Women's Health Doctor: The Health Industry Is Failing Women (Here’s Why)

I'm going to introduce our host, Mr. Rich Roll. >> How's everybody doing? Are you having fun today? I think this promises to be a potentially life-altering conversation with one of the world's most renowned exercise physiologists and nutrition specialists. So, without further ado, let's welcome the wonderful Stacy Sims. >> Thank you. >> Stacy, what a delight to have you here today. I'm so excited to talk to you and I want to start um with just uh you know, the quote that gets the most traffic. This thing that you constantly refer to. This idea that women are not small men. So, what do you mean by that? What are you trying to communicate? >> Yeah, I think um a lot of people don't really understand like the biological and physiological factors that make us XX versus XY. Cuz from a cultural standpoint, you go in any shop and then you have like the men's section, the women's section and it doesn't really matter. Like you just go where you want to go. But when we're looking at scientific research or we're looking at health outcomes, we know that most of the research in health and and sports science has been done on men and generalized women. Even small things like aspirin for heart attack. There were no women who were in the original study. So, they were looking at men and generalizing to women. Uh same with osteoporosis research. So, when we start going women are not small men, it's because we as women deserve to have research done on our bodies and our physiology because the dose of the X chromosome changes if you have a double X versus an XY. And we see this from in utero all the way through uh aging processes and into death. So, the women are not small men kind of started as a funny when I was teaching in the afternoon and trying to wake my students up and I was teaching sex differences in training principles and practice and it's like women are not small men and this is why in the cardiovascular system. And then when I started a sport nutrition company way back, we started with a women's line and the tagline was women are not small men to differentiate and then that just became a resounding mantra for so many people. >> How did we get here? Why is it that so much of the fitness and dietary advice that you see out there is really oriented around men and not women? >> This is This is more of a historical kind of question to ask. If we think about the origins of medicine and science, women were not invited into the room cuz they were as much as I love Darwin, I also don't like him because he said women had smaller brains. And when we're looking at the origin of scientific design, it was men in the room and women weren't even thought of as we need to include them because at that point no one really thought that women could be different. They were just smaller versions of men. So the origins of the scientific design of medicine all came through the male lens. But as we've progressed and science has progressed, we realize that that's not really adequate. So now we're looking retrospectively, well, how do we really look at women in a different light? How do we really investigate their physiology? So we're going back and we're looking at methods. How do we actually nail methods down to accommodate for things like the menstrual cycle? Even that isn't really nailed down yet. We start looking at it's 2026, we don't have an answer for PCOS or endometriosis. Why? Because of the patriarchal way that medicine and science started and how ingrained it is in all of society. So there is a little bit of a push now, I shouldn't say a little, a big push now to really look at scientific methods and make sure that we are including women not from a hormonal status, but from a biological genetic status of XX as well as how different hormone profiles will affect the outcomes. >> So your sense is it is changing, maybe not changing fast enough, but uh there is change afoot. >> Yes. Yes. >> Um what is the main thing that we need to understand about the fundamental differences at play here before we get into the specifics? Like how is it and why is it that women are different? What are those What are those differences? >> So one of the studies that I was talking to Mary Claire about and she didn't even know this and she is a OB is in utero, we see that a woman who is pregnant with a baby and XX or a boy baby is under high emotional and environmental stress will have a higher chance of miscarrying than if she was carrying an XX because we see that some of the genetic coding that really protects an XX fetus is driven by some of the epigenetic stressors that the mom experiences. And then after the baby is born, we think that kids are pretty similar, but you'll see through development there are just inherent things that boys will gravitate to versus girls. And then when we look at puberty, the changes that happen at puberty, we see that girls with the epigenetic exposure of their sex hormones, we see a shift in our biomechanics. So women's heart or hips will widen, their shoulder girdle widens to accommodate for the widening of the hips and that happens because in a reproductive sense you need a wider hips to have a baby. With that we also see a really fast uh lengthening of our extremities. So women become more quad dominant and so they have to really relearn how to do all the fundamentals. And this is one of the play factors of why girls drop out of sport because their body doesn't feel like themselves. Whereas boys at puberty will get stronger and fitter faster more aggressive because of testosterone. And then as we go through our reproductive years, we have ultimate changes in the reproductive years. No one really has a regular menstrual cycle and even within that there's variation from month to month. If you're traveling, if you're not, daylight, that kind of stuff. Then we have things hormonal contraception, IUDs, then you might have PCOS and endometriosis, all these things that affect women. But inherently, even aging is different. We know that not associated with hormones, women have more dysfunction in one of their proteins for muscle contraction that makes them lose power and strength early before they lose actual muscle mass. Whereas men don't have that dysfunction, they just lose muscle mass. So when we're looking at aging from a biological sex difference, we have to really say, are you XY or are you XX? Because the aging factors differentiate not from a sex hormone decline, but actually from what's happening from a genetic code. And I mean, I could spend the whole time talking about cardiovascular system, how our lungs are smaller, we have less hemoglobin, we have less oxygen carrying capacity uh from a sports standpoint. We also see differences in mood and anxiety compared to men and women under the same stress. We also see that women become less uh their bodies become less accommodating for cortisol stress even if they're exposed to the same stressor, whereas men do. So they have less extremities of cortisol peaks when they're stressed with the same stress. So it becomes this whole big thing of, okay, it's becoming very complex. But if we just kind of look at male and male data, it'll be good enough. But it's not. >> Well, maybe the the easiest way into this conversation is to start with a very common question that a lot of women face when they enter perimenopause, which is why is it that the things I used to do are no longer working? Like, why is it so difficult for me to like lose weight? I'm gaining weight, and everything that I used to do to manage my weight and my well-being seems ineffective all of a sudden. >> Yeah, and this is um some new research is coming out that's really interesting. So, we're teasing out aging versus what's happening in perimenopause. So, we used to think that the symptoms associated with perimenopause was just based on hormonal dysfunction. Cuz usually when you're thinking about what's happening in perimenopause, you're having more and more what we call anovulatory cycles. So, if you don't ovulate, then you don't produce progesterone. So, you start to have wild disruption in our ratios of estrogen and progesterone. Why that is important is because we have estrogen progesterone receptors in every system of our body. So, as I was saying at puberty, how everything changes because of the epigenetic exposure of estrogen and progesterone, same thing is happening cuz there's a wind down. And our body becomes very sympathetically driven. The other thing that happens with it is all of our metabolism goes down. So, our resting metabolism decreases, our sleep metabolism decreases, the energetics required for bone and and bone turnover and muscle turnover also decreases because the body is under extreme stress. So, we see at any point when the body is under extreme stress, it starts to wind down its metabolic processes. So, this this is attributing to some of the weight gain. We also see that about 4 years before that one point in time of menopause, there's an incredible decrease in our gut microbiome diversity. Which then exacerbates the body's ability to store body fat because we start having an overgrowth of the phyla that is obesigenic or prefers to grab all of the energy out of all the food that we're eating and make you crave simple carbohydrates. >> What is the root cause of the microbiome dysregulation? >> This is your drop of your sex hormones because we look at how sex hormones are metabolized and distributed through the body. There's a point where it is our sex hormones are released and then they are bound with sex hormone binding globulin to be effective in their work. This is excreted into the intestines through bile and then unconjugated or taken off the sex hormone binding globulin and shot back out in circulation. So, our gut bugs do that. As we start losing our sex hormones or having wide variations in estrogen and progesterone and to some extent testosterone, those gut bugs die off. And so, what happens because the body is extremely stressed and sympathetically driven, the phyla that really thrives in those stressful situations starts to overgrow. And unfortunately, that is that obesogenic phyla, which is why when we start looking at what is one of the big things that women can do is increase the fiber and diversity in their diet to make sure that gut microbiome diversity stays. >> And also downstream of this of these hormonal shifts is correct me if I'm wrong is this signaling to the body that it needs to conserve its fat and its energy stores, right? So, in conjunction with the the kind of microbiome changes is that hormonal signaling that's that's that's leading to a retention of that like visceral fat and and belly fat. >> Yes, and we know that estrogen is a very strong anti-inflammatory agent. And so, as that starts to decrease, we have a conversation that is happening between the liver and free fatty acids. And because there is more inflammation in the body, the way that the body responds is is to change the molecular structure of free fatty acids to make them what they're called esterified. And esterified is stored as a visceral fat. So, it's it's like we have this very stressed body. We have all these things that are happening that's causing inflammation. Our main driver anti-inflammatory responses is decreasing. So then, the response is we are in this tizzy, we have to be able to conserve things, have extra fuel. So, we're going to downregulate the things that take a lot of of which is bone and muscle. We're going to upregulate the storage of things that will provide fuel, which is fat. >> And how uh does that evolve as women age up into menopause from perimenopause? >> So, it happens all across menopause. If we don't do anything, we're going to have significant body composition change. We know that the like the peak of all the changes is the 2 years before that one point on the calendar called menopause. In postmenopause, early postmenopause, we start to see some leveling out, and then things start to get better on the other side. You're not going to have any real change in body composition unless you make an active effort to do things during perimenopause, and also when you get to postmenopause. If you haven't done anything, it's not too late. So, we always look at an exercise stress to create an adaptive response, as well as what kind of nutrition we're putting in to really support and kind of counter all the negativity that's happening in the body. Cuz we know that feedback mechanisms and and some of the adaptation mechanisms from exercise stress really do increase anti-inflammatory responses. Changes in epigenetic uh protein or causes an epigenetic response within the cells to be able to pull more glucose in without insulin. So, there are many, many things that we can do without pharmaceuticals for the most part to counter what's happening to the body, to improve body composition and mental health to carry women through perimenopause and have a better baseline at postmenopause and keep building. >> Before we tease out some of those specific counters, what in your mind is the biggest myth or misconception that gets propagated out there about uh this phase of life for women? >> That it's something to be afraid of. Because we see now that there is so much fear factor in the marketing around it like you shouldn't do high-intensity exercise. You're going to get a cortisol belly, you're going to break your bones, you need to take this supplement, you need to take MHT, you need to do all of these things. And in the reality >> fragile. >> Right. And you become fragile. And in reality, it's we have to change that conversation. It's like let's do the basics. Let's hit the good sleep, the exercise, the nutrition, the mindfulness and community, and then we build from there. But so many people will get so afraid that they drop out of everything that they're doing cuz one, they don't know what the what's going on, and two, they feel awful. They don't want to exercise, and then they feel like they're letting their friends down if they're the slow person in the group, or they're not motivated, or they had poor sleep. So it's like let's change that conversation. Empower women to understand what's going on so they're not afraid, and they can still keep doing all the things they love, but with modifications. >> So we're going to talk about nutrition, we're going to talk about fitness, and then other just general uh daily lifestyle habits. But these things all overlap, like the Venn diagram overlaps. But let's let's begin with nutrition. You have a very specific kind of take on how women should be eating as they're, you know, inching into their later decades. So what is your thesis on this? >> I've been doing a lot of um reading and have some colleagues who are in the chronobiological world of research. And what I really want women to understand is their circadian rhythm. So men and women have different circadian rhythms, where women's is a little bit shorter than a man's. And our circadian rhythm is tightly tied to different hormone pulses. So hormones don't rise and fall in a linear fashion, they're pulsed out throughout the day. So it's not only our sex hormones, but it's our appetite hormones, it's our thyroid, everything that is part of the endocrine system. So if we are doing something like holding a fast till 11:00 or so, and we are eating in a a small window cuz we'll stop eating at 6:00 because then we want to sleep well. We have effectively phase shift our circadian rhythm. Because the most powerful ways that you can change your circadian rhythm is light and dark and food intake. So, if you wake up and you're withholding food and maybe you're exercising or not and you're going through a stressful day, the body is like, "Wait, what's going on?" So, we know that the hypothalamus comes into play because when a woman wakes up with her cortisol awakening response, that peak is higher than a man's. And with that comes um acylated ghrelin, which is the active form of our hunger hormone, and PYY, peptide YY, which is appetite suppressant. So, it's a counter. If you don't have