by DND | Mar 21, 2023
Can Women’s Health Get Better With Age? | Stacy Sims PhD
STACY T. SIMS, MSC, PhD, is a forward-thinking international exercise physiologist and nutrition scientist who aims to revolutionize exercise nutrition and performance for women. She has directed research programs at Stanford, AUT University, and the University of Waikato, focusing on female athlete health and performance and pushing the dogma to improve research on all women. During her tenure at Stanford, she had the opportunity to translate earlier research into consumer products and a science-based layperson's book (ROAR) written to explain sex differences in training and nutrition across the lifespan. Both the consumer products and the book challenged the existing dogma for women in exercise, nutrition, and health. This paradigm shift is the focus of her famous "Women Are Not Small Men” TEDx talk.
In this episode we discuss:
• Training methods for everyday women, not athletes.
• Should women be taking exogenous hormones?
• How to maintain fitness during menopause.
• Can your health get better with age?
Dr. Sims, Dr Lyon
Dr Lyon 00:01
Welcome to the Dr. Gabrielle Lyon show where I believe a healthy world is based on transparent conversations. In this episode of The Dr. Gabrielle Lyon show, I sit down with Dr. Stacy Sims, she’s a forward thinking international exercise physiologist and nutrition scientists who aims to revolutionize exercise nutrition and performance for women. We talk about some of my most commonly asked questions, which include fitness and menopause, how to avoid weight gain in and around menopause, as well as training specific for women in terms of sustainability, not just for athletes, but for the every day person. I hope you love this episode. Stacy has some very interesting perspectives. Dr. Sims has directed research programs at Stanford, AUT University and focuses on female athlete health and performance, pushing the dogma to improve research on all women. If you’d like this episode of The Dr. Gabrielle Lyon show, it would mean so much to us. If you take a moment to rate subscribe and share it with someone who needs to hear it. Thanks again. Stacy Sims, welcome to the show. Thank you so much for taking the time to be on and have a conversation about literally one of the hottest topics, and that is menopause and beyond as it relates to physical fitness and training.
Dr. Sims 01:36
Thanks for having me. I’m excited to chat
Dr Lyon 01:39
Yeah and you actually coined there’s a phrase that women are not small men.
Dr. Sims 01:44
Yep. Yeah, I’ll take credit for that one.
Dr Lyon 01:48
You and You are a PhD researcher, you’ve been in a field for easily over a decade. Isn’t that true?
Dr. Sims 01:54
Yeah, much longer than that. Let’s not do the math. Thanks for the kindness.
Dr Lyon 01:59
Well, your lighting looks really good. And we’re good to go. But I think that it’s amazing to have a female researcher talking about female hormones, menopause, and training and ultimately, body composition. I would love for you to share a little bit about your history and your story to how you got where you are right now.
Dr. Sims 02:19
I grew up as the kid that always always asked why. And when I got to undergrad and translated myself into exercise physiology, and started asking those questions about women. There weren’t any answers. And I was like, what, what do you mean, I’m not the same as these guys who are running on the treadmill next to me. So I kind of put a bee in my bonnet when all across my university studies master’s degree was always Why do you want to study women, we don’t know enough about men. And I was like, because men don’t have periods. And I know that we’re different. So as I started getting more and more involved in high end athletics, racing professionally, as well as doing research, I just realized that there’s so much out there that wasn’t answered. And so then that became the like, bee in my bonnet of I want to make all the efforts that I’m doing, my teammates are doing and the other women I’m racing with, as viable as the efforts of men are doing. So we need to look at, at how we’re recovering how we’re training, how we’re approaching things. And all the way through I’ve been pushing and pushing and pushing. And it wasn’t until the past about four or five years that it really started to explode. And people started really talking about menstrual cycles and menopause and all these things that I’ve been trying to get out in the foray for a couple of decades.
Dr Lyon 03:40
Isn’t it funny how that works? it almost has to reach a critical mass. Until there’s some kind of explosion of interest.
Dr. Sims 03:48
Dr Lyon 03:49
Where did you do your Where did you do your training? And what did you do your training in?
Dr. Sims 03:54
so the long, I guess the biggest thing is I ended up coming back down to New Zealand to do my PhD. I’m originally from the US, of course, army brat did my undergrad at Purdue, my master’s degree, Springfield College outside of Boston, worked for a while and then came down did my PhD in sex differences in heat of climatization because I was racing Ironman, I was going to Kona wonders know, like, what we should be doing, why some of the things that the women were doing were different from the men. So I really got involved in that. And then after that, got recruited to go to Stanford, and to work and ended up doing my postdoc there. And then rolled into a position that I was then resigned from a month before I gave birth to my daughter, because there was also the time we launched a company.
Dr Lyon 04:43
Wow, wow. And what did you do postdoc in
Dr. Sims 04:47
women’s health? So the Women’s Health Initiative that everyone talks about with regards to menopause hormone therapy Martius Defanic was my mentor. So I had one hand in the Women’s Health Initiative data and doing clinical stuff there as a subsequent follow up. And I also had one hand in human performance. And looking at thermal regulation because I studied initially as a thermal regulation physiologist, looking at sex differences, and wanted to know what we could do about vasomotor symptoms, what kind of complementary alternative medicines might be out there with regards to like black cohosh adaptogens? Also, could we predict some of the bio rhythms that were prior to a hot flash, so then we could attenuate them. So it was in my wheelhouse to really be looking at women’s health in that. So when people started talking about menopause, I thought everyone knew what I knew. But coming to find out that no one did.
Dr Lyon 05:43
That’s interesting. And that was actually well, before. You know, oftentimes, we go into areas of interest because we’re experiencing that ourselves. But this was well, before you were I mean, you were just about to have a baby. Yeah, exactly. Interesting. But
Dr. Sims 06:00
yeah, it was all about physical activity, right. And it’s looking at we know that physical activity in nutrition are to the Paramount interventions for almost everything that ails us. So if we’re looking at the demise of women in menopause, especially late menopause, where they don’t have muscle mass, they’re not eating well, they keep getting sick. It’s like, okay, well, let’s start early. Let’s look at the time period right before and see what we can do to then extend the quality of life. And at the same time, I was really interested in that physical activity scope. I was also interested in helping women who were still competing, who were leading up to that perimenopause, post menopause age, because it’s like, my coaches and their mentors, were all like, Okay, now what’s going on? Am I aging out? Or how do I help other people? So it was just a collection of things that all came down to physical activity? And how do we implement different aspects of physical activity to help women across the lifespan?
