbohydrate per day which is on the low end if you're thinking about the big schematic of things. But when you start adding movement and exercise, you need more carbohydrate. So then this is where body weight, activity, duration, daily life stress all comes into play. So the bottom baseline, like we say, you know, your resting metabolic rate means that you're lying on the couch not doing anything. Your resting carbohydrate intake should be between that 110 and 120 mark. And then every time you get up and do something, you know you need to add more carb. But this is where you can do some carb cycling. So if you're an endurance athlete, and you're used to going out and training for three or four hours, and then one day you're only training for one hour, you're not going to

need as much. So that's where we start to get into the misstep of how many carbs do you need, because people don't take that movement and intensity and duration to account. Yeah. And similarly, intermittent fasting is really popular right now. I know you've spoken about it. And during this time of isolation and lockdown, I've actually seen a number of gyms and nutritionists suggest fasting as a way to reduce calorie intake because people aren't moving enough. Is this something that we should be recommending? And if not, why not? If you are not moving at all and you are post-menopausal, then yeah, intermittent fasting

can work for you. But if you are premenopausal, and you're doing some activity, then intermittent fasting is not a good idea. And the reason for it again comes down to endocrine health. And the fact that your immune system is so tightly tied to what is happening at the gut level, as well as carbohydrate. So if you're looking at intermittent fasting, and maybe even doing a fasted training session, which I hear a lot as well now in this COVID-19 of, oh, you want to lose weight? Well, let's do some intermittent fasting followed on with fasted training. It is disturbing the gut microbiome and really reducing the diversity and your immune system

gets compromised. So that's what we need to think about from this COVID-19 aspect. But in the big general picture of health, it comes down again to that cispeptin perturbance, where if a woman is doing intermittent fasting and stays in this longer catabolic state, then she's really putting forth the feedback mechanism for perturbing his pepton and reducing endocrine health. Yeah. And I think when you mentioned faster training, a lot of people don't realize that that can actually impede their performance. And then overall, they're not actually getting as much out of their training sessions. And therefore, you're almost having a bit of a step backwards overall. That's something that's not really talked about when people are promoting kind of train efficiency by burning more fat, women already

are maximally adapted to fatty acid oxidation by the nature of estrogen and by the nature of the sex differences of having more protein enzymes in the muscle for beta oxidation. So the theories and the arguments for doing IF are not appropriate for women and the more research that comes out about it the more robust evidence there is for women not to do intermittent fasting and fasted training the caveat again though is if a woman is not training and is obese sedentary needs to lose weight get better health and is not interested in any kind of exercise, then that is a step in the right direction to do intermittent fasting, provided it's done smartly where you're not eating after dinner and you're not eating again until breakfast so that you have that 12-hour overnight fast, which is a good significant amount of fasting

to reset the body the way that the literature on IF talks about. Yeah. And I think something like 12 hour fast is something people can do, especially if they're having their evening meal slightly earlier, it doesn't really disrupt the eating pattern throughout the day. And so moving on to kind of nutrition around training, we kind of talked about the do's and the don'ts, but what kind of things should people be considering when it comes to eating before and after a workout? And when I say people, I mean females in specific, is there anything different that you'd recommend from like a male population or is it pretty much the same principles?

No, it changes and it changes across the lifespan as well. So when we talk about pre-exercise eating, that can be pretty much standard across the age span where you want to have a little bit of carbohydrate and protein within two hours before you do any kind of training. And for women who do their training first thing in the morning and can't eat or say, you know, I can't handle anything. I'm going to go for a swim or a ride or run at 530 in the morning. It's not a major meal. It's maybe a half a banana with a little bit of nut butter, or maybe it's a fortified latte

where you have a tablespoon of protein powder with almond milk and a shot of espresso. So it's maybe 150 calories mixed protein and carbohydrate because you want that amino acid pool to be elevated for the recovery purposes. Now recovery is where it starts to get interesting because we know that we utilize different fuel sources and have a different ratio of amino acid utilization during exercise than men. We also know that women tend to use more free fatty acids and spare carbohydrate across the board, even more so in the high hormone phase than the low hormone phase. And we also know that resting metabolic rate comes a lot faster in women than it does in men. What I mean by that is that after exercise,