food, then with the rise in cortisol, it kind of stays elevated, which keeps that um acylated ghrelin active. And the peptide YY can't make you not feel hungry. So, the hypothalamus is going, "Wait, wait, what's going on?" So, then we start having a cascade of responses that starts to downregulate things like your incidental movement. We see less incidental movement. We see more of the walling in the afternoon. We see more of a craving for simple carbohydrate in the afternoon cuz your body feels like it's in this such a fatigued state. And then in that smaller window of eating that women are holding a fast, um they aren't necessarily getting all the micronutrients they have. But then we also see from population research for those people who hold a fast later, they end up with no metabolic control that a fast is supposed to give them. So, when we start looking at how should women eat? It's like, let's work with the circadian rhythm. We know that you want to eat within a half an hour or so as you wake up. It doesn't have to be a large meal, but just enough to bring blood sugar up and signal that yes, there's some nutrition coming on. Then we look at having protein and fiber at every eating opportunity. So, that's at every meal, every snack. We want to stop eating with dinner. Don't eat after dinner so that you have a good two two three hours before bed. And then you have your overnight sleep where you're having all your reparation. So, if we're thinking about fasting, if you don't eat at 7:00 or you stop eating at 7:00, and then you wake up at 7:00, and then you don't have breakfast till 7:30 or 8:00, you're looking at a 12, 12 and 1/2, 13-hour fast, time-restricted eating. So, you're getting the benefit of having a break from eating as you are going into night, which is beneficial. It's how your body works. But, then you're not interfering with key signals throughout the day that your body relies on to be able to overcome stress and be stress resilient, to have cognition and focus, and to be able to understand what an exercise stress is and recover from it. Um so, I think that there's this whole disconnect of like, I need to fast and hold calories because I've heard about all this stuff how fasting helps with the autophagy and helps with parasympathetic and telomere length and metabolic control, but that's for male data. So, when we start looking at the female data and looking at chronobiology, we see that the best way a woman can eat is according to eating during the day, fueling at hand, and then having that break overnight. So, we're not phase shifting, we're not going to bed with an a full stomach where we can't get into a deep sleep, and we are actually able to follow that rhythm, which it improves our oxidative capacities, it improves our anti-inflammatory capacities, and by the way, it improves our sleep. >> How does everything you just shared correlate with a woman's age? Does this become more acute the older that you get, or do these principles apply across the board irrespective of age? >> Well, the circadian rhythm doesn't change with age, but what does change is sleep and sleep architecture. So, the biggest problem that a lot of women have when they hit their 40s onwards is sleep and having a lot of difficulty sleeping. And we see, yeah, there's a change in serotonin and melatonin production, partly because of gut bug changes, but also we become more sympathetically driven. So, we're really trying to improve sleep, then we want to really pay attention to what we're doing in the day. Because if you're eating well in the day and front-loading calories, then you aren't going to be sympathetically driven and unable to get into a parasympathetic response for good sleep. Why do we want good sleep? Because we can't have any kind of metabolic or body composition change if we have poor sleep. And that's the biggest limiting factor, especially when when we get into perimenopause, with changes in body comp and the inability to sleep, and then they're fighting back and they're trying fad diets, or they're trying to hold a fast, and that's interrupting sleep even more, which becomes this big cascade of events where it's like just hold up. Let's look how the body works. Let's look at that circadian rhythm. Let's work on sleep. Because once we get sleep nailed down, become more stress resilient, your body can start making changes. >> It seems like those principles would apply to men, also. >> You would think, right? But, we see that phase shifting is more difficult in men, because they are not as sensitive to calorie changes and nutrient density as women are. Uh I pull uh a lot of the examples out of what we call low energy availability, which is really high in active women and men. And we see that the calorie kind of intake bare minimum for women before they start have dysfunction is around 30 calories per kilogram of fat-free mass, but for men it's 15. So, we're looking at the baseline level for our nutrient needs, it's different. So, men can hold a fast, and they're not going to get dysregulation, they're not going to have necessary changes in their pulses, because it's not as strong of a stimulus for change as it is as it is for women. It becomes more of a protective factor from a biological standpoint if there isn't a lot of nutrition around, women's bodies start to really conserve. >> Right. So, the translation is basically if men are undergoing some kind of fasting protocol, intermittent fasting or whatnot, they're able to lean out and still maintain or build lean muscle mass, whereas women's bodies the signal is conserve and so they're going to retain uh they're going to retain that fat. So, the fasting is at cross purposes with the aim. >> Right. Granted, of course, there are outliers. Like, if you have a a really significantly obese woman, then fasting can be beneficial cuz they're trying to get control and see we see that um fasting can be more beneficial than severe calorie restriction. But, when do we break the fast is the question, right? So, if we're looking at a woman who is obese and trying to get control, it's not breaking the fast late, it's breaking the fast early and then having the fasting window or the eating window in the day and then stopping eating at like 4:00. So, you have a longer overnight fast. It's not about working in the in the morning because even in women who aren't active, they still have this circadian disruption. >> Yeah, that was my question. I mean, obviously, if you're obese, uh that's a you know, set up for a cascade of all kinds of lifestyle ailments. Um and I can understand why a fasting protocol would be efficacious in that regard, but what about like how much of this is applicable to someone like yourself who is super fit, very active versus, you know, the average 40-plus or 50-plus year-old woman who, you know, does enough here and there, but also is, you know, working full-time and is a mom and has all of these other kind of stressors or or pressures in their life. Like, is there a use case where fasting might be beneficial from your perspective or are you taking it off the board? >> I'm taking the traditional idea of holding your fast till 11:00 or 12:00 off the board. Um and that is I'm like I look like I'm really super fit and everything, but I'm not. I'm the mom who's rushing around and have a really hard time like maintaining my mass. I don't have a lot of time to train. But no, across the board it's like >> Suns out, guns out, Stacy. >> Yeah. No, I got harassed last weekend because I wore jacket on stage and people like, "Where are your arms?" I didn't know it was a thing. Um but no, if we're looking at like the traditional case that I have that will come see me and say, "I I really really need help." is a woman who is in her mid-40s, has two kids, super busy, having intermittent sleep issues, highly stressed, um exercises when she can. She's trying to, you know, eat clean, do all the things and she's like, "Help." But then it's like she leans into it's really easy not to eat first thing in the morning cuz I'm so busy. I have a training session with my friends or I go to the gym at 5:00 and I get home at 6:00 and then I get the kids up and get them out the door and then I have meetings and emails and then it's like 10:00 before I've had any food. The very first thing that I do is like, "Let's re-examine the morning." Yes, I'm not going to have you have a full meal before you go work out at 5:00 or 6:00 in the morning, but let's have something, something really small. We know that Abby Smith-Ryan, who's a researcher at UNC, has done research in this and shows that just 10 g of protein before strength training program significantly helps avoid phase shift and improves exercise adaptations. If you're going to do cardiovascular type work like a strength a circuit or putting in some Metcon in there, adding 30 g of carbohydrate to that does the same thing. So, we just look, it's like how do we support the body in the times of stress where it actually needs nutrition. Because then we're avoiding any kind of phase shift and when women start to adopt that and even even if it is just the infamous protein coffee, they're like, "Oh my gosh, I feel feel in my workout. I have more clarity in the day. I have energy. Then when the 3:00 slump comes, I'm not craving simple carbohydrates. I can actually reach for something that's good so that when I get home, yeah, I'm stressed and I'm tired from the day, but I'm not at that tipping point where I just can't deal anymore. So, it becomes really important for the normal, really highly stressed woman to acknowledge the fact that not eating is not good. It doesn't make you stress resilient. It actually exacerbates the condition. >> But you can imagine the vicious cycle of, oh my goodness, I'm putting on weight. I'm working out more than I used to and I still can't seem to manage this. Uh so, I'm going to eat less or I'm going to skip breakfast or and then, you know, that impairs appetite control later in the day and you have all these sort of, you know, kind of energy um lulls, etc. and you're just compounding the problem. >> 100% See it all the time, especially in the the age group of women who are in mid to late perimenopause, postmenopause, that grew up with the supermodels and the Kate Mosses and the ideal that skinny is best. And I hear the rhetoric all the time, I'm just trying to lose weight. But in order to lose weight in a highly stressed situation or not even a highly stressed situation, you need food. So, when I tell people, you actually need to eat more to lose weight. We need to look at the quality and not volume of training. You actually need to eat more. And it's a mind switch. And people like, what? I need to eat more? I'm like, yes, but it's not like calories. We don't talk about calories in, calories out. We talk about the quality of the food and the timing of the food. And once we start getting that in place, then the body composition changes. >> In the Stacy Sims hierarchy of needs though, sleep, it seems, is at the top of that pyramid. >> Mhm. >> Nutrition and exercise can inform your sleep hygiene, but first things first, you got to dial in your sleep. >> Yep. Yes, you do. >> Um one of the things you you have also said is that women are often more metabolically flexible than men. So, what does that what does that mean? I mean, you're you're dancing around it in everything that you've just shared, but maybe just drill down on that concept. >> So, when we talk about metabolic flexibility, this is where a lot of the zone two stuff came out. Like, we need to be able to train our bodies to burn more free fatty acids. And we look that there is This is where we have sex differences, not hormone factors. Sex differences that occur within the muscle itself. So, women are born with more of the endurance type fibers, so our our slow twitch fibers. We're also born with more mitochondria, protein for mitochondria respiration, that So, that means a more robust ability to use free fatty acids. Um, this is why we see women can go really long and slow without so much fuel. Men, on the other hand, are born with more fast twitch and glycolytic fibers. And so, they actually have to do more of the long slow training to enhance their fibers to be able to build more mitochondria, to be able to use more free fatty acids. The other thing is when we look at our reproductive years for women, they go through times of relying more on carbohydrate versus relying more on fat, depending on ovulation and progesterone. Because after ovulation, the body is taking a whole bunch of carbohydrate to grow this really lush uterine lining in case an egg is implanted. So, we have more glycogen being stored in the uterus than we do in the muscles. So, when we start looking at carbohydrate versus fat and exercise adaptations of carbohydrate versus fat, women are already metabolically flexible by the nature of the sex hormone coming into play. So, when we start looking at metabolic flexibility and the issue with that, it's should we be telling every woman that we need to be doing zone two to improve free fatty acid metabolism? Not necessarily. Because we already are metabolically capable of using those free fatty acids. Do we need it to become more metabolically flexible? Well, actually, no, cuz our body is already metabolically flexible. It's learned that. We start having hormone dysfunction. Yes, there is an uptick of not being able to use carbohydrate very well, becoming more insulin resistant. But, if we do the right kind of exercise, then we are creating an environment where we become more metabolically flexible and can use that carbohydrate really well. So, this is where we start getting into how old are you? You're not getting any change. What you're doing isn't working for you. So, yeah, let's look at how we can can modify what you're doing to create an exercise stress that's actually going to create an adaptation the way hormones used to support or the way that your training used to. We just have to look at what that stress is. >> With the FIFA World Cup 26 coming up this summer, I have been thinking about the ripple effect of something like that. Thousands of people traveling, showing up in new cities, looking for a place to land, which got me thinking about something pretty practical. When you're away from home, whether it's for travel, work, or just getting out of town, your space is just sitting there, and listing it on Airbnb is a simple way to make some extra income while you're gone. Doesn't have to be complicated. You can list your entire place or even just a room, whatever fits your situation. 