unPAUSED with Dr. Mary Claire Haver - Why Women Gain Weight on the Same Diet as Men: Fueling, Fasting, and Biology with Dr. Stacy Sims

Episode Date: July 14, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with exercise physiologist and nutrition scientist Dr. Stacy Sims to unpack why so much fitness and diet advice built on male physiology leaves women confused about why the scale will not move, and why weight loss can feel so much harder for women than for men on the exact same plan. Dr. Sims, author of Roar and Next Level, a former professional cyclist who has taught and coached at Stanford, breaks down why women following the same diet and training program as their male partners often end up tired and stuck rather than leaner and fitter. The conversation covers the biological reasons women conserve fat in a calorie deficit, how female circadian rhythm differs from male circadian rhythm, and why eating within an hour of waking helps regulate cortisol and appetite hormones like ghrelin and peptide YY. Dr. Sims explains why fasted workouts can backfire for women, why front loading calories earlier in the day supports better metabolic outcomes, and why time restricted eating works with a woman's biology in ways that intermittent fasting often does not. Guest links: Dr. Stacy Sims Dr. Stacy Sims (Facebook) Dr. Stacy Sims (YouTube) Dr. Stacy Sims (Instagram) Stacy T. Sims, PhD (LinkedIn) Dr. Stacy Sims Newsletter Dr. Stacy Sims Microlearning Course Books “The New Perimenopause,” by Dr. Mary Claire Haver “The New Menopause"⁠ by Dr. Mary Claire Haver “Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond,” by Dr. Stacy Sims “ROAR: How to Match Your Food and Fitness to Your Unique Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body for Life,” by Dr. Stacy Sims

Because there was so much to cover with Dr. Stacey Sims, we have broken this episode into two parts. This is part one, and we will publish part two later this week. You've not touched once on calories and calories out in our entire conversation so far. And for so many of our listeners, that is all they've been told. That was all I was taught in medical school. Oh, yeah. That's what we were taught earlier too. But when you start looking at that, the human body is not an algorithm.

And we see the brain uses more fuel than some of the adipose tissue. And if we start thinking about calories in, calories out, it doesn't quite work. Because calories is also a rough idea of how much energy of food has. And it also comes down to quality because we're now in ultra-processed global ultra-processed food. And people are like, oh, I had 2,000 calories. And if you look at the 2,000 calories as someone, I hate to say this, but I'm, going to in the U.S. diet is the typical American diet. Yeah, standard American diet. It's different from other countries who don't have access to all the ultra-process foods. So that's where I'm like,

I don't want to talk about calories in calories out. I want to talk about the timing of your food, the quality of your food, and a focus on protein and fiber for your gut microbiome. And we need protein for satiation, not just lean mass development. The views and opinions expressed on unpaused are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Today's guest wrote a book that made me go back and look at advice I've been giving for years

and realize some of it was wrong. I found her the way I find most people who end up changing how I practice medicine. I saw a video of hers. I looked her up and two hours later I was still reading about Dr. Stacey Sims. Then I read her book, Next Level, and I started rethinking things. Not just for my patients, but for myself, the way I was training, the way I was eating around training, the way I had been telling women in my clinic to push through, eat less, do more

cardio, and wondering why their bodies were not cooperating. I was giving advice, built on research that was never designed with women's bodies in mind. Not bad advice by the standards I was trained to believe, just incomplete. An incomplete in perimenopause and menopause is costly. Dr. Stacey Sims is an exercise physiologist and nutrition scientist who has spent her career studying how women's bodies actually work across the menstrual cycle, across perimenopause and menopause, and across every stage of athletic performance. She has worked with elite Olympic athletes and everyday women trying to figure out why their

bodies stopped responding. She has taught and coached at Stanford, authored two influential books, Roar and Next Level, that have reshaped the conversation around women and exercise. A few years later, I was invited to the diary of the CEO Roundtable on Women's Health. Seven hours, some of the sharpest people in this field, and I spent half of it watching Dr. Stacey Sims be more certain, more precise, and more right than I had even expected. That doesn't happen often. Women are not small men.

That's not a rallying cry. That is a biological fact with specific clinical consequences that we are only now beginning to properly address. This episode is going to inform how you move, how you eat, and how you think about what your body actually needs. Not what works for everyone. What works for you. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

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use the code unpause to get 20% off your first order. That's L-A-N-G-E-H-A-I-R.com and use the code unpaused for 20% off at checkout. Dr. Stacey Sims, welcome to unpause. Oh, thanks for having me. I'm so happy to be here. You are one of the most requested guests. So we are so, so, so excited to have you here. So you are a former professional athlete. bike racing, yes. And you've worked with Olympians, but you've also worked with like normal people like me. So most of our listeners are just mere mortals and humans. But I like to caveat that and say anyone who exercises on purpose is an athlete. Okay. Because I like people to get into the mentality that they are an athlete. So they actually start to respect their body and take care of their body.

Awesome. What made you really kind of lean into women's health and, and how female physiology is different than men's physiology? Primarily experiences, I think, from growing up, being in a military household, grew up down the road from where we are now. Which is San Francisco. San Francisco, yes. And I remember not really having any kind of conscious liking that there's a difference between boys and girls.

We just had friends who were boys and we had friends that were girls and we're all doing the same stuff. But then as I got older and got to a point where it's like, well, what do you want to do with your life? And I told my dad, I was like, I want to be an Army Ranger or a seal. And he's like, well, you can't. And I was like, well, I can't I. He said, because you're a girl.

And that's the first time there had ever been a hold on anything that I wanted to do because I was a girl. And that kind of planted a seed. And then when I went to university, and I was seeing all this stuff coming out in exercise physiology classes where the reference was referenced man. And all the positive aspects of sport was always through a male lens. And if it was talking about a female athlete, it was always about the pathophysiological aspects of anemia, bone problems, lack of menstrual psych, stress fractures, all of those things. There was never any positive acumen in being a female athlete. So the combination of what my dad said with the presence of, you can't do this because you're a girl, plus seeing all this stuff coming up that wasn't represented to.

