Episode 435: Dr. Stacy Sims: Workout Like a Woman Not a "Little Man" + How To Train Based on Hormones

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Dr. Stacey Sims, I want you to know that I've been a fan of your work for, I just said this earlier, but for years, because I saw your TED Talk on basically how women are not these little men.
And, you know, the fact that you've been out there, like you said, talking about women and how women are not like men and they shouldn't be training like men and blah, blah. I want you to kind of talk from your words, like what you do and why it's so important.
Yeah. So I started as an athlete and an academic and an academic in sports science and nutrition.
And all the things that we are learning in class didn't really apply to me as an athlete or my teammates. So that really started the question of what are we doing? And as you started digging in, realizing that there really wasn't very much research on women.
And even when you're looking at the textbooks and textbook pictures of representation, they're all male, male bodies. So that was so many decades ago.
And ever since then, I've been really trying to dig into both research and the application of research to get women to understand that their bodies are different. We have different physiology from birth.
We have hormone fluctuations, and these affect every system of the body. And we respond to training differently than men.
We respond to stress differently than men. And the more we dig into it, the more we realize there's a lot of research to be done.
So the research that we do have, I'm really adamant about getting it out so women can be empowered to understand what is going on. Because face it, we put as much work into our training and we take time out of our day to really work on our health and well-being.
So it should be appropriate for us. We shouldn't be fighting the battle against our own bodies because of protocols based on male data.
So that's my mission across the lifespan is to get women from puberty all the way through postmenopause up to speed about what their bodies are doing and how they can modify or alter what they're doing to get the best benefits. Right.
Because, you know, I think a lot of times a woman and a man can do the same workout, eat the same food, do all the same training, and the results are very, very different. And it's frustrating.
I mean, it's frustrating for me anyway, right? Yeah. So true.
Yeah. So true.
And, you know, a lot of times I would, I would kind of, you know, people chalk it up to genetics or that men just have more muscle mass on them. Can we, can you kind of go, I mean, this is what the podcast is about, but can we talk about what you, how you see how men should train versus women and what women should be doing across the evolution of the different timelines in their life, 20, 30, 40, 50? Yeah, for sure.
I like to kind of start this conversation when we look at the sex differences that exist at birth. So that's like without our hormone fluctuations from our menstrual cycle and stuff.
So when we look at XX versus XY, because that's the primary area of research that we have, very binary, but that's all we have at the moment. If you are born XX, then you have more endurance type fibers.
So your slow twitch, your oxidative, very aerobic type fibers. And with that comes a lot of mitochondria work.
So that means your body's really able to take fatty acids and use it, use oxygen and go long and slow. When we look at XY, they're born with more of the fast twitch glycolytic power-based fibers.
So good at speed, good at quick reaction time, good at doing super high intensity work. And they have to work on developing that aerobic system.
So as we feed forward and see at the onset of puberty, what happens is there's another divergence where with the, what we call the epigenetic exposure or the situational change that happens with estrogen, progesterone, to some extent testosterone in girls, we have a change in all of our biomechanics. So our center of gravity goes from being up in the chest area, down to the hip area.
Our hips widen, our shoulder girdle widens, but we're not told about this. So we feel ungangly in our bodies.
We aren't taught how to run again, how to jump, how to swing, how to land or any of those things. They're just, well, you are at this point, you get your period.
We know girls drop out of sport, but it has to do with the fact that the actual biomechanics of the body have changed. So when we start looking at all of these trends that are out there and about doing like zone two work and improving our aerobic capacity and trying to do ketogenic diet for improving our fat burning capacity.
All that's based on male data because being born that XX, you already have all of that capacity. What we need to work on throughout our entire life is working on that power base and the fast twitch.
And I say that because we want to be able to produce power. We want to be able to run fast, to jump, to land, to have good coordination.
But more than that, when we look at longevity, and we see this is really important in peri and postmenopausal, that we keep producing lactate for brain health. Because if we keep producing lactate from that fast twitch and that higher intensity work that we've been trying to build throughout our life, we are slowing the rate and the risk for Alzheimer's and dementia.
So when we see that sex difference in Alzheimer's and dementia, it comes down to the type of muscle fibers and the metabolism that we've been exposed to throughout our life. So that's why it's like, okay, if we look from birth all the way through to the end of life, there are unique things that women need to do to keep progressing and improving their health for longevity and performance, whereas men are more of a linear because they don't have all of these changes that women have with regards to biomechanics and hormone exposure.
So of course, it makes sense that you see all this data that comes out for men and men are scribing these protocols and they're improving, that when you take that and put it into certain points within a woman's life, they're not going to respond the same way because physiologically and biomechanically, they are not the same as where that data originated from. Biomechanics is a really big one, right? Because even women who have, I'll talk about that later on, but like later on in life, but I know I saw something about how women have more ACL issues, right? And we have all, where are the other injuries and things that women are more prone to injury wise or happen to women versus men because of our biomechanics? And then also how should we train for our biomechanics? So women are more quad dominant, just the way our posture is and our center of gravity.
So this already predisposes us to change a direction injury, soft tissue injury. That's part of the reason why we see a greater predisposition in ACL injury, because we don't have the hamstring strength to counter some of those cutting motions that causes an ACL tear.
So when we're looking at that and what we need to do is we need to put that focus away from the knee and the lunge and all that quad dominant type work, put it posterior. So you're looking at developing the glutes and the hamstrings, a lot of extension work.
And we see that when women start to do that, they reduce their injury risk and they have better posture and cutting motion. And when we're looking at things like what FIFA has put out for warm-up, it's all about warming up the posterior chain and trying to get those muscles firing as a counteract to some of those cutting motions that predispose women to ligamental tears.
We also see that as we get into perimenopause, there is a definitive increase in plantar fascia issues and frozen shoulder or bursa in your shoulder. And that has to do with the changing of the tensile strength in the ligaments as well as a weakening in the muscle contraction.
So again, we're looking at what do we need to do to prevent that? We need to keep the strengthening and the faster type power-based action to create an environment that reduces injury, reduces the inflammation of the tendons, and allows better range of motion. So when we look at men who are in their 40s, rarely do we hear about a plantar fascia issue.
You look at women in their 40s, it's one of the leading issues that make them go see a physical therapist or an osteo or a chiro. It's an inherent sex difference, right? I can see you're like, you've probably experienced it.
I'm laughing, crying and laughing at the same time because I'm in my 40s. I had the frozen shoulder for two years almost.
It's finally now dissipated. And I had the plantar fasciitis.
And I didn't realize that those were two things that went with my age. I had no clue until I went down.
I thought maybe I pulled a muscle in my shoulder. And the guy was like, no, you have a frozen shoulder.
And I'm like, what the hell is that? How does someone get that? that? They're like, you're old, basically is what he said to me, right? And I never understood, like, I get the ACL because you're right. Like we are quad dominant, right? And women tend to do those lunges and those squats, but the frozen shoulder, I didn't understand.
I did not understand that. Yeah.
So frozen shoulder has to do with, we have a wider shoulder girdle because our hips have widened. But if you think about all the