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And since then, my focus has shifted away from chasing these really big, audacious performance goals, like I did in the past, to now accepting my limitations in this current reality, and learning how to build a daily rhythm that actually feels sustainable for where I'm at right now, today. And Whoop, this wearable health and fitness coach that you see right here on my wrist, every time you see me, is this amazing tool that gives me insights into all the things that influence how I feel and how I perform. My sleep, my recovery, my strain, and my overall health, so that I can better understand how my habits are influencing how I feel. And what's interesting is how these insights translate beyond training. Better sleep changes improve how I show up at work. Recovery changes how patient I am with my family. And when I'm planning for bigger goals, like lining up to participate in the New York City Marathon to celebrate my 60th birthday this fall, Whoop helps me stay grounded in what my body needs right now, not what my ego wants it to do, or what I used to be able to do. And I think that's really what adding more life to your years means, making decisions today that allow you to show up more fully tomorrow. Go to join.whoop.com/roll for 1 month free of Whoop. >> Let me just back up and say, uh basically uh on this idea of like a cascade of wrongs, like you know, you're in this phase of life, what you're what you have done in the past isn't working. You're off your rhythm in terms of what you need to be doing nutritionally, uh but you're kind of you know, literally and figuratively on this treadmill where you're just upping the cardio because that's the solution to the weight gain problem, right? And so, the nutrition's off, the sleep's off, but but you know, you're doubling down on all you know, like the orange theory and the F45 and like all of these kind of like fitness classes. Um what say you, Dr. Stacy Sims? >> So, I'm going to preface it with any movement is good movement, right? And I come from it from how do we optimize? So, if I'm looking at a woman whose journey is I'm just going to start exercising cuz I'm having all these changes and I don't know what to do. Then, yeah. Do what you love. But, if we're looking to optimize, we want to make sure that we're really polarizing the exercise. So, this is where we're very specific in our interval and our interval training. We're very specific in the type of strength training we're doing. >> Mhm. >> Because we know that any beginner is going to get massive gains, but as you are more and more trained, you have to really look at what kind of stress you're putting on the body to get absolute change. So, if we're looking at someone who has been a lifelong exerciser and has been doing lots of running, doesn't really like strength training, starts to have body composition change, and it's like, "Oh, I need to do some high intensity work." And her friend goes to F45, "Hey, come join me." And this is the first time she's ever done any kind of strength training or anything like that. She might, in the first couple of months, see some change, but after that, it's not there's nothing there's going to be no change because it's not truly high intensity work. So, we're looking at an F45 or an OrangeTheory, you're sitting 45 minutes at an intensity that isn't high intensity. It feels that way cuz we've all been conditioned to come out of a workout feeling really sweaty and wasted. But, that's not effective. And I say that because when we look at the intensity needed to invoke change has to be really, really strong. This is a survival mechanism for the body. So, if we're looking at high intensity exercise, 45 minutes is really moderate intensity. So, it's not hard enough to be hard to invoke change. It's not easy enough to be easy for recovery. It's just kind of put you in the middle. So, then we start to see an increase in cortisol, we don't have a post-exercise response for growth hormone, and we don't have a post-exercise anti-inflammatory response. We are sympathetically driven, so that doesn't help with sleep. It becomes uh a continuation of the problem that we already have. So, when we start looking at optimization, we have to look at, okay, high intensity interval training is really good when we do it right. So, the Norwegian 4 by 4 that everyone talks about, 4 minutes at about 80% where these 4 minutes feel like 4 hours. And then your 4 minutes recovery where you're like, "Gosh, that felt like 4 seconds." Because we're really working to one develop lactate, which is really important for brain health. But two, we want more metabolic control. So, if we're holding a threshold um intensity for 3 to 4 minutes, then our body's like, "I need carbohydrate." So, it creates a response within the muscle and in the cells to what we say translocate GLUT4 protein. So, it's taking proteins from within the cell, it's pushing to the cell wall to open up the cell wall so carbohydrate can come in without insulin. And if we do the stimulus enough, then we are reducing our insulin resistance. Because now the body has more of these proteins, understands carbohydrate glucose can come in without having to rely so much on insulin. And when we look at lactate, lactate is super important for women to produce because one, we have less glycolytic and fast-twitch fibers than men. But two, it's preferred fuel for the brain. And we know that there's a massive sex difference in things like dementia and Alzheimer's. And part of it is our brain metabolism and dysfunction that occurs with glucose metabolism in the brain. So, if we're introducing more lactate and the body understands what lactate is, it helps equalize some of that metabolism, which is a reduction in the risk factor for dementia cognitive decline. >> Did everybody follow that? You're going to be tested the end of this. Um >> I need a flow chart. >> Yeah, I I have I have plenty to say about that, but before I do, is is anyone Does anyone want any clarification on that or do you have any questions that come up about what Stacy just shared? >> Just a question on the interval training, you know, you say 45 minutes is is too long. Um or or sorry, maybe not long enough, but can you can you do effective training in in shorter amounts of time? Can you do like a 30-minute workout that's as effective as 45 minutes or an hour. Is it And is it just like the intensity level and then the break level that you need to dial in? >> Yeah, that's more it. So, I mean, like if we're thinking about a 45 minute to an hour, um in that you would have someone that warms up really well and then leads into really dialed in uh intervals. So, we know it could be 1 to 4 minutes of variable uh variable intensity from 80 to 90% and variable recovery. So, your whole work time within that might be 20 25 minutes with your interval and your recovery. So, then if you have a long warm-up and a cool down, you could easily fill up an hour. But, when we're looking at the classes, they don't do the interval part right. So, if anyone's ever been to an F45 or an Orange Theory, I know they already have targets on me, so I'm happy to talk about them now. Um they don't They're all about go go go go go go go go go go go go go go go and they don't really explain what you're supposed to be doing and how you're supposed to be feeling. It's all about the fast movement. It's about the sweat. It's like go go go from um station to station to station. So, you're not really doing the interval properly. So, this is why when you're looking at those classes, yeah, it's a sweat sesh, but what did you really get out of it? For me, I don't want to take it away from people because it's their social connection. So, I tell them, "If you understand what you're trying to do and you go to these classes, you can modify those classes for yourself." So, you know, F45, instead of doing more reps with less weight, why don't you use that interval and lift heavier with less reps? So, that you can make it work for you and your body and still get that social connection. And we're seeing that happening more and more and more in these classes where people are owning it and saying, "I know I need this for my body and I don't want to give up the time I have with my friends or the camaraderie that comes." It's just what are you doing specifically for that interval? >> Thank you. >> Yeah. >> The the TLDR of all of this is women need to be lifting heavy weight more. They need to be doing true high intensity training. And that should be mixed in with, you know, some some polarization, some zone one, some walking. >> Mhm. >> From my perspective, this gets translated and help me clarify this. This gets translated on the internet to stop doing zone two and just lift heavy weights. And if I could translate a little bit what you just shared, which I'm totally on board with, basically what you're talking about is most people are, you know, generally unbeknownst to them, uh, engaging in like zone three. They think they're doing zone two or zone five. >> Mhm. >> Uh, so they're in that gray zone where they're not really, uh, developing their aerobic capacity, uh, you know, getting that mitochondrial density, recruiting those slow twitch fibers, and increasing their ability to utilize fat for fuel. Uh, and they're also not going hard enough to get the stimulus to increase muscle mass and bone density and the like. And when you're in that middle zone and you're new to fitness, you will, like all movement's good movement, you will have you know, you will have gains and you will get more fit, but you will quickly plateau. And people who are in that zone either think they're doing the hard work or they think they're doing the zone two work and they're not doing either. >> Right. I I mean, I've had people came after me and go, "You're such an absolutist and you're telling women things they can't do. You can't do zone two. You can't do this. You must do lifting in the heavy range and you must do interval training." And I come back and like, "Look, to optimize women who have already been exercising, these are the things we know that work, but I'm not saying that's the only thing they can do. That's not what I do. I go to the gym three three a week specifically for lifting. It's taken me a very long time to learn how to lift heavy properly. And I'm also adding plyometrics in there because one of the other things that you really lose as you get older is proprioception and um the ability for power. So, it's like let's work some plyo in there. On the weekend, you're not going to find me at home or in the gym. I'm either going to be out ocean swimming for a couple of hours cuz we have a 7K loop or I'm going to be on my gravel bike. None of that is zone two or zone five. It's my soul food. So, when we're looking at optimizing and for women who have a very short amount of time and let's face it, every woman and man who get up on purpose to exercise at oh my god, it's still night is an athlete in my mind. And I want people to think like an athlete. And you know from being an athlete that there's a specificity for every session that you do. So, I'm like I'm not going to tell you that you have to do high-intensity interval training every day of the week and then throw in some heavy strength training. That's the only thing you can do. Let's look, how many days do you have to exercise in a week? Let's optimize. If we hit two high-intensity sessions and we have two heavy lifting sessions, that's great. So, what is that? Maybe an hour and a half to two hours of your entire week. So, what are we going to do the rest of the time? Let's move how you want to. I don't want to restrict anybody. But we're looking to optimize for brain health, for bone health, for muscle, these are the things we know that work inherently really well for women who are not only having an age factor that diminishes muscle power and capabilities as well as bone. We also have a fluctuation in our hormones that also affect the same systems. So, let's look at how the body is aging and going through perimenopause and use things to optimize the body for change. >> So, women lifting heavy weight. >> I know. >> Uh what do you say to the woman who says, I I don't want to do that cuz I don't want to get all bulked up? >> I know, I hear this all the time. You won't get bulky. If you have a genetic predisposition for putting on a lot of muscle mass, then yeah, you probably will, but it's really, really difficult for women to get bulky. Um, and when we start looking at the power-based end of our ranges, which is your 80% of one rep max, and we're looking at that heavy load, it's a neuromuscular connection that we're after. We're looking at how is the nervous system now going to come down and stimulate the muscle fibers to create a really strong contraction and a powerful contraction. We want to lift a heavy load, so we have a neuromuscular connection because estrogen is not there on your side anymore. And when I talk about um myosin dysfunction, which is you have actin and myosin as your two contractile proteins, the form of myosin becomes dysfunctional with age as well as a drop in estrogen. So, with age, we want to do some heavy power-based stuff. When we lose estrogen, same thing, because then we are changing the molecular or the isoform of myosin so that it will grab on to actin the way it used to. And this is why the basis of that power-based stuff is really important. But, the other thing is we see from a randomized controlled trial that came out last month that those people who lift on the heavy end, both men and women, lift on the heavy end, get more prefrontal cortex neuro connectivity. So, that means they're actually empowering the neurons in the prefrontal cortex more so than those people that are lifting moderate weight or body weight. Those people who are lifting moderate weight and body weight do affect other in the brain and it's like BDNF increases, we have a little bit more connectivity, but only the heavy end of lifting really does affect the prefrontal cortex. >> So, there's a neuroplasticity aspect to this. >> And essentially what you're saying is as estrogen goes down, you need to replace that stimulus with a central nervous system stimulus, and lifting heavy weights accomplishes that. >> Yes. And then you can look at we get that increase in our neuromuscular stimulus in this pure strength and power. And then if you really want to try to put lean mass on, you have to eat a lot and you have to be in the gym a lot and you have to look at what are some of the other rep ranges to cause hypertrophy. Because I think the confusion in the space is people are missing the mark when they're talking about strength and resistance training. Where people are thinking about building muscle mass is also strength. Yes, you're going to get strong, but you're not going to get as strong as if you were to stay at the lower end. And the way I try to get people to understand this is you can train to do 50 push-ups. Are you going to have more strength? A little bit. Are you going to have a lot of muscle mass and endurance from that? Yes. I'd rather you train to do 10 push-ups with a 20 kilo pound on your back or 20 kilo plate on your back cuz then we know you're going to be strong. Are you going to have more endurance? Yeah, a little bit. Are you going to have more lean mass? Probably not that much, but you're going to be really strong and powerful. And that's the eye that we want for women because we know that power strength is really, really important for longevity. It is a critical factor for how we age and our proprioception. So I'm now at the point where I'm like, let's optimize women not so that they are in the moment now aesthetics. Yeah, that's part of it, but we know that women live for a much longer period of time than men, but in really poor state of health. So all the things we do now is kind of banking that we aren't going to get in that poor state of health. We're doing everything to protect our bones, our muscle, our brain, our heart. And these are the things that women need to start thinking about. >> To get really specific, uh like how many rep like you're going into the gym, okay? How many reps? Like what is the how do I set the weight? How many reps should I be able to do? How many sets of those exercises? Like what it what would be a typical like routine? Like on this day I do these muscle groups and I do this many sets of this and that. Like what does that look like? I mean obviously it's customized it's very specific to the person but in a general sense. >> So this one is hard to answer. Every woman's journey is different and how they approach weight strength strength training. If you are a woman who has a long history in strength training and you're like I'm going to start to embrace this heavier lifting stuff. First you want to have a periodized program. So if you're coming in and you're like this is the strength like the really hard base building part. Then we look at 5 by 5's and that's five reps five sets at about an eight on a scale of one to 10 more talking about our rating perceived exertion. You're working hard. >> So meaning you could probably do two more reps or so. You're not going to failure. >> Correct. But you probably are by the time you get to that fifth set and maybe the third or fourth rep. So you are pretty much going to failure but that's not necessarily the end goal. And you're not doing that on every muscle group. We talk about compound lifting because you have your stabilizers as well as the actual major muscle groups. So maybe Monday you're doing a squat focus and