It's bad to be a female athlete. Exactly. All these bad things will happen to you. I was like, this is not right because there are so many female athletes. athletes who are successful. So let's go to your, what I think is, to me, your most famous quote and the one that makes the most sense is women are not small men. Yeah. And I've repeated that, and I try to give you credit every time I say it. What made you make that? You're such a flag bearer for that statement. Oh, I mean, you go into any shop, right? On the external touch points,

everything's divided by gender. You have deodorant for men, deodorant for women, you have clothes, everything, right? But when it comes to the inherent aspect of how we live our lives healthfully, there is no representation of gender or biological sex, really, until recently. And when I was teaching Stanford, I'd have a class that was about training principles and practice, and I was really fully into the female body versus the male body, and I would open up the class with women are not small men, and today we were talking about the cardiovascular system. And I would skew it. Instead of coming through the male lens that everyone is used to, I would start through the female lens and then say these are all the things that women experience. These are

biological differences. These are our hormonal differences. And this is how men compare to women instead of how women compare to men. So just really trying to flip it to get people to understand that there's a different viewpoint and a different lens to look through. Then when I started a sport nutrition company, that was our tagline for the women's line. Women are not small men trying to make a stamp in a very aggressive niche kind of area where it was very male nominally. Did you get pushback when you tried to do stuff? Absolutely. You're talking 12, 15 years ago and you're starting to really say, you know, women are different.

We have different nutritional needs. We have different training needs. And people are like, no, no, there's no difference. Kind of have that now sometimes, but it's move forward. Yeah. I see it on social media. Oh, yes. But it's usually in the form of just buy my product and you'll be okay.

Yeah. You don't need something special for women. So let's talk about women in general. and what are the most common mistakes you see that women are being led to make in training? Oh, my gosh, there's so many things, right? If we look at the training scope and coaching in the fitness world, it's still very much driven through the male lens. Where we're looking at a male body and then generalizing to a female body.

And if we look at how men age, they age in a very linear fashion. So what we do when we're 18, we could probably still do when we're in our 30s. But what we do when we're 18 as a woman is different than what we can do when we're 15 because of puberty changes. And it's definitely different than what we can do in our 30s. So when we start looking at how we're training, we have to look at where we are in our hormonal profile, where we are in our life phase. And understanding what is our goal? Is our goal to build muscle and bone? Yeah, sure.

Is that a definitive aspect that people really focus on when they're in their 20s? Probably not. It's more aesthetics. But for damn sure, it's what people are focusing on when they get into their 40s. But when we're looking at men, it doesn't really happen the same way. They don't really start to get concerned about their lean mass and power until they're in their late 50s, early 60s, where they start feeling a little bit of a demise. So when we're training women, we have to look at where they are, the focus of what they want to do,

and really understand that the female body responds differently. We need to be fed before we do a training session. We need a little bit more recovery. How are we hitting intensities? Why is intensity a little bit more important than long, slow distance stuff? Unless we're training for a long, slow distance race. And none of those questions really get asked until after the fact, when someone's overtrained or injured or hurt.

And I read a stat recently because my daughter plays soccer. And there is a huge uprise of girls aged 11 to 12 with ACL tears. Right? I had Jocelyn Wittstein on Orthopedic Surgeon. And women are seven times more likely to tear their ACL under the same stress as a man. And I look at it and I had a conversation with Jocelyn because she was down in New Zealand. And we were just riffing about this stuff. And it comes down to those puberty changes.

When girls are 11 and 12, their biomechanics are completely changing. Their hips are getting wider. Their shoulder girdles widening. They're becoming more quad-dominate. They're not retaught how to run, how to jump, how to land, how to change position. So if we were to take a warm-up that's really activating posterior chain and lateral movement, then that helps prevent ACL injury. The FIFA warm-up isn't quite right for girls who are going through puberty.

It's okay. For our listeners, FIFA is soccer. So they've taken an active stance of trying to prevent ACL, but for our young girls, it's not enough. And if you are predisposed to ACL injury at the get-go because of all your biomechanical changes, then your risk is increasing the further you get into sport. So Jocelyn and I are talking about let's try to do something at this end to prevent it now so that we can have a reduction in the ACL injuries along the way. Amazing.

A lot of women are very, very focused on weight loss, especially my audience, which is perimenopause, menopause. So pretty much 35 plus, right? Yeah. And, you know, we were socialized. And even in medicine, I was taught thin as healthy. if you just, if your patient is thin, that's one less thing to worry about, focus on the other things, never, never about her body composition, muscle mass, bone density until late 60s. So women were coming to me and saying, you know, I'm eating like my husband, I'm working out like my husband, and he's, you know, we're on this diet together and we're running or

doing whatever exercise, and he's losing weight. Yep. And I am not. Yep. And he just rolls over in bed and loses 10 pounds, you know, and I've been at this for months. You know, why is this happening? So there's a biological theory behind it where women can serve when they're in a calorie deficit. And that's primarily for survival of the species. So we look at when and what are you eating. And

when we're bringing it right back down to chronobiology or, you know, working with your circadian rhythm, we see that women's rhythms are different. And it's really important to pay attention to that rhythm because of our hormone pulses throughout the day, including cortisol, how our appetite hormones are regulated because it's different than men. So for women who are looking to lose weight and they're trying to follow the same diet and exercise program as her male partner, it doesn't work necessarily with what her body needs. So the example that I always like to give is when the fasting intermittent fasting stuff is really huge, right? So we see men can hold a fast until 12 or so and they'll go do their training and they'll lean up and they'll get fitter and they'll lose weight. But women, they get tired and fat. And they're like, what is going on? I'm doing the same thing.

I'm putting the effort into exercise. It's because when we look, women's cortisol, awakening response is similar to men, but their peak is higher. And with that is a correlation with appetite hormone. So if we don't eat something within the first hour of waking up, we have a dysregulation of our appetite hormones that last our entire circadian 24 hours. So what that really drives is we might not feel hungry until noon or so because there's so many women are like, oh, I'm not ever hungry until 12 or so. and then in the afternoon, incredibly hungry, tired, and they get what I call the wall lean

where they're not incidentally moving enough. Like we always are kind of moving when we have enough energy, but people who don't have enough and tighten their eating window to like late afternoon or noon to six, they get that wall lean

where they're not moving incidentally and their appetite hormones are disregulated. And then they eat more in the afternoon, which then interrupts sleep. And if we're not getting really good sleep, we don't get metabolic control. So it's just a common. compounded variable that's pretty much like phase shifting.

Like if you are a shift worker and we know there's so many metabolic problems with shift workers, that's what's happening to women when fasting and exercising and trying to follow a male protocol because their initial chronological aspect of their cells and cell function is different from men. And does that change across the menopause transition? We see in the menopause transition, and I think you even post an article about this, all systems downregulate. So we have a decrease in our sleep metabolism and our muscle metabolism. All of those things kind of downregulate. So we have less of a calorie need and it's more of a survival system, right? The body's trying to conserve because it doesn't really know what's going on.

We're highly stressed. But there are ways to counter it. Right. So this is where we look at building lean mass, both muscle and bone. We look at stimulating our systems with high intensity exercise, an epigenetic change for glucose control. We also end up having a... For our listeners, what is an epigenetic change? So if we look at genetics and we have a genetic code, it's like a locking key. You have a genetic blueprint that you're born with. And epigenetics is a key that will unlock certain characteristics or lock up characteristics.