metrics that we've taught to do push-ups, pull-ups, they're all in a grip strength or

a grip width that's based on male data, male physiology. Because if you go to do a pull-up

and you're a bit wider, like no, more narrow. So it puts a lot of strain where it shouldn't.

Same with push-ups.

They're trying to teach you to be really tight and use more tricep.

But our shoulders as women, we need to be wider.

So it's just that inherent that we're, and we tend to, like, when we get in our 40s, we're like, okay, yeah, I really, most of us have a challenge and we want to accomplish.

So it could be a push-up or a pull-up or we start doing more up and push-pull motions.

And even, like, lifting things overhead, groceries and all that kind of stuff, it's just the mechanics that we are not taught how to actually maximize with our wider shoulders. And you couple that with changes in our estrogen-progesterone ratio, which changes tensile strength and the actual texture kind of of our tendons and our bursa, and it just comes on.
So I'm always trying to reteach from a young age, from puberty onward, how we move in these new mechanics to reduce injury risk at the onset of puberty, but also as we get older into peri and postmenopause. So what should we be doing to offset that type of injury in the frozen shoulder?

What is a good exercise to focus on?

So a lot of it is you're dropping your traps and you're pulling back.

So you're doing a lot of rhomboid work. You're also looking at where you're placing to be able to use more of your back muscles

when you're doing a pushup.

Also back muscles when using a pull-up instead of relying on the shoulders. And the same when you go to lift something up.
Most of the time we're lifting or hitching our shoulders. If we're thinking about dropping our traps and we're using our back muscles to pick something up and then extending through the hips to lift it up, we're reducing the load in our shoulders and in that rotation, which reduces the whole onset of injury or soft tissue damage that can perpetuate injury.
And what about for ACL issues to kind of strengthen? What do you think is the best way to strengthen our posterior chain? All the glute work where you're thinking about deadlifts, you're thinking about Romanian deadlifts, you're thinking about hip or glute bridges, hip thrusts, all of those things, right? And really focusing on getting the hips strong. And a lot of other things that can perpetuate it is we have weak and tight hip flexors.
So really working on developing that hip flexor strength so we can lift the hip and the leg up and over instead of stumbling. Oh, that's good.
Right. And so, but as we get older, we talked about, you were saying like, as you're getting into perimenopause, menopause, let's stay with that.
Cause I think my audience can appreciate that. And that's something that I feel like that's become super trendy now too.
Like I don't remember, maybe because I'm at that age, I'm seeing it more or is it something that,- No, it's come up. Right? Yeah, definitely.