and you come back down to the normal resting state, your core temperature is down, blood flow is normal, then that happens within 90 minutes for women. But in men, they have three to 18 hours. So we look at that small window of opportunity for really maximizing repair. Then we get to, well, what do we have afterwards? Because you've heard the chocolate milk, 20 grams of protein. And when you look specifically at some of the research, even the recommendations for protein research, it's all male data, except for a few scattered in there, women on eating disorders and amenorrhea, which don't really have that much bearing. But if we look at some of the non-sport literature, but looking at muscle protein

synthesis in women, it has to do with the leucine. And it's not the amount of leucine that's in the muscle. It has to do with the amount of circulating leucine and the amino acid pool so that you can get enough leucine to the brain to trigger a feed forward mechanism to trigger that mTOR in the muscle, which is not the same as men. So when we look at the recovery aspect, 20 grams of protein is not enough for premenopausal women. It's more than 30 grams of protein post-exercise. And then when we get to peri and post-menopause, it's closer to 40 grams because we've lost the anabolic stimulus of estrogen which affects the basal cell of the muscle

for reparation so when we're looking at post-menopause we even need more protein as well as a different training stimulus to get that lean mass and bone development. That's so interesting, though, from a kind of protein requirements. I knew post-menopausal that you required a higher protein stimulus to kind of get that muscle protein synthesis. But in terms of kind of pre-menopausal women, it's something that I wasn't aware of. So that's interesting, especially for myself moving forward. Yeah. And it's really important in the high hormone phase because progesterone is catabolic and it counters estrogen with regards to refueling glycogen. So when you have times of elevated progesterone, your metabolic recovery is significantly compromised. This is where you have to put in nutrition practices to overcome those hormonal responses. And above all else, get out of the catabolic state so you don't get into

the low energy availability repercussions either. So do you recommend maximizing kind of recovery around that phase as well, in terms of sleep, stress, all of the good stuff? Yes. So we talked about food and supplements is something I want to quickly touch on, which is huge, obviously, in the athlete world, but also amongst the general healthy population, it feels like everyone's taking something at least. Are sports supplements something that you recommend to enhance performance? Or are you more of a food first approach? Or is it a bit of everything? I'm a food first approach person with regards to taking care of your general nutrition, your sport nutrition.

There's a time and a place for supplements if you're looking for an ergogenic aid. And you can have blocks of training where you want to get a bigger training boost, where you might look to use some beta alanine or some caffeine just to get that ability to hit that higher training stress so that you can get that stronger stimulus for greater fitness gains. But I'm not someone who will blanket say you should go out and you should have beta alanine and load on it or creatine and load on it. There's a periodized approach. But the biggest worry with supplements is the unregulation. And I work with a lot of athletes who get tested.

So it's the concern there. So the blanket statement really is don't take anything, use food first. There is a time, like I said, there is a time and a place for supplements. But even there, the research isn't robust in women. I have a PhD student in Canada who published the literature on and her research on nitrates and beet juice. And so there doesn't work in women. And from a physiological perspective, it makes sense it doesn't work in women because estrogen is tightly tied to endothelial function and the nitric oxide cycle. So if your body's used to having vasodilatory constriction due to estrogen, then when you take in a nitrate, then it's not going to respond the same as it does in men who don't have that perturbation. So it's interesting when you start digging in and trying to do

specific research on these touted supplements that give this ergogenic effect and then finding it does nothing for women. Yeah, it is. I think when it comes to supplements, there are a few kind of more than there are less that I would find that don't really have any evidence for them. And it's the same for basic supplements that you take every day in terms of like multivitamins and minerals and the benefits that we see in people who are already healthy following a balanced diet is very minimal if anything at all and I think what we need to do is encourage people to focus on maximizing what they can in terms of their food intake first and of course there'll be situations where supplements are necessary based on you know