If we're doing high-intensity exercise, then it's a key that unlocks the body's ability to use glucose a little bit more efficiently. So it's able to translocate some proteins, which means create more proteins within the cell that open up without insulin. So we're able to use more glucose and regulate it better without insulin, which counters that insulin resistance. So, you know, you've not touched once on calories and calories out in our entire conversation so far. And for so many of our listeners, that is all they've been told. That was all I was taught in medical school. Oh, yeah.

That's what we were taught earlier too. But when you start looking at that, the human body is not an algorithm. And we see the brain uses more fuel than some of the adipose tissue. And if we start thinking about calories in, calories out, it doesn't quite work. Because calories is also a rough idea of how much energy a food has. And it also comes down to quality because we're now in ultra-process global ultra-processed food. And people are like, oh, I had 2,000 calories. And if you look at the 2,000 calories as someone, I hate to say this, but I'm going

going to in the U.S. diet is the typical American diet. Yeah, standard American diet. It's different from other countries who don't have access to all the ultra-processed foods. So that's where I'm like, I don't want to talk about calories in calories out. I want to talk about the timing of your food, the quality of your food, and a focus on protein and fiber for your gut microbiome. And we need protein for satiation, not just lean mass development. So walk me through this circadian rhythm puzzle. I think a lot of people don't understand it and the differences between males and females and how this affects women so differently. So we talk about a circadian rhythm as 24 hours, but it's different for men and women. Men have a little bit longer, women have a little bit shorter.

Okay. We talk about a cellular circadian rhythm and a whole body system. Okay. I think most people are familiar with the whole body, but not cellular. So like I'm very interested in. Yeah. So we can get in the weeds of that, but things like people talk about mTOR. So that's your memmil. transfer of rabbiacin. That's what the tour is. And it's a way of turning the cell on to grow. So we have different signals in the liver than we do in the muscle, and they're on different timing, and it depends on what kind of exercise or food stress they have. So every cell responds differently depending on the tissue and the system around it. So that's a circadian rhythm. And a cellular level is that it has its own little clock to work within its system. All those

systems work together as a whole body circadian rhythm. Okay. So if we talk about whole body's circadian rhythm. Within that, we have our different hormone pulses. So we'll see, you know, you have cortisol that rises that allows you to wake up and then it comes down. And then it pulses throughout the day, depending on different stresses. It starts to go down and we have a kind of a lull time about four, and then it might start to come up and then it plateaus and goes down a little bit more so we can go to sleep. Melatonin we see starts to peak around 9 o'clock or starts rising about 5, starts to peak about 9. There's another peak at 11 for women. For men, it's a different. It's about 10 and about one. So we see that there's differences

in our sleep in the way that the sleep onset is. So if we're talking about circadian rhythm and we want to make sure that all of our systems are working well, then we have to look at light and dark and food intake because that's how we shift our circadian rhythm. So we know that when you wake up, yes, you want to see light to signal to the whole body. It's time to wake up, which then jumpstarts appetite, appetite hormones. It starts our pulse of our cortisol, testosterone, esterdial, all of our other hormones that have an effect on all the cells. They have pulses throughout the day. If we phase shift it, then it interrupts the cellular responses and it interrupts the whole body systems of understanding what's going on. So this is where chronobiology is so important when we're

looking at circadian rhythm because that's one of the biggest mistakes I think that women and men too, but women fail to understand is that I'm not sleeping well, what's going on? Well, let's back it up and see what are you doing in the day that's going to interrupt your sleep. You're fasting, you've interrupted your appetite hormones. Okay, then that's going to interrupt sleep. You held your food and your food intake until later in the day or before bed. Then that's also going to interrupt your sleep. You're hanging out on the couch with your male partner at 9 o'clock. You've missed that first melatonin peak, and then you try to go to bed and you can't fall asleep. It's because you've missed that first peak. So there's lots of things that happen in that 24-ish hour cycle

that women should be educated on in order to maximize how their body's responding to improve their overall health. This podcast is sponsored by Middy Health. Have you noticed the conversation around menopause is suddenly everywhere? It's trending on social media, celebrities are opening up about their symptoms, and conversations that used to happen in whispers are finally out in the open. And honestly, it's about time. For decades, women were dismissed, ignored, or told their symptoms were just part of aging. And while I'm glad the conversation is happening, here's the truth. Menopause care isn't a trend.

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Follow and listen to Money Moves with Jill Schlesinger, wherever you get your podcast. I've really been loving the idea of throwing on a cute casual outfit and then pairing it with just the right piece of jewelry to pull it all together. It's funny how that one small detail can completely change the whole vibe of what you're wearing. It makes you feel more put together and a little more confident, even on the simplest days. That's the beauty of Jenny Bird. Everything is designed to mix and match. You don't have to overthink it or plan it out. Just grab a piece or a few and you're instant.

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go outside, you know, bright natural light is the best thing. If you can get outside, if not, you're looking at really, really bright light inside, and it's to stimulate the penal land to say, hey, wait, I'm awake. It's time to go. For those of us who live in the extremes of the hemisphere, so up Iceland and Scandinavia or down. Alaska. Yeah. All those places are down, Australia, New Zealand. In the winter, when it doesn't get light until 8.30 or 9, you're not going outside when you first wake up. So you do have to have a sunlight or something like that to wake up. And it's important so that your body knows, okay, time to wake up, let's go. Let's do. Let's do what we need to do in the day.

And then when you had dark at night, then that's when your body starts to wind down and have more a parasympathetic response, starts to kickstart the melatonin responses so that you can get into a deep repetitive sleep. Talk to me about timing of food to do with the circadian rhythm. Yes, so we know that women really do need to eat within an hour of getting up.

Why? Yeah. So we have that cortisol awakening response. That's how we naturally wake up. If we wake up to an alarm, we have a greater peak of cortisol. Now, cortisol is not a bad thing, but it's tightly tied to what we call assolated garylin, which is part of an appetite hormone control. When it's elevated, it is a hunger hormone.

It's also countered by peptide Y-Y, right? So in order for those to work synergistically and together, we need to eat so that the hypothalamus understands there's nutrition coming in. Yes, we can have garralin drop down, peptide Y-Y-Y-Y comes up. so that we feel satiated and then all of our cortisol levels drop and can pulse at a normal rate throughout the day. Dysleptin, which is also a satiety hormone. Part of it, yeah, but it's not as important as the other two. PYY, yeah. So what about eating before movement?