it's that knee hinge type focus. And then you do some subsidiaries around it. So your main focus is your compound squat focus and that's your 5 by 5's. Then maybe you do some residual Brazilian squat or some split Bulgarian split squats. So you might be doing eight to 10 reps but it's more about further fatiguing the muscle and getting more of a stimulus for the strength as well as some of the muscle hypertrophy. Maybe Wednesday's a push pull. So it's upper body you're doing overhead press maybe you're doing bench press maybe you're doing a pull so it's all the push pull. And then Thursday or Friday you're doing posterior chain. So it's all like these are the the muscle groups and the compound movements we want you to do, but how do you do it? We need you to have a program. We need you to go, "Okay, I'm going to do this for 6 weeks and then I'm going to have a deload and then I'm going to move into this." So, we're continuously adding load and we're recovering from it and then we're changing up the loads cuz the body likes to have a challenge. So, to see progress, we need consistency and we need to be able to challenge the body. >> It's very difficult to adhere to a truly periodized program without a a plan and you know, in the best case scenario like working with somebody who's monitoring this. The typical experience and this applies to men and women, you go to the gym, you kind of have your thing, you do your routine and that's just what you do and it's the equivalent of zone three, I think, you know, in in in for endurance athletes like and you just kind of hit this ceiling and you never really see the gains because you're not taking those deload weeks off, you know, you periodize we you know, daily, weekly, monthly, yearly, right? To really be able to figure out how to like optimize what you're doing and you need somebody guiding you. >> Yeah, and for a lot of people it's hard, right? And so, one of Well, there's two things I tell both men and women when you're looking at a periodized program. If you don't have a coach and you don't have a plan, then we're kind of wasting time, but not really. So, if you want to do a quick hit, let's deload during school holidays. So, you know, your kid has a week off and instead of focusing on going to the gym, let's spend more time with your kid or know that that's a point where you need to deload cuz the school year is broken up into pretty good breaks where you have a week off and then maybe 2 weeks and then you have summer break. So, you can use that as like a baseline for how am I I'm going to focus for this before the next school break. Just gives you an eye to a calendar. And the other thing I have for for women because they're more afraid to push themselves cells heavier, I go, "Okay, I want you to go pick up the weights that you're going to use for a Romanian deadlift. And I want you to tell me how many you can do with that weight." They'll go pick up some lighter weights. They might do a set of 20. I might, "That's way too light. Let's go pick up the next set." They'll go to from like the 10s to the 12 and 1/2. I might, "Skip the 12 and 1/2. Let's go to the 15." And they're surprised they can still do 15 reps without an issue. So, it's like really trying to challenge yourself instead of doing more reps, let's pick up a heavier weight. And it's getting that mindset of, "Okay, for this block before the next school break, let's focus on lifting up a heavier weight even though you're doing the same routine. Let's just change up what routine you're doing by increasing the load or maybe we're doing resistance bands and some pogos as a warm-up instead of a static stretch." Just small little things cuz I don't want people not to go to the gym. I don't want to break up their consistency, but it's just reframing what they're doing by adding a little bit or taking away a little bit and breaking up the calendar and something that makes sense. >> On the other end end of the spectrum, we have the high-intensity work. Uh you mentioned the Norwegian 4x4 like everyone likes to talk about that. That's just one example of of of Yeah, of many, of course. Um but what is something else that somebody should know like what does that look like? Like you're talking about like all out efforts with plenty of recovery other than, you know, some kind of uh indoor cycling or treadmill sprint situation. Like what is another type of high-intensity sprint-based workout? Is the circuit training like fall into that category? Yes or no? Like what are some other options that women can think about? >> Yeah, so if we think about circuit training, I tell people we can go on the the aspect of every minute on the minute or every 2 minutes on the on the 2 minute where one minute you're doing one exercise and you might have 20 seconds where you get to the next one. So, you have four exercises and then a minute of recovery. And then you might do that two or three times. And you can do that outside on the playground, right? You could do air squats and then you can go into uh hang on the on the monkey bars. You can do walking lunges. You can do some sit-ups. Um there's lots of availability. Rebecca Rush, she goes and she lifts rocks on her run. So, there's lots of things you can do outside of the gym. And it's it's about the intent and the intensity. It's not necessarily where you are that you have to do it. So, there are I mean gym intimidation is real. I get gym intimidation depending on where I am in some things. And I've been in and out of gym since I was 16. So, I know gym intimidation is real. So, I'm not going to push every woman to go to the gym. Might not be time effective. Also, fear factor. So, let's look. Okay, maybe we start with 10 minutes in your house and we're just doing bodyweight circuits where again, we're doing 30 seconds on, a minute off. Maybe we're doing a minute on, a minute off. Just starting slow. So, it does become more feasible when people start to think about that. It's not about running for 2 minutes on the treadmill, jumping off and doing 30-second kettlebell swing, 30 seconds off, and then getting back on. Like that's more personalized and and really high-intensity. But if we're a woman who's just starting this journey and she's used to walking for 5 miles in the morning or 3-mile loop, during that walk, let's pick up the pace. Or maybe you have some stairs. Instead of avoiding the stairs, let's do a couple of ups and downs of the stairs. So, that becomes an intensity factor. Or you're meeting your friend in the park to walk your dogs. Well, let's see. Let's do a bodyweight circuit while we're there. You walk to the end of the the you're going around the lake. You get to a certain point in the lake and both you stop and you do some jump um some air squats or maybe do some jumping lunges. So, there's lots of ways that you can fit it in. But I think we've all have been so conditioned that high-intensity means XYZ in the gym and strength training has to be in the gym or has to be, I don't know, in a personal training session. But, it isn't like that. It's like it's available to everybody. We just have to know who the person is, the personality, do they need a buddy or not, would they like an app or not, do they want to go to the gym or not, are you more of an outdoor person? I go to the gym so that I can be strong enough to do things I love to do outside. I didn't go to the gym because I love it. I go to the gym for protection against injury. So, there are a lot of people like, "I don't want to go to the gym. I want to be outside." Great. Let's see what can we do outside that's going to hit these marks. >> You mentioned jump training and when I hear that I think about bone density. You know, obviously when women age up, you know, we hear a lot about osteoporosis and and bone density loss. What are the exercises that drive bone density retention or improvement the most and what are some myths out there about that? >> Myths are rampant. Well, running improves bone density. We think about yoga, like all these modalities, they don't. They're not a strong enough stress. So, if we want to improve bone density, we need a multi-directional stress coming up. The ground doesn't move, our body does. So, we want something that's really hard to come up through the skeletal system to invoke that stimulus for for bone turnover and bone strength. When I talk about jump training, so many people, especially um perimenopausal women, are like, "I can't. My joints hurt." It's like, "I'm not talking about plyometric high box jumps." It could be something as simple as a toe raise and a hard heel slam. Because you're dropping hard and you're absorbing all those forces, that's a multi-directional force through the skeletal system. There's a fantastic um research program over in Australia called Lift4 More and they look at strength training and proper jump training where it's hard landing and they're getting significant improvements in women who have had osteoporosis into the bone density of normalcy in men as well. Uh, out of New Zealand as well, OsteoGains. It's all about the kind of jumping and hard landing that you're getting, not soft landing that we've all learned to absorb the forces. And it's 3 minutes a few times a week to really improve bone density over the course of 3 or 4 months. >> You mentioned plyometrics earlier. Uh, I don't know that I even know what that means. Does that include things like yoga and Pilates? >> No, so >> And where do those >> Where do they fit? >> fit in? >> Yeah. So, plyometrics is power-based training, explosive training. So, this is your box jumps. This is your counter movement jumps. So, all that stuff that's really fast and reactive. Um, when we talk about Pilates and yoga, uh, there's a whole subgroup of people who are Pilates lovers that hate me cuz they think I hate Pilates. I was in a Pilates class before I got here. Not today, but a couple of days ago. I don't hate it. I think it's really good and people should look at it as really fantastic for uh, proprioception, for balance, for isometric hold. We need all this stuff, especially for tendons and ligaments. Same thing with yoga. If you heard um, Keith Baar talk about tendons and ligaments, he really does like yoga in the last bit of the hold where you're shaking cuz that gives you a stress in the ligament and the tendon to instigate more plasticity and and and strength within those tendons. They're complementary. They aren't strength training in the way that we're viewing strength training for brain health and neuromuscular connection. They all can can all fit together. So, if you're someone who loves Pilates, you don't have to give it up. But, add 1 day of of pure strength training in. If you're someone who loves yoga, same thing. You don't give it up. It's like, how are we going to change what you're doing to optimize your life? I don't want anybody to give up their love. It's like, how are we going to look at what you're doing in the time in the week? And strength training doesn't have to take a long time. It could be 10 to 15 minutes if it's focused. It's not an hour and a half in a gym that you don't like. So again, it's individual and how do we look at it and what are we looking to do? I think yoga and Pilates are really important as we get older because we lose proprioception, we lose the ability for flexibility and mobility. And those two um modes of activity really do help with that. But it again, it doesn't tax the bone and the muscle the way we need to to age well. >> The supplement world. Let's just say it's a bit noisy out there with endless products promising quick results or products that are making all kinds of unsupportable claims. But over many, many years, what I have learned is that lasting progress usually comes from getting a few simple basics right and then doing them consistently. I bang on about this all the time on the podcast, but the one area that doesn't get nearly enough attention is fiber. In fact, and amazingly, almost 95% of Americans aren't getting enough. Let that sink in. 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For a limited time, ProLon is offering my listeners 15% off sitewide plus a $40 bonus gift when you subscribe to their 5-day program. Just visit prolonlife.com/richroll. That's p r o l o n l i f e {dot} com {slash} richroll to claim your discount and your bonus gift. From a weight management perspective, what is your message to the person who says, "You're asking me to dial back my favorite aerobic exercise that I've relied upon for decades to keep my weight in check and you want me doing three to five reps of these heavy weight. Like how is that going to impact like my bottom line which is like I got to keep I got to keep the weight, you know, down. >> Yeah. I like to talk about what we stand to gain, not what we stand to lose. Because in the diet culture, it's all about weight loss and fat loss. I'm very conscious not to say those words. I don't use them on my YouTube channel. I don't want to instigate anything about loss. I want to think about what we're what we stand to gain if we get into the weight room. We stand to gain muscle. Muscle is a very active tissue that helps regulate all sorts of things. Body weight, our blood glucose, our immunity, just so many things. We get in the gym, we're also protecting our bones. So we stand to gain so much more from those few times in the gym than we do pounding and increasing cortisol doing our favorite aerobic 90-minute aerobic session. Um and when we start thinking about what do we stand to get to gain when we're in the gym and gaining all those things for brain health and muscle health and bone health and longevity versus what we stand to lose if we stop doing the 90 minutes. We actually aren't losing if we stop doing the 90 minutes. We're gaining so much more because if we're looking at the more muscle that we have and the more muscle centric we are, the more that your body composition is in a better place. And it is it's a really hard for all of us that grew up in the idea of 90-minute step aerobics and going for massive long run on the weekend and all of these things to keep our weight in check or doing fasted training cuz it keeps our weight in check. When we get this mental shift of being in the gym to help with all of that, it's time effective and we also see significant body composition change. But it is a significant work on the brain to do that. A lot of times a buddy system is really helpful because you don't want to let a a friend down if you're both starting on this journey. Um sometimes I'll have run groups where I'm like, "We're going to start the run with doing some strength training and then we're going to Now we've prepped the muscles that you're going to run more effectively and more economically, so it it reduces injury risk." So then we can lean in on we want to reduce injury, you want to improve your running form for the things that you love. Let's get in Let's do these these preps and let's stimulate the muscle in a way that it does. >> Um I made a big to-do about this being participatory. I don't think I've actually lived up to that. So like let's get some questions. Yeah, there's one in the back there. >> Uh I was just curious regarding what you were saying earlier regarding uh circadian rhythms and how it pertains to the optimal time for women to uh fuel and you know, start their day with nutrition and everything else. Um how does that factor into uh training schedules? Is there an optimal time of day for women to train? And how does that compare with men? >> I don't know. That's hasn't actually been done. From a research standpoint. We know from behavioral standpoint that anybody who exercises first thing in the morning is probably going to stick with what they're doing. Um we also see at the end of the day tends to drive a little bit more low energy availability and sleep disruption because people are going into a session not that well fueled or they come home and it's too late. They don't feel that hungry or they feel hungry an hour before bed so they overeat. And that's both men and women. So from a behavioral standpoint, we always