Dr Lyon 06:59
And the burning question is, can an individual get better with age, both athletically and even body composition wise? Can they get better with age?
Dr. Sims 07:08
Yes. So when we look at like the existing guidelines have 150 minutes of moderate activity per week, right? This is exactly the opposite of what women who are in perimenopause should do. Because if we’re looking at what’s changing, and we’re looking at the ratios of estrogen, progesterone, it’s not the absolute levels, but some ratio of change. Then we see a demise in the sensitivity of our estrogen progesterone receptors, we see a change in our gut microbiome. And all this feeds for to body composition, change to brain fog, to vasomotor symptoms, and then acceleration of bone mineral density loss and lean mass loss. So if we’re looking at let’s put an interventions that will actually stress the body and create adaptations the way these hormones used to help us. So this is where we look at the polarized training effect. So we want to do super high intensity work for metabolic control. And creating some longer term epigenetic changes within the muscle so that we aren’t necessarily reliant so much on insulin, especially as we start to become more insulin resistant. And then we have to look at the central nervous system effects and how that affects strength and power. So if we’re looking at resistance training, and we’re looking at lifting heavy loads, it’s all about the central nervous system effect, because estrogen not only stimulates the basal cell, the satellite cell of the muscle itself for muscle protein synthesis, but it’s also responsible for how strong the muscle contraction is. So when we start to have changes in that estrogen concentration and changes in estrogen, progesterone, the first thing that goes a strength and power, and then we start losing lean mass. So we look at lifting heavy loads, it’s a central nervous system response that now the body’s like, I don’t care, we don’t have estrogen, I have to lift this load. So I have to have a faster nerve signaling, I have to have more acetylcholine to depolarize that muscle and have a very strong muscle contraction. So that’s the adaptive stress. So we don’t have to worry so much about not having estrogen to create that power. And that strength, we have to look at that central nervous system response. So if we go back to that 150 minutes of moderate intensity activity with a couple of days of resistance training, they’re not giving the hosts whole that story from what happens with women. Because we’re in that moderate intensity exercise. It’s not a hard enough stress to create adaptive responses, but it is hard enough to raise cortisol. And when women are in perimenopause, we’re already in that sympathetic drive. And we already have an elevation of baseline cortisol. So if we do things to instigate more, then we’re not going to get any kind of body composition change. And for looking at the resistance training, they just say, you know, 10 to 12 exercises, but they don’t talk about load rep sets any of that. So it gets lost in that conversation.
Dr Lyon 09:53
Yeah, I think that that’s really important to point out because if you look in the literature, again, most of the studies are done in male And there was a recent paper that Brad Schoenfeld and Alan Aragon has had published and it was really talking about the strength continuum. So I’m a geriatrician by training. And one of the things that we would always talk about is, is it the load? Or could someone get away with a lower load higher volume? Right. And I think that there’s a lot of discussion in this space is that it’s really about the amount of muscular fatigue. Yeah, and I’d love to hear what kind of what your thoughts are. But what I’m hearing you say is that women, you know, and cognitively, I absolutely agree the women should be lifting heavier weights to get a stimulus. But do you find that that is always true?
Dr. Sims 10:42
Well, when we look at the fatigue rate, right, and we’re looking at the whole aspect of muscle fatigue, that’s all about muscle protein synthesis. So if we’re looking at lean mass gain, then yes, you want to go to fatigue. But if we’re looking at the strength and power aspect, that is so essential for carrying our bodies within, you know, space and time and having proprioception and being able to prevent falls, we need that heavy load adaptive stimulus, we need that central nervous system response. So when I’m talking about lifting heavy loads, I don’t want anyone who’s never lifted to go into the gym be like, oh, gosh, I got to lift 150 pound deadlift. No, it’s all relative, right. So if bodyweight is taxing enough, and you get fatigue within that, then that’s how you start. But I always want women to start with mobilization, learning how to move properly, so that then they can put load on and not get injured. So it’s not about a training block, which is so much of the conversation within the sport side. So here’s this training block, then when we recover another training block, it’s the I to the rest of your life. So we want to look at undulating periodization, of course, where we lift loads, and we bring some down, we lift loads, but it’s for the rest of your life. It’s not about I’m going to build up for a particular race or build up for a particular physique competition. It’s about how am I going to maintain strength and power from the time I’m 50, all the way to the time, I’m 100. And there’s been some really interesting studies that have come out in the past six months looking at women who were in the 70 to 80 year bracket. And they’ve changed up the traditional 10 to 12 reps of lighter weight and put in the five to seven reps of heavier load heavy for them. And they increase their power, their lean mass, their strength, and had better proprioception for falls prevention. So I think the inherent thing is women just don’t know what it means to push themselves for lifting heavy. Of course, those of us who are in in this world, in this fitness world, we know what it is and how to push ourselves. But for the general population, they think that 20 air squats is resistance training. And that’s not what it’s about.
Dr Lyon 12:49
I love that. And I would love for you to give kind of an example of what someone who is just new at the gym, right? And I know it’s very difficult because ultimately, what you’re looking at is, like you said, an adaptation. What does that look like for that for a very novice individual who is just entering menopause.
Dr. Sims 13:09
Yeah, so the first thing I always tell people is like, you want to work with a physio or physical therapist, or a kinesiologist, who knows movement. So they can give you cues of how you’re squatting. So you don’t have a discrepancy in hips, you’re actually getting full range of motion. So anyone who’s novice going to the gym needs to have someone watch them so they know how to move. And I know it’s intimidating. And it doesn’t even have to be like in a big massive gym set. Because that’s a whole nother cultural aspect where we look at, you know, the masculinity of gyms, that can be a different conversation, could be a small personal trainer could be a physio, so you learn how to move. And then when you go to the gym, it’s not about putting lots of load on the barbell, it could be that 30 pound barbell, where you’re just moving, and you’re feeling the muscle fatigue, and it can be five sets of five. And by the time you get to that fifth set, you might only be able to eke out three with good movement. So we’re looking at proper mechanics through that load. And it doesn’t have to be massive load. When you have proper mechanics, you’re gonna get that fatigue. And as you start to get better in the movement, that’s when you start adding load. So it could be two or three months down the track, then you start lifting heavy, first three months is all about phasing in for that proper movement.