I was under the impression probably based on male data that, you know, fasting workouts were fine. Yeah, no, not so much for women. And I mean, those of us who might be in the 5 a.m. club, the idea of getting up and having a full, breakfast right before is just like, oh, no, let's not do that. How much do you have to eat then? It's just enough to bring your blood sugar levels up and to signal to your brain that, yes, there's fuel on board where we can do this exercise. And I will back it up with when we are exercising, we are creating a breakdown stress on the body. We want that to be a very strong stress that is targeted, meaning that we have a specific plan for each exercise session that we

are doing. Then the reparation comes afterwards. If we go into a session fasted, we already have an elevation of our breakdown hormones and we can't quite hit intensities that we need to, okay, because we're not giving our body the fuel that it needs to hit intensities. And for people who get up and say, yeah, I'm just going to go for an easy walk, it's not as easy as you think because your body's already like jumped out. It's like, whoa, it's time to get up. Let's go. Cortisol is elevated. If you're not eating, then it feeds forward into the appetite hormone and cortisol distress that we just talked about. So something small, if you're going to go for a 30 or 40-minute walk, maybe you're just having half a banana. Okay, a piece of toast. People who can't do that,

maybe they're having protein coffee. What is protein coffee? Profi. So this all started like from the social media aside from me because people ask me what I would have first thing in the morning. I love coffee. It's one of my only real vices besides maybe. That was Diet Coke. Yeah. People are going to kill me for that. So it's just a cold double espresso with some almond milk and a scoop of protein. So it gives me some carbohydrate from the sweetened almond milk, a boost of caffeine, and it tastes like a latte, but you also get a good 20 or 30 gram hit of protein, depending on how much you put in. And so that allows my body to get nutrition. I drink it because I'm like, yeah, A great sits well, and away we go. And then I have a real breakfast after training.

Okay. So, yeah, it's just something small. Abby Smith, Ryan's lab showed that for women who are just doing strength training in the morning, 10 to 15 grams of protein. That's really cool. Yes, get that in based on her research. Yeah, and then if you're doing a cardio aspect to it, add 30 grams of carbohydrate. Okay.

So it's not that much at all. Why does getting breakfast help you sleep better at night? So this falls into the whole circadian rhythm, right? So if we're eating breakfast, then our whole body is in its right rhythm throughout the day so that you can hit that parasympathetic, get that initial melatonin peak, and then your body is primed and ready to fall asleep naturally. I tell people you want to fuel during the day. You don't want to fuel for your afternoon wind down because a lot of people are like, oh, I'm not hungry,

I'm going to hold it, and then I'll have lunch, and then I'll eat throughout the day, and then I'll have a big dinner, might have a snack after dinner, and then they try to sleep. You're just fueling for your afternoon wind down, and we don't want that because you've missed the whole part of the day where your body really needs fuel and needs to be fueled well for brain, movement, cognitive focus, all of those things. And then we also want good sleep because that's where we make change. So you can't have any body composition change if you have disrupted an intermittent sleep. That is a frustration a lot of women have. I see on social media, I'm eating the protein, I'm lifting the weights, and I'm not seeing the body composition changes. So how would you address that? Yeah. So I see this so much as well.

And I wish I could take each person individually, right? Because that would just be very helpful. So I tried to get people to really look at what they're doing throughout the day. When do you first eat? What are you eating? How much? Where are you stacking your calories? Because we know that you want to frontload your calories to have more of your food in the front part of the day. You want to have protein fiber at every meal because it's helping gut microbiome. Gut microbiome, when it's healthy and diverse, increases serotonin production, helps with melatonin production, all of those things. It also helps with circadian rhythm, and then when we get to sleep. So if we have interrupted sleep, then your body composition isn't going to change even if you're doing all the right things. It's about metabolic control

and how your body is understanding glucose, what it's doing with protein. A lot of women, unfortunately, will try to stack protein in the middle of the day, or maybe they'll have a big hit for a thing in the morning and then they kind of forget about it. But protein is really important for satiation. It's also important for a lot of functions that happen, including hormone production and things like melatonin and serotonin are neurotranspans. How do we build muscle? Like what is, how does that work? Oh, so this is, this is the complex. So we're looking at muscle. It is a push pull, right? We want to increase the resistance of all of our push pull motions. If we are looking at a young person who's in their late teens up to their mid-30s, then they have the availability of push

pull and some protein intake and that's going to really help what we call turn on the mTOR include signals for building that lean mass and it's going to get stronger against the resistance. When we start getting older, our body has what we call an animal. metabolic resistance to both protein and exercise. We have to be very specific in how we're building muscle, because it's incredibly difficult to build muscle when we get older. I know that every time I travel, I come home like three kilos lighter, and I'm always like, oh, it's lean mass, even though I'm going to the gym. It's because I'm highly stressed, and I might not be eating enough or eating properly. And then it takes a year to put it back on. When we're looking at strength and power and lean mass and older women,

We have to have regular, consistent doses of that strength training, and we want to be on the lower end of reps and weights as we develop the capability of getting there so that we can preserve our fast-twitch fiber. We can preserve our appropriate reception. We can improve our prefrontal cortex connectivity. And we have... So explain to our listeners. So what is a fast-twitch fiber? Fast-stitch is all of our really quick energetics. So you go to reach for something and you accidentally hit something that's hot and you jerk your hand away.

That's a fast twitch reaction. All of our ability to jump, to skip all the power-based movements, those are all fast switch. And we lose them rapidly, especially as we age. Women lose them faster than men. And we lose our ability to produce power, which is really important, much faster than men. men lose lean mass as they age women lose power and strength first and then they'll start to have cell death or lose lean mass so when we start to get into our 40s it's the focus on how are we building that power and strength because that's going to not only preserve that end of the spectrum but also help build lean mass because it's a stronger push pull okay we'll come back to that but and then you also talked about proper perception yeah and so i know what that is yeah so pro pre perception is your body in time and space So it's your balance. Balance. Yeah.

And so if you step off a curb, you still have the ability to catch yourself and not fall over. And people are amazed at how fast it goes, even in their 40s. They're like, whoa, I can't run down that trail. I'm too afraid. I might roll my ankle or something. It's because they've lost that proprioception. So it's not when we're thinking about when we're in our 60s and 70s, we start to lose it. We start losing it in our 40s.

How do we build that back? Specifically, proporeception. Propore reception. A lot of balance and one-legged stuff. we can do our one-legged closed eye balance test. We do a lot of functional stuff with our feet, looking at toe grabs and widening our toes and balancing our feet on different platforms.

One of the other things that people might forget is that as we're losing power and strength as we get older and lean mass, we're losing it from our feet, from our calf muscles, all our stabilizers. We have to work those well too. And you also said frontal cortex. Yes, our prefrontal cortex. So it's the front part of the brain that's responsible for cognition reaction.