try to say let's do more in the morning if we can. Um but really fit it in. And if you have to do it at night, there are things that we can do to help mitigate metabolism and help with the refueling and help with sleep. >> Thank you. We need some women questions. Yeah, okay. Thank you. >> Um I have a question. This is Sarah. Thank you for basically outlining my upcoming nutrition and workout plan. >> You're welcome. >> Um, that'll be $1,000. >> Yeah, thank you. >> Um, so for the interval piece that you're mentioning, you just kind of mapped a few different versions of that. Are there specific modalities or movements within that interval plan that you would consider more optimized than others? Right, you mentioned a few few movements in there, but like is cycling versus running versus mixed movement more optimized? >> Whatever you like. Whatever is going to motivate you. If you're learning how to go super hard, I always tell people to get on the assault bike with a friend next to them telling them, "Go, go, go, go, go, go, go, go." Cuz you cannot cheat on an assault bike. Once you know what that feels like, then anything goes. >> We are very behind on the research and women's bodies are complex. How do we get there faster so that we can know more and make more advances in women's health? This becomes a group of people working together cuz we see, especially in academics or in academia and in the research world, there's lots of silos and people are like elbows out, this is my realm. But there is quite a group of us that are coming together to really try to close that gap. I'm finding that I'm an expert in one thing, but I'm not an expert in all the things that Emily's an expert in. So it's like let's gravitate and bring all of us together cuz we can really put an impact on and have a louder voice and find money and grants and distribute it. And then part of it is we're launching company about that same thing where we're going after AI and we're really vetting research to be able to give output and insight for women that's going to drive research and improve it the touch points. So there's behind the scenes where we're all really trying to close that gap and address the funding issue and find innovative ways to actually go after that. But it isn't it isn't an individual, it's a team. And we're finding that there is a really good group of men and women who are doing research in the space that are coming together and being complementary to really hone in and try to close that gap. In in the different areas, we have the oncology area that is is really booming with all sorts of different techniques and and you have a lot of researchers coming together to help each other. Same in the sports space, same in the reproductive rights and reproductive research space. So it's an exciting time. >> Hi thanks to Ambrose. I'm the dad to a 14-year-old young woman and I want to be the best parent. I want to be the greatest parent I can to her. What are some habits that I can help instill with her and support her in and she's as she's in this part of her her growing up? >> Girl dads, I love girl dads. My husband's a girl dad. So it it one of the biggest things is communication. A lot of times girls will shut down especially with their dads. So if you just have a like we still instigate family dinner every night and have conversation. So it's like how was your day? What were some of the high points? What were some of the low points? And then at night having conversation with her and I she'll offload and I'm like just vent. I'm not going to fix. So when they know that you're a safe place to vent and not looking for solutions or they know that they can come to you and say things and not be judged, it's really important especially as they're going through their teenage years. There's going to be ups and downs. They're going to have all sorts of mood swings. But if you just consistently there as someone who's not judging and they can vent, it's like I tell my daughter when you get to the point where you might be going to parties and you feel unsafe, call me. I'm not going to judge. I'm not going to get mad until maybe the next day. But I don't tell her that. She'll know now cuz she'll watch this. But it's just really important to understand that both physically and mentally is an enormous change right now and we want to do everything to foster a positive environment. So it's like we don't have any kind of body language in the family. So we aren't we talk about being strong and how fast you can run and all the things that she loves for soccer. We don't talk about food in a negative way. If you want chocolate, you can have some. It's a sometimes food. Just remember your soldiers don't want to grow on sugar. Our soldiers are your immune system. So just really coming to a place where I understand you. I got you. I'm not going to judge you unless I really have to because I'm the parent. But for the most part that undercurrent of just being supportive goes immensely far and then the other thing that is really important is your phone. Put it in the phone jail when you first walk in the house. That way you're not on the screen all the time which becomes a habit for all of us and then they lead by example because if everyone puts their phone in the phone jail, then you end up with a very safe environment in the house. >> Thank you. >> You're welcome. >> Hi, I'm Meredith. Um I guess my question is about sleep. I am chronically a terrible sleeper, always have been and in the last probably 10 years it's gotten so bad that I am well and people around me are also like looking for ways to get through the night, to stay asleep, to go to sleep and so it's like there's pharmaceutical options, there's herbal options, there's you know friends that can't go to sleep without a glass of wine and I'm just curious is like is sleep sleep or does it have to be good sleep? Does it have to be like sleep that naturally comes to be able to have that recovery? >> We want to see that you have a really good sleep architecture cuz you need REM sleep, you also need slow wave sleep. We know that if you're using alcohol, then you don't get into slow wave which is your deep reparative sleep. One of the things that is really effective is cognitive behavior therapy. There's a a group out of the Veterans Association that has I sleep. And it is was designed to help people with PTSD coming back from Afghanistan to be able to sleep. And it's really effective. So one of the the most effective ways is like cognitive reshuffling or some other cognitive behavior therapy with things like L-theanine and magnesium threonate that cross blood brain barrier that have an active uh part in parasympathetic responses. It does take some time. And it's it is a bit of a frustration when you first start, but stick with it because it it significantly improves sleep and sleep architecture. >> Hi, my name is Emily. Thank you so much. I'm getting so much from this. Um as a 34-year-old woman you realize how little education you have on your own body. And so I'm all here to optimize everything you're saying. One thing I'm coming to is working with the cycles of my body, especially someone who has endometriosis and is on a fertility journey. So I hear about these three to five workouts a week, and then I think about how I might be during my period or something like that. Um what are some of the ways that we can help to support ourselves instead of looking at every week as the same? I know that that's where I'm going to drop off with that consistency. >> Yeah, so um it's it's knowing that three times a week you should be doing strength training, right? So does it mean you have to go do the same thing every Monday, every Wednesday, every Thursday or Friday? No. You have your periodized plan, but sometimes you go and you're like, I just want to lift really heavy or I don't. I just want to work on technique. It's it's feeling how you are, and I tell people when you go to do a session, there's two things. You have the physical and the mental. And if you show up at a session, mentally you're a two, but physically you might be a six. Let's do a little bit of a warm-up with mobility. Maybe we do a couple of heavy lifts to stimulate central nervous system. So, here mental goes. If your mental doesn't come up, call it. Have an active day. Just do what you love. But, most often that mental comes up. And then you're like, I'm super motivated. I feel great. So, maybe your physical now comes up to an eight, and your mental comes up to an eight. And people usually will give up within the first 10 minutes when they come in feeling that way. But, if you are doing specific things to kind of boost mental in this 10 minutes, you're like, I'm here. I feel great. Let's go. Um and then again, listening to your body, cuz I think that so many people disregard how you feel on the mental aspect of how you feel. So, if you are suffering from uh severe endometriosis and the symptomology that comes with it, then you're not going to push yourself, and that's fine. It is absolutely fine not to push yourself. Um we know that the inflammation that comes with endometriosis can be very systemic and and be very impactful. So, then maybe you want to look at an environmental stress. So, we look at heat, and we look at at cool water, not ice water, but cool water, cuz those both induce a massive anti-inflammatory response that helps with endometriosis. So, instead of going and pushing yourself through exercise, maybe you just look at an environmental stress. One, it brings more mental and parasympathetic activation to calm, but it also does great things for inflammation in the body. >> In furtherance of that, how do uh things like birth control uh and hormone replacement therapy impact training, how one how a woman should think about their their nutrition uh and just overall health and energy levels? >> I'd like to say we have solid answers for that, but we don't. Because with hormonal contraception, there's so many different variations of the formulas, and a lot of research hasn't been done on it. We do know that in general combined or a contraception knowing that we have estrogen progesterone in it increases oxidative rates. We see it increases inflammation. So those are factors to consider if you're trying to adapt. Um so we look at having more anti-inflammatory foods. We look at what can we do to calm post exercise uh inflammation and and recovery. Um but for the most part how does it truly impact training and adaptation? It's an individual response and depends on the formulation. When we get to menopause hormone therapy, part of it's a wild west because we had the Women's Health Initiative in the States versus the UK Million Women Study in the UK with vastly different outcomes. So depending on where you are in the world, you hear mixed messages. What we do know is that when you're using menopause hormone therapy, it slows a rate of change but it doesn't stop it. So if you're looking at body composition, it isn't going to help just on its own preserve body composition. It will slow the rate of the um laying down of visceral fat. It will slow the rate of muscle loss but it doesn't stop it. The only thing it does help we know emphatically helps with is bone and bone density. It's very protective. Um so when someone's considering hormonal options, it's like yes, have an informed choice but you can't neglect the lifestyle parts that come with it. And if you I have um younger reproductive year clients and and um athletes. And if they're changing their a pill or they're going from a pill to an IUD, we want to track how they're feeling because symptoms really will dictate how they're responding. Because if you feel awful, you're not going to be able to put in a good session. So, we want to know what the patterns are over their hormonal contraception or their IUD and if they change it, how that affects them, too, so that we can dial back and we can push forward when we know that we have the opportunity. >> You you opened answering that question with a with a sort of we don't, you know, we don't know enough. Like, so what I take from that is like, how is it possible that these aren't studies that are being done? Like, is there there's clearly not enough research being performed on this. >> No, but I will borrow from Lisa Mosconi. She's like, we don't know this yet. We have studies that are down the track and we're planning for them and she has a massive grant to really look at menopause hormone therapy and the way it affects the brain. There are other people that have um a long There's the menstrual cycle research group that's doing is collabing across the world to really nail down what's happening with hormonal contraception and the different formulations. So, it's in the pipe. It just hasn't been done yet. It's in the process of. So, hopefully in two to three years I'll have more definitive answers. >> You mentioned uh hot and cold water. Uh so, let's talk a little bit about that. Like, sauna, cold plunge. Everybody loves to talk about their protocol, their routine. Uh you know, where do you stand on this from a women's point of view, women's health point of view? And what's different about women with respect to men when you're thinking about these >> Yeah. >> activities? >> So, this is where I bring it down to sex differences, not hormonal differences. There is an inherent sex difference in thermoregulation, where men will um start to sweat and they'll really offload heat through sweating when they get hot, but women will vasodilate first before they start sweating. Women's thermoregulation um baseline also switches across the menstrual cycle cuz progesterone increases your core temperature and the body adjusts to accommodate for that. So, if we're looking at the sauna, women will have more robust responses from being in the heat because their body's used to change. So, when they go there, the body's like, "Hey, I know what this is." And it will really improve our metabolic control, improve heat shock protein responses. Men will still have the same, but they have to have higher, or I guess more times in the sauna for that actual longevity. If we're looking for heat acclimation, it takes women longer the body is used to the perturbation of the temperature. So, we see men who are doing sauna exposure for performance, they need less time in there because they hit get a big boost to cardiovascular responses faster than women. So, when we're looking for health outcomes, women, they can tolerate the heat more, they can get in there, they can stay in there longer, and they get more robust responses than men. Cold's different. >> Staying on sauna, just to be really specific, like how long and what temperature Is there a temperature threshold? Like, where do you where do you set the thermostat, and where do you set your kind of timer on how long you need to be in? To get that response. >> Yeah, the response. So, in research, we can't keep people in heat when their core temperature goes up above 39.5°. So, that's about 104° Fahrenheit. So, when we're looking at how does that play into responses, you get responses well below that cuz I'm saying that because I think Bryan Johnson was like, "I have to keep my core temperature >> Yeah. >> It's like, "No." >> He said, "I hadn't been I wasn't in long enough. I didn't have it hot enough. I had to stay in there crazy long." >> Yeah, no. That's That's hazardous. Like, we can't get ethics to drive people to get their core temperature up. So, at 39.5, you're out. So, when we're looking at all the responses that we're seeing, it's well below that. So, we see about 38.5°. So, what is that? Uh I don't know. Quick do do the math. Someone do the conversion for >> Somebody do the math on that >> Cuz I'm just going to stay with metric. As a scientist and someone is an expert, we talk metric all the time. >> Uh one on one. >> Okay, one on one. >> Tap yes, time time day, duration. >> Okay. Time of day, ideally if you can do it after training for 10 minutes, it extends the training stress. So, you actually get more out of your training than if you were not to go in the sauna. Uh but