Dr Lyon 14:25
And is that a more of a central nervous system kind of connection? At first?
Dr. Sims 14:30
Dr Lyon 14:32
So once that adaptation happens, and an individual is weightlifting, three days a week, you think so the 150 minutes, we know I mean, that’s just so grossly understated, right? I mean, it’s so funny, right? Everybody asked you and you want to be evidence based. So if they asked you Okay, well, what are the current training recommendations? Well, the current training training recommendations are 150 minutes of moderate to vigorous activity. A week that’s, it’s abysmal, right? And it’s just
Dr. Sims 14:58
Yeah, but that’s based on science that’s about 20 years old, because coaching and guidelines takes so long. But if we look at the current evidence of Sprint interval training, resistance training, this is probably what you should be doing.
Dr Lyon 15:12
Right? Let’s talk about that the sprint interval training because sprint interval training is very different than high intensity interval training sprint interval training is by definition, what is that is almost 90% Your V02 max what?
Dr. Sims 15:23
it’s super and maximal. So it’s higher than that. So we tried to go like 95 to 110%. and this is why it’s 30 seconds or less. And a lot of people will be like, Oh, I do sprint interval training. And it’s like, not really, because you can hold that for a minute. And then you do that eight or nine times. That’s not sprint interval training.
Dr Lyon 15:42
So that’s how that would be like considered high intensity interval training. Right?
Dr. Sims 15:45
Right, right, because sprint interval training is part of high intensity interval training, but it’s a subset. So if you’re doing proper high intensity interval training, then it might be a 30 minute, 40 minute workout with a warmup and cooldown. So the intervals and high intensity interval training are a minute to two minutes long. And then you have variable recovery. But when we talk about the subset of Sprint interval training, this is where you are going as hard as you possibly can, like you’re pushing the ringer for 30 seconds or less. And then you have a long period of recovery so that your central nervous system fully recovers so that the next sprint, you’re going as hard as you can. And when you first start doing this, you might only be able to do 3 30 second bouts, with maybe two or three minutes in between. And the most you should be doing is up to eight or nine. So the whole workout in itself is maybe 15 minutes. And that invokes so many metabolic and central nervous system adaptations, that when we look at things that are all supporting, perimenopause, and menopause with regards to like menopause, hormone therapy, resistance training, all of those things are kind of secondary to that sprint interval stuff. So if I could get every woman doing a couple of sessions of sprint work in a week, I would be so happy.
Dr Lyon 17:08
That’s very profound. I’m just going to repeat that statement for the listener. Basically, what you’re saying is that if you could get individuals to do sprint interval training, that is by far Paramount over hormone therapy, any other modality or any other therapy as it relates to impacting the physiology?
Dr. Sims 17:26
Yes. So we look at all the public burden diseases that come with menopause, right? So we have metabolic syndrome, cardiovascular risks, and we look at bone, mineral density, all of these things that come out of it that then if we look at the actual stress that sprint interval training does, puts a load on the muscle, it puts a load on the bone. So it helps attenuate that, we look at how intense it is for metabolic control. So it improves blood glucose and muscle uptake of glucose. And then we look at the changes in cardiovascular. I guess the best way is your adaptations for blood pressure control and the ability for your blood vessels to dilate and constrict with that high intensity work. You have to push a lot of blood around really quickly. So it creates that adaptive response within the blood vessels as well. When we’re talking about body comp, that’s different.
Dr Lyon 18:23
Let’s talk about body comp.
Dr. Sims 18:24
Yeah. Body calm. Yes, like you say, and we all love is protein. Super important. Right? So there was a study that was published just a few weeks ago on protein intake on sedentary, obese normal weight women, so women who are skinny fat, and just manipulating protein intake up to that 1.6 or approximately one gram per pound, versus the standard, which was about point six grams per pound. Over the course of 12 weeks with no resistance training, no exercise intervention, the people with a higher protein intake completely recomp to their body, improved lean mass, decrease fat. We also know that with resistance training, just a little bit of resistance training with high protein you can completely recomp your body faster with strength. So when we look at perimenopause and the that five years before that one point menopause, we’re all these body comp changes happen. We need resistance training in high protein, not only for that recomp but also women become very anabolicly resistant, we need more protein, that absolute dose has to be around 40 grams post exercise and we also look at regular doses across the day every three to four hours, especially at mealtimes just to keep that amino acids signaling up to keep that protein synthesis and the recomp going.
Dr Lyon 19:53
I couldn’t agree with you more. So that’s really really profound when it you know when we think About body composition. Obviously, there’s the input as it relates to exercise, which is so profound and you talk about that all the time. And then on the flip side of that, it’s almost as if you can’t really make drastic improvements. If you don’t have that protein piece together, it just seems very difficult. Why do you think around. So just to take a step back defining perimenopause, that’s really the time around before menopause. And then all of a sudden, after one year of not having a period you’ve now magically entered, you’ve magically entered into the land of menopause, right? Which is so funny, because it’s not just all of a sudden urine now a new category, right? As as it relates to training. Why do you think that it’s, you know, around menopause women, I mean, that’s the number one complaint is that all of a sudden, they have visceral adiposity. And they’ve done what they’ve always done, they’ve trained and now they’ve gained weight?