And we want to have a lot of neurons that are connecting and connecting well in order to preserve our cognitive focus and reduce our risk factor for dementia and Alzheimer's. Okay. You say we need to eat more. Yes. To lose fat and build bustle. That is a paradigm shift. I know.

From what I was taught in medical school, and now having worked with thousands and thousands of patients this time of life. I completely agree with you. Yay. But quality is right in there with quantity. Explain to the listener why this works. You know, why she's been fasting and fasting and fasting or just calorically restricting.

And she is on the struggle bus. So I'm going to come back to the quality because one of the questions I had in a seminar a few weeks ago was so I can eat as much as I want whenever I want. And I was like, no. Valories are important. Not quite, but you cannot build muscle. and bone without abundance.

And people go, well, what do you mean by that? And I was like, well, if you're in a calorie deficit or you're stressed under fasting conditions, then your body thinks that there isn't enough food to maintain or build tissue. It's going to conserve fat. It's going to increase visceral fat. And you are not going to be able to build lean mass.

If you are in a severe calorie deficit and you are also not having a higher protein intake, then you're going to lose lean mass first and conserve even more fat. So when we talk about we want you to eat more, we want you to eat that wide variety of colorful fruit and veg, good protein sources, high quality food. And this is where I lean in and say, I'm not worried about calories per se. I'm worried about the quality of your food because if you're eating appropriately throughout the day, you don't get overly hungry. You don't crave the sugar. And your body has more of a relaxed aspect where it's saying, oh, okay, I can get rid of this extra fat and I have the capability

because I have the nutrition to build muscle. And it is a paradigm shift because we all grew up in the calories and calories out, fat burning workout, let's work out for 90 minutes. Let's have that cardio sweat session. Two hours. Yeah, yeah. Yeah. And it's like that is counterproductive. It doesn't create the exercise stress that we want because it kind of put you in this moderate intensity, highly cortisol, sympathetic-driven stress, which is more of a fight or flight scenario, not a let's change body composition scenario. So what should a woman do exercise-wise to change that body composition? Meaning, in a positive way, get rid of visceral fat and gain muscle and bone. Yeah. So all movement is good, and I'll start with that because I have had pushback

when I've been absolute because there's, you know. And I 100% agree with Dr. Sims. You know, if you are sedentary, a 30-minute walk a day will decrease your risk of diabetes by 50%. Like all movement is good. Yeah. So say you're already walking. What's the next step?

The next step is add some intensity to that walking. Because I like to look, if you're already in the consistency habit of doing some aerobic type work, like walking. Let's add some intensity to that. How would you do that? Yeah, exactly. We pick up the pace for a minute or two. We might try to walk upstairs at a faster pace.

We might go in onto a hill. So we're just increasing the intensity. And we're doing two to three minutes of an increased intensity, right? And then we come back down. And we have a couple of sets of higher intensity during our walk. If we are looking at, I'm already walking, I'm already doing hills. Then the next step is, okay, well, now we really want to add in some super high intensity work. Okay.

How do we do that, right? Well, let's look at some kettlebells. Let's do some kettlebell swings. Or maybe if we don't want to go down the route of kettlebell and into the gym environment yet, let's look at doing some squat jumps. So let's do a bodyweight circuit within that session. So you walk to warm up, maybe you're going up your hill. And then at the top of the hill, let's do five to six perpies and 15 air squats or squat jumps.

Walk down the hill for recovery. Run back up or walk back up the hill. Do it again. And there we have a higher intensity, total body, and we're getting more. of what we need. And this is all about the exercise stress because we want to look at what kind of external stress can we put on the body that's going to invoke change. This summer, Colorado is home-based for me. So I'm spending a lot of time outside, hiking, walking, eating dinner on the patio, just soaking it all in. And with the temperatures

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but time restricted eating is not necessarily intermittent fasting. So intermittent fasting is when you purposely withhold food and have a very tight eating window. Most people will hold a fast till noon, maybe 11, and then they'll have an eating. window from 11 to 5 or maybe 11 to 6. And then they're holding a, you know, a 12 to 16 hour fast. If we're looking at time restricted eating, this is where we eat according to our circadian rhythm, where we eat within an hour waking up. We eat periodically throughout the day to fuel our body well. Then we have dinner and then we don't have anything after dinner. So then you still end up with a 13, 12 to 13 hour overnight fast, but you're not interrupting your circadian rhythm and you're not

phase shifting any of the important hormone pulses and appetite control and sleep metrics that happen with intermittent fasting. Okay. And this just seems to get way more important across the menopause transition. Absolutely. Because our hormones are in chaos and disrupting our sleep and like just adding on to all of this. You kind of get away with it. Yeah. In your 30s. Yeah. And then all of a sudden when the hormones start swinging, you know, it becomes a critical mass. Exactly. Because I'm pretty sure that someone who's in pari menopause isn't going to go out to the pub, come home at 2 o'clock in the morning, have a big feed, go to bed, wake up and say, I feel fantastic. I feel great.

Okay, in one study, people ate the same meals and the same calories, but those eating bulk before 3 p.m., had better metabolic outcomes and lost more weight with no calorie restriction. So just timing. Just timing. Amazing. Yeah. And there's more and more of the public health research coming out who's talking about early fast versus a late fast. And breaking fast early, which means eight to about three, you get all of the

metabolic controls that you find with full day fasting and super calorie restriction in rats. But in humans, we don't get that when we're having extreme fasting. And again, it's because we're working with our circadian rhythm. And then we are allowing our body to have that rest and digest process and get into that repetitive sleep. And we're not exactly sure why we need to sleep. We just know so many functions happen while we are sleeping that is important for total body health. So if you eat so close to that time, why is this disrupting so many women's sleep? Your body's spinning all this energy trying to digest and it's actively working instead of resting. If you are trying to digest, then you're having lots of metabolic processes that are happening and your body thinks it should be awake.

and your brain is like, I should be awake, but yet I'm sleeping. How do you talk to shift workers? Because I was a shift worker. Yeah, it's hard. It's really hard. So looking at how their shift plays out and looking at when they get off work and what they need to do, can we exercise when we get up before we go to our job or do we have to do it afterwards, preferably before so we're not doing it.

And working a little bit with some chronobiologist looking at microdosing melatonin. And knowing that with shift workers, you don't want to take it right before you go to sleep because it's too late. It's the same as women with ADHD. We see that if you are using melatonin three or four hours before you should go to sleep, it helps reset the brain to be able to get into the sleep that it needs to. So when we look at ADHD, it's effectively a phase shift of the circadian rhythm as well. So if we look at microdosing our shift workers. With melatonin. With melatonin.