Yeah, absolutely. And it's scary because the conversation has not been out there.
And now it's a buzzword and everybody's grabbing onto it. And there's a lot of misinformation that's being spread.
And from a scientific point of view, where I've been in the whole perimenopause, menopause research world for 15 or so years to all of a sudden see the conversation out there and people are misconstruing a lot of the research or they're in one camp bucket of pharmaceuticals or one camp bucket of suffering through it and none of it's actually right. And then there's just so much, it's just so noisy.
So I'm like trying to cut through the noise and go, okay, ask me what you want to know, and we're going to unpack it for you. Thank you.
Cause I think that's a great point. Cause like I said, I see it.
If you, if you scroll on social media, every second post is about menopause and or perimenopause. And I think the problem is there is so much noise and so much information.
People are very confused. I know I'm confused.
Right. And I do this for a living and I've had like all the same top doctors come on here and talk about it.
And I'm still confused because they don't even agree with each other. You know what I mean? Exactly.
Exactly. That's it.
Yeah. And I'm finding that a lot of the, and I don't want to put people on the bus, but unfortunately those with some of the loudest microphones tend to not stay in their lane.
And what I mean by that is like, if you're an endocrinologist or you're a medical specialist and you understand things like hormone therapy, then talk about that, right? If you're someone who's like me, who's an exercise physiologist and a nutrition scientist and understands that and environmental stress, I talk about that. I can give a high touch on hormone therapy, but I'm not going to be a definitive person on that because that is not my area.
I'm going to refer you to Jen Gunter or Mary Claire or some of the other experts that are out there who actually know the nuances of hormone hormone therapy and how it can be applied to you as an individual. So that's part of the confusion too, because everyone's kind of in their silo and trying to be an expert in everything instead of saying, you know what, this is my lane and these are the things that I know and I can talk at a high point on some of the things I don't know, but I really want you to seek out these experts who know what it is in that lane.
Right. I think that, I think there's so much confusion.
So let's start with perimenopause, right? Because it's before menopause. What, how, how should women be training, eating, recovering in that space for optimal results? So as a physiologist, I'm going to explain what's happening on the undercurrent of everything.
So we look at estrogen, progesterone, and testosterone, and they affect every system of the body. So when we start losing the higher doses and pulses of estrogen, and we have more and more anovulatory cycles, so we don't necessarily produce progesterone, every system gets affected specifically bone and muscle.
So we'll have women who are complaining about waking up feeling squishy overnight, and they can't even open the jar of pickles because they don't have the strength. And they're like, what's happened? That's an estrogen effect.
Because when you look at how estrogen affects skeletal muscle and the feedback mechanism for strength and power development, it's in every part. It's on the satellite cell to develop more muscle fibers.
It's on the nerve endings to be able to say, yep, let's create a really fast nerve conduction across the gap junction to be able to fire a lot of fibers to create a strong contraction. And it's also part of the contractile proteins itself to be able to grab together to create a strong contraction.
So when you lose estrogen, you're losing the impetus for those three main points of strength and lean mass development. So when I start explaining this, people are like, shit, now what do I do? It's like, okay, well, now we want to look at a nervous system response.
Because if we can find an external stress that's going to create the same cascade feedback mechanisms that estrogen did, then we can keep progressing. And that is strength training.
But it's not lightweight, going to failure type stuff. We have to take a page out of the power-based work where we're looking at zero to six reps.
We're doing heavy loads. We have lots of recovery between those loads because we're trying to really stimulate the central nervous system and peripheral nervous system to say, you know what? I've got to have a lot of muscle fibers and I need to be able to recruit them quickly to have a very strong contraction to withstand that stress and load.