Dr. Sims 21:01
Yep. Because if we look at coaching protocols and training protocols, again, primarily based on male data, and men age in a more linear fashion, but for women, we have this discernible change point in around our mid 40s. Because we know that the ovaries age a lot faster than the rest of our bodies. Not sure why yet, but we see this so we have more and more and ovulate Tory cycles, we have more estrogen and no progesterone. So like I said, when we have these changes in our ratios, we also have a whole change within every system of body with regards to how estrogen progesterone affect them, because we have less sensitivity to it, because we have less of it. And estrogen progesterone are essential for more than just reproduction. It affects every system in the body. So when we start seeing the significant change around the three years before that one point in time and menopause, then we see again, that loss of lean mass and increase of visceral adiposity. And it is the body going Hey, what is going on? Like I don’t have signaling to keep lean mass, but am I going into a starvation aspect? Am I going into, you know, a hibernation aspect, I don’t know. So it starts putting on more and more body fat. So when women keep training and eating the way they have up to this point, it’s not going to work because again, like I said, it’s not a strong enough stress to create adaptations in this changeover in the body. So this is why we really have to look I’ve so many women who are endurance athletes, power lifters, right? And they’re like, I’m so tired. And I don’t have any strength. I don’t have any power. I’m putting on body fat. What am I doing? Like? Well, we have to look at that stress. And we also have to look at nutrition, because we can’t get away with some of the things that we’ve been doing up to this point, we have to really look at gut diversity, because this is where we have so much of our hormones that are metabolized and spit back out into circulation. And we have to look at how are we going to stop that lowering diversity occurs in perimenopause. So we look at changing up the diet. And we also look at what kind of stress which brings us back to the sprint interval training, the polarized training and the resistance training. Because all of those things in conjunction will create an adaptive stress that will attenuate these body composition changes, help slow or stop menopausal symptoms. And it also puts the body in a better position when it gets into post menopause. So that you can keep progressing you can get stronger, you can get faster, of course, not as fast and lean as you were when you’re in your 20s. But in relative to where you would be if you didn’t make these changes.
Dr Lyon 23:42
And so basically what you’re saying it’s not inevitable that you’re going to gain a bunch of weight and have really low performance just because you’ve gotten into menopause.
Dr. Sims 23:51
Dr Lyon 23:53
And that gives people a lot of hope. Because you can do something about it. Yeah, I
Dr. Sims 23:57
Yeah, I know. And that’s a big thing, right? From a cultural standpoint, menopause has always been this like scary thing where no one talks about it. You see images, especially in the media and in television, where you’ll have this couple getting older and the man might be debonair and suave and all dressed up and fit and lean. And then his wife who’s equivalent age has like dowagers hump and dressed off from being and has like the menopausal adiposity. And it’s like these images are not appropriate. We need to change the narrative we need to change the way we view menopause because there are two absolutes in a woman’s life puberty and menopause. Neither one are discussed. So we need to push it out there right and the more we are empowered and the more we understand what’s happening in that whole menopause transition aspect, the more women don’t have to be afraid because they have the information to take charge and not get into this downward spiral that happens so often and then at the other end, people are like, what happened? Why didn’t I know these things in advance?
Dr Lyon 24:55
What would you say some of the biggest mistakes people make when they’re entering menopause to try to offset weight gain?
Dr. Sims 25:01
They don’t eat. Because the automatic response for most women, because especially this age group, we all kind of grew up with Jane Fonda and the supermodels of the 90s right? and the whole information of calories in calories out fat burning. And if you want to lose weight you need to not eat. So the automatic response is people stop eating and try to train more, which then puts them into a low energy state. And if you are in a low energy state, then that down regulates thyroid, it increases muscle catabolism it increases bone catabolism and puts more body fat on. So the very first thing that I try to get people to understand is we want to fuel in and around training. We don’t want to do fasted exercise, we don’t want to not recover post exercise because the best way to really manipulate that training adaptation and manipulate body comp is when we’re fueling for the stress at hand. And then if we want to have a little bit of a calorie restriction, because we have extra body weight to lose, then it’s at night away from training. And we look at maybe a 10 at the most 20% total calorie reduction. And all these things feed forward into having more energy, having more cognitive awareness having more success in the training that you’re doing, because you’re giving your body the fuel to hit those high intensities, and to hit those heavy loads and then recover from it. So when we start getting people into a better pattern of training and fueling, then it feeds forward rather quickly. And people start saying, Oh, I get it now I’ve getting these adaptations.
Dr Lyon 26:37
So that’s interesting. The you know, there’s a lot of discussion around fasting and and fasted cardio fasted training, and and I’m sure you’ve heard it right, so that they would say that, or the evidence would suggest that fasted training didn’t change body fat loss, right? It didn’t necessarily matter as long as that there was this total 24 hour calorie intake versus outtake. But what you’re talking about is something very specific. You’re talking about women with hormonal changes. So you’re talking about a very specific subset where I think that that nuance perhaps is often missed, right? So what you’re saying
Dr. Sims 27:13
But even in reproductive years, women shouldn’t be training fasted. The data for fasted training comes from male data set who are looking to increase their ability to burn fatty acids, during exercise, have, quote, more metabolic flexibility. But women are already there by being born women, right, we already have more of the protein within the mitochondria for using free fatty acids. We also have estrogen progesterone, that shuttle carbohydrate away into the endometrial lining during the high hormone phase. So we’re already there at that fat adaptation. But we know from research that women who do fed training, so it’s not a full meal, it might be 100 150 calories, we look at 15 to 20 grams of protein before resistance training, maybe 1520 grams of protein with 30 grams of carbohydrate before cardiovascular, it drops cortisol and allows the body to have adequate access to blood glucose, which then allows women to train harder and then recover. When we look at the data set for fed women versus fasted women fasted women end up with more hormone dysfunction. Because if we’re doing fasted training, then we start to perturb the kisspeptin neurons in the hypothalamus. So women have two areas of kisspeptin neurons in the hypothalamus because one area is responsible for appetite and nutrient density, and the other is responsible for endocrine function. So if we don’t have enough calories coming in under stress and load, then it down regulates those kisspeptin neurons, which then feeds for to downregulating thyroid, which again, is the beginning of low energy availability. But for the male data set, we see that fasted training makes them have better metabolic control doesn’t necessarily lead to better performance, but then they’re able to have more free fatty acid available for metabolic use during exercise. So that’s the big conversation right there about fasted training, intermittent fasting versus time restricted eating and where that fasted window occurs. And there were two studies that came out looking at postmenopausal women and telling them Oh, you need to do fasted and or ketogenic diet, but it was a very small subset of obese postmenopausal sedentary women. That thing gets fed out to the general population, and it just doesn’t work for women who are already active.
Dr Lyon 29:37
Right? And if it not only does it not work for someone women, but it can also be counterproductive.