Everyone hears microdose now and they think gLP1. We'll talk about that. Melatonin. Microdosing melatonin because what you buy over the counter is way too much. Right. So what is microdosing melatonin? So we're looking at 0.5 milligram, not 5 milligrams. So you can get a 1 milligram tablet and crush it if you really need to.

But you can also get a prescription for 0.5 milligram. And that's your microdose. And you take that three to four hours before you, need to be asleep, and then it kicks in and allows your melatonin to work properly while you're sleeping and allows your body to reset. And what is the mistake people are making? I know when I first tried it, you know, I heard about it, didn't read anything, and went to the drugstore and bought a 10 milligram tablet thinking more is better, right? Like it's a sleeping pill. I had no idea how it worked. Yeah. I thought it would put me to sleep. And like a sedative and had crazy dreams and

completely drugged the next day. Yes. Yeah. And part of it also is, because you're a woman, right? And the doses are primarily for men, which is why we've had issues with Ambien, but it over-stimulates the brain to be in its kind of sleepy, fatigued state. So you wake up feeling hungover and drugged. Yeah. If you're using very, very small doses, then it actually works with our GABA system in the brain. It helps parasympathetic activity. So it does the things that melatonin is supposed to do. But a big whack, which is how all Western ideas are the more the better is way too much and your brain is like, I can't handle this. Okay.

What is your eating window? Do you mind sharing? This is not prescriptive. No, it's not prescriptive. So full disclosure, when I'm highly stressed, I forget to eat. So my husband is always tapping on my shoulder. But I get up and I have some food maybe half an hour-ish after waking up. Then I'll do some training.

I'll come home. I'll have real breakfast, which might be 8.30 in the morning. then because I live in a Commonwealth country, we have morning and afternoon tea. So about 11 o'clock, have some more protein fiber. Then I have lunch about one. And then we have afternoon tea, which is more protein fiber stuff, about three when my daughter gets home from school. Her afternoon snack is also how we have our afternoon tea. And then dinner is between 630 and 730. And then I go to bed about 10. All right. Let me walk you through mine and tell me if I'm making any mistakes. Okay. So I wake up and I have coffee, black, and I have a view of a beautiful view of the water from my bedroom, which I'm super fortunate. So I sit with my laptop and I get, I answer a few emails. I drink my coffee. I do my meditation, my journaling, my like, you know. And then I get up and I make my shake, usually when I'm at home. And so that is a giantormous, God bless myself, but I have. I've seen it. My protein, a little bit of collagen. I have my. I have my.

Greek yogurt, usually frozen berries, and I have my Zoe 30 seed mix in there so I can get my 30 plants. And a little extra scoop of fiber. It's like eight more grams of fiber in there. And so I sip on that. I try to get like a quarter of it down before I head down to the gym. So I have a gym in my home. And so I go down there and I do usually my lifting and sprints or whatever, my high interval stuff. And then I get on the treadmill and take all my calls. And so I have a walking desk. It's not super intensive, but it's better than sitting. And so I do that and while I'm sipping on my shake for the rest of the morning. Okay. So are you sipping on your shake while you're on your treadmill? Well, I'm walking and working. Yeah. Perfect. So, and then I finish that up by like 11 noonish,

and then I'll go have lunch. Okay. So, and that's my biggest meal is lunch. Yep. And then what do you do in the afternoon? So I'll probably like have apple and cheese or some kind of snacky thing or some fiber crackers, you know, mid-afternoon, I'll get hungry. And then my husband and I eat really are, we're empty-nested now, which is super fun. And we'll have some kind of a lean protein, some veggies, a salad, whatever, for dinner. And we go to bed. I stop eating by six usually. Yeah. Great. What's the macronutrient profile of your massive shift? So typically, when I look at it, I usually don't pay that close of attention, but I'm trying to get like 100 to 120 grams of protein a day. I get 50 in that shake. So that kind of helps space that out, you know, get

get that kick in there. And I'll note that the 50 is not just protein powder. It's from your nuts and your seeds. Yeah, all of it. Yeah. Because people think that when you say 50 grams of protein, you're just scooping in the protein. No, no, no, no. It's not two scoops of protein. Yeah. No, no, no. I get it from multiple sources. Yeah. And then I really only count really protein and fiber and try to get 30 plants in a day. And I get at least 35 grams of fiber a day. Yeah. Perfect. From multiple sources. Exactly. That's how I think about it too. I'm like, completely different than what I was doing 10 years ago. Right. Which was eat as little as possible and work out as much as possible.

Drink lots of coffee. Yeah. All day. When I was working as a doctor, like full time and taking call, the only liquids in my body were coffee, diet doctor pepper, and an occasional sip of water. That was it. Yeah.

Sounds. Yeah. And then when you're really down for the count, Mountain Dew. Okay. So I'm doing okay. And again, this is not prescriptive to our listeners. This is just what Mary Claire does. And literally completely different than what I did 10 years ago.

Yeah. Because I'm thinking about me at 80. Yeah. instead of me in a bikini. Right. Exactly. But you'll still be rocking hot at 80 in a bikini. I think I'll look great at 80 no matter what, you know, and I will wear a bikini and hopefully be chasing my grandchildren if they ever ever appear.

Yeah. All right. You said something that was a revelation. All those diets, keto, carnivore, plant-based, intermittent fasting are designed to create health outcomes through eating. But if you just exercise, you get all those outcomes. Yeah. I know. Funny, huh. We chased this whole diet culture, right? We're bombarded by diet culture, right?

I was part of the problem, and I followed that hookline and sinker for years. Yeah, I think we all did. And it was either personally or when we're working with clients, we're telling them something. I remember looking back at some of my old files from maybe 15, 20 years ago, and I had some female trans athletes doing some fasted workouts because that was the research that we had at the time. And now I'm like, oh, my gosh, I'm so sorry. Yeah. But when we're looking at things like keto and the goal of keto is to lose body fat, right? You talk to any lipidemiologists and then like the outcomes for a healthy person using keto is just dire on lipids. It's really specific for people with traumatic brain injury, epilepsy.

It's good for brain health. The problem with a lot of these diets is they've come from a clinical scope and then pulled over into the health and fitness world and got traction. So everyone's after the aesthetics when they're looking at it. None of these are really promoted for health span. If we look at exercise, exercise in itself is a really strong stress that your body is like, yep, okay, physical activity, we have to do something about it. So it has so many different feedback mechanisms that allow your body to look at that stress, encounter that stress, overcome it and repair itself better. So if it has that stress again, it can have less of an impact on the whole system. So when we look at atopagy, and everyone's like, oh, what is atopagy for our listeners?

