So in this part of the conversation I want to talk about exercise, nutrition, fasting, lifestyle, sleep, environmental factors. And the first question is why does muscle matter as a woman in particular?

Muscle matters because it helps your brain produce more neurons and that's super important for brain health. As far as protection as we age, it's directly correlative to the amount of muscle that we have. And if you have something like PCOS or endometriosis, it's even more important for you because building muscle is going to fight insulin resistance and inflammation.

I've got two questions to ask. Should women exercise differently across the menstrual cycle? And what is the reason why women hear what you guys say and they don't do it?

I'm so glad we're having this conversation. We're back with the leading voices in women's health to unlock the specific insights, data, and tools needed to combat the growing challenges women face throughout their lives. For women forever, it was all about aesthetics. I'm healthy. I'm thin. Because they are under the assumption through sociocultural ideas that a woman is coming to the gym to lose weight, not to get strong, not to gain muscle.

But what we've ended up with is an epidemic of osteoporosis and frailty and really dementia where 40 to 50% of women will have low bone density. 70% of all hip fractures happen in women. And when you have that, 30% of the time you have a chance of dying in one year.

Because most of it is based on male data. And I see a large number of women trying their hardest to be healthy but what they are choosing to do is actually having a negative impact on their hormonal health and it's not your fault and this is where we have to educate and it starts now.

Which brings me to questions from the audience like what's the best and healthiest way to lose weight? Is there a diet for fertility? Should women ask is there a link between environmental toxins and early menopause?

We think so. But also, if you were to design perfect workout regimes for menopause and perimenopause, what would you Oh, Stacy's clapping. Go ahead. This is part two of my conversation with four of the world's leading experts in women's health. And in this episode, we go even deeper into actionable, practical things you can do to improve your health.

And by the way, if you're a man and you've been sent this episode by a girlfriend, a wife, a daughter, uh whoever it might be, I know you might not think this conversation is for you, but more than 50% of this planet are women. You have a tremendous advantage in your relationships, at work, and just being a human being going through life.

If you understand the majority of the population and for so long, women's health, women's bodies, women's anatomy, their psychology and physiology has been a mystery because there hasn't been the same amount of scientific research done to understand them. So, in this conversation, we're going to demystify all of that so that you can understand your wife, your partner, your daughter, your colleague, your mother, your grandmother even better.

So in this part of the conversation, I want to talk about exercise, nutrition, fasting, lifestyle, sleep, environmental factors, and all the things that we kind of alluded to when we were referencing hormones and menopause, but in a more actionable sense. And I guess the first question is similar to the first question in part one, which is why does it matter for us to have a conversation about women in this context versus fitness generally or nutrition generally?

Sport and exercise science in itself is a small subset of like sports medicine and medical research and most of the research has been done on men. So if we look inherently at most of the recommendations of exercise, recovery, nutrition, it's based on male data and we established earlier that's not generalizable. So when we really want to get into the nuances of how do we create an adaptive stress for women, we have to look at it differently to look through the female lens. understand the female physiology and acutely how hormones can affect adaptations and how women respond to different environmental cues than men.

Yeah, our hormones distinctly control a lot of our environment and the b our other cells that are not what we think of as our hormone cells work with our hormones. So, if we think about the gut, we think about the liver, our immune system. A lot of this is so hormonally derived, but it's a two-way street. Meaning, your hormones influence what is happening in your gut, but your gut influences what is happening in your hormones. And because women have different hormones than men as far as what's predominant and when they are, we have to come at this and approach it a different way.

There's so much to do with messaging that women receive as far as their health goes. and this, you know, be small at any cost, you know, you know, get to that number on the scale. And I see it on social media that the conversation is changing hopefully. Now, GOP ones is tampering this a little bit, but strong over skinny, nutrition over calories. Like we are trying to build bigger, stronger bodies and take up more space is the message that needs to have.

I mean, forever it was all about aesthetics. You have to look young, feel young, be young, anti-age, you know, all those things. And what we've ended up with now is an epidemic of osteoporosis and frailty and and really dementia.

Should women exercise differently across the menstrual cycle. So this is the nuance and this is something if you'd asked me maybe 5 years ago I would have said sure from a molecular level we see that there are certain things that happen with estrogen being in isolation for the most part and then when you have estrogen progesterone we see their metabolic shifts we see their temperature shifts.

but the caveat is we don't know if a woman ovulates or not and I'm sure that Natalie can you know give some stats about the an ovulatory incidences in most women if If we were to understand and know when an woman ovulates in addition to how she feels across her cycle, then she can individually tailor her menstrual cycle to her training. But for general plan, we can't do that.

I think it's important that you know building muscle, using muscle, consistency is a huge part of effectiveness when it comes to exercise or to building strength. And so one fear we have when we say do this in one phase of your cycle and do that in another phase is that if you know 15% of patients are not ovulating or they have no idea when their follicular and ludial phases are they then doing overall less because they're waiting on this directive to tell them what is not untrue though.

and how I frame this to patients is that strength and resistance training should be the core of what you're doing regardless of the phase of the cycle you're in regardless if you're pregnant regardless if we're doing fertility treatments, building muscle, using your muscle. Now, what you do on other days is where you should allow yourself to say, "How do I feel this day? What do I need this day?" And be okay with giving yourself the grace that that may look different on your period, in your follicular phase, in your ludial phase, and saying something and moving your body is still ultimately, we're all going to agree, better than sitting on the couch.

Okay, many women will say they have more energy in that late follicular phase. And so if you are looking at your workout structure, this is a day I want to try heavier weights or more reps, it can be smart to put that in a time where you have a higher chance of being successful.

That's how I explain it. I'm like, if you have your own data and you know what days you feel really fantastic, that's where you want to put your higher intensity, your heavier lifting because you know that you're going to hit those training metrics. What we don't want is for someone to go in to do a highintensity session on days they feel flat cuz then they won't hit the metrics that they need to get the stimulus we're after.

Can you explain this to me like I'm a 10-year-old in terms of where in the cycle typically women will have more energy and really be able to push themselves

right here 5 to 7 days before ovulation. Some women feel really great around ovulation. Some have a transient where they'll feel really awful on and around ovulation and maybe 24 hours later they feel really fantastic. Most women are variable through the early ludial phase. So if we think about day 6 to 14, that's when we see women feel really robust and strong and feel like they can take on the world

because estrogen is rising.

Yeah. Exactly. And you see the physiological changes, heart rate variability, resting heart rate, your immune system is um more prone to taking on virus and bacteria. It's not pro-inflammatory. So you have that working for you. Your core temperature is lower.

You can ask access um carbohydrate a lot easier. So you have more availability for fueling to hit high intensities. Then when we see with ovulation, like I said, some women feel really fantastic right around the time of ovulation because of the estrogen surge. Some have trans transient where they don't feel so great. They might

when that follicle ruptures and the egg is released the granulosa cells that are surrounding it which is what actually makes estrogen get disrupted. And so some women feel that transient breakage and their estrogen's dropping before it reforms to become the corpus ludium and make again. So you have this high peak estrogen and then some women are really sensitive to these hormonal changes and they feel that drop. So that ovulation day may not always be your very best feeling day, which makes women feel like it should be and like something's wrong with them.

On a side note, we did um survey on women experiencing pain on ovulation because it's something that was never talked about.

Middle schmirts.

Yes, exactly. Middles.

We had So you can feel the follicle rupturing and that's called middle. So it's German for in the middle because it tends to happen in the middle of your cycle when you ovulate.

And it's a it it's painful.

It's a pain. It can't be painful. It's like a cyst bursting inside your body.

And then some women are down for the count because of it. So they can't they don't plan any physical activity around that because they just can't from a physical and mental standpoint put themselves through anything. So that's why I'm saying like ovulation some women feel bulletproof. Other women have this transient feeling of really flatness and pain.

And then afterwards in these early ludial phase, so day 16 to about day 22, it's variable. Well, some women will feel like on top of the world still. Other women will feel m I can't quite hit eye intensities. And then in general these few days about day 24 to 27 before those hormones actually drop this is where you have your PMS your premenstrual syndrome and cramping and fatigue and a lot of women are like not so great.

That's when your progesterone

when both of them drop. I just love how you guys explain it because what I see on social media is absolutes. You must do this doing ficular. You must do this at ovulation. you must and I'm just like really you know and so I love how you're like well some women it may affect them this way and others this we generally tend to see xyz so rather than like you absolutely have to do this at these different times.

I think learning to listen to your body and the signals that it's giving you I mean across the stages of your life that's that's really key to so many of the questions that we're talking about because you want to understand your own response and where many women are falling short is that they've been suppressing their cycle, so they don't know about it. And they were not taught all of these different changes that are perfectly normal. And so it's very hard to then hear a social media post that says only do this in the follicular phase and don't ever do cardio in the ludial phase. And you get a lot of mixed messages when in fact there's no absolutes.

And in terms of training, some people think moderate training is better for women. Some people think high intensity training is better throughout the cycle. and sort of also considering what goals you might have in fertility. What would you say there is is is should I be doing highintensity interval training if I'm a woman or throughout the cycle and throughout my life?

So this is where we have to think about periodization first lifestyle but also how a woman is feeling. We don't want people to do highintensity interval training every day because that's just not going to create an adaptive response. We have to think about the reason why we're exercising is to create a a stress that the body's going to respond to. We don't get fitter during exercise. We get fitter from the stimulus of exercise and the recovery from it.

So, if someone's doing highintensity interval training every day or 5 days a week, they're not ever going to get that subsequent recovery to be able to hit those high intensities and that stress that we want. We talk about high intensity during our reproductive years. you can pretty much get away with whatever you want to do during your rep reproductive years because you have the benefit of our hormones working for us.

We start getting into pmenopause and we start getting into menopause. This is where we have to really carefully look at volume versus intensity. So that means if we're doing lots of stuff or are we doing really purposeful high intensity versus low intensity because we're trying to create what we call a polarization of the training so that when we hit high intensities we're actually hitting the intensities we need to create change.

But on the other side of it we want to hit really low intensity so that we can have recovery. It gets harder to recover as we get older regardless if you're male or female. But in pmenopause, we don't have the benefit of estrogen supporting anti-inflammatory responses. So we have to be very cognate that we need more recovery.

So I'll give you an example. So my office, my orthopedic office is in a fabulous performance center. Outside my windows, I have floor to ceiling windows. There's a football field inside. That field is filled seven days a week with people taking a class I called Ignite.