Dr. Sims 29:43
Dr Lyon 29:44
And also, now you’re raising cortisol levels, and they’re going into some kind of energy conservation that can happen and you know, I’ve fasted for a very long time and I am beginning to change my perspective on this, especially as it relates To someone of the circadian biology, which it sounds like, although you did temperature regulation, you know, it almost alluded to a bit of circadian biology in there So that so that would be kind of in in conjunction. So what are some of the things that Peri menopausal women should do women that are still menstruating? There’s a lot of discussion, training and eating based on your cycles. I’m curious as to what your thoughts are. Because when did you write roar? That was two years ago? Maybe?
Dr. Sims 30:28
No, it came out 2016. And we’ll have a second edition out early, early 2023, updating a lot of the science that has evolved since then.
Dr Lyon 30:42
Great. Well, I would love for you to update us here. And then of course, don’t forget to send me the book. Because I obviously want to read.
Dr. Sims 30:49
you’re on the list, don’t worry. So if we look at all the things, not all the things, but a lot of the things that have changed is looking at oral contraceptive pill, menopause hormone therapy, menstrual cycle regulation, how the immune system changes how the body is stress resilient around it. And so we know that in the low hormone phase leading up to ovulation, the body’s super resilient to stress. The immune system is highly resilient to bacteria and virus. But after ovulation, we have more of a pro inflammatory response because the body doesn’t want to attack a fertilized egg. So we look at stress resilience across the menstrual cycle, we know that you’re really adept to putting your body under a lot of load and stress up to ovulation. Then after ovulation, we have to look at lowering the intensity. And then the few days before your period starts. This is where we want to have a D load or we’re looking at technique, cognition reaction. Of course, it’s very individual right, so women need to track their own cycle. So this is what we talk a lot about now in the new edition of tracking your cycle, what it means what your heart rate variability means, especially as it changes across the menstrual cycle. And then how that differs between the IUD the oral contraceptive pill and Peri menopause and post menopause. So we allocate a lot of the biohacking to that and really understanding it so you can really dig into your own responses to hormone variability. We also have updated a lot on the gut microbiome, explaining how sex hormones are metabolized versus how, or I should say your natural sex hormones are metabolized versus synthetic hormones and how that can affect body composition, oxidation, inflammatory responses. And then we also put in a big thing about training and what is sprint interval training versus high intensity? How do we dose it? When do we dose it? And as we’re looking at these perturbations across our lifespan, and perimenopause, how do you track when you’re getting really close to that one point in time menopause, when you’re still naturally cycling, we start looking at the bleed pattern, right? So women cycles, they’ll start to lengthen. And that’s more the follicular phase, because the body’s trying to be resilient, to build up to have a very mature egg. But as we get into more and more ovarian failure, we don’t have that this is why the cycle length extends. But if you don’t have an extension or shortening of your cycle, then how do you know so we look specifically the bleed pattern. So you’re you have a normal bleed pattern. But when it starts to change, either getting heavier or shorter, and paying attention that you know, you’re having more and more changes in your estrogen and progesterone ratios. So this becomes the telling sign as well as other symptomology with regards to fatigue, brain fog, not recovering, having changes in body comp. So it’s a layering effect of how to really determine where you are and that perimenopause into menopause transition. So when you start having the symptomology of perimenopause, this is where we have the eye of dropping volume increasing intensity, regardless of if you’re more endurance oriented. If you’re more strength oriented, or if you’re just general fitness, who’s like, Okay, I train three times a week, what should I do? So we talk really in depthly about if you’re training three times a week, what do we do to sprint interval sessions, three heavy lifting sessions, and you can actually do a heavy lifting session and finish with some sprint intervals for time efficiency. If you’re endurance oriented, we’re dropping the volume putting more quality stuff in on the week, and then we’re race specific with regards to volume. If we’re strength oriented, we look at changing and having different sets and reps across the way. And we also want to put in some sprint interval training for metabolic control. So we talk really in depthly, about all of those things in the new edition. So, basically, that one of the things that I keep hearing you say sprint interval training, and that is not talked about in a lot of the training modalities, right? It really is about strength hypertrophy, or power and then maybe cardiovascular and then quote High intensity interval training. You know, you’re talking about sprint interval training, you’ve listed all the benefits, right? It’s going to improve insulin sensitivity, it’s going to help with whole body homeostasis. Where does that mental piece come in? Because it if anyone has done sprint interval training, it is like you have to embrace the suck. Yes, you do, you do.
Dr Lyon 35:22
And you know, for a novice trainer or someone who or when I say trainer, I mean, a novice individual or even someone who’s a moderate exerciser, to put them in some kind of Sprint interval situation, how do you suggest that they start? Those are very difficult to do alone.
Dr. Sims 35:38
They are, they are very difficult. So, again, this is where we’re looking at our own bodies, right? So you know, there are times where you’re like, Yes, I can do this, I can do something that’s really hard. And other times, you’re like, I’m just like fighting the day. So the ideal situation, of course, is having a couple of Sprint interval sessions in a week. But if you end up doing one a week, or one every 10 days, that’s still going to give you benefit, rather than not doing them at all. So it is that mental fortitude of okay, how am I going to do this, we find that the motivation is much better if you’re in a group situation, or if you’re actually at the gym, and you’re in the cardiovascular room, and there people around you, there’s this inherent like, I don’t want to fail that so many people have when they’re in that group situation. So even if you’re doing like sprints on the treadmill, and there are people around you, that is a motivation, rather than trying to do them outside on your own. So it is finding where you’re gonna get that external kind of cueing and motivation, even if it’s subconscious to go hard. And I mean, there are other people were like, I just can’t face the treadmill, I can’t face being inside, but I get the motivation from the wind at my back and the beach. So I’m gonna go hard there. And it’s a very short period of time. So if you are like, I just can’t do this, but you end up doing two in one day, that’s better than none in one day. So again, we have the ideal, and then we have reality. And we have to have the idea that within reality, we look at the 8020 rule 80% of the time you’re doing what you need to do and what is with theory 20% Is life where we have the stress of life, we have the mental downfall. And it’s okay, it’s absolutely okay not to have to go hard and put your body through the wringer all the time. And I don’t think we give women permission, just to just to be, that’s the other thing. We put so much pressure on ourselves. And we have the external pressure from social media, from family expectations, and our internal pressures ourselves of being competitive. But we also have to learn that it’s okay just to chill. And if you don’t feel like doing that sprint interval, then it’s okay.
Dr Lyon 37:48
I’m gonna I’m going to quote you on that. I’m going to call you when that time comes. And I’m looking at that assault bike sitting in my now living room.