whether you exclude certain foods from your diet or you kind of, for vitamin D, for example, in the UK, something that we kind of need to supplement. But other than that, I think you're kind of scraping the barrel to look for good evidence for lots of these supplements. Yeah. And there was a, I think you might afford it to me, or someone did. It was a study that was put out in Nature maybe four or five months ago looking at the morbidity rates of individuals that either got their micronutrients from food or they got it from supplementation. And those who got it from food actually reduced their risk factors for metabolic syndrome and cardiovascular disease. But those who took supplements were no better off than those who had a poor diet. So it just goes to show, you know, like when you're taking supplements,

we're not as smart as nature. We don't know the cofactors in food that make things work for us. So when you're paying all this money for supplementation, that was probably going to do more harm than good. You got to take a pause and be like, okay, what's going on here? Yeah. That's the thing. When you take food, it's packaged in this wonderful vehicle of fiber and various different nutrients and phytochemicals and antioxidants that you can't create in a lab. So I'm with you on that one. And before we wrap up, one thing I wanted to touch on is gut health, which I'm really interested in at the moment, as is everyone. But I think when it comes to athletes, there's a huge issue with kind of gut related issues,

especially in those who are doing endurance sports like triathlons or Ironmans, where you're doing like intense exercise over a long period of time and people feel nauseous. They may vomit. they've got diarrhea, but it also happens in other forms of exercise. What are some of the factors that cause this to happen and how can we maybe prevent or mitigate them? Yeah. So the biggest driver for GI distress in endurance athletes is the stuff that they're actually fueling with. So you're looking at all the engineered nutrition that is primarily gels, sports drinks, really quick hits of carbohydrate. And a lot of the stuff that they're using from an osmotic pressure standpoint is too high for the intestines to actually be able to absorb it and use it. So if you're looking at a typical sports drink,

you drink it, it comes in, the concentration of the carbohydrate is too high to activate all of your transport mechanisms for fluid across the intestine. So it sits there, has a brush border effect, causes a little bit of leaky gut, causes the bloating, the gassiness, a lot of the too full bloated feeling and nausea. Then you add a gel onto that and just compounds the factor. So when we look at some of the too full bloated feeling and nausea. Then you add a gel onto that and just compounds the factor. So when we look at some of the incidents of GI distress and change up what people are eating, it tends to attenuate. When we look at the sex different aspects, women tend to have a greater amount of GI discomfort and GI distress. And this has to do

with the inability to absorb fructose readily, as well as the way estrogen affects the tight junctions in the intestinal cells. So you can get a little bit more leaky gut around high hormone timeframe and around ovulation, which contributes to the issue of GI distress and diarrhea. And then when we get to athletes in general who are really pedantic for the most part about what they eat and how they perform to a certain extent, like they don't pay attention to what they're eating from a training standpoint, which they should, because that's one of the biggest drivers for gut microbiome, I guess, perturbation and reducing the diversity. Because when you start exercising and you have blood flow

diversion from the gut, you're increasing the heat and reducing the oxygen within that whole digestive tract. So if you're feeding it simple sugar, then the bacteria that can thrive in those conditions and eat the simple sugars are the ones that are going to overgrow. So then when you start to eat real food and whole foods, you start getting bloating and discomfort. And you're like, wait a second, I'm allergic to these things, or I'm having an issue. So they go to a dietician and they get put on the FODMAP diet. And when we look at the FODMAP diet, there's a lot of things that are taken out. So again, you're reducing the gut microbiome diversity. And no one tells athletes how to put it back in.