Ignite has a lot of midlife women in it who are never exercising at low enough intensity to recover and never exercising at peak intensity to change their body. So what happens five or seven days a week they're out doing moderate mid-range intensity training but they're not seeing body changes. They're not seeing recomposition. They're hurt every three weeks and in my office wondering why they're hurt because they're doing a lot of reps of medium intensity. So, they're not really recovering and they're not intense enough to really change their physiology. But that's really common.

There are whole brands built around mid-intensity and

and that falls into the whole socioultural thing where we've grown up that if you don't have a good sweat sesh and feel completely smashed when you leave, it wasn't a good workout. But that's a misconception, right?

So they are smashed. They're dripping as sweat, but it's not at peak heart rate ranges for short bursts of time, right? So it's I know. Look, it's very confusing because I don't know 20 years people have as they've switched from only cardio, they're like now we're going to do high intensity, which is fine. I'm not opposed to that word. It's just that how do you define that? What is high intensity?

And so like you, because I've read your books, that we're we're exercising people at pretty low heart rate where they're about to flip from burning fat to carbohydrates cuz that's really metabolically healthy, but not so intense that people are going to get hurt. And I also prescribe really peak sprint interval training. And I did that myself in midlife, you know, to recompose my body, sprint interval training because it's intense and lifting, right?

Is the advice different for different women at different stages of life here? So, if I'm if I'm before pmenopause,

you get away with most stuff.

Assuming you have a regular menstrual cycle, right? I think there there's different time periods which we've mentioned before PCOS, hypothalamic amenorhea, time periods where you're not making estrogen or making it reliably, you can get away with less. And so we want to protect a little bit of that.

But when it comes to exercise, variety is the name of the game. You want to adapt. So you shouldn't be doing the same thing every day. That doesn't mean you can't have a plan. There's seven days in a week. You don't have to move every single one. But you should pick these different activities based on your life, your schedule, what you want to accomplish. And it it will vary some in different phases of your life because your goals are going to be different.

And so when it comes to exercise, we always have to think about what needs to happen. Are you somebody who is overweight and needs to lose weight? Are you somebody who's underweight and is trying to gain weight? Are you trying to get pregnant or going through fertility treatments or in menopause? So there's nuance to it which always makes it hard. But there's not a one do this one exercise every single day. That's pretty much not the answer.

So the most popular class for females right now, I just saw the statistic somewhere is Pilates. And my daughter loves her lree and gets on that machine. It's like, you know,

where does that fall in all of this?

I have a lot of um Pilates. There's a social aspect to it. You know, there's people hate.

Yeah. because um we did this real talking about how Pilates was not appropriate as strength training, especially as a rehab. When we look at Pilates, it's a complement to true strength training. What I mean by true strength training is you're lifting a load that's heavy in multiple planes.

With Pilates, it's really good for isometric control, core strength, balance, propriception, but it isn't a stress that's going to create adequate muscle gain and strength of the bone, which is what we want from strength training. So, just like yoga, Pilates has a place. It does definitely fit in the scheme of things, especially from the social and the fact that it does give you control and propriception, but it isn't the beall end all for strength.

people that do pilateses frequently will be shouting.

But I'm see it's so it hurts so much and

I know I hear

well I'm sure it's hard the times I've done it it's not easy but the

but it doesn't uh set you up not to be frail.

It is not building strength and power. And I have women who have done so many Pilates 1500. It's like a badge of they count their classes.

1,500 at the deficit of anything else. It's all that goes on

and and I think that is another, you know, you got to mix it up. Number one. Number two, I say the same thing. So, I'm not very popular in those crowds, but it's great for the for the standard that I ask people do of of flexibility and joint range of motion so that you don't become really stiff and hunched over and shuffling old person, but it will never give you strength and power in the way to protect yourself from falling down

because there's not enough weight

for the most part. Yes. And we also have to think about when you're doing strength training, you are in uh you're creating a multidirectional force through the muscle and the tendons and the bones. With Pilates, especially if you're looking at the reformer, it's not multi-directional in the movements. It each movement is one plane and you can be

yeah, you can be in in different planes, but each motion isn't multiplaner.

So if we think about what are we trying to get out of out of Pilates, we're getting neuromuscular control. We're getting core strength, we're getting some breath work, and all that is beneficial. But again, if we're trying to grow muscle and bone, take up space, be strong, it doesn't quite hit the points that we need to in order to create this new strength to to bring us to that health span that women are looking for.

So do it a couple times a week.

Yeah.

Not seven days a week. Correct.

So if my my partner, she's 33 years old, so she's not quite at per menopause yet. If you were to design a perfect workout regime for her at that phase of her life, what would you Oh, Stacy's clapping, you know. Go ahead.

So, if she has three days that she can go to the gym and has, oh, I should say three 1-hour sessions that she could have at the gym in a week over seven days. Each one would start with mobilization. So using resistance bands or maybe you're doing a Pilates reformer warm-up so you're getting through the range of motion.

Why?

Just to open up the joint capsules, make sure you don't have any restriction so that you can get really good range of motion for the movements you're going to do next.

The next movements would be

does that stuff actually work? I do wonder this. So many of my friends are getting injured at this age because that they're my age and a bit older because they walk into the gym and they start picking weights up.

Oh yeah. No, I mean I spend more time mobilizing, I think, than I do actually training now,

just to keep range of motion going and keep the joint capsules open. And so that's using the heavy resistance bands to distend and distract all the joint capsules to increase range of motion.

Stretching doesn't do that. Stretching will get to an end point of the muscle to allow you to have more flex in the muscle, but it's not actually stretching in the joint capsule to give you range of motion. So when we talk about mobility work, we want to get into that full range of motion. So if you have a stiffening, so as I was saying earlier about the guy and my voodoo flossing, well voodoo floss is a way where you're creating some blood flow restriction, then you go in a range of motion and that blood flow restriction, you take the voodoo band off and the blood flow comes back and you go in the range of motion get deeper in that range of motion.

So, it's all about accessing the tissues and making the tissues more viable for increased range of motion so that when you go do the lifting, when you go put on a heavier load, you have better control, better range of motion and avoid the small little sticky points that cause injury.

Tears. The micro tears.

Yeah.

Uh so it's the micro tears that are going to lead to in injury and the micro tears come when I haven't warmed up

warmed up properly. Yeah. So, like shoulder, what would that look like?

Or your shoulder. Uh I wish I had a rig. So, you can take one of those thick um the big and wrap it around a rig or or something and you can pull and distend. So, you're actually pulling the shoulder out

in different ranges. So, you can rotate, roll, pull, extend, pull, extend.

What about this?

So, this is more trying to work the muscle, right? And you have paleo press as well where you're working rotation, but that's not getting into the joint.

So you want to be

So if you're distending, you're pulling back. You're not bending your elbow. You're actually pulling through the shoulder and distracting. And then the band is going to pull you forward to give you resistance to pull your shoulder joint out. And it's not a painful, but you're just really getting into that full joint capsule.

You can do that with the hips. You can do a banded pigeon stretch. just so many different ways of getting into the joint capsule, which not only gives you more range of motion and prevents injury, but it also gives you more of the flexibility that people think they get when they're stretching.

The reason this is important as we age is because ligaments and tendons and uh the capsule the inside skin of a joint is made of collagen and the covealent bonding collagen is like if you envision strands of rope the covealent bonding meaning the bonding between those strands becomes stronger as you age and you uh become more and more stiff.

Well, when we lose joint range of motion, we're injured more. Um, it's why we start shuffling down the street, hunched over, shuffling instead of striding because we have full hip range of motion or full knee range of motion. And so, one reason to do this is to maintain full range of motion through all of our joints.

We want full range of motion not only to avoid injury but for instance if your knee is stiff whether it's an injury or because you just haven't maintained your motion it will change something called your kinetic chain meaning we really are from our big toe to through our spine connected the big toes connected to the footbone the footbone because the way each of those body segments works activates the next body segment.

So, if you've got a glitch in the system because your knee doesn't move or let's take this one, this is easier. Your ankles get stiff because we've never worked on it. Your calves are tight, right? You're a jumper. You've got tight calves. Your your hip your ankle doesn't flex. Well, then your shin bone or your tibia is not going to internally rotate. Well, without that, your knee is not going to bend as much and your femur, your thigh bone is not going to rotate. You must have the rotation of these bones to activate your glute.

So if you're not activating your glute, your butt muscle, people are very hurt or they're not getting as strong or they start having lateral thigh pain. So everything works together and it starts with among other things the flexibility and range of motion exercises. We're talking about it right now. So that the body works like a chain.

If I lose my range of motion because I never did all these things, can I get it back when I'm 50? So, like, you know, I'm 33 now and I'm think, damn, I've not been doing enough of this stuff.

Yeah. Yeah, you can. Unless you're having bone changes due to to arthritis and it's blocked. Yes, you can.

So, I can start I could theoretically start at 40

cuz if you think about your muscle and how it responds to picking up a weight and right, you're going to build the muscle. So if you're creating a force within the tendon and the ligament and the collagen and it's a repetitive force, a positive force, you're going to invoke change.

Tissues are malleable.

So people that think they're stiff and they say, you know, I can't touch my toes and they can work on

they can get it back.

Here's another reason. So what happens in midlife men and women actually they remember what they used to do and then they're like I'm going to start working out and I'm going to start

their success. This is when I get people who just show up on the basketball court after not having been there for quite some time and they return to their memories of success but because they haven't lengthened their tendons, their joints aren't moving quite so well. They rupture tendons because the load outstrips the ability of the tissue to be compliant.

That makes sense. Friends have been getting injured and I think that's in part why because they're trying to work out like they used to work out.

Yeah. And listen, they can return to really high level, but you can't stop. You can't start where you left off 20 years ago or 10 years ago. It takes a minute.

Few weeks for me.

It takes a minute. Yeah. So Mel's 33. You

mobility work when she gets to the gym first and foremost.

on day one or every day?

Every day.

Every day. So I'm assuming, and I could be wrong, that she already has a strength training history.

Yeah, she does. Yeah.

Okay. So we do the mo mobility work for about 10 minutes. Really warm up. Well, then we pick one compound movement we're going to work on. So could be squats on the Monday. So we're going to work on loading in a squat pattern. So that's your knee forward, you know, quad dominant type squat motion.

Back squat, does it matter?

Back squat, front squat. You could do Bulgarian split squats. So we're adding load and we have a periodized program. So this is just a snippet of one day in a periodized program.