Dr. Sims 37:57
Yeah, you can do 10 seconds, instead of 30 seconds, I could do 10 seconds
Dr Lyon 38:01
100% 100%. I think that it becomes very challenging for women in terms of tracking their periods or in the perimenopause stage, to accommodate their training. If someone is not an elite level athlete, or doesn’t have any significant impact that is noticeable to them, would you still suggest that they go through those heavier lifting days plus the D loading phase prior to their period? Or could they just continue a training program that they’ve set in motion,
Dr. Sims 38:31
we tend to look at it as having two weeks on one week easy. So we have two weeks of focus training, where we’re doing the intensity and the quality during the week with some soul food on the weekend. And then we have one week words absolute recovery, where you’re just doing the things that you love to do. And if you’re an endurance athlete, then that’s during your really slow, long, easy, easy stuff. If you’re someone who just loves going to gym classes, right? Then you go in, you’re like I’m having fun, my body feels this way, I’m going to do this. So it’s that one week of kind of play in recovery. So we keep it on. In you know, the technical terms of undulating periodization, two week block a one week D load two week block, one week D load you can have two weeks of focusing of I’m just going to focus on Sprint stuff, or I’m going to focus on increasing my heavy weights in my squat for two weeks, and then I’m going to D load and then I’m gonna have another focus in the next two weeks, so you can play around with it. But if you’re actually training for something specific, you can still work in this confines. Because as we get into perimenopause, we need more recovery. Our bodies are under a lot of of stress from these changes that are going so we have to counter in more recovery.
Dr Lyon 39:43
And one of the other things that you talk about in next level. Well, there’s there’s a handful of things that I found very interesting. I had never thought about. Estrogen is anabolic, and I’m going to tell you why. Just because in the literature when I think about muscle protein synthesis I often Times just the hormone receptors and the way estrogen impacts muscle up until late seems to be very confusing and somewhat nebulous.
Dr. Sims 40:12
Yeah, so when we look at estrogen with regards to muscle protein synthesis and the satellite, so we know that when it’s not countered by progesterone, it does instigate more of the mTOR pathways. When we look at how it affects strength and power, we know that estrogen is responsible for how strong myosin bonds to actin. So if we have estrogen, we have a really strong bond of amicin to actin, we don’t have estrogen and we don’t have as strong of a of a bond there. So we don’t have as strong of muscle contraction. We also know that acetylcholine that hangs out in the gap junction between the nerve and the muscle. If we have estrogen, we have more acetylcholine in the vesicles. So we have more to depolarize the muscle and create that that strong muscle contraction when we don’t have estrogen, we have less acetylcholine and less of a stimulus for that strong muscle contraction. So we have estrogen available, and we have estrogen not countered by progesterone, then we see this upturn in lean mass development, muscle protein synthesis, as well as strength and power cues. When progesterone comes in, it counters it, especially as it rises because it is the antagonist estrogen. So that’s where the messaging within the muscle anabolic properties of estrogen get confused. Because we have some studies where we’re looking at estrogen isolation. Right before ovulation, we have the estrogen surge and we look at estrogen rising from mid follicular to ovulation. And we do a lot of strength work and power work in there. And we see how it affects it. When we start looking at estrogen and progesterone, we get confusing messaging. Because progesterone is catabolic, it increases more lean mass breakdown catabolism because it needs those amino acids to build that endometrial lining. So when we talk about estrogen by itself being anabolic, and we take advantage of that, then we can make it work for us. But when we talk about the combination of estrogen and progesterone, this is where estrogen doesn’t exert as much of the anabolic property because progesterone comes encounters it and has a big catabolic response on muscle protein.
Dr Lyon 42:21
I see. So it’s not as cut and dry as looking at estrogen in isolation. In a lot of the studies, when you are thinking about the postmenopausal woman, what are your thoughts about estrogen progesterone testosterone replacement? And as of course, it’s interesting hearing this from you because of your work. You’re early on, work it with the Women’s Health Initiative, which obviously is like a legacy paper.
Dr. Sims 42:47
I know it is. But I think some of the misconceptions about the Women’s Health Initiative is the goal of the Women’s Health Initiative was to look at older postmenopausal women starting hormone therapy. And this is where it gets confusing because if we look at the million women’s study out of the UK where they start hormone therapy, perimenopause, early post menopause, we see all these benefits. When we look at the Women’s Health Initiative data in in late post menopause women so they’ve been eight or 10 years post menopause. That’s when we start seeing all of these contraindications. So when we look at the entirety of menopause hormone therapy, notice I don’t say hormone replacement therapy, because we’re not replacing, right. We look at menopause hormone therapy. The other thing that I think is not in the conversation is though synthetic hormones are not metabolized and used exactly the same as our endogenous hormones. Not only that, as we go through perimenopause, like I said earlier, we haven’t changed in our receptor sensitivity and the density of our receptors as well as our ability to metabolize hormones because we have this change in the diversity. So we’re looking at menopause hormone therapy, it is a therapy. It is absolutely fine for women who are perimenopause, early post menopause, who were having so many symptoms that they can’t get through their daily life like this change is really invoking such a significant impact that they just can’t live right. What I have an issue with is when women automatically turn to it because they’re afraid of what their body composition is doing. Because we know that menopause hormone therapy does not help with body composition change. You have to do the work of training and nutrition to get that body composition change. The menopause hormone therapy is very beneficial for slowing the rate of bone loss for helping with vasomotor symptoms for helping with cardiovascular issues. But it is not the be all end all which a lot of the conversation in the UK is having about replacing and stopping female deficiency hormone syndrome, which is what they’re calling Peri and post menopause. So there’s definitely a time and a place for it. But I don’t think it’s the pancetta in that that actual key that so many people think about. Because you go to a physician now and like, Oh, you’re perimenopause, do you want to talk about hormone replacement therapy? It’s like, let’s talk about all the other things that we can do. And then if it doesn’t work, we can go to, to menopause hormone therapy.
Dr Lyon 45:25
And do you find that because you’re concerned about risks in terms of adding in any kind of hormones?