It's very misunderstood. And you might say autophagy in your head, because I did that until I heard someone pronounce it. Yeah, I did the same, yeah. Yeah. So we look at cells and recycling dead cells in some of the parts. And we want to have the body recycle some of the parts of the cells. Otherwise, we have a whole bunch of different cell parts and free radicals and things like, yeah, that aren't so great for the body. So autophagy is your body's way of cleaning up.

garbage and recycling it, not just throwing it away. And we see people want to do long fasts because it triggers autophagy and it also helps with telomere length. So this is increasing the health of our DNA. If we look at exercise, exercise in itself is an atophagy event because it's breaking down fuel. It's breaking down muscle tissue with every contraction. Impact will load the bone. It also breaks down the bone. And after exercise, it has to clean it all up. And that part of the reparation process. So if we're looking at a strong stimulus for cell repair and cell regeneration and cell recycling, it's exercise. Because the post-exercise response of that stress is to clean everything up. If we're looking at increasing our fat metabolism, which people want

with the ketogenic diet to lose abdominal fat and overall body fat and distral fat, this is where we look at the intensity of exercise and strength training, right? Because those in conjunction are going to create a metabolic shift to reduce body fat. In the actual moment of exercise stress, if we're doing high intensity, no, we're not burning fat. We're using our fast glucose because we need it for fast energy. So if we're using a lot of glucose, then at rest, our bodies relying on fat because it wants to conserve glucose for that exercise stress. So when I see all these diets that are purporting better body composition and aesthetics, it's let's exercise and let's fuel for the exercise because we know we cannot out exercise a bad diet.

Right. And we cannot get all the changes we want from crazy diets. So when we're looking at the research world, there's physical activity researchers and their nutrition researchers and rarely do they come together. When you find those people who come together, you're like, it makes sense. We have exercise, that's distress, all of these feedback and signaling. happen for the reparation, and then we need nutrition for those signaling and feedback to actually make a difference. So that's why I said, you know, all of these diets will do something, but if we

are specific in the exercise and what we do, we get better outcomes because we are controlling that stress and actually putting a proper stress on the body to get the outcomes that we want. Back to another midi-paws. I'm Dr. Mary Claire Haver, host of Unpaused. Today, let's talk about something that often flies under the radar until it becomes a serious problem. Bone health during menopause and why dexas scans matter more than you think. Osteoporosis isn't just a bone issue. It's a major women's health crisis hiding in plain sight. It's the most common bone disorder, yet many women don't think about it until a fracture happens.

And the statistics are hard to ignore. Half of all women will break a bone due to osteoporosis. A hip fracture in particular isn't just an injury. It can be life-altering. One in five people will die within a year of surgically repaired hip fracture, and that number rises to 70% when surgery isn't an option. So why does this happen? As estrogen levels drop during perimenopause and menopause, bone turnover increases.

We begin losing more bone than we build, and the process is silent. You won't feel it happening. which is why osteoporosis is often called silent disease. For many women, the first sign is a fracture. In fact, women can lose up to 20% of their bone density in the first few years after menopause without even realizing it. That's why this stage of life is such a critical window to start paying attention. This is where dexas scans come in.

A dexas scan is a simple, non-invasive test that measures your bone mineral density, typically in the hips and spine, the area's most vulnerable to fractures. Think of it as your baseline. It tells you where your bone health stands now so you can make informed decisions moving forward. And while many women are told to think about bone health later in life, the reality is that earlier awareness leads to better outcomes. Don't wait until there's a problem to get your first scan. The good news is that there are clear evidence-based steps you can take starting as early as your 30s and 40s to protect your bones, but it starts with having the right information. That's where platforms like Midi Health can make a real difference. Midi takes a more comprehensive approach to midlife care,

including bone health. Their clinicians can help you determine if and when a Dexas scan makes sense based on your personal risk factors, walk you through your results, and help you build a plan that is tailored for you. Just as importantly, their virtual model gives you access to care that understands menopause without feeling rushed, dismissed, or left to figure it out on your own. Because the truth is, you deserve more than a quick dismissal. You deserve data, context, and a plan. Bone health isn't something to think about after a fracture. It's something to be proactive about now. So ask about the scan. Know your baseline. And make sure you have the right support to protect your long-term health. Go to join Middy.

Join M-I-D-I-com and connect with one of their clinicians today. It's so exciting. So when I'm in the gym, I stopped thinking about aesthetics for the first time. I look at aesthetics like that now, not like, oh, the bikini vision I used to have in my 30s. But I'm also thinking about what's happening on a cellular basis and like how it's lowering my risk of depression and my risk of dementia. And I literally am like, one day less than the nursing home. Yeah. You know, like that's my thought process when I'm down there. And it just motivates me so much more than me trying to look like a 14-year-old.

Yeah. My mind shift changed when, well, I had a hard pregnancy and all the things that I planned after pregnancy didn't happen. So I had to find ways around of going from rehab, from surgery to surgery to rehab, to putting weight on, a whole bunch of things. And keeping a human alive. And keeping human alive, yeah. And in the back of my head, I was like, I have. I have an extreme risk factor for dementia in my family. So I was really started going down that route going, what are these things that we can do to prevent dementia and Alzheimer's? And you're reading the research. You're like, there isn't anything, especially for women.

Why is this? We see that women are the ones that are getting all this cognitive decline. So then because of my education and ability to be in a human performance and looking at neuromuscular changes that we see with athletes and motor patterns. and going, okay, if we're looking at increasing motor patterns and getting faster athletes when they're in their 20s, what's going on neuroplasticity? So then we come down to research coming out now within the past four or five years. And looking at motor patterns is a driver for neuroplasticity, which means that we're increasing connections of our neurons, we're not developing talplex, like all of these things, as well as lactate production. So this is where the high intensity work comes in.

And we're looking at... Walk me through that. Like why that is important. Yeah. So lack of... There's a lot of drama online with the gym bros about who should be doing hit training or not. I know. I hear this.

Don't worry. When we're looking at the gym bros and they're relying on the male data, right? They're like, oh, yeah, we don't necessarily want women to do high intensity work. It's bad for their metabolism and increases cortisol. It's like, no, no. Inherently, there is a sex difference between women and men. and muscle fibers. We know that women have more endurant fibers than men, which also means we have more of

the proteins in our mitochondria, which are a powerhouse of our cells, to be able to use free fatty acids or fat than men do. So when we're talking about the zone two work and all the low intensity work, that's all for male data. Because men need to do that to become more like women. They need to do that in order to have more enduring, right? But women, we look, we can go long and slow forever. My daughter can run a full marathon. Without too much training.