So they'll keep restricting and restricting, reducing that whole diversity aspect, which again, perpetuates all the GI issues that you see, the common complaints. And there was a couple of review articles that was really investigating this. And there were two studies that pulled up looking at gut microbiome diversity in endurance athletes versus recreational athletes and sedentary, like the standard American diet. And the endurance athletes that ate a lot of the simple sugars during training had the same gut bacteria as the standard American diet. But the recreational athlete who didn't really eat much during training, but ate a good wide variety of other foods had a really good

diversity of that gut microbiome. So it's really paying attention to what is this athlete doing? What are they eating in and around training? and then what's their diet the rest of the time because a critical factor is increasing that diversity yeah and in terms of kind of food around training then for people who are doing endurance training maybe they're going on a long cycle or a run is there any kind of nutrients that you advise maybe limousine i don't know fat would be one because it can be quite difficult to digest sometimes. Or like you mentioned, these gels, which are, you know, very simple sugars that have high osmotic potential. Is there anything we can have instead of a gel in training? Yeah, so I often get the thing,

oh, I can't eat when I'm training. And it's like, well, you can eat. You're just mentally like, can you chew gum while you're running? Yeah. Okay. Well, that's a start because you can chew while you're running. So when you're riding, you have a greater ability to eat because you don't have the impact of running. So real food and the fact that you can have, what did I take today on my ride? A mix of semi-dried strawberries and some crushed almonds. And then my kids' Mabel Crunch gluten-free cereal. So I had a little bit of quick carbohydrate from the cereal and a little bit more sustaining from the dried strawberries and the nuts. And I think we did a four-hour mountain bike ride this morning. And that's

enough to sustain and push the power. And we're doing hill reps and stuff. So it's just getting your head around that. Racing Ironman and stuff, the same thing. Like I work with a few athletes who have very sensitive stomachs and we've started doing what we call salty balls. So it's a plant or a whey based protein mixed with brown rice syrup or rice malt syrup as the base with some nut butter. And it creates this cookie dough consistency that gives you a little bit of fat,

some protein, and some sustained carbohydrate. And it works fantastically. And then on the run, a lot of people are like, oh, I need to have X amount of calories in the run, especially if I'm doing long distance triathlon. And you can get by with eating less and just trying to maintain blood sugar through energy chews or small bites of bliss balls or even glucose tablets, depending on how long the run is or where you're having a dip. And you're not going to perturb the gut as much as if you're using all these simple carbohydrates. And I guess this for kind of people who are going on shorter runs or just gym goers, like intra training fuel isn't necessary. I know some people feel like they do need protein or BCAAs for a training session, but I guess if your session's less than an hour,

it's not something you need to be concerned about. No. If you've eaten within two hours, then you really should focus on hydration, especially at the end of the day, because we all become passively dehydrated during the day just by the nature of our lives. But if you're looking at a gym goer who's going to do like a CrossFit class or a spin class at the end of a workday, you don't need anything during. But then it becomes imperative for that recovery food. So if you can get home within 45 minutes and have dinner, perfect. But if you know you're going to be delayed, then you need to have some kind of snack with you just to lengthen that recovery window for your muscles and your metabolism. Yeah. Okay. Awesome. Well, thank you so much for your time today. That was a huge

knowledge bomb that I think we covered. Where can people find more about you, read more of your work? So specific to women is the drstacysims.com website and social media as well as the Dr. Stacey Sims. But pretty much if you just do Dr. Stacey Sims, it'll link you to everything that I'm doing. Amazing. And you've got an online course, right? Yeah, we do. I'm standing in the green room at the moment. Are you?

Yeah, I am. Our guest room that's been turned into the green room. Yeah, so we have right now a seven-week intensive Women Are Not Small Men course that goes into depth about all of these things that I've alluded to today. Also talks about menstrual cycle from a natural standpoint versus an OC or an IUD right into peri and postmenopause. Amazing. I'll definitely keep an eye out on that

and try to get some learning in on my days off. Yeah, cool. Thank you so much again. And I can't wait to see more of your stuff. Yeah, thanks for having me. It's been great. Okay, guys, that was Dr. Stacey Sims. Hopefully learned just as much as I did if not more whilst listening to that episode I know that I'm going away from this thinking about how I can train around my menstrual cycle how I can feel better and also how I can recover better so hopefully we'll be moving forward better athletes and also again to say this episode is not just for the women out there it's for men as well whether it's your partner or if you are a coach and you're training female athletes there's some really

important takeaways in that episode that I think we can all bring forward in our coaching and our training see you again next time guys