if you're timing it, generally whenever you can, right? We know at the end of the day when you're passively dehydrated and your core temperature is a little bit more elevated, then that can promote more red blood cell responses. But for general health and continuing aspects of of actually getting that heat exposure, 10 to 15 minutes three times a week tends to be the minimum. And we're looking at 80° C cuz some people crank it all the way up and it's way too hot. Um and so it's it's pretty moderate. It's like we sit in an environment that's so controlled all the time. We have central heat, we have central air, we get in our cars, we turn the air on or roll the window down. We're not really used to being above 80° cuz we become very uncomfortable. Women find 80° super comfortable, men start to find it a little bit too warm, but that's beside the point. So, we're looking at heat exposure, it's a moderate dose more regularly, and we get really good health benefits from it. We're talking about heat acclimation, we know that five days in a row at um that 80° C mark for up to a half an hour is what your body needs as a man to get cardiovascular, meaning blood volume expansion, sweat rate changes to be able to perform well in the heat. For women, it's nine days because we have to ex- extend it cuz our bodies are really used to that fluctuation. For health, it's not the same thing. So, we look the minimum dose is 10 minutes three times a week. >> Cold plunge. >> Oh, yeah. I caused an international shitstorm with this one. And it wasn't my opinion. I was just reading the research that's been around since the '90s. Where again, we look at sex differences in thermoregulation. So, the ice water, the ice bath that comes along is way too cold for women. It causes more of a sympathetic drive. And once we get over that sympathetic drive, then the responses for parasympathetic still are not as robust as we see for men. So, men can do fine in ice water. But for women to garner parasympathetic changes and metabolic changes, cool water. So, we're looking at 55° F, around 14 to 16° C. It is in the research. Women do well in that where it's cold enough to create a stress where the body will adapt, but it's not icy cold that causes an opposite response. >> Why did that cause a shitstorm? >> Because of the entire >> their >> their ice baths. Yeah, their billion-dollar ice plunge. >> Yeah. Where's Julie? Julie should be happy about the other she's >> Oh, good. No ice for you. >> no, she's she's not into it. Um let's talk a little bit about a little bit more about nutrition. Uh fair to say you're a pro protein person? >> I am. Yeah. >> Uh underscore your perspective here. >> So, when we look at protein, I'm glad it's making the heyday, right? So, we look at it as when you're looking at the initial RDAs, people have to remember that a recommended daily allowance is the bare minimum someone needs to prevent malnutrition. So, when we start looking at protein, the recommend recommendation that is there in general for women in the US guidelines is enough just to exist. But when you start adding activity, you start adding age, we need more. Not only that, higher protein diet is satiation. Because we're in an ultra-processed world where a lot of people are gravitating to really fast foods, meaning not fast food, but fast to grab and eat. And those ultra-processed, they don't really feel satiated. But if we have a higher amount of protein, not only are we able to contribute to more muscle generation and and bone building and all the things that we think about with protein, we also get better appetite control. So we start looking at the guidelines for protein, we know from the research that 1.6 to 2.2 g per kilo, which is about that 0.8 to 1 g per pound is optimal. As we get older, we become more anabolically resistant. So that means our body doesn't use protein as well, doesn't respond to strength training as well. So we really do have to make sure that we stay on an upper end of an intake. There've been some research recently that shows that it doesn't matter what time of day you take it or how much you have at any meal, as long as you get what you need in the day. There's a caveat for that. Because as you get older and you're more resistant to protein intake, try to get it as close to the end of exercise as you can, because that's going to really enhance those post-exercise mechanisms for muscle repair, tendon repair, all of the things that we think about with protein intake. >> And that's more particularly acute for women versus men. >> We see, yeah, because the metabolism aspect for women post-exercise comes back down to baseline a way faster than men. We see that for women, we're back down to a euglycemic or a a blood glucose control of baseline within about 90 minutes. For men, it's 2 to 18 hours, depending on what they've done. >> So more important to make sure that you're replenishing your protein post-workout, uh in that 30 to 60-minute window, then it that's more important than it is for men. >> Yes, and the other thing is women tend to undereat anyway. So, if we're looking at let's nail food before and after exercise, then we can make sure we're keeping you out of signals for low energy availability. I know Emily Dr. Emily Kraus is here and she does a lot of work in RED-S and low energy. And the eating opportunities that are available, we look at every eating opportunity. Most people are like, "Yeah, post-exercise I should eat. What do I eat? When do I eat it?" It's like, "Okay, well, let's make sure we really maximize that post-exercise eating window to help eliminate low energy availability." >> No fasted training. >> Correct. >> Say you. >> Yes. >> Yeah, this is another controversial flash point for you on at least as far as the internet goes. Yeah. >> Yeah, exactly. >> And that's that's that's sort of flies in the face of somebody who's thinking, "Well, if I'm trying to lose weight." Like if if weight loss is like what's guiding those decisions, like I should just get up and get after it without eating anything and then just, you know, try to manage portion control throughout the day. Of course, your appetite is going to spike in the aftermath of that and you're depriving the body of the nutrients it needs to basically create like a a stasis point, right? And repair itself. >> Exactly. And I mean, when you think about why are you going to do exercise? You're not getting fitter in the exercise session. You're trying to create a stress. And the stronger that stress is, the better your body adapts. So, if you're going to create a stress without food, you're not going to create a really strong stress. You feel like you are, but from the body from a cellular level, it's not as strong of a stress to create the adaptation that you want. You're going to have more catecholamines, so that's your cortisol and your breakdown hormones that are being produced so that it can fuel your workout. But let's just take that negative stress away by putting a little bit of food in before you go training so that you can really maximize the exercise stress and then get the adaptations that you want from the post-exercise recovery. >> Your critics out there say that your position on fasted training or just intermittent fasting in general for women is is not supported by the evidence. So I wanted to give you an opportunity to respond to that. Like what is your What do you say to that? >> Yeah, there's also the rumor that only cite rodent studies and that's not true either. Um so when we're looking at the evidence for fasting and fasted training, most of the stuff that people are coming out with, yeah, you should do fasted training, it doesn't matter, you should do intermittent fasting, is still guided by male data. You go into the chat GDP, it tells you the same thing. Why? Because there's this echo chamber in the bell curve that's just pulling up the rhetoric that everyone is talking about. When we go into the research and we're looking specifically from things like endocrinology and we're looking at fertility and we're looking at population research where the appetite and appetite control, it all gravitates to women do better in a fed state. We look at the studies that have been done in the sports science world, there aren't a lot, but there are ones that are done, it still points to women do better in a fed state. We have this variation in appetite and appetite control, like I was talking about with chronobiology. We look at the exercise stress points and how people adapt and we see that women, their bodies respond when there's fuel on board. We look at the people that are pushing out, well, she's not based on evidence, it's because they're looking at that bell curve as of just sports science evidence. There's so much more to exercise training, appetite than this really small amount of sports science research. So, I'm always like, here's the evidence. It's not coming from the Journal of Sport and Exercise Science. No, it's coming from endocrinology, or it's coming from this population, but these are randomized controlled trials. This shows the the variation of of exercise versus fed, and here is the evidence. And I give that to them, and they'll still critique. >> So, maybe just walk us through a a day in your life of eating. Like, what does that What does that look like? You're like, oh, you should feed before you work out and after, and all of that. But, like, what are you doing specifically? >> Yeah, so there's the ideal, and then there's reality. And I'm more than happy to share reality, because I'm I'm here, and I don't eat very well when I'm stressed. >> real. This is reality, Stacy. >> is reality. >> a real moment. >> I know we are. So, um regardless where I am, I do get up, and I have something first thing in the morning. That's where the protein coffee thing came in, cuz people were always asking, "What do you have first thing in the morning if you're going to go swimming or training?" I'm like, I'm not hungry. I know most people in the 5:00 and 6:00 a.m. club aren't hungry, but I love coffee, and I want to maximize that. So, I'm also going to put in some protein and some almond milk, so that I'm getting some protein and eating some carbohydrate. And that's how the protein coffee thing became a thing. It doesn't mean that you have to do it. There's no evidence behind it, but it's what I do. Because then I get a boost of protein, some carbohydrate. I'm going into a training session. I can maximize my training, and I have caffeine, and everyone loves that, well, for the most part. Then I come home, and I have real breakfast. And I try to have it with my daughter before she goes to school. I'll have uh a bowl of overnight oats with some chia seeds and some nuts. Um might put in um some protein powder. I'll have another espresso. And then I get on with my day. Lunch is a variation of a Buddha bowl. Afternoon, as we call it in New Zealand, afternoon tea when you come home from school. Um is another variation of nuts and veggies, crackers, hummus, and then we have dinner. And my husband isn't plant-based. My daughter isn't either, but we all start with the base of the same thing. So, it is um more of the Buddha bowl where you're having different grains, you're having different veggies, you're having different greens. Um then I put in some roasted uh sweet potato or other roasted veggies, some tempeh, edamame, some garbanzo beans, and then I'll put tahini on top as my dressing. Cuz I'm not a big fan of salad dressing, but I love tahini and then mix it all in and some avocado, and then there's a bowl of about 40 g of protein and some fat, and it's great. And then later I'll have some dark chocolate cuz I love dark chocolate. >> I mean, that all sounds like very doable and reasonable. >> Yeah. >> You know, and I think when you see uh 1.1 g of protein per pound of body weight, like that's intimidating. That sounds like a lot, but walking through like what you eat in a day, I'm like, yeah, that sounds basically like what I do without really thinking about it. It's not like it takes some kind of ultra focus on the protein aspect of this to meet that requirement. >> No. And also leaning into like fiber and 30 different plants a week. >> Diversity. >> Right? And so, it's like if we can get protein and fiber at every eating opportunity, people get what they need in a day. They get the higher protein intake. They get the diversity. They get the fiber. Let's not make it difficult. I quote the research, and those are all in numbers, but the reality is it's pretty easy if you're thinking I just want regular normal food. >> people like to make it difficult. They want to make it difficult. >> People like to pick fights. They like to make it difficult. >> Um supplements. >> Yeah. >> Let's talk about creatine. This is another topic that's there's a lot of discourse happening right now around this. This supplement that's been around forever kind of began in the bodybuilding world and now has made its way into mainstream discourse. Uh Uh and there's a lot of discussion around amounts. So, first maybe explain what creatine is, what it does, and how one should think about uh using it. >> Yes, so creatine if we're thinking and I'll get a little bit biochemical right now, we're talking about fast energetics. The first 0 to 20 seconds of inner any cellular process um requires creatine because we have ATP and CP. So, that's adenosine triphosphate and creatine phosphate. So, when ATP splits to produce energy, you have this floating thing that then gets taken up by creatine. So, when we're looking at why we need creatine, we need it for every fast energetic in the body. Anything about the brain, the heart, the gut, the bone, everything requires creatine. Um for women, by the nature of being women, we have less lean mass than men for the most part. So, we have less stores um just by the lean mass part of it. We also tend not to eat as much creatine containing foods, which we think about you have to eat five chicken breasts to get your, you know, dose of 5 to 6 g of creatine. If we're looking at supplementing, we know a lot from Darren Candow's work and Abby Smith-Ryan's work that it takes about 3 weeks to saturate the body with 3 to 5 g. So, what does that mean? When you're fully saturating, your body has more availability for those fast energetics. The brain works better, the heart works better. We see that we have better um mucosal lining integrity. So, the very first thing that erodes when you start exercising or get stressed is the mucosal lining of our intestinal cells. And if we don't keep that, then we know that we get some endotoxin release, which people call leaky gut. We see more of an IBS situation for women that are running. So, if we're just boosting the levels of creatine and have more available for all the fast energetics, then the body works a little bit better. Um you can not use it, and that's fine. Your body naturally produces 1 to 3 g a day from the liver, but we want to maximize and optimize, and that's where the research is coming where we're like, "Okay, every fast energetic works really well." We see now from brain research and TBI or concussion research that creatine becomes really important for improving brain metabolism and helping getting over the concussion. Why is that? Cuz it's trying to repair itself, as well as still function. So, improving um the amount of creatine is available, it can do all the fast energetics it needs. We see that for um building bone, we need some creatine, it's part of the fast energetics. So, we're starting to see all this research come out, and there's a systematic review that was published 2 weeks ago that was looking at all the studies not in the fitness world, but actually in the health world of the studies that have come out to synthesize who should optimize their health by using creatine. There are 153 studies in the systematic review. Of it, the conclusion was women 18 to 60 should be using 3 to 5 g of creatine supplementation to optimize and improve overall health. And so, that's where the research is leaning into. Yes, you have outliers like, if you're a shift worker