What if you didn't have that strength training history?

Well, then we work on adding load through our I want to see how she moves first and we want to make sure that you're moving well before you add load. So this is where we would work with lighter loads and more reps.

What if she's doesn't have you there?

Yeah, that was my question. Like what if you're not there on her own?

Yeah. So this is still like how do you squat? Where are your sticking points? So you can assess, self assess. If you've done your mobility, then you'll know like, oh, my hips really tight, so I need to work on that. So let me do some air squats to see how I move. Then the next time you go in to do squats, maybe you're picking up um two 10 pound dumbbells and you're holding them and doing air squats with your dumbbells. And eventually you're gonna move to the barbell. So it's all about small progression under load to get to a point where you feel more confident to use a barbell back squat to get into more of those compound movements.

Why don't people exercise? Specifically, if we just focus here on women, what is the reason why people hear what you guys say when you're talking about exercise and they don't do it? They don't start.

It's hard.

For what what set of reasons make it hard?

Well, for women, it's set up in a gendered environment. Like I always use the example of a woman who has an interest in strength training. if they go to a typical like 24-hour fitness or another brand gym that's out there, they'll walk in and they'll say, "Yep, I want to join." And the membership person most often will say, "Great. Here's the class schedule. This is where we have our spin classes. This is where we do our our classes."

They never direct them to the lifting platforms. They never look and say, "Hey, here are are the way to get strong." Because they are under the assumption through socioultural ideas that a woman is coming to the gym to lose weight, not to get strong, not to gain muscle,

not to recomposition. Yeah.

Right. But if a man walks in, then it's always the great, here's the lifting platforms, we have x amount of barbells, we have x amount of bumper plates. How much weight do you want to gain? Do you do you want to work with someone to, you know, help you build that mass?

Vonda, why does it matter? You know, cuz there's a big social pressure on women to look a certain way and it doesn't typically involve muscles in the especially in the upper body.

Yeah. So, you know, we're still living under the times of be as small as you can, but small doesn't mean lean. There's a concept of skinny fat which you know it's you can be as tiny as tiny but you can be 50 you can have a body fat of 50% which means you're neither strong you're not metabolically healthy you're just little right

so it's there is also a misconception that lifting heavy is going to automatically turn you into a physique model or a bodybuilder shape if that's your goal that's probably going to take you five years or a decade. It's a lot of hard work for a long period of time with proper nutrition. So for a woman who's wants to feel better, the goal is to build muscle to be lean, to recompose, not lose weight, right? I'm not really interested in somebody's weight. I'm interested in their body fat percentage and their lean muscle mass.

Um because it's what you're made of that matters, right? Not the size of the shell.

And why does muscle matter as I age? As a woman in particular,

it matters for everyone, but for uh muscle matters because it's not just part of locomotion. It's not just part of moving you around. It is a metabolic organ. It is critical for glucose metabolism. It's critical for uh insulin sensitivity. It uh talks to the bone. Bone and bone and muscle are endocrine organs which cross communicate all the time.

So both bone and muscle have access to the brain. Right? Uh muscle will produce a hormone called irri which has multiple functions in the body. The the axis between muscle and brain helps your brain produce more neurons. Right? bones access to the brain has a role in satiety. Isn't that amazing?

Which means not hungry anymore. Why would you think these locomotive structures, if that's what you limit them to, would would even have those functions? It's because we put organs in a box. So to answer your question, muscle in men and women, but women in particular for this conversation, we need as much muscle as possible to fight the insulin resistance that we get when estrogen walks out the door.

We need uh muscle for glucose metabolism. We need muscle for the pure strength of it because we do not want to become frail and be one of the twothirds of nursing home residents who are women because we can't do something as simple as get up out of a chair.

But I could just get muscle when I'm 70.

You can actually harder.

So why does it matter for Mel to be thinking about it when she's 33?

Well, here's the great part for Mel is she still has all her estrogen. Mhm. Estrogen has a profound effect on muscle protein synthesis. Um it is a significant anti-inflammatory.

So high inflammation, chronic inflammation, we've talked about decreases muscle synthesis. It decreases bone synthesis because inflammation with its high cytoine level I've mentioned them before IL6 tumor crosis factor those are all detrimental to these normal metabolic pathways. So the wonderful thing for Mel who is entering what I call the critical decade which is 35 to 45 estimated. It's the prime time to set your physical activity standards and to build as much as you can while you still got all your estrogen.

In addition to the fact that for proper hormonal health, you think about inflammation coming in, it's like static on a walkie-talkie. The brain's trying to interpret your hormones and when inflammation's coming in, it's making the signals really hard to hear. So, we need to make sure that we're actively fighting that. And building muscle is one great way because it's going to use up glucose and fight insulin resistance, which means makes your cells more sensitive to when it sees glucose and able to use it better.

If you have another thing that is pro-inflammatory such as PCOS or endometriosis, it's even more important for you because your inflammatory burden by default of what's happening at a cellular level is higher. We now need to not just say, I need to not make it worse by being exposed to things. We have to say, I need a plan to fight this because my world is pro-inflammatory on a daily basis. What is my game plan to fight this? And building muscle. It's not just exercise is better than no exercise but specifically building muscle because as everybody's saying it's has a metabolic function in your body is going to help you the most.

There's a term called geroprotective geroproction. So gerero is is the term we use for aging. So gerontology is the you know the part of medicine that focuses on the elderly patients. And so when we look on in females and the organs that are, you know, are the most ger protective, it is the muscle and the ovary and the ovaries go away. We have a shelf life in our ovaries. So then we're just really left with our muscle as far as protecting us in those elderly years as we age.

And it's directly correlative to the amount of muscle that we have because if you have a lot of muscle, you're going to have stronger bones.

And this this is where the intensity part where um Dr. I was talking about seeing the ignite class and everyone's in that moderate intensity all the time. With moderate intensity, you don't have the post exercise anti-inflammatory response. So, if we're trying to build muscle and we're trying to dampen inflammation if we're always doing this moderate intensity cardio, then we're not one going to be building the muscle we want and two we're going to have this baseline elevation of total body inflammation.

So we need to mix it up and have that precedence on being muscle centric and building that muscle one to help with aesthetics. I mean that's the byproduct of lifting weights. You tend to look better but it's more than that. We see it improves brain health because of the neuro connections and the neuroplasticity of the brain and I told

sleep all of those things you get an incredible parasympathetic response when you've done a significant heavy lifting session or a sprint interval session which you don't get with that moderate intensity cardiovascular work.

at the end of that golden decade that you referenced 45 years old Because you have changes in estrogen, one will expect to see a a natural decline in muscle.

Yes.

Um and an increased chance of osteoporosis, osteopenia, bone issues later in life? Do women, this is several questions, I apologize, but do women then also tend to have more frail bones in later life and is that linked to the muscle loss?

So this is how it works. So both men and women build bone and peak about up to 25 some sometimes 30 and then bone loss plateaus for a little while. Men continue to lose about 1% a year. So men do not arrive with hip fractures or devastating fractures until their 70s or 80s or older.

Women also decline slowly until we lose our estrogen. And then the rate of decline, and I'll tell you why it happens, for bone doubles or triples such that you will lose 15 to 20% of your bone density during your pmenopausal period just from loss of estrogen alone because estrogen plays many roles. I've already talked about estrogen being a huge anti-inflammatory. Bones are very sensitive to inflammatory chemicals in your body.

Estrogen also directly affects the balance of the two main cells that subtract minerals from bone, the osteoclast and the cell that builds the bone, the osteoblast. And in well hormoned times, there is a balance. The body loves balance. We take what we need, we build it back. But because estrogen has such a profound effect on the osteoclast, the Pac-Man bone eating cell, there's a dis there's an imbalance and we take more bone than we're capable of building. We're still building bone, but the rate cannot keep up with this.

So with the inflammation, with the direct effects on the osteoclass, women will lose bone density if they do nothing. Well, number one, they're going to lose bone density, but they must do something about it. The reason it's so critical for a 33y old is because you still have your estrogen. So, let's learn how to lift heavy. Let's take advantage of the estrogen circulating. Let's learn to have a jumping practice and impact our bones.

Right? So the the way our body tells our bones to build more is um there's another little cell called the osteocy. It sits encased in bone but it's connected to these other uh cells by little tunnels that contain fluid. When you jump, the biomechanical impulse of that fluid shifting in the little tunnels is translated into a biochemical stimulation that tells the bone, "Oh my god, she's jumping around. I need to build more bone." So, we need that impact to stimulate the laying down of more bone.

I was looking at this graph, which is what you were describing.

Yeah. um men and women aren't that far away in terms of bone mass.

So this is showing the fact that because of the way testosterone interacts with a man's bones, he will peak at a higher bone mass than a woman will.

Yeah. So he's starting at a higher level.

Yeah. So I would want young women to do everything humanly possible to start at the highest possible level. But I see lots of 20 year olds, 30 year olds, really young women with poor bone density for a lot of reasons. And so I'm a big proponent for having bones measured early. Don't wait until you're old so you know where you're starting,

but that's not the standard recommendation.

No, the standard recommendation is 65, which long way for that. But because I do do either a DEXA scan or a REM's ultrasound to look at bone quality on everybody, um, we can catch it earlier. And that's really important to get in front of it because it's estimated, uh, research says that in order to affect bone density, if you're going to use estrogen for instance, you need to have do it for 10 years.

And why should people care about bone density? Everyone cares about muscles, but very few people talk about bones.

Fracture. can't carry your muscle around if you have weak bones.

So without bone, muscle is just a heaping pile of steaming metabolic tissue sitting there, right? There would be no bicep to complement, right? Because it has to be connected to a bone. So they're important for locomotion and giving support to the muscle. But bone is an endocrine organ that secretes hormones that go to your brain to help build neurons to your pancreas to be active in insulin uh release to the muscle for glucose metabolism. In men to the testes to build testosterone and that's only one of the many hormones that the bone produces.

The bone is not not only structural, not only hormonal. I've already talked about it being a storehouse, but it's an incubator in our pelvis is where we build all of our blood cells.

And so it has these multifunctions. But to Mary Claire's point, for women, 40 to 50% of women will have low bone density. And when you have that, 50% of the time you'll break a bone. So if we're looking around at this table, if we all have osteoporosis, which we don't, uh, one in two of us will fracture.