So now we can build lean mass, strength, and power without estrogen. So when we're looking at perimenopause, we have to look at all the systems that are being affected and we have to look at that external stress to apply to the body to create the adaptations that we want.
So when we look at it, it's all about the intensity and the quality of the work. It's not about volume.
So like I said earlier, where zone two is not really appropriate for women, at this point, it doesn't really do much for women at all. Because when you take away our sex hormones, we're really endurance.
We're really fatigue resistant. We burn a lot of fat.
So we have to look at how do we polarize it. We want to do some true high intensity work.
So that's 30 seconds or less, as fast and hard as you can go with two to three minutes recovery to have full recovery to be able to do it again. Might do that two or three times, or we do true high intensity interval training.
And that is a little bit lower intensity and a little bit longer, but you're still really polarizing where when you go to do your interval, you're doing it at the intensity you're supposed to and the recovery, you're fully recovering so that you can hit that intensity again. So the three big things there are proper strength training and the intensity of your sprint or high intensity work.
So like I said, it's not a lot of volume, it's the quality. Because each one of those factors affects the body in a way that will cause positive change.
So strength, like I said, you know, you're going to get that central nervous system response to build bone and muscle. When we're looking at that high intensity interval training, which is not full intensity, but maybe 80%, this causes more of a cardiovascular and a blood glucose improvement.
And then when we're doing that high, high intensity sprint interval work, it causes a cascade of what we call myokines. So these are little hormone and feedback molecules that go from the skeletal muscle to the liver and the storage area of body fat and says, you know what? We don't need to store body fat.
We don't need to take these circulating fatty acids and make them visceral fat. We need to use them and store them in really active tissue.
So the aspect of doing those three things is the mainstay during perimenopause is to benefit body composition, our metabolic health, our cardiovascular health, and then most importantly, our brain health. Because if we're doing strength training and creating a neural pathway plasticity, we're doing lactate training to improve brain metabolism.
Then again, we are able to support the brain when it is starting to lose the receptor sensitivity of estrogen, progesterone, because we don't have those sex hormones anymore. So I got so many questions.
Okay. So you said, you said polarity.
So when people, women hear high intensity training, they're thinking orange theory, they're thinking Barry's bootcamp. I don't know if you know what these, I mean, in New Zealand, if they have Barry's Boot Camp.
They're thinking of these classes that are, they're like taking you to the max and, you know, or they're on the treadmills and then they're going back and forth. And you sweat like a, you know, you sweat like a fiend.
I heard you say that that is not actually high intensity training. Why is that not-intensity training? When you look at those classes, it feeds into the mentality that we've grown up with where you have to feel smashed, absolutely smashed and burnt out when you finish a class to make it worth anything.
Because it's about the, quote, calorie burn and the smash aspect. I think Orange Theory even has splat points or something like that, trying to navigate how hard it is.
But the length of those classes and the speed at which those movements are done is really a precursor for injury with how fast the movements are underweight. And you can't really recover well enough to hit that 80 plus percent for your interval.
because if you're looking at a 45 to an hour long class, you can't really recover well enough to hit that 80 plus percent for your interval because if you're looking at a 45 to an hour long class you cannot hold high intensity for that long that puts you in moderate intensity now the problem with moderate intensity is our bodies when we're perimenopausal are already under a significant amount of sympathetic stress so this means we're tired but wired We have a really difficult time coming down from that anxiety and that awakeness, flight or fight sensation. And moderate intensity perpetuates that.
When we look at what it does from a metabolic standpoint, it doesn't have a post-exercise response that true high intensity does of increasing growth hormone and testosterone that drops cortisol. So when we're doing this moderate intensity stuff, we end up with a higher