or jet lag or if you have overnight combat missions, then there's a time and a place to use higher doses. I think the circulation is 0.38 g per kilogram, which ends up being about 20 g for a 130-lb person. So, there's variations within it, but for the baseline to improve fast energetics and overall mood, heart, brain, all those things, it's just 3 to 5 g. >> Uh yeah, the the the conversation now is sort of creatine maxing, you know, like oh if you didn't sleep well or you're jet lagged take 20 g and it will compensate for that. It will give you some degree of mental acuity to overcome the the lag in your sleep. >> Yes, but it takes more time for the creatine to cross blood-brain barrier. So an acute dose actually isn't effective on that acute time. You need to do it dosing up to knowing when you are going to be traveling. >> so you have to you have to uh you have to predict the future and take it before you have the night of sleep where you're not going to sleep. >> So consistently consistently take low dose so it helps, but yeah. >> Is this something that should be cycled or is it safe to just take if you're taking like 5 g a day, just do that? >> it, yeah. We look at cycling creatine in the higher doses and that's a lean into the bodybuilding muscle performance side of things where was 5 g four times a day with 20 g of carb to really maximize what's in the muscle then cycle it off to lose some of the water weight and then cycle it back on for different training modalities. So we're looking at cycling on the lower doses, it's it's a kind of a moot point because when we look it takes 3 weeks for your body to fully saturate and then if people cycle off it then it comes back down to baseline. So if you're just taking that continuous low dose, your body fully saturates and then stays there. >> The same woman who has the concern about getting too bulky from lifting heavy weights may have this concern around creatine that it's going to lead to bloating and water retention and there's a you know, there's some other things that come with that. You can get you know, like some diarrhea, some stuff like that. So what do you what do you say to that person? >> There are two things that we want to kind of nip in the bud here. First is how much is she starting with? Because a lot of women who start with a 5 g dose and they're smaller in physique, then they might have retention because with creatine you're also storing more water in the muscle, so that's a given. It's transient. It It will go by the wayside within 2 to 3 weeks and most women who are freaking out about bloating and and water retention are they don't want to wait the 3 weeks. So, let's start at a smaller dose. Let's start with 1 to 1 and 1/2 g and work our way up to the 5 g over the course of a month. That way your body is starting to saturate, it's getting used to it, you don't get the bloating and the side effects. The other one that's really critical is the quality of the creatine that you're using. The cheaper versions of creatine use more of an acid wash and so we're looking at the residual acids that are in there, it's not that great, it causes side effects. So, the higher qualities like our good friends Momentous, they use a water wash. And that reduces any kind of the residuals that cause side effects. So, first make sure you have a high quality and two, let's start with a lower dose and work our way up because we're not looking for an acute hit here, we're looking at how are we going to saturate and really improve and optimize over time. >> Any burning creatine questions out there? >> I have a question about creatine in different stages of your life. So, you know, you talked about perimenopause or on a fertility journey, if you're pregnant, like what is like the optimal time and are there times to avoid using it? >> Um so, there's even been pregnancy research that shows that um supplementing with creatine is beneficial. So, we look at creatine is beneficial across the whole lifespan. There are individual cases where it's like if you're iron deficient with endometriosis, it's probably not a good idea because there's an interplay between some of our fair potions and and and things that affect iron absorption and increasing endometrial cell proliferation. So there's some small research that suggests that. So then that becomes more of an individual case-by-case. Let's see what are your symptoms? Are you iron deficient? How severe is endometriosis? So yes, there are causes and cases within each that we have to be aware of but in general you are safe to take creatine across the lifespan. >> Other than creatine, what are the other supplements that you would suggest women be taking and maybe some supplements that they should be avoiding? >> So I will also say vitamin D3 is really important for those of us that live in the extremities of the hemispheres. It's really important in the low light for people who live in places like Seattle where you have winters that are super gray as well. And just in general get your vitamin D levels checked because we know that low vitamin D is associated with more severe PMS and PMDD in women, more severe perimenopausal symptoms. We also see this is oppression immunity. We also see vitamin D is really important for things like bone and bone density. So it is pretty important. It works as a hormone within the body to facilitate a lot of the responses. We also see that women who have low iron and low ferritin also tend to be low in vitamin D. So in general I tell women just taking a vitamin D supplement will help boost. If you are worried about having super high vitamin D levels, get tested first. Then we start looking at what you should not take. We see that there that like nitric oxide is a very widely used one for sport performance. We see oh yeah, it's a vasodilator. We know from the research that it doesn't work in premenopausal women, but it works really well in postmenopausal women. Because estradiol or estrogen is really tightly tied to endothelial cell function. So, that's the lining of our capillaries or our blood vessels. So, when we start introducing nitric oxide, it interferes with the natural response. So, premenopausal women who have adequate estrogen will have a negative response. They don't have as much vasodilation. They might end up having more of an orthostatic like uh stand up with head rushes. So, orthostatic hypo- hypotension, so low blood pressure. But women who are postmenopause who don't have estradiol on board benefit greatly. They have improvement in circulation. They get really good vasodilation. We see women in late perimenopause with severe hot flashes can have some benefit by using nitric oxide cuz it helps with the vasodilation constriction. So, there's like this is the efficacy of knowing that there's been research done in women in in the supplement. A lot of the other supplements haven't been studied in women. So, we're looking at beta-alanine. There has been very few studies done in women. So, a lot of the sport performance supplements haven't been studied, but we know that protein supplementation has been studied. It's beneficial for women. We know that vitamin D has been and omega-3s have been. So, most of our general health ones that are promoted have been studied in women and are beneficial. >> On that topic, uh of all the things that you shared today, uh what uh where is like the the strongest evidentiary basis and where is the evidence like more emergent where we need more research? >> For women? >> Yeah. >> Across the board, I'd say we need more research in everything. >> With that as a baseline. >> Okay. As that is a baseline. >> Yeah. >> Within that world, um you know, you've shared a lot of insights today uh and I'm sure there's a spectrum in terms of like what's what's, you know, where there's enough kind of evidentiary basis and where you would like to see more studies being done. >> Yeah, I think um for the most part, I really want people to understand there's a significant division line between what's clinical and what's health and fitness and there tends to be this blur. So, if we're like dividing the line down and going, "Okay, from optimization health and fitness, everything that I've talked about has evidence behind it." Um what do I want to see more of? I want to see more research in um strength training and how does the methods within the health and fitness world crossover to the clinical instead of everything in clinical crossover into the health and fitness. So, uh for example, I won't say who has given us the grant cuz it hasn't been announced yet, but we now have a grant to look at strength training in prevention and the heavier end of things. So, like that kind of stuff, I want the merger from high performance to come over, especially in women. So, we have some pretty good tight controlled studies in high performance because when we're in that world, we can really garner and leverage. When the clinical world with the randomized controlled trials, we can't really generalize. We can say in this population of pre-diabetics, we know that this works in women like here. But then the biggest thing is we need more diversity in all research. I was on the stage this weekend at a longevity and women's health summit and someone stands up and says, "As a black woman, my symptomatology is is more apparent and I've heard that it's worse for perimenopausal symptoms in black women." And there is Jessica Shepherd and she's like, "Yes, this is true, but no one really knows it." And I'm like, "I'm a white woman and I know that most of the research that's been done has been done on white upper-class women. So, regardless of if it's clinical or if it's health, we need to be able to look at other populations. The idea of a human ovary or naturally cycling woman with really spot-on periods and menstrual cycles, no pun intended, is rare. So, when we start saying we need to do um really tight controlled trials on women with menstrual cycles that are X amount of days and we know that have specific phases, it's a very very very very very small population that can't be generalized out. So, we have to look at those nuances, too. So, what is the big foundation of evidence? We look and say, "Okay, well, let's look at the methods first." And what is that and where does it come from? Can I say what has a lot of robust research? A lot of the stuff that has the the population research and the anecdotal studies as well as some of the randomized control trials. So, we see that in muscle development. We see that in bone development. We see that in sleep and mood. But, every area needs more research and every area needs to be more diverse in the population of the research. >> If funding wasn't an issue, there's no budgetary constraints, what is the dream research project that you would like to see happen? Like, how would you design a study that would answer your most pressing questions? >> Uh I don't I have so many pressing questions. I don't think there's enough money in the world to answer them. Well, no, there's money. >> Just pick one then. >> There's money in the world, but it's the time factor. So, um I I think it changes. Like, right now I'm really interested in heat and how we see an increase in ovarian function after controlled heat exposure. So, I'd like to do a really large study on a whole bunch of different ethnicities and cultural nuances in women who are having fertility issues. Cuz if we see that post-controlled hypothermia, we have an increase in estradiol, luteinizing hormone, and follicle-stimulating hormone, can we get that to a point where we can use that as fertility treatment? So, that's one really massive pressing question I have right now. So, if anyone wants to fund that and has a team that could research it. So, it's like looking at these environmental conditions that the world is now entering into. We have severe heat, we have severe cold. How's that affecting different pockets of populations with the big fertility issue? Like, that's not something that someone like me coming from high performances as an environmental exercise physiologist would really come out with, but I'm really concerned. I'm like, "Okay, well, we know this happens in controlled heat, but we also see this whole change in the global environment and this uptick in infertility. Well, let's see what happens if we're using these little things to our advantage." So, that would probably be a big pressing question because if we're killing off the human race because of things that we're not doing right, well, is that a good thing or not? Maybe that's the bigger plan for whatever is out there, but right now I'm like, I want to be able to make an impact and really investigate this with regards to what's happening from a global impact as well as a population impact. >> I don't know if you all know this, but last year Stacy appeared on some of the biggest podcasts in the world, Diary of a CEO, Mel Robbins, Huberman You did Huberman, so yeah. And not only was she a star guest on these shows. >> Thanks. >> Your episodes on those shows were the most viewed or listened to like for that show for that year, which is kind of an amazing thing, right? So, it it really catapulted you, you know, into like this different kind of sphere of influence in your areas of expertise. But I'm curious like what is the what is the question that you're not being asked or that you wish you were being asked that that just doesn't come up in these sorts of scenarios? >> Yeah. Um one I can't believe that that's happened cuz I'm still like Jiro's mom and I still like to like do research and I like to help people. So when I'm stopped in the bathroom washing my hands, "Oh my god, you're Dr. Stacy." I'm like, "Who's that person?" And so it's just been like this big push. I think one of the conversations that has been had is the optimization versus general. And we had that today. So I thank you for that. It's like what are we doing to optimize health and what are we doing just to improve health? And those are the nuances. >> Performance and longevity and general health are are, you know, sometimes contradictory. >> Right, exactly. It's like what you do to help someone win an Olympic gold is completely different than what you would do for someone who's just trying to optimize their health for a long period of time. But a lot of times that research and those conversations get blurred. So again, thank you for asking about optimization versus general cuz that is is something that hasn't been asked. >> One question I want to ask you is what do you what can you share with men to help them understand the women in their lives to support them? Like this is a mystery box, you know, for someone like myself and you know, it's just like there should be a woman up here into talking to you about this, not a guy, but I want to understand and you know, just as a as a sort of an avatar of all men out there like help me understand how to, you know, be as supportive as possible and that comes with greater understanding, of course, but you know, help us out. >> Yeah, well, first we need men in the conversation. So you should be in that chair interviewing, not a woman. So, I appreciate that, too, and all the men here in the audience. Um cuz the more we understand, the more we can be supportive. It's like if your wife comes to you and is like, "I'm having this horrible time. I have severe anxiety." It's like just listen. Just like I was talking about with his daughter and being a a girl dad. It's like, "Listen. You don't try to fix." Cuz that becomes a problem where women feel like they go to talk to their partner and their partner's listening to fix something, not listening to be empathetic. Um and I also want to I'm not doing this to promote, but I'm doing it to to say that Joe Warner is uh a guy in the UK who used to work for Men's Health. He's a journalist. And we had a podcast episode and he was really like wanting to know more about the perimenopausal journey for his partner. And he interviewed a whole bunch of experts and he just released a book. It's called um Frozen Out and Burning Up. And it's to help men understand what's