When that fracture is a hip fracture, which is very common, 70% of all hip fractures happen in women. 30% of the time when you hit the floor and something breaks, you have a chance of dying in one year. This quick, your life changes. 50% of the time, even if you survive, you will never return to prefall function, meaning you can't go home.

And that puts your family in this situation of having to figure out 24-hour care or you move in with your eldest daughter or you go into a facility where you use your life savings until you have no more and then you have to apply for Medicaid and the government will pay for it. These are terrible situations to get at something that we could have prevented had we started early enough.

So, you want to start early. So, I'll have Mel. So, Mel's going to be doing strength training, not just for the muscle benefits, but also because it's going to help her build strong, healthy bones in that critical decade.

Yep. And then we finish it with some jump training.

Jump training.

Yeah. So plyometric type work or if we're looking at not having the robustness of doing straight pio then you can do banded assisted pogos. You can do low depth jumps so you're getting some impact the bone because as um Dr. Roy is talking about it's a multidirectional stress not people think oh I run I'm going to have strong bones but running doesn't do it. You need multidirectional stress.

So if you think about it when you land your body has to move the ground doesn't. So it's called the ground reaction force that comes up through the bone to create that strength.

So that ideal situation in a workout for her would be some mobility, some heavy lifting. If we're doing plyio, that's also strength or a sprint type training. So you're getting a metabolic stress. So you're hitting all the major factors in one 1-hour workout.

I read that um that there was a study done with some Australian elderly ladies on bone growth on lifting and bone growth.

Yes.

Yeah. Lift more lift more study by Dr. Beck.

Yes.

She was trying to dispel the myth which I hear every day that you've got osteoporosis, you can't lift weights.

And so her study because we're big proponents of teaching people to progressively lift heavier and heavier and that scares people. but especially if you think you're going to break. So she did a study where the load was five reps, five sets under a supervised situation. So five reps means that it was heavy enough that at five reps they were near failure.

Right? So these women all osteoporotic not only were capable of lifting heavy under supervision, none of them broke and uh they built bone.

Yep.

So that answers the question, right? Can you lift? Yes.

Yes, you can. And the other thing that isn't really brought up into these conversations is when you hit pmenopause, not only is estrogen sort of the stimulus for sat satellite cell where we're building muscle cell, but it has a distinct um I guess influence on measin. So meosin and actin are are two contractile proteins. So if you think about a sliding filament or coming together, you have meosin and actin that bond together to then pull and move and pull and move and that's how you have a muscle contraction.

Estrogen is responsible for how tightly meosin bonds to actin. When we start to lose estrogen or we start to have variability in our estrogen, we get myosin dysfunction. So that means we're not going to get a very strong contraction.

So we get weaker.

We get weaker. And this is one of the very first things that people complain about to me. I don't have power. I don't have strength. I can't I my grip strength's gone. I don't know. But their body composition hasn't changed yet. So if we think about lifting heavier loads, it's a neuromuscular response. And that direct stimulus creates the adaptive change in measin that now estrogen isn't responsible for. It's a different external stress that creates that change in measin to go, yep, I have to grab onto actin and have a very strong contraction.

So we see that this dysfunction happens first before we start seeing a change in our lean mass development. So if we are already in the habit of lifting heavier loads, then we can offshoot some of that measin dysfunction that occurs with the estrogen change.

So when my patients come in and they are looking to prevent osteoporosis or they've gotten a diagnosis of low bone density, you know, what can they do? I've discussed the Lyftmore trial. The new study just came out May of this year of 2025 and they looked at very similar to the protocol used in Lyftmore. So there was a control group where they just did nothing. Then a group that did the they did three days a week and they did resistance training and jump training. And then the third group did all the same exercises and added HRT. And depending if they had a uterus, they got estrogen or estrogen plus a progesterrogen.

And so, of course, as expected, the do nothing group lost bone. You gained bone as expected in the resistance group, but it seemed to be synergistic. When we added hormone therapy and the resistance training together, they grew even more bone. They had even better results.

So, when my patients are like, I want to hedge my bets. My mother fell and fractured. she's broken her hip in a nursing home, whatever. And I'm trying to avoid this. I'm we're hitting all the points and the only medication of it. Now, we have other medicines that will help slow down resorption of bone, the bisphosphinates and stuff, but they, you know, there they can be hard to take and they have a lot of side effects. So, to me, prevention is always better than cure,

right? So, I'm trying to get them and get them early. I just ignore the guidelines that say you have to wait till 65 unless you have some chronic medical condition to get a bone density. I'm telling patients you can find it for about $99 around I work in Houston and that is worth the investment for you to go get your baseline bone density.

I don't know a single orthopedic surgeon you know a singer exercise physiologist or anybody who deals with with osteoporosis who thinks 65 is a good idea. So if your listeners are like oh well you know my insurance won't pay for it. I'm like, there are centers popping up now where you can go and get a DEXA scan and just pay out of pocket and get a great, you know, and figure out where your starting base is.

A DEXA scan is

a bone scan to see your bone density is the easiest way to describe it

and your muscle mass.

Yeah, they can do that as well.

This conversation is really important though to extend besides just menopause or permenopause that there are women of reproductive age years who have profound periods of low estrogen who are also at risk for serious problems with their bone density both now and down the road.

And so if you come to me and you say, "Oh, I haven't had a period for 7 years. No big deal." Well, that is a big deal. And depending on the reason why, many of the causes will result that you had low estrogen and you were not ovulating and you have hit that graph you showed of while you're building your bone, that person's on a different trajectory. And those women do need bone scans much earlier so that we can see where they are and see what we need. But

it's one of the biggest reasons. Bone health is one of the most acceptable medical reasons for why we should put younger women who are have low estrogen time periods onto estrogen treatment because it can so profoundly change their bone health long term.

So in my uh niche of active women, we see there's a very very high incidence of recreational active women and low energy availability, meaning they're not eating enough to support daily life as well as their training. So the subclinical aspect of not eating enough creates a myriad of of issues that does create lower bone density, menstrual cycle dysfunction, greater inflammatory responses.

So you know the end result would be hypothalamic amenora. So their periods have stopped which is a low estrogen standpoint. So, you know, keeping track of of your period, make sure you're eating enough is one of the first stop gaps that we have in the athletic realm. It's like we want you to eat enough.

And if you're looking at bookending our calories on either end of the day, that's not appropriate. We have to look at how your circadian rhythm works because the circadian rhythm, like we talked about in the first um half, was about the pulses of our hormones. So if we're holding our calories on either end of the day, then there's this big space in the middle of the day where your body thinks it's under a starvation threat. So you start to have this down downturn of all of our metabolic functions.

We see after 4 days of low energy availability, there's a direct impact on thyroid function. So we have to be very cognate that women who are saying, "I haven't had a period in seven years or my periods are really irregular." We have to bring it back to the energy function as well.

So, I know unfortunately we're still in this environment of aesthetics and I'm always like, we need to eat. And if you eat in and around your training and fueling appropriately for what you're doing, it has a positive impact on body composition.

You're not going to gain body fat, you're going to gain lean mass, you're going to gain bone, and you're going to see a decrease in body fat. But it's a trusting the process that out in general socioultural concepts is just not acceptable for so many women right now.

And with that exercise regime I asked you to make for a woman that's pre premenopause. Was there anything left off there? We had day one which is mobility works strength training.

So if you were to do three days a week in the gym that would be pretty similar except for the compound movement. What are we doing for each of those compound movements? A different muscle. So it would be the knee forward squat motion one day, push pull upper body next, and then uh posterior, so your hip thrust, your deadlifts, that kind of stuff.

Because women are quad dominant to prevent injury, we really need to build the posterior chain. And this is your glutes, your hamstrings,

your deadlifts,

your Yeah. So you're getting really uh strong around the knee joints, the hip joints because again that feeds forward to better movement, movement economy and prevention of a misstep for a hip fracture later down.

What about cardio? And

so that's where like if we're looking at those three days a week and we're finishing with pio or some sprint work, then the other days just walking, lowle intensity walking or maybe you have soul food, you want to go for a bike ride, you want to go for a run. If you're not training specifically for something, then those three strength training days are your key workouts and then you can pepper in all the other things that you like to do.

I hear a lot about V2 maxes, so I thought but we should all be driving our cardiovascular performance up to get a high V2 max.

Well, that's where the intensity is. Yeah,

I think it's only I mean, and correct me if I'm wrong, but my understanding after reading and watching everything is doesn't take that much to build V2 max. doesn't it's that high intensity that's a little bit uncomfortable where you're pushing at that max for uh you know about four minutes to build that V2

in the sports science world it's always been the 4x4 the Norwegian 4x4

4 minutes on four minutes off four minutes on four minutes

but that's not three days a week no

protocol is once a week

once a week at the most right

and the other sprints just to give you I tend to give my examples because it makes it more real but When I'm doing sprint intervals, um, I do it the 30 seconds on and then complete recovery, meaning I'm for 30 seconds I'm taking my heart rate as high as I can get it

and then I'll completely recover, which takes me two to three minutes. I just happen to do it on a treadmill, but the reality is you can do it on anything. It's a heart rate function, not an apparatus function. So, for me, on a treadmill, after I'm done warming up, you can't do it cold or you'll hurt something.

After I'm done warming up, cuz I'm a really short person, I punch the treadmill up to 11 and I am just working so hard I don't fly off the back. But that gets my heart rate up really high, about 186. Everybody's top heart rate is different.

And then I completely recover. And I do that four times.

And that's all you need.

It doesn't take that long. And you feel so good when you're done.

Yeah. So I can't run at the moments. This morning I did explosive kettle bell swings.

Why can't you run at the moment?

Uh torn hamstring and miniscus. So I can't run at the moment.

Running is in. Run clubs have come in strong. It's back in.

It's not happening.

Are you at all concerned with the fact that people are running all the time and doing resistance training less? Because running is cool like cool now. It's how people date. It's it's they're not going to nightclubs.

It's a sacrifice of other things. It's like we said about Pilates, you know, if all you do is running, then that is definitely not the best way to be. It's not the healthiest for your whole body. It's not that you're unhealthy, but we're really talking about how are we optimizing your body and your hormonal health for a variety of different goals.