Dr. Sims 45:33
Yes, and no part of it is, if we look at the way Western society works, we see that a girl going through puberty, right, she’ll have irregular cycles, until she’s about 15, 16, 17, depending on when she started. And that’s normal. But when they’re having irregular cycles, and they might have some skin issues, they go to their GP, and the GP is like, hey, you know what, you can use an oral contraceptive pill, let’s put you on the pill, or athlete to our A Minarik, either primary or secondary, let’s give you an oral contraceptive pill to give you a period. But it’s not a true period. So downregulates, your endocrine system and ovarian function, they might come off it if they want to get pregnant, and then they go on it again, right. And then they start menopause hormone therapy. So their entire life is being driven by exogenous hormones, so they never really have true ovarian function or endocrine function. So we never know exactly how well that woman would be with regards to body composition, the psychological aspects of mood and neurotransmitters. And there’s just such a big push from Western society, you have women on exogenous hormones. And yes, there is inherent risk, when we look at oral contraceptive pill use and the oxidative stress aspects and the changes in the ability to produce power in some of the side effects that we’re seeing coming out with some of the derivatives. And then we’re looking at the inherent risk in later, postmenopausal women on exogenous hormones, I have to sit back from a cultural standpoint, a socio cultural standpoint and be like, if we asked men to do this, would it still be okay? And we know that the answer is no, they wouldn’t. So women go through all of these things, trying to just live this linear life without really embracing what some of these hormone perturbations should be. So that’s my inherent bias. But that’s just me. So when we’re looking at other women who have significant issues with hormone perturbations, and yes, there is a time and a place to look to the therapies that are available from an exogenous hormone standpoint, but I don’t agree with the Western society of let’s put them on when they’re 14, and then have them all the way on some kind of exogenous hormone until they’re like 70.
Dr Lyon 47:50
In the postmenopausal timeframe, let’s say a woman is not having any kind of vasomotor symptoms, and she’s actually relatively asymptomatic. But what she is noticing is a significant decrease in sex drive. Do you think there’s any benefit from a physiological perspective, say adding in a low dose testosterone to actually help any of those symptoms for her
Dr. Sims 48:15
if she has low testosterone? Sure, but we can also look at adaptogens, we can look at using maca, we can look at using ashwagandha, we can look at using Reishi. Because all of these help with stress and sex drive. And those those things aren’t discussed either because everyone looks at ashwagandha and maca and stuff as oh, let’s mitigate stress. And let’s help you sleep better. But actually, part of it is creating a hormone balance to bring your sex drive back. And you know, there are alternative therapies instead of reaching for hormones. But those conversations are very small, which is another reason why I’m like, let’s talk about adaptogens. Let’s talk about all these other aspects, right. And low sex drive can also come from a misstep in neurotransmitters not just testosterone. So if we look at using an SSRI or SSNRI, then that also brings sex drive back, which is opposite to women who are in their reproductive years who are using it for anxiety and then they lose their sex drive. Because there’s again a change in our dopamine and serotonin as we go through peri and into post menopause.
Dr Lyon 49:18
And do you use adaptogens? In your when you work with because you do work with athletes and clients now? Yes, or someone from your team? Does?
Dr. Sims 49:26
I work Yeah, across the board from women who are just getting into their fitness journey all the way up to Olympians
Dr Lyon 49:34
and what kind of adaptogens do you typically use? Or do you use a combination?
Dr. Sims 49:38
I use a combination and depends on what they need it for. So in my I’d say most of my reproductive year women, I have them use them to help with some of the estrogen metabolism and a lot of swings that they have and we also look at using magnesium and zinc and Omega three use to help counter some of the prostaglandins. We’re looking at perimenopause, the biggest complaints that we get is that high stress and lack of focus. So then we look at using ashwagandha and Shandra. And then some people might be contraindicated to ashwagandha with regards to their thyroid. So then we look at using holy basil or Rhodiola. And then in post menopause with lack of sleep and body composition, then we look at another couple that we can implement.
Dr Lyon 50:28
And are the mechanism of action, pretty well defined with these herbs? And adaptogens?
Dr. Sims 50:34
Yep. yes, for sure. And I only really use nine that have been studied really well. So if we go to the NIH complementary alternative website, then they have a list of all the adaptogens that have really good peer review studies. Who else has it? The Sloan Kettering clinic also has it from both the medical practitioner what’s happening and the patient, you know what’s happening. So I’m very, very cognizant of what’s out there from a literature standpoint. And this again, comes from my time at Stanford when I was working with one of the top CAM researchers who came over from Columbia. And she was the one who first introduced me to adaptogens. And I started implementing them because I was traveling all over the place. Going to Europe coming back racing, being a wife being a you know, a postdoc researcher. So circadian rhythms stress all over the show. And so it just became part of what I was doing, and I still use them. So there’s a lot of really robust research in some of the ones that I do implement. But when we start looking on the fringes of the new ones, I’m not quite sure because there’s not a lot of research on them.
Dr Lyon 51:44
What about your nutrition? What about your nutrition personally, and also, just in general, from the perimenopause to post menopause? I would say the protein is is really critical for all ages.
Dr. Sims 51:58
Dr Lyon 51:58
Especially, you know, so I think that once we established the dietary protein role, what are your thoughts on carbohydrates, carbohydrates around training versus fat? Is it just a personal preference? And I’m not talking about necessarily endurance individuals, but just say for? Yeah, exactly.
Dr. Sims 52:16
Carbs are good. And women have this like negative connotation around carbohydrate, right? When we start getting into perimenopause, and have more and more insulin resistance, then we have to be a bit more cognizant of when we use carbohydrates and what kind we eat. But for the most part, if we’re looking at having a wide variety of fruit and veg, whole grains, maybe some sourdough bread, that’s fine, right, and we put it in and around our training, we have it during the day. It’s absolutely great. It helps with gut microbiome and helps with energy levels. But there is a subset of women who are like, I eat carbs, but I keep putting weight on and we have to look at the quality, right? We have to look at the quality because there’s so much processed food that takes the place of what real carbs are. And then when people start eating that and gravitating towards that, that’s when we start seeing issues. But the biggest thing is really that wide variety of colorful fruit and veg. It’s so important regardless of age, but really, really important with protein in perimenopause.
Dr Lyon 53:18
And do you have a macro target number, for example, protein, one gram per pound ideal body weight, is there a certain measurement that you use for carbohydrates and fats?