going on and how to listen to their wives and help them. So, there are more and more resources coming up, too, but I think the bottom line is listening, understanding, and trying to be empathetic, and not trying to fix. >> Awesome. Let's put it out for any questions before we wrap it up. >> This is a little bit of a follow-up to the creatine conversation. Um I have two daughters and they are athletes. So, I think my curiosity and question really is more about what how should we guide female athletes, young female athletes, on this journey in terms of supplementation, nutrition, um understanding. What would be your suggestion there? >> I I would refer to the FASTER Women's Program at Stanford. Um but in general, when we talk about it, we want to change that diet culture. Like we don't want to introduce that. So, we're talking to our young female athletes, it's all about fuel for what you're doing. If you are fueling your body, you're becoming stronger, you're becoming more resilient. And then we also have to think about the mental mental stress of of trying to grow, develop, understand your personality, and become part of this world. So, it's also having the eye to what is the mental status today? Like how am I talking to my daughter? How am I using empowering language instead of negative language? Um when we're looking at a sporting culture as well, unfortunately, the default is to be compared to boys. We see this in coaching and and it's really disheartening for girls to always be compared to that norm. So, if we're trying to change the sporting culture, we're trying to encourage our girls, it's talking about being fueled, it's talking about being fast and powerful and strong. And all of that positive language and not talking about oh, calories. Oh, you need to eat this. It's not about that. It's like, let's put it in that performance space. Let's talk to them like they are athletes, cuz they are. You need to eat enough, you need to fuel for your training, you need to fuel for your brain, you need to fuel for your endocrine system. It's all about fueling, because your body is growing, you're learning, you want to be the best that you can be in your sport, and you want to do all of these things. We need fuel for that. >> Would you suggest supplementation as they start to get more serious about their sport, depending on their sport? >> I would I would hesitate to say yes. It's trying to do real food first, because the problem with it, even though there is some evidence that creatine helps in young girls, and protein supplementation helps, but then it opens the whole Pandora's box. And we want to not we want the training to come through for adaptation. We want the fuel to come through for supporting that adaptation. I always think about when I was back in the day when Interbike was in Las Vegas. I was sharing a cab back to the airport and this guy got in and he didn't look healthy at all and he was talking about how he's going to go to a bike on a bike ride, but he had to use his beta alanine and beet juice first. And I was like, "What are you talking?" And he goes, "Oh, yeah, well, that's how I can go hard on my bike." I was like, "Have you tried training without?" He goes, "Why would I do that?" And I was like, "Okay. Where do I start?" But cuz that is an enhancement. We want your body to understand first before you try to enhance. Hi Stacy. >> And hello Dr. Kraus. Thanks for the shout-outs. Um I I am surprised this question hasn't come up yet, but want to ask about wearables. >> Oh, yeah. >> Oh, yeah. There are a lot There's a lot of data out there and it can be overwhelming for women to interpret whether it's sleep, whether it's recovery. Sometimes um some athletes have unhealthy relationships with data. So, what do you recommend as far as wearables and how we can interpret wearables as as girls and women? >> So, first and foremost when we look at wearables, the algorithms are based on male data. And I like to use the example of heart rate variability. How many people have a wearable and pay attention to heart rate variability? Yeah, okay. So, there are a lot of women who are like, "What's going on? My Garmin's yelling at me. You're in the red. What's going on? What's going on? You're sick. You're sick." But actually, they just ovulated. And these algorithms are not picking up the fact that when we look at physiology for women, there's an inherent change across the menstrual cycle with regards to autonomic nervous system. So, we know after ovulation with progesterone, our respiratory rate comes up. Our resting heart rate comes up. Our heart rate variability goes down. the algorithms read it as you're not recovered. So, when I tell women with the wearables, look at it trends over time so that you can compare your follicular to follicular or in perimenopause, you can see things going all over the show knowing that after you get through perimenopause, you have a new baseline. So, really you're just looking for trends over time. With sleep and sleep architecture, they're not fine enough to actually pick up sleep architecture. The benefit of using a wearable overnight that I find for women is if they don't eat enough, they have a lot of awakenings at night from hypoglycemia. So, you're having a lot of poor sleep and you're like, "Oh, I've got a lot of awakenings." It could be you haven't fueled well enough in the day and you're getting hypoglycemic when you're sleeping. We see this in some of the C the seam the continuous glucose monitor CGMs that that are being used. So, there is usefulness in them, but only for trends over time. >> I really appreciate that you spoke about not fearing perimenopause. I'm definitely still a little scared of it. >> Don't be. >> How can women know that they're entering that phase? Like, what what are the signals that will specifically tell you that you're you've entered that? And if you could boil it down to one thing, like what's the first thing to tackle when when you do enter that phase? >> There isn't any one like bell that goes ding ding ding, you're in perimenopause. It could start as early in your mid-30s. Maybe it doesn't start until you're in your mid-40s with regards to symptomatology. But, we knew do know that you have more and more an ovulatory cycles as you get older. So, we generally say that once you hit 40, then we know you're in perimenopause. It's a rough guide. Some people have really severe limiting symptomatology. Some people breeze through until like the last couple of years before that one point in menopause hits. But it's a it's a significant individual journey and although everybody who's born with a uterus goes through it, we're still not sure why. Why do we have this ovarian wind-down? Why are we having all these changes? And what are the definitive tests that we can do? We don't have those. So it is an individual journey. Um if you're like, I'm starting to be really anxious and I'm not sleeping, that's probably perimenopause. You are finding more soft tissue injuries, that's most likely perimenopause. One of the big tells for runners is they start getting more and more plantar fascia issues because we start having disruption in tendon um tensile strength and we are getting weaker in our calf muscles because we lose strength and power first. So we start getting more and more tendinopathies and soft tissue injuries. So all of those are in line with yes, you're perimenopausal. But don't be afraid cuz there's lots of things you can do. >> I'd like to follow up on these two questions. I'm Rachel. Um so I'm a researcher and I do a lot of diagnostic testing in my labs. So you've mentioned many of the tests, the blood tests specifically. And these are becoming more and more available in the commercial space. Everybody's talking about testing 9,642 biomarkers. Um particularly hormones and I'm wondering if you have blood tests that you recommend and if you do, how regularly you think that you should be getting them? Thinking about the difference between what you're calling out as general health and maybe some of the more sophisticated things that you or I might like to do in the lab. >> Yeah, I'm not a fan of hormone testing because it's just giving a snapshot of that time of day. If you're really to optimize getting something like estrogen, you have to know day two. Well, women's cycles are all over the place. so I really don't put stock in getting hormone testing unless you have fertility issues. Um, when we look at blood tests, I find it it really useful to have things like ferritin and to know your baseline cholesterol. We also look at CRP, so some of the basic inflammatory markers we want to keep track of. Uh, one of the the tells for perimenopause actually is a change in your cholesterol and you have an an increase in LDL. So, we see this you haven't had any cholesterol problems all and then all of a sudden your LDL is elevated and your HDL has dropped out. And then you're told, "Oh, you need to eat more fiber." Actually, it's perimenopause. What do we do about that? So, having a baseline of just your basic blood tests for trends over time is very useful cuz if you start having symptoms and you go get a blood test, that's just telling you that one point in time confirming something you already know, but you don't know what your previous normal was. So, that's why I tell women it's like, "Get a DEXA every year. Know what your bone mineral density is. Know what your body composition is. Hold on to that." Get your ferritin tested every 3 to 6 months if you have a history of low ferritin. Keep track of your cholesterol every year. See your CRP. Get your vitamin D tested at the beginning and end of sum um the season, so end of summer and the beginning and end of winter. So, just small things to be able to optimize, but you don't have to go spend $500 a month to get all these biomarkers uh because we just need to take care of the baselines first. I love cold plunging. >> Okay. Is it inherently bad for me if I'm doing it at like I normally it's like 45° F, which is like 7° C, but like is that inherently bad? >> It's not It's not bad for you. It's if you've already acclimatized to it, great. I'm not going to tell you not to do it. But for all the rhetoric of every woman needs to do really cold ice baths, It's intimidating because you don't have to. There are other things like if you're already doing it, great. If you're a cold water ocean swimmer, it's really beneficial so you can keep doing it. But if you're someone who's looking to optimize health and you're trying to see what environmental stressors do, cool water if you want to examine that. But for the most part, I try to push women to the sauna. But other people are like, I can't handle the heat. I was like, okay, well, maybe cool water plunge is good for you. If you're already doing ice and you're already doing cold, your body's adapted. It's fine. But maybe you also want to add sauna to get some better health benefits. >> Oh, I've got the sauna, too. Perfect. >> Yeah. >> I find I have so many women in my life who um have mysterious chronic illnesses or women's health issues and they're exhausted by it. They come into clinical settings where they are not believed or it doesn't feel like the doctors are necessarily asking the right questions. Um what's your advice? I I hear you speak today and I actually have so much hope and excitement for where women's health are going now that we're included in studies. But for today, we are still in that sticky period. What are ways that we can advocate for ourselves in these clinical spaces and advocate for ourselves outside of these clinical spaces? >> Yeah, so um I come from a cuz I don't live in the states, so I navigate a different kind of environment with regards to health care where we can go and advocate and say, I want to I want to get a DEXA and you can either pay out of pocket for like 100 bucks or you can get a referral and wait 3 weeks to get it. Here is completely different. So when we're looking at advocating for ourselves is having conversations. It's empowering each other as women. It's um talking to your physician and saying, these are things I have. I'm not Dr. Google, but I have been talking to the other women that's similar and you just really try to be on the level of the conversation. And there's not a lot of time. It's like maybe 15 minutes of an appointment. So, if you can go in and and have a a more of an empowerment approach. Cuz I'll talk to physicians that like 15 minutes isn't enough because I don't know what the history is. I don't know what they've tried. I don't know if they've Googled it. I don't know. So, the more information that you can provide and you can bring in scientific articles or whatever just to put them on the right track is very helpful. Both they learn and two they realize that you're coming in with something that's genuine. You're not just coming in as a hypochondriac. The other thing is to look at the physicians that are available that are in the know in this space. So, if you're looking for female fertility issues, you go to someone like Natalie Crawford who's in Texas, but you can also see her list of friends and and her network across. If you are an endurance athlete and you're having issues, you can again at Emily's program at Stanford and see what her network is. So, we're all coming together and creating these networks. It's just trying to figure out who's the person to follow and that's where the conversations can really be beneficial. >> Hi, I'm Julie. >> Hi. >> Um in the large world of peptides, >> Oh, yes. >> have any input on that? >> We were just having conversations about this. So, um in the large world of peptides, I really lean into there's no evidence for them and it's the wild wild west right now. Um they're not regulated. I think someone was telling me that they just read a New York Times article that the peptides in general bought from reputable places still had a lot of lead and things in them. So, it's like you don't really know what you're injecting cuz they aren't controlled. They're for research purposes only. Most of the research that's been done on the peptides are still rodent studies. They're very very small like in a five or six men. So, we don't have any of the robust research. I'm hopeful because people are putting such stock in it that there is going to be more research. We know that GLP-1 is a peptide and there's lots of research going on because of all the benefits there and that's kind of the push for all these other peptides. So, the bigger demand there is, the more research is going to go into it. It's just kind of a holding pattern. Let other people be lab rats for themselves while you see what happens and then you can make a decision. >> Thank you. >> You're welcome. >> Hi. Um we talked about strength training as part of this conversation and you've expressed the need for women to really lift heavy. What is heavy? Like how should a woman think about where they should be targeting with that? >> Yeah, so um I often tell women if they're first starting their strength training journey, I don't want them think about lifting heavy. I want them to go in and just just do any kind of strength training. Get the resilience, get the gains and then when we start looking at increasing load, when we talk about lifting heavy on a scale of 1 to 10, the effort needs to be about an eight or if you go pick up a dumbbell or barbell and you can do five or six reps really well with really, really good form and you think maybe you could do one or two more, that's where you stop. Cuz it is very relative. >> Thank you. >> Yeah. >> Stacie, I just wanted to acknowledge you for uh the tremendous public service that uh you are providing people. You're you're a powerful and important voice. Uh we need more women uh like you out there who are advancing women's health and I just want to commend you for the work that you're doing and uh I appreciate you coming here and sharing so openly with all of us. So, thank you. >> Thank you. >> Yes, let's hear it for Dr. Stacy Sims, everybody. Thank you. And thanks for coming. Cool. >> Yeah, thanks for coming. >> Yeah, sure. >> Woo. Woo.