circulating amount of cortisol, which becomes our new baseline, and we don't get any of the

metabolic change. We're not going to see a dissipation of our minnow bellies or visceral fat.

We're going to see an increase in that. We're going to be completely tired all the time, which means we are not sleeping well.
And if you can't sleep well, you're not going to invoke any change. So when we're looking at that moderate intensity work that people feel is high intensity, I feel like it's such a disservice.
And what makes me angry about these classes is that they are really marketing to women 40 plus. And this is just not appropriate.

These women are coming, wanting help.

They want to do some strength training.

And the protocols you're throwing in there

are specific for men.

And you're not looking at what's happening

when women hit 40 onwards.

So when we talk about true high intensity,

we look at taking a page out of High Rocks or CrossFit

where they're doing every minute on the minute

for four minutes and then one minute full recovery. and you might do two or three rounds of that and that is true high intensity work because each minute you're going to go as hard as you can it might be 40 or 50 seconds 20 seconds to get to the next one then you do that four times in a full minute to like come down maybe it's two minutes to come down repeat that that again, and maybe a third time.
So all up, it's 20 minutes of work. And that is true high intensity work.
And so does that, so if I were to do or not, or anybody who was perimetopause in their 40s or over, and they think that they're doing themselves a service by going to Orange Theory five days a week or Bears Boot Camp,