But also, if we look very micro at running, 58% of runners have a ludal phase defect. That means that the second half of their menstrual cycle is not going to be able to last as long as we want it to. Likely due to what Stacy was talking about earlier, this relative energy deficiency coming back to the brain. the brain signals not as strong to keep that corpus ludium what happens after the follicle alive.

and a lot of women say I still have my period so I'm okay but if we're using our cycle as a vital sign we can actually say the ratio of energy balance is not great and it's often because we're doing it at sacrifice of other things. So, if you're doing the strength training three times a week and you're running, however, you're spacing out your other days, that's such a healthy balance. It's hard that you're going to be in a bad position with that and you'll actually improve your running more so than if you were to run every day or every other day.

Cuz if you're getting strong through full range of motion, then that feeds forward to better running economy. Then you can vary your pace without getting injured. But for people who are running every day and they're shuffling and they're getting stronger in their strong muscles and weaker in their weak muscles, then it perpetuates this.

And they're in my clinic.

Yeah.

People are very keen on doing marathons and half marathons at the moment and got a couple of friends that are doing a lot of marathons at the moment and they're very very very skinny.

Oh, welcome to my world of Texas.

Yeah. Is that healthy? I'm not even sure if that's that's the right question or one can judge from just looking but being extremely skinny in that regard being that sort of marathon runner physique

there are some that are naturally predisposed to that

right so naturally predisposed having really good running economy running biomechanics having a leaner body and this is what we were talking about the Olympics earlier where we can see the ideal body type for that particular sport and then there are those like me who build muscle naturally it's pretty easy so I'd never be a skinny little runner and my running economy is a little bit off because of where I build muscle versus not.

So, not everyone is meant to be a long-distance runner and there are some that are meant to be long-distance runners. So, if we're talking about your friends who are like super skinny, are they e economically viable for being a long-distance runner? Possibly. But we also have to look are they male or female? What is their injury rate? What is their fueling?

And then for me, I'd want to see the dexas of the women that are just training long distance and super skinny because most of the time we see a higher visceral fat in um in and around the organs as we're talking about. Even though on the outside look super lean, but they have a really high percentage of visceral fat because of the inflammation, the low energy intake and most likely estradile suppression.

And that's the skinny fat thing you you talked earlier. Is is there an evolutionary lens on this? I always think about this when we're having these conversations like what what used to happen thousands of years ago.

If we talk about the evolutionary biological theories and there are a lot of sociologists that will counter what I'm getting ready to say, so I'll apologize in advance. We look at original huntergatherer type communities. The male body was designed to go out to find the calories. The women body was designed to stay and take care of the offspring and make sure that home was set. If it was low calorie, menstrual cycle would stop because you didn't want to reproduce in a time of low calories. Body fat would come on because there weren't a lot of calories.

And so the equival now is that I'm not eating enough or I'm burning more than I'm consuming.

Exactly.

So I'm in a calorie deficit in some way.

Exactly. In an energy deficit. So with the male body and we see this their brain and hypothalamus is not as sensitive to those nutrient deficits as much as a woman's body because we have menstrual cycle and menstrual cycle function. A man will lean up and get more cognitively focused in times of low calorie intake. So this is what we see with fasting data and we see with restrictive diets

and that was we need to bring it back to that biological lens. low calorie, I have to go find the calories. I have to be fit to go find the calories. Low calories, I need to not have to eat as much. So, I need to store fat and I can't have a baby because we don't have enough calories.

And then stress,

when we add modern stress onto that, that's a comprehensive addition of cortisol and addition of inflammation and that also perpetuates body fat.

I mean, like stress 10,000 years ago would have been like a lion.

Oh, yeah. It's a lionic, right? We had stress and that this is a natural stress response. We have to have them to survive. But these were episodic,

right, stresses. Well, and your hormones would change for a very specific purpose that you would then go do. Your body would free up glucose from your liver. You're getting it ready in your bloodstream so you can go run from the lion and then things would shift back to normal. And what's happening with chronic stress is you're getting all the hormone shifts because your body's really getting ready for the lion except it's just that bad meeting you had and then you're just sitting there longer and you're not using that glucose up. Exactly. Exactly.

Are women increasingly overtraining?

I think the problem in this country is not maybe in the women who are really intentional maybe there are some that are overex exercising but if we look at a population nobody is exercising enough. Exactly.

I mean, I would take People ask me all the time, "Tell me the first thing people need to do." I'm like, "I'll take anything."

I mean, I'll take getting off the couch with any method, whatever makes you happy.

I'll say, get off the couch and do 10 air squats. Thank you.

That's enough. Yeah, that's enough.

Resistance train.

So, so in the crowd that's like, I'm going to invest in my health every day. That is not the majority of people.

Yeah, that's my bubble. Yeah, but who the people who listen to your show might be a different demographic we have to acknowledge, right, than population of America. I mean like a lot of people who listen to your show, Stephen, are interested in health and their body and achieving certain goals.

And so certainly, you know, I have practiced fertility in North Carolina and in Austin and I see a completely different patient population, you know, in Austin, Texas, which is a very fit area. PE women are constantly overtraining. But to Stacy's point earlier about this maybe evolutionary what happens women go into this hypothalamic dysfunction even before it's what we call like amenora. Hypothamic amenorhea is essentially where the brain where the hypothalamus is shuts off says can't reproduce right now. XYZ reason no FSH and LH are coming out. You're not ovulating. You're not making estrogen. You're not going to get pregnant.

So you're more likely to survive.

Yeah. It's a survival mechanism.

Pregnancy is dangerous as in in hunter gatherers,

but there's state modern medicine acts like you're perfect or it's turned off. And the reality is there's all these shades of gray in between where these different chronic stressors and your insulin resistance and your inflammation and you're overex exercising and you're under fueling come in and make it so the hypothalamus is not responding correctly. And that's what we're trying to get people to intervene there before it gets too bad.

And I see a large number of women who do fall into that zone where they are trying their hardest to be healthy, but what they are choosing to do is actually having a negative impact on their hormonal health and how their brain is interpreting their hormones. And you it's very rare to see that in a man. Meaning the number one reason why I will see low testosterone is purely because many men are taking testosterone or because of other exogenous factors like marijuana use. It is very rarely my brain is not sending out the signals to cause my testicles to make testosterone.

I like to frame it where women are under recovering not overtraining.

So if we're under recovery then it makes it more acceptable to fuel and I always want to bring it back to it doesn't matter like because I come from high performance I'm going to use those words where it's like you're not recovering enough. We want to focus on recovery on these days. We want to make sure that you're eating and fueling around. So, it's never overtraining. It's always under the balance is wrong. They're not.

So, what do you say to all the voices on social media that are just yelling at mostly women and telling them it's just a matter of willpower and you don't have the body composition you deserve.

Well, you swipe left and don't talk to those people.

But that's me, right? But I mean, I'm talking to the woman in Ohio who's feeling defeated and stumbles across someone screaming at her on the internet that her body composition that she's not happy with is her fault.

I hate that because it's a construct of society, right? Especially western society. This is where we have to educate. It's not your fault. These are the things that have come into play and lined up to create this situation. But now we have tools to offer you to take one step out of that situation and let's see how many more steps we can get you away from the situation to improve your health.

And are the rules of exercise slightly different once you've entered permenopause?

So, this is where we really need to look at how we can use exercise and some environmental stress to create a really strong adaptive stress and a really strong recovery stress.

Stacey, can you explain adaptive stress? Because I'm thinking of the 10,000 people who follow me who will be like, "You have no idea what adaptive stress is."

So, if I go and I uh do some resistance training, some heavy lifting, I want to create a stress on my body that's going to then have a signaling cascade to repair the muscle in a stronger way than when I first

lifting the muscle damages the muscle.

Yes. And it creates a series of feedback mechanisms that make it repair stronger than when you first went in. So, that's an adaptive stress. And we're looking at what levels of stress we can put. So it's a training stress or what levels of stress we can use through exercise to really really create an environment that improves our health. Okay.

So if we talk about sprint interval training, the 30 seconds on and the two to three minute recovery, the reason why we want that super high-end stress of our heart rate is it then creates a eventual epigenetic change. So, it's that environment that's going to create a change within the muscle that's going to allow that glute 4 protein that I mentioned earlier to open up and have glucose come in, reducing insulin resistance.

Also, with that really high high heart rate, we're having a lot of stress on the muscle that's going to release some myioines, which are little hormone signals that then will go to the liver and say, "Wait a second, we don't need to store visceral fat. we need to create non-estrified fatty acids which can then go into our skeletal muscle to be used in the mitochondria as fuel. So we want to have the stress that's strong enough to create these cascades of feedback mechanisms to improve our overall health.

If we stay in that moderate intensity zone, we aren't creating a strong enough stress to create that signaling.

What are we doing?

We are exacerbating inflammation. we're exacerbating cortisol. Now, cortisol isn't the demon, but when we have an elevation of it, and especially in pmenopause, when we're sympathetically driven and we already have a higher level of baseline cortisol, if we are continuously in this moderate intensity zone, we never get a signal to allow that to drop.

So if we're looking at polarizing which is top top end and low recovery end then with the top end we get the signal cascade of improving body comproving uh insulin sensitivity as well as getting growth hormone and testosterone responses which then feed back to drop cortisol.

So am I right in thinking the solution if I'm permenopausal is to do highintensity interval training for short periods of time. So, we look at the quality of the training, not the volume of the training. So, if we're in our reproductive years, then yes, you can do the moderate intensity stuff because you have estrogen and some of our other hormone feedback signals that are going to drop cortisol. It's going to allow your body to recover and repair.

And when you what makes quality training? What is quality training?

So, this is your polar. So, you have a very specific session that you're going to do.

So, for Vonda, it's your 30 seconds on as hard as possible, 2 to 3 minutes recovery. You do that four times. That's your session.

Okay. I'm going to try and summarize this. See if this is a test. See if I understood all of this stuff. So, if I do a lot of volume, but I I play in that sort of medium intensity range, I'm basically just like stressing out my body in all the worst ways.

Exactly.

Like the inflammation, it's just not good for my body necessarily. If I don't do vigorous enough exercise, then that's also bad because nothing's going to break and therefore build. it's nothing's going to adapt, nothing's going to grow.

If I do it for long periods of time, really anything for long periods of time, that's also stress. But the key thing to do is to do shorter, higher intensity exercise that will cause my body to adapt, but won't put it into that inflamed stressful state.

And you also have to pepper in some lower intensity work. So this is your flexibility.

Mhm. so that you have recovery, you're getting u blood flow circulating, you're tapping into some mitochondrial work so that you are still getting benefit of exercise but it's not in that modern intensity. So that's what we mean by polarizing.