No? No. Good mechanics, but also metabolically, women can go along as low. This is why we're seeing ultra runners and ultra cyclists. They're all women dominating the ultra fields because our bodies are designed for that. We look at what's happening in perimenopause across into postmenopause. We have a significant change in brain metabolism, meaning that our brains become less capable of using glucose. And this is where we start to see a misstep in our body's metabolic rates across the board.

We also see this is where we have an increase in cognitive decline. Yeah. Mastonni talks about that specifically in like how we consolidate memory. Yeah. But also when she looked at glucose uptake across the transition and how much it changes based on estradiol levels. Right. So lactate is preferred fuel by the brain and the heart. It's not a byproduct.

And for our listeners, how do we make lactate? So lactate is when we do higher intensity work. And this could be one to four minutes where we're just at a threshold where it's really uncomfortable. And people used to say it was the burn because it is an acid that's produced at the byproduct of glucose metabolism. It's not a waste product that people used to think, oh, you know, you got to flush out the lactate.

While you're producing lactate, your brain and your heart are like, great, yay, better fuel. So if we produce lactate on a regular basis, one, we are able to keep fast-switch fibers because those are the ones that generate the power that then produces the lactate. We also increase our body's ability to use lactate, both in the muscle and the heart, but also in the brain. So if we're able to increase the lactate levels that get pulled into the brain to be used as a fuel, we're improving our brain metabolism. If we're improving our brain metabolism, again, that reduces dementia risk. we see it reduces the towel plaque and the amyloid development. So lactate is super important. And this is why I get so frustrated with people like,

you shouldn't do high-intensity work if you're a perimenopausal woman because they are not looking at the full picture. They're looking at male data. And if we're looking at strength and conditioning, they're very much in the, what are we doing for muscle? What are we doing for muscle? They're not looking at bone. They're not looking at brain health.

They're not looking at metabolism as we get older. Again, because men age differently. women, even in that 40 to 60 range where I get a lot of pushback because I keep telling women you need to lift heavy. And the barossa, it's like, no, you don't, you just need to do resistance training. I'm like, to optimize women for health span, we look at the changes that are correct. Because let me be clear, what we're doing right now is not working. We have an epidemic of osteoporosis and frailty and dimension in our, in our older women over 65. Right, exactly. And I'm right here and right now. I'm not okay with it. I am not either. And I, I mean,

My grandmother lived to be 106, so I know that there's longevity. And I'm facing, I'm only halfway through my life. And she was independently living, and she did all the things, right? And so I'm like, I want to be like her. Whereas my grandmother on my dad's side was the one with dimension in a wheelchair, and I don't want to be like her. So I see these two in my future. I'm like, I'm going towards the 106-year-old who is living by herself.

So when we look at aging between 40 and 60, there's a definitive change in both men and women. We see that there's a definitive aging aspect. How do we tease out perimenopause, menopause from aging? Well, I'm not so concerned about the hormonal profile. I'm concerned about what's happening on a cellular level of the muscle and also how that affects bone. If we look specifically at women, and this is not hormone-driven, we look at specifically at women from an aging factor. We lose our ability to produce power. Why?

Because we have two contractile proteins in the muscle. One is mycine and one is actin. Myosin is tightly tied to neuromuscular, like the way that our body contracts the muscle and how fast it contracts the muscle. There's a dysfunction in that in women when we start to age. When we have estrogen that fluctuates, it's even worse. It exacerbates it. So a lot of people are like, oh, it's just estrogen. If we use MHT, you'll get better.

But it doesn't. It doesn't work that way. Target tissues and all the things that happen with an exogenous hormone. So that's a whole other podcast. But for women, when we're looking at the basic molecular changes that are happening for muscle protein, we have to be down on the heavier end of strength training so that we keep that neuromuscular connection, so that we keep targeting myocin to do its job, so that we change what we call the isoform into one that actually works and not a dysfunctional one. For men, they don't have that same problem.

Men over the course of 40 to 60 want to focus on building mass because they lose lean mass. We lose that power and strengthened and then we start to see cell death or the loss of lean mass. But if we're preserving that end, the power and strength, we're also preserving lean mass. What percent of the population do we think is actually doing these things in the gym? I don't know. I think it's very little. I'm sure it is. I think it's getting better.

The message is getting. out, but there's still so much misunderstanding misinformation. So I'm Gen X and the generation right above me of the boomers. I think the boomers are still concerned with being slim. Absolutely. You know, slim, slim, slim, I need to be slim. I get DMs from the, you know, the 60 to 70s and they're just concerned about their waistline. Exactly. What would you say to them? Yeah, I mean, I see this with my mom's friend group and they're out walking and they think that's enough. And I'm watching fraility increase. And one of my mom's good friends has early onset dementia. And I'm like, you just need to do strength training. I don't like the gym. I don't like the gym.

I don't want to go to the gym. I don't need to lift weights. I want to be thin. I don't want to be bulky. I'm like, well, one, you're not going to because you are at an age now where it's incredibly difficult to put any kind of lean mask on so you actually have to work on it. But their response is, I only gave weight in my middle. I don't want to necessarily want to eat more and try to put weight on. And I'm like, okay, you're here at this point right now. And we see over the past year how frail you have gotten. Next year, how do you want to be? Walking is not going to do it. We have to put in some resistance training. And I'm not saying go to the gym. I'm saying, let's do a circuit of air squats and some pushups against the wall. Let's do stuff that's a push

pull to increase the neuromuscular connection. The question is, what's neuromuscular connection? I'm like, brain health. You don't want to have your early onset dementia accelerate, and you other women do not want to get that. So if we are doing more to increase that neuromuscular connection, you are maintaining your brain, but you are also maintaining your health. So if you are out on a walk and there's black ice because you live on the East Coast and you slip, you won't necessarily fall and break your hip. Because if you fall and break your hip, we know that's one of the leading factors of why women end up in hospice and a very fast demise. Yeah. So I bring it all back to what are the main things that is going on right now?

It's not about being slim. It's about let's protect your brain. How do we protect your brain? We have to get those neurons firing with motor patterns. So Lisa Muskoni talked about not everyone with plaques and neurofibrillary tangles, will have the symptoms of dementia. Right. Some of them will never, you know, they'll have the biological process,

but they'll still be cognitively intact. And I wonder, listening to you, is it the neuromuscular connection where they're just working around, you know, their genetics? Yeah, most likely. And they're never going to lose their cognitive abilities, even though they've got blacks and tangles. Let's hope.

Yeah, I really hope so. You can connect with Dr. Sims through her website and her newsletter at Dr. Stacey Sims.com. You can find her on Instagram, Facebook, and YouTube at Dr. Stacey Sims. She's also on LinkedIn at Stacey T. Sims, Ph.D. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at

the pauselife.com. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.