Dr. Sims 53:27
not really because I don’t like people getting into the numbers, we’re just getting ready to publish a position stand for the female athletes. So if we look at the most of this recent literature, we look at protein, having those macro requirements where we’re looking at one, or point three, five 2.38 grams per kilo for each meal. And across the board, you want to really look at getting that 1.7 to two grams per kilogram of body weight. With regards to carbohydrate and fat, don’t worry so much about fat in the carbohydrate can be tailored to what your intensity load is how much training you’re doing, how stressed you are and when you are taking in that carbohydrate. So we know that post exercise, we’re looking at that around one gram per kilogram over a course of an hour for refueling. But other than that there really are no guidelines about carbohydrate intake for general pop, when we start getting under heavy training loads, and that’s where we started looking at three to five grams, all the way up to eight to 12 grams for heavy heavy training loads
Dr Lyon 54:37
and any other supplementation above and beyond the adaptogens.
Dr. Sims 54:41
creatine. Creatine. yes. Creatine monohydrate is one of the most study supplements out there and there’s so much efficacy for women and I’m not talking about like the bodybuilding, heavy loading I’m talking about a half a teaspoon to a teaspoon day so that’s Three to five grams a day. We know that women have 70 to 80% of the creatine stores that men have, but we still have so many fast bioenergetics that require creatine. So when we do that low dose of three to five grams, all of a sudden we see improvement in mood and gut health and muscle performance. And when I’m talking about muscle performance, I’m not talking about training. Of course, there’s a benefit to training. But just in general, lack of dead and fatigue if you don’t get enough sleep, because then your body has available creatine to work with this facet energetics under high stress loads of sleep deprivation. We also see creatine is very effective for pulling people out or depressive since symptoms. So we’re looking just at a three to five grams. And it’s so essential for women, the who put it on their list of essential supplementation list maybe six months ago saying creatine is really essential for a while.
Dr Lyon 55:55
Yeah, they so you said that they have what 30 To 70% less than men
Dr. Sims 56:01
70 to 80%.
Dr Lyon 56:04
But why is that just based on muscle mass,
Dr. Sims 56:07
women tend to eat less foods that contain creatine, and yes, less muscle mass. But overall, just the way that we are looking at metabolism, men tend to go through more creatine because they tend to have more fast twitch and fast action, as opposed to women because we are more endurance. So we rely more on endurance fuels. So if we’re looking at people who eat the same women will still have 80% Less stores than a man even if they are eating the same. So it’s just about making sure you’re getting more in and having an available because it doesn’t necessarily benefit just the muscle. We look at gut integrity. And there’s so many women who are talking about gut distress, having leaky gut, IBS, all of these things and it comes down to maintaining the mucosal lining and integrity of the intestinal cells. And creatine is so essential for that. So for low in creatine, one of the first things that goes is that mucosal lining and the integrity of our intestinal cells,
Dr Lyon 57:06
yeah. And actually even overall protein because one of the precursors for mucin production is threatening. Exactly. Yeah, that’s really, really important. To summarize, when we’re talking about what an individual should eat a female, Peri menopausal postmenopausal. You’re not necessarily really talking about weight loss, you’re talking about maintaining body composition, and really prioritizing dietary protein determining carbohydrates or fat based on your activity. And what you had also mentioned was carbohydrates in and around your exercise, and really getting a wide variety of fruits, vegetables, and colorful foods. Did I miss anything?
Dr. Sims 57:50
Nope, you got it. And then for those people who are like, but what about all this stuff on fasting I’d say, you know, let’s look at time restricted eating where you stop eating after dinner, and then you have breakfast one that gives you the, quote benefits of a 12 hour fasted window, but two works with your circadian rhythm. So we’re giving the body food when it’s under stress, and we’re letting it relax when it has to do is reparation. And really time restricted eating is a fancy way of saying normal eating.
Dr Lyon 58:20
Normal eating. It’s true, right? Because now you’re pushing that feeding window earlier as opposed to eating late at night. Yeah. Are there any other tricks or tools that you would recommend for individuals who are having hormonal changes and really just really struggling with conceptually thinking about going into menopause?
Dr. Sims 58:40
Yeah, because people are so afraid of it, they are not really having those conversations. Right. So there are quite a few good resources to have those conversations with other people. US right now on this podcast, and then there is a hit play not pause group that’s really beneficial for active women who are going through all of this. But also don’t be afraid to have a conversation with your physician, like, let them know what’s going on. Because all these changes make women feel like they’re going crazy. And they’re not. It’s normal is part of normal aging. And if we have those conversations and say to your physician, hey, I think I’m going through perimenopause, then they’ll be like, Oh, well, first, they’ll probably offer you some kind of hormone replacement therapy, but just making and vocalizing it and reducing the fear factor goes so far in allowing them to become empowered about it.
Dr Lyon 59:31
That’s really good advice. And I’m actually going to link to all your information, your next level, your war book. I’m really excited and what is next for you? What are you really interested that is up and coming? You know, experts in the field are always going through new evolutions of their own experience, and I’m just curious what’s next? What are you thinking about?
Dr. Sims 59:52
I’m thinking about Christmas and the fact that I haven’t finished my Christmas shopping
Dr Lyon 59:56
Join the club totally okay.
Dr. Sims 59:57
Yeah, no. So I have some really fantastic colleagues that are in the States. And our dream is to have a female athlete center for all women. And we say athlete is any woman that exercises on purpose, to have it a central hub for research across the lifespan, but also women who want to be educated or need to be tested or industry that wants to do proper research to have the center hub. So we’re working, really to see if it can be actually a dream come true, and really get resources behind it. And then pulling all the other like, I am on the Scientific Advisory Board of whoop, and working with them to really develop a robust wearable for women. And it would be really cool to then have that in that female athletes center to do research across the age span of puberty all the way through post menopause. So that’s the big dream, and we’re working to stay tuned for next year.
Dr Lyon 1:00:56
That sounds amazing. And a big shout out to Kristen Holmes. Yes, a friend of mine absolutely love her. I do too. She’s awesome, is amazing. So Kristen, there’s a podcast spot open for you here in January. Just kidding. But I think that that is really, really profound work, and I’m excited to see what you’re gonna do. So thank you so much for your time. Yeah,
Dr. Sims 1:01:19
thanks for having me. It’s been fun.
Dr Lyon 1:01:22
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