So if we were to talk in like the zones talk that everyone talks is out there, right? We're looking at

what is zones?

So if we're talking about heart rate and the way that your body works, we have zone one, which is just sitting around, you know, like you're Yeah,

we're in zone one. in in zone.

Zone two is the bro science kind of thing where you're like, let's let's work in this zone two area where we're working.

I was in zone two when you were talking about menstrual cycle.

Okay, there you go. That's it. A little elevated.

Your heart rate's elevating. Still a little bit have a conversation. Um, for women, it's good for recovery, stress release. For men, it's good to improve metabolic flexibility. When we're looking at zone 3, four, that's the area you want to stay out of unless you're specifically training for something that requires you to be there. So that would be your half marathons, your endurance races, that kind of stuff.

Everyone wants to stay out of zone 3, four, during cuz that's the medium range, right?

Yeah, that's medium range.

So you want to jump into zone five, hang around for

five, six. Yeah.

Okay. A couple of minutes and then get out of there.

Yeah. But in a week, this is what

Yeah, let's be clear. So, two to four days a week, you should be lifting progressively to lift heavy, meaning um heavier weights, fewer reps, right? One compound lift a day, plus the augmentive lifts that go behind it, right? So, you're warming up first, then you're going to do one lift, and then you're going to do your jumping or your balance work.

The other days of the week you will do preferably low intensity doing anything. Walking briskly down the New York street could count as that. It's it's continuous motion. And then a couple days a week add in your sprint intervals, your really high zone five six high intensity.

And then when you've got that, you can add in your 4x4 V2 max on one of the other days because it sounds like a lot, but when I work with non-pro alathletes, I layer on behaviors.

Absolutely.

Because if I say all of this at once, nobody's going to do anything.

I always describe it as we have these pillars, right? First, we have to nail sleep. Doesn't matter who you are, you have to because you cannot

sleep is non-negotiable.

Yeah. We cannot invoke any kind of metabolic or body composition change without adequate sleep. Also improves stress resilience. Then we look at nutrition and physical activity. The behaviors that go with both of those are somewhat independent. You have some people that are more motivated to do physical activity and some people who are more motivated to change nutritional habits. Most of the time they're two different personalities. So we have to look at what comes next.

And then we also have which isn't lesser importance but often neglected is the mindfulness and community. So this is being out in nature. It's connecting with friends. Might be going to a group exercise class. It might be just having coffee but that is really really important for parasympathetic and whole like whole being response. Exactly.

So there's a new book out um coming out called Joycepan. I don't know if you've spoken with her. So she's a gerontologist and works with the very elderly and she has a very specific,

you know, what determines who's going to kill it in that last decade of life. And that community part using your brain, you know, having interactions with human beings seems to be the key. And if you don't keep that going through this 40s, 50s, 60s, when you get to 70 and 80, you're not going to have a great end of your life.

What about the last phase then? So someone's post menopausal, does their exercise recommendations change at all?

We like to start the habits early and continue them through. If you haven't started, it's not too late. As we're seeing like with Lyftmore and some other of the older age resources coming out, it's never too late to start. We just have to be very careful of how you start to have support and phase you into these different exercise mo modalities.

Is it the same exercises though? meaning you know the three days a week the mobility the strength

I am firmly postmenopausal and I am doing all these things

but it's different different people always ask me what does heavy lifting mean

right it's relative

it's relative my heavy is not going to be Stacy's heavy or I should say it the other way Stacy's very heavy is not going to be my heavy

in lift more they just the authors describe the one the one rep max and so one rep max is like safely what is the heaviest you can do one rep, you know. So, for a bicep curl, what is the heaviest weight I can do one to fail? You know, I'm going to fail after this one. And for me, that was about 20 pounds

with good form.

Exactly. Safely with good form. And so, I could nail 20. And so, then they took them down to about 70 80% of that. Um, which for me was about 15 16 pounds. So, that you can usually do about five reps before you hit failure. And that is what they consider lifting heavy. That seemed to really resonate with my followers to understand what that meant.

And there's so many women that underestimate their strength.

See them and they gravitate towards the 10 lb dumbbells. It's like, put that away. Go to the next one. Do a couple of lifts with that. And then ideally, I want you to put that away and pick up the next one cuz that's going to challenge you. Because women have been so conditioned to do 10 to 15 reps to get quote toned and not really put in the work they need to to build muscle and to get the benefit out of strength training.

And I always telling women, you're underestimating yourself in so many facets. Don't cheat yourself with the strength training as well because people have to remember what we're what we're training for now. It's different than I had a woman recently say, "I was taught to do biceps curls five pounds 30 times." Well, after 30 times, not only are you bored, but you'll probably be at failure 30 times.

That will build endurance. I am training to be as strong as possible. And when I'm a when I have strength down, then I start playing with tempo so that I could build replace some of the explosive muscle fibers that I'm going to lose over time.

And in terms of supplements generally, do you know, again, not to bring Melon to this for the thousandth time today, but a couple of um couple of Christmases ago, I told her that she should be having creatine because I all these people on my podcast told me it and she said, "No, it's for bodybuilders."

Yeah, that's the old school thought. When we're thinking about creatine and how it got its chops in the supplement world, we're looking at muscle performance and taking five grams four times a day with some carbohydrate to enhance muscle performance is how it started. But when you start really disseminating down into the health aspects of creatine, creatine is used in every fast energetic of the body. So that means your brain, your heart, your gut, muscle, everything that requires energy from 0 to 30 seconds, creatine is involved.

Women have about 70 80% of the stores of men. And when we start looking at all the different types of diets that are out there, lots of exclusionary food diets, then the intake of creatine is lower. What we're finding in the research from health perspective is that it does so many positive things when you're able to saturate the tissues to bring it up with even a small dose of 3 to five grams a day. Our liver makes about three, but we don't necessarily eat enough to help supplement all of the tissues.

How much would it take? Like 12 chicken breasts or something?

22.

Okay.

22 chicken breast. A lot. So when we look at the supplementation and being able to saturate all of our tissues thoroughly to support those fast energetics, we see things like better cognition focus. We see a faster recovery from small brain traumatic like a friend's daughter hit her head on the um the laundry door of the dryer and got a TBI or a small concussion from that, started using creatine, came out of it a lot faster. I mean, there are things that help with brain metatasm.

We see women who have incidences with IBS or gut issues and they're using creatine. It helps decrease the symptomology. We're seeing now studies coming out about fatigue. And this is where the 38 g per kilogram of body weight or the equivalent of 20 gram if you're 60 kilos helps with fatigue and focus. Especially if you're under a lot of high stress.

Because if you're under a lot of high stress, your body's going through a lot of blood glucose trying to keep up with that stress. So creatine isn't just the bodybuilding set. There's so many different health benefits and it keeps coming out with more and more research to show how beneficial creatine is.

Could you give me the menopause supplements, if there is such a

Okay, so in general, um, we're not going to cure menopause with supplements. Let me just take straight up. Okay. Most women are going to be deficient in fiber and most women are going to be deficient in vitamin D. And vitamin D is hugely important in multiple enzyatic processes in our body. And it's really hard to get enough through our nutrition, even eating stacks of salmon a day, which is really high in vitamin D.

So about 80% of my patients are not only just low in vitamin D, they're deficient. So, that is one that we can supplement safely up to about 4,000 IUs international units is how vitamin D is measured a day without worries of becoming toxic or having too much vitamin D, which is possible. And so, usually I'm having creatine. Absolutely. It's like a go-to. And we're looking at her nutritional profile. We're looking at her fiber intake. And then we're adding in a fiber supplement if she needs it.

Natalie, in terms of fertility, what is the fertility supplement stack,

Percy? And first and foremost, we're going to say that if you are trying to get pregnant, which by asking fertility, we're going to presume, we want to make sure you have folic acid on board. So folic acid is the essential component, one very important part in cell division, but it's essential for a baby when it comes to brain development and spinal cord development. We call these neural tube defects.

And the reason why I'm bringing it up is that there's a lot of chatter about folic acid out there, but it is the only supplement folic acid in its folic acid form that is proven to prevent these neural tube defects such as your baby being born without a brain. And interestingly, in today's world, a lot of foods are also fortified with folic acid. But these are some foods that are often processed and people are consuming less. So we are having less consumption of folic acid in our diet. Therefore making it even more important that we are supplementing with folic acid.

As Dr. Haver said, vitamin D, vitamin D is essential for your entire body. But when it comes to hormone metabolism and fertility as well, we even see women who are going through IVF with donor eggs and we know they're very good quality, have lower success rates if they have lower vitamin D levels.

This is something that almost everybody is deficient in. We do test and then target treatment to try to get you to an optimal level. But also omega-3 fatty acids are really important in your entire body, but especially in your reproductive years if you might get pregnant. And I often recommend magnesium for most patients as well.

And then from a fertility standpoint, if you have infertility, there are studies that show that co-enzyme Q10 can be highly beneficial when it comes to egg quality. This is important in our mitochondrial health. And for the sake of the one question you asked, remember when we talked about eggs, we've got our genetic health, which is largely dependent on age. We have our metabolic health.

The mitochondria from the egg controls all development for the embryo. And in fact, the cellular functions for an embryo, the first three days of life, solely come from the egg. The male genome doesn't even kick in until day three of embryo life. So the function of the egg to be able to divide and do normal cell functions is very important.

And sometimes we see that reduced in infertility patients and co-enzyme Q10 is an easy thing we can get over the counter. Doesn't appear to have any harmful side effects and has potential benefits in some subsets. So my infertility patients I add that on.

Wonder all things aging, performance, strength, bone.

What is the supplement stack for for longevity? vitamin D, magnesium is critically important for a variety of of uh metabolic functions. Omega-3 for anti-inflammation,

creatine, I'm a big fan of. If we move looking at at uh scinesscent cell load and inflammation, we haven't really talked about longevity, but scinsesscent cells are those B those cells left over from normal function that are so damaged that they can't flip into programmed cell death. So they circulate around and produce noxious um chemicals that can lead to a variety of disease.

So we want to minimize those and one way to do it is lifestyle. Another way is to use an herb called fiseten. So I add that on and then also I do myself and check levels on my people of intracellular NAD+. NAD is a co-enzyme in 300 metabolic reactions. It's an it's an uh an energetic pathway. Now, it's very popular right now.

And the critical differentiator for me is that taking whole molecule NAD such as in IVs, our body needs to make it. So for myself and for my people, I supplement with NMN, which is the immediate precursor of NAD+ so that my body can then turn it into NAD+ and it can work intracellularly.

It can also be delivered two reactions out uh in the form of NR. These are in the B vitamin categories. So that in two reactions your body makes NAD+. So the data does not show that you can IV NAD+ for ac efficacy cuz it works intracellularly. So you supplement its precursor.

I've heard so many people talking about NMN recently.

Yes, that's right. That's what I'm talking about.

Is there clinical evidence to show that it's effective? So you know those the lab that I work with uh I happen to know the scientist and he has hundreds of thousands of data points checking before NAD+ levels intracellularly supplementing and then after and he can elevate those levels

and it's associated with longevity like intrinsically associated with longevity a lot of the the the bro science I guess longevity

well it's intrinsic intrinsically related to lots of normal metabolic function and uh energy in the body. Whether or not it makes you live longer, I don't have that data.

Is it a tablet?

It is a powder the way I take it.

What about collagen? People talk a lot about collagen. It's in all the protein powders now.

I know, but it's not a protein as we think about it. Like you'll see all these collagen protein. It doesn't count as dietary protein for muscle development.

Does it work as a supplement?

There depends on what you're looking for.

Yeah, exactly. and Mike Orsby out of of um University of Southern Florida, he has been doing quite a bit of research on collagen and joint pain um and found that there is some efficacy in taking the type 2 collagen to reduce joint pain. It doesn't help with cartilage regeneration. It doesn't help with osteoarthritis, but it does dampen inflammation and joint pain. So again, it depends on what you want to use it for.

In the first episode, we talked a little bit about environmental toxins and I wanted to before we talk about sleep and close off, I wanted to just mention environmental toxins and the role they play. The term microplastics has been very very popular of late. When we talk about environmental toxins, are we talking about microplastics in the air and maybe the water? What do we mean?

Essentially, it's anything in our world that is impacting your body and how it functions. There's a few different types, right? So, we have endocrine disrupting chemicals. These are actual toxins in the environment, in cosmetics, cosmetics, our kitchen, our food that change how our endocrine system works, our hormones.

There's also things like microplastics like you mentioned, which are actually going to deposit in our body and can cause fibrosis even in our ovaries, therefore changing how an organ's able to respond even if it is given normal hormone signals. And then I also lump into this category behavioral toxins, right? things like alcohol, marijuana, cigarettes, the the choices that are toxic in our world as well. So that toxins is kind of a large category.

There are some toxins you can control. You can try to filter your water. You can learn what is in your water so that you can say at the, you know, EWG, this is my zip code. This is what's in my tap water. What type of filter might I need to try to have healthier drinking water in my home? You can change what you're cooking with, not using non-stick cookware or teflon. you can get rid of plastics and especially what you're putting hot foods and beverages in because the heat is allowing those toxins to leak into those things.

And then as Dr. Haber said, our cosmetics, things that you use every single day that you put in and on your body are things that you're having a higher exposure to. And it's really important to decrease those because things like air quality, you might not have as much control over based on where you live.

And there's so many toxins in our world in general that it's unrealistic to say, "Let's avoid all of them." And because of this, we have that same mentality that we see with exercise sometimes. Well, it's just there's too many. I can't avoid them all. So, I will ignore this category because it's easier to just do nothing instead of making active decisions to start to live a less toxic life.

What changes have you made to remove pollutants and environmental toxins from your lives? Because we're in that fertility journey. I remember I came home in one day and like all my shampoo and stuff had gone.

Yeah. So my nice stuff is

starting to look through your products and get getting rid of things that have endocrine disruptors in them. You want to look the kitchen is probably the greatest source of exposure for most people. So there's really no need to have any plastics in your kitchen. So getting rid of them. But many people don't think about when you do have processed foods. The wrapping, the container, anything that's coming packaged likely has toxins in it.

When you order Door Dash and it comes and you have it in a container, that's often hot food in a container that is leeching chemicals into it. So, a simple thing is take it out of that right away, even if you're not eating it. Put it into something glass or a different type of container. So, you can try to minimize that exposure.

Thinking about hot beverages, things that go in the microwave or the dishwasher, especially, but then other things like thermal receipts. So, getting receipts, uh, thermal receipts have BPA in them. So, getting receipts or

receipts. Yeah. So the airline tickets or that thermal paper. So just the receipt from the grocery store when they say, "Stephen, do you want your receipt?" You can just say, "No." And then if you work with thermal paper, maybe you're a cashier and you touch it over and over. I highly recommend you wear gloves because your exposure to that thermal paper is so much higher that it can become problematic for you.

Does it really make a difference if I take the receipt or not? You know, there's a lot of things where you can do that say that person touched receipts all day and they still got pregnant or their sperm was great or they lived a long time. We can list a whole lot of negative behaviors or habits or exposures that one person might tolerate just fine. And for somebody else, the sum of all of these behaviors add up to be something that puts them in a place that is very pro-inflammatory, not healthy for the now or for the future.

That to me is an easy dec on the scale of decisions that are hard or that are easy. Trying to change the things that you're exposed to in your world. You have to spend some time to learn about it. You might have to buy some new things. But over time, those decisions are ultimately easier than how you eat, your exercise. Those those take longer commitment.

And especially if you're partnered, if you live with somebody, then the foods that you eat, your sleeping habits depend on them. You both have to be together on this. So sometimes I always say toxins are to one place a thing you can do. You can look at your products. You can start to when they run out say is this one healthy for me? Should I get something that's going to have less of an impact?

That one time of using very scented hand wash is no big deal. But when you wash your hands with that highly scented hand wash five times a day over and over, it is just an avenue of endocrine disruption that can add up to the litany of the other ones that you're experiencing. So we're all saying these little changes on one hand singularly probably do not matter much, but together they do.

And there's a link between environmental toxins and menopause or early menopause.

Early menopause, we think so. So, you know, you were born with a shelf life, a genetically predisposition shelf life on the ovary. Okay? And we don't know a lot of things to extend that shelf life cuz we have a certain number of eggs. But there are a lot of things we can do to speed that process up.

So, that's going to be smoking. Women who smoke cigarettes or, you know, um even we're looking at vaping now because it's a newer thing, but definitely tobacco consumption, you know, in the form of smoking. We see earlier menopause.

um the so there was this incredible study where they looked at women who were sexually abused who then had children who were sexually abused went through menopause I think nine years sooner so and it's the only study that looked at this and it happened to be the stress they looked at was sexual abuse in the mother and the child and so they went through menopause nine years sooner so there is a component of emotional stress and long-term chronic emotional stress

it does cause chronic inflam- And the ovaries are highly sensitive to chronic inflammation. We know that BPA exposure has shown that if you have a higher level of BPA exposure, you have lower ovarian reserve, meaning less eggs in your ovary will go into menopause earlier. And

what is BPA?

BPA is one of those environmental chemicals that we're exposed to to largely through plastics, but it's also one that's in the thermal receipt paper that we're trying to avoid our exposure to. And that's where some of the data even when it comes back to food where soy intaking soy products can actually be very protective because it combats BPA.

So how it works. So when people say, "Oh, you shouldn't have tofu. You're a man. Soy is so bad for you." That's actually false. And we found that people who had greater exposure to soy products actually had the lowest level of BPA and improved reproductive performance because of that. So there's definitely correlation with these toxins in our world and we might say, "Oh, is it linked to menopause? Maybe nobody's done that exact study, but it absolutely is.

If you have lower eggs at an earlier time period, that's going to give you an earlier menopause going." You know, the flip side of fertility is menopause. So,

and lastly, I wanted to talk about sleep.

Well, it's all of our favorites and we're doing it last.

So, yeah, Vonda, I've heard you refer to sleep as the pillar of everything. Mhm.

And I say that because we think sleep is just passing out like we're not conscious. Well, that may be true from a from a uh our viewpoint, but it is the most regenerative period in our day. Actually, the brain is processing information, getting rid of toxins. The body is able to uh settle and again get rid of toxins. But many women in midlife have completely disrupted sleep because estrogen is critical.

Yes, 80% very high. Um, estrogen is critical for uh sleep patterns. Um, many women wake up at 3:37 or thereabouts either with a plummeting blood sugar or that seems to be around the time in the middle of the night that the sleep disruption has. So this broken up sleep, if you don't do it, then all the lifestyle things Stacy and the rest of us have been talking about are nearly impossible to do if you're underreovered.

And so I have made after nearly 11 years of not sleeping because of training and child a religion almost like I am dedicated to this function. I do not eat 3 hours before I go to sleep. Uh, it's one of the primary reasons that I made the decision to stop drinking alcohol because that completely disrupted my sleep. And I am more conscious of circadian rhythm than I've ever been in my life. Meaning I go to bed when I'm except except probably when I'm traveling, but at the exact same time every night, but more importantly get up at the exact same time every day to start my circadian uh day. um and to start my adenazine usage so that by 9:30 at night I'm ready to rest. It's that important.

A woman's guide to a aging with power. Unbreakable.

Yes. Unbreakable. And central to that is circadian rhythms and sleep,

right?

Yeah. It is because the premise of this book is that uh women are already winning the longevity race but we suffer longer and we have this vision of women aging which is usually a vision of frailty. But through the mindset changes through the behavior such as sleep and lifting and considering hormones we can age in a different way. So I'm trying to re-educate the world that a woman's destiny is not frailty. A woman can age powerfully but not if we sit around and wait for time to make us its victim. We must be proactive.

And sleep is one component of that. This should be the very first thing you do. Sleep sets the stage for your entire day. It's really that foundation of your health. If you are going to start the day in a sleep deficit, you're starting out stressed, inflamed, insulin resistant. There's going to be no behaviors you can do during the day that are going to overcome the deficit.

And we know that women who get less sleep, they take longer to get pregnant. They have higher rates of infertility. We know that men who get less sleep have lower sperm parameters and lower testosterone levels. So if we are saying you Stephen, you know, what's one thing you might be able to do? Well, are you sleeping well? That's one of the first things you can start to do to say, am I getting 7 to N hours of good quality sleep?

That's not just time in bed because Mary Cla has her phone on her. That is actual sleeping time. And that makes a huge difference in trying to achieve, you know, a hormonal health, which is really what we're all saying here is how do we get our body in the best quote unquote balance that we can, which means working with the different building blocks of our body in the most optimal way for as long as possible to be healthy.

And even if we're not looking from a fertility standpoint, you can't invoke any kind of metabolic or body composition change without adequate sleep. So that's what I mean. It's like when we're talking about the pillars and sleep being one of the first things we have to work on, you can't invoke any kind of change with

we're not talking about ambient induced sleep. No, medication induced sleep doesn't count.

This is not medication induced sleep. There's a huge percentage of patients out there who are addicted to these medications and it has become the only way that they can sleep.

I've been really shocked at several of the women in my life that are between the ages of I'm going to say 35. Yeah. 35 and 45 who have like three to four hours sleep and they appear to be perfectly fine.

They are not. They are not. Their cells are not fine, Stephen.

No.

Cuz obviously cuz I do this a lot. I I learned from all these scientists. But there's one partic there there's two particular women that I'm very close to that I actually work with in different capacities who showed me their Whoop data and would often tell me they would say I get three hours four hours sleep. And I thought there's no way because she did a 5K this morning at 6:00 a.m. So there's no way she's getting three to four hours sleep. to put a sleep tracker on her and she was getting 3 to 4 hours sleep and her restorative sleep is like 45 minutes

but she's springing into the makeup chair next to me and she's all she's got all the energy I'm thinking what the hell is going on

youth

but I'm younger than her

yeah I mean when I was in training I was getting 3 to 5 hours and getting up and operating but I cannot do that now

if I got 3 to four hours I was good for the day

how

because I was 20 years 25 years younger

I think we all got through like I was telling some of my earlier years

breastfeeding mother is getting 3 to four hours you know that is part of the wow we're built we can function but age will take that resilience away from us

because permenopause causes sleep fluctuations as well that because of the change in hormones right

exactly

and are women just assuming that's normal and rolling with it or is it okay

I think we have more at public education about how important sleep is and and the number of hours you need and the quality of the sleep. So, I think years ago it was their normal and I'm just going to keep going, but now they're coming in saying, "This is a problem."

Yep.

I need help.

And I would be interested to see your glucose monitor.

When you first used it, because that's how we can kind of navigate sleep, too, is showing hypoglycemic effects for women who are exercising in pmenopause and not eating enough. Melatonin is that a solution?

No,

it can be a tool in the toolkit. Most of the time, you know, most people are taking too high a dose of melatonin, which is actually doing more harm than good.

What harm is it doing?

Well, it's actually shutting off part of the brain to be able to help control their circadian rhythm and then they're completely dependent upon it. And it's such an artificial induction, it's going to w wear out of their system. So your melatonin is supposed to rise, help you go to sleep, and then it falls at a rate for when you're going to wake up so that when it's lower, you're going to wake up and your cortisol will naturally rise.

Melatonin can be helpful in very low doses,

like three. Most people are taking 5 to 10.

10. Yeah.

Yeah. So I often recommend, you know, the patients take maybe like a milligram, but you have to buy a children's melatonin very often for that dose of it because people are taking these huge huge amounts over the counter. You can just get so much.

And so what you want to make sure is that if you're using it, you're going to take melatonin at a time where you're going to be able to go to sleep about 30 minutes afterward, too. Because people are also using melatonin and then not allowing themselves the restful moment when it's trying to kick in and then they're taking more or they're staying up later and they're suppressing their brain's ability to make their own melatonin.

One of the questions we had from the audience was from a young girl that said, a young woman that said, "I'm 24 years old and I struggle so much to fall asleep. How can I fix my sleeping naturally if I have disturbed set circadian rhythm and especially during my menration my sleeping pattern seems to get worse.

This one would be interesting to see like what is her daily like what are her daily habits if we can kind of bring calorie intake and all those things back into the day so she's not phase shifting and then use things like eltheanine which is a a nonproin amino acid that works the GABA right trying to bring parasympathetic activation back and making calm down

yeah and seeing what is what are your sleep hygiene habits is your phone out of your room do you have um like a cool bedroom. Do you have earplugs to block out some of the extraneous noises that might partner doing?

Yeah, sleep sleep is really a lifestyle problem for most people, isn't it?

But magnesium can be advantageous as well, especially if you're on your menstrual cycle and you're having menstrual related sleep. So, I think that's an important thing.

Well, it's just many women run low in magnesium, especially when your hormones are very low, especially when your estrogen and progesterone low, you're having, you know, contractility of your uterus, when you're having menstrual cramps. Magnesium can help counter some of that and can also help you, if you're taking it at night, get into a more restful pattern.

So, um I've been working with a sleep medicine specialist um and one of the things she points out which I now discuss with my patients is listen if we're women wake up in menopause from hot flashes from from night sweats and then the the relaxation we get from progesterone is gone so we can add that back in. So say we we've done all the things we've given her a touch of melatonin we've put her on hormones she is still waking up at 3 in the morning consistently. Mhm.

She deserves a workup for sleep apnea because women disease differently than men. And men with sleep apnnea, it's a very common presentation of snoring. They're waking up the partner, you know, all these things. Women are much quieter about it. They still have the pallet that falls back and the relaxation. And that's hormonally driven for a lot of women.

And so they're becoming hypoxic in the middle of the night from you know that's one of those side effects of of having sleep apnea is you stop breathing and you lo your oxygen levels decline you become hypoxic but we are not recognizing it in women more than 50% of women are going undiagnosed and are living shorter lives having more Alzheimer's because of this. So if I have a patient coming in and we've done everything and she is still consistently getting up I'm sending her for a sleep apnea evaluation.

M I've also been reading literature on on um CBT, so insomnia CBT that they've done with a lot of veterans and shift workers and that seems really interesting

to help them fall back.

Yes. To break the pattern because your body and your brain learn that wake up pattern. So if you can reset it, then that's very helpful as well.

What is the most important thing we should have talked about that we didn't talk about? Dr. All right.

I think we covered an amazing array of information, but what I want women to walk away from this is with there's that there's a hope for feeling like themselves again.

Yeah. and that they are worth investigating to the ends of the earth to find the answers they need and not simply giving up the first time somebody says no to them or doesn't hear them when they say that they don't feel like themselves. They must continue to pursue it. And number three, that they are worth the work that it takes to age with power.

Beautifully said, Octavia,

you really kn do need to be the CEO of your own healthcare. Um, we have a medical system that was not built to serve the aging woman. Um, after reproduction ends, it's just we become small men with rust and uteruses to quote Dr. Sims.

And you, it's okay to educate yourself. It's okay to read the books. It's okay to go in educated with checklists and you're going to probably have to do that and to go find someone who's educated in the health of women after reproduction ends. And that could be your internist. It could be family medicine. But like there's no no one owns menopause life after reproduction ends. You know, no specialty really owns it.

And so you are going to have to quarterback this a lot of it yourself until you find the right partner in this care. But it is worth it.

Beautifully said as well. Yeah, I think when it comes to your health journey, nobody is really responsible for it except you. But there's this idea that we should wait until things are wrong to then go get them fixed. And what we are all trying to do across the spectrum of you know women's health and their lifespan is to say many of these things if we start focusing on them much earlier and take a preventive approach which is often against some of these recommendations about when you should screen or when you should do testing.

But if we say, well, what is best for you as an individual? Focus on setting up a life that is going to help prevent some of these diseased outcomes. Start testing things earlier. You're going to be in a position of power to make the decisions that are right for you from a place of education and not be left making them out of fear or misinformation or not knowing.

because when it women will go through these stages. Time will make your fertility decisions for you if you do not. that that's a fact that your ovaries will stop functioning. You will go into menopause. So, we need to both prepare for our reproductive years, optimize our fertility the best we can if that's a life goal for us, but to realize that it doesn't stop there. That you're have to prepare for the next stage of the journey and what that's going to look like for you.

But the steps to take care of yourself start well before if you're able to. I look at the the research and the health outcomes right now for women and it is a very confusing space. So I always preface with the fact that I want women to be empowered and how do you do that? You can't Google things and find out. So it's asking questions. It's sharing information. Most of all taking up the space because you've earned it.

I get so tired of the rhetoric that women should be small and demure and be like a delicate flower and things are happening to them that they can't control. I want the narrative to shift. I want people to say I own the space. I'm taking up the space and it's my I don't like to use the word right because it invokes a lot of angst. But it is your ability to understand your own body and advocate for yourself that's going to allow you to take up that space and get the answers that you want.

I've been advocating for so many women, myself included, and the push back that you get from the medical society is real. It's not that they necessarily are trying to gaslight you, but it's just a product of the system. So, you do have to push those boundaries. You do have to ask those hard questions. You do have to go in prepared to have that push back, but take that space because everybody deserves a place at the table and women's healthcare is being shunted in a way right now that is really unacceptable and we need to have ground swell movement to push back.

Thank you all so much.

Thank you.

I really mean that. I I'm thanking you on behalf of the many millions of people that are probably listening to to this conversation um because you know your conversations on this show have delivered more than 30 million downloads between you so across YouTube and across audio. I was looking at the numbers and it's staggering and you think about the impact of reaching potentially 30 million people just on this show in long form and then their friends and then their family and then the advice that they give to everybody they know and that domino effect is causing this wonderful ripple across the planet.

and it's turning the lights on in different households and within families and amongst business owners like myself so that we can all cater to the the plight I guess of women's health in a more effective way cuz you know even as a man I've learned oh god so much from you for

and the impact it's had on my life through improving how I show up for the women in my life but also the the way that I'm able to respond and support my partner, my sister, my mother in difficult times has been profound and I think some you know and well done to all the men that have listened to this conversation and have gotten to this stage because I know you don't kind of you often don't think it's a problem that you're going to deal with

but when 51% or 52% of the planet are women is going to be a huge part of your life whether as a as you having daughters or sisters or or mothers and through all of the work that you've done I've been able to understand the women in my life better and actually that's protected my relationships and if it's protected my relationships it's protecting me and um I've really noticed that I've noticed how I've changed especially through understanding the menstrual cycle um how I treat treat my partner.

but but it's you four you are like the avengers of what you do. You're the you're the very best in your industries and um

I highly recommend everybody goes and checks out. I'm going to link all of your books below. Uh Unbreakable, the fertility formula, the new menopause. I believe you've got a new book on the way menopause.

The new permenopause. I'll link that as well if it's available for pre-order and raw, but also just your you'll make content, have Instagram pages, and have websites. So, all of that will be linked in the description below. And if you want to go deeper on these subjects that we've talked about today, then those are the doorways into a a deeper understanding. I appreciate you all so so much.

We've been for what 9 hours now and uh I'm sure it's a lot of people. So thank you.