will those classes actually make them worse off with more body fat than if they just didn't do anything or just, I don't know, just walked around the block? It wouldn't necessarily make them worse off as you're looking at it comparing to someone who's just doing low-intensity work all the time. But what happens in those classes and low intensity or sitting around is there's a really high incidence of being skinny fat.
So that means you might look lean, but you don't have a lot of really good quality lean mass and you have low bone density. There are so many women in the past about six months that have come saying, I don't understand what's going on.
I got my DEXA scan and I go to these classes. I go to bootcamp.
I go to Les Mills. I go to Orange Theory.
I'm osteopenic and I have a very high amount of visceral fat. I'm like, okay, well, there's two things.
One, you're probably not eating enough. And two, you're putting yourself under this moderate intensity load almost every day.
Your body has no chance to recover and polarize and understand that it needs to step up its game to be able to answer the challenge of exercise because it's not getting the feedback to actually adapt. It's getting the feedback to stay tired, but wired and in a stressed state like you have to run from a bear.
Wow. So if I were to do like a weighted vest, like if I wore a weighted vest and went for an incline walk on a treadmill at a low pace, would that be more beneficial than doing orange theory class for preparing menopause? Yeah, no.
I get this into because of the weighted vest. So if we look at the weighted vest, that changes your biomechanics.
Because like I was saying earlier, our center of gravity is down in our hips. So if you're putting a weighted vest on, you're putting all the weight up here, which is not where our center of gravity is.
So that changes your biomechanics. And this is why you see a lot of women are like, oh, I've got a tendon issue.
I've got an Achilles issue, which then develops into plantar fascia problems. It would be better to get on that treadmill without the weighted vest, but holding two heavy dumbbells and trying to do farmer's carry five minutes on, two minutes off on that incline.
So you're getting strength, high intensity work, and then some recovery in between. I love that you said that.
So you know, it's really funny. I'm laughing and giggling because I get all these questions all the time and about what do I do? Should I do what's better? This or that, that or this.
And, you know, weighted vests have become like, again, it's like the new pale, like everything. There's all these trends that like come and go.
And, and, you know, then all of a sudden, all the same people who are wearing these weighted vests are now complaining that their foot is hurting, their Achilles is hurting, they can't walk. Yep.
Because the weight from here is going down to your foot because it's not properly balanced. Right.
Exactly. Exactly.
So, okay. So then to do that, that's a better option.
Okay. So then what is polarized training? Because you said that word too.
You said polarized training is a big one. Yeah, so polarized means that you go top in capacity and recovery is really low.
So when you first start doing high intensity work, you might find you need more recovery in order to hit that top in capacity. And that's fine.
Women underestimate recovery all of the time. So polarized means that you're staying out of that middle zone.
So you can go super hard when you need to, and you recover super easy. So we look at the moderate intensity stuff as it's too hard to be easy, and it's too easy to be hard to invoke change.
Stay out of that. You want to be hard to invoke change, and you want to go easy to recover so that you can go hard again.
How many times a week would you recommend someone doing this type of workout? Bare minimum, we see two sprint interval sessions or one sprint and one high intensity session and three lifting sessions a week. But you can combine the sprint and the lifting for one day in the gym.
So you might do lower body posterior chain work where we're doing hip thrusts and deadlifts, and then we finish off with some sprints on the bike, and then you're done and dusted. Or maybe you do box jumps instead of sprints on the bike as your high intensity work, and then you're done and dusted.
So like I was saying earlier, it's about the quality of the work that you're doing rather than the volume of the work that you're doing. Why is jump training so popular? Not popular.
Why is jump training so important? When we look at how bones respond to stress, we need multi-directional stress to invoke actual bone regeneration and increasing our bone density. Jumping does that because you're landing and it's complete stress in all the different planes that go up through the skeletal system, which then causes a cascade response of I need to be stronger through the entire bone.
If we look at just running, it's very uniplanar and it doesn't cause that mult-directional stress. We look at walking,

it doesn't either. Strength training does, but not to the extent of jump training.
So if people can't jump, strength training is going to help improve bone density, especially the heavier work that you should be doing. But just plain running doesn't do it.
What would be considered jump training? Like plyo jumps, like on a box? You can do that. When we're looking specifically at building bone, it's a landing, not how we've been taught with soft knees, but absorbing the impact through our bones.
We're not jumping really high. We might be on a low box and jumping off as a depth jump and landing kind of flat-footed hard or doing pogo, pogo jumping where you're flat-footed and absorbing the impact through your skeletal system.
And it only takes 10 minutes, three times a week at the most to invoke change. So don't laugh, but how about just jumping on a trampoline? Because you're still going up and down vertically.
But you're not getting the impact from the ground. Because our body moves when it hits the ground, the ground doesn't move.
Whereas the trampoline, it moves. So you're not getting the same kind of reactive force through the skeletal system.
How about, you're a nutrition scientist as well. So what is your take on women and fasting in perimenopause and menopause? If I were to use the buzzwords of fasting, I would say you do your 12-hour overnight fast.
That's what you do for fasting. But when we look at it from a hormonal response, reducing stress, improving body composition, brain health, all the things that people want with fasting.
For women, we need to eat within a half an hour of waking up because we have a cortisol peak and we need to drop that peak. We also see from circadian research that fueling throughout the day improves sleep, but it also improves the feedback for increasing lean mass development and dropping body fat.
So when we have a big hole of no food and what happens for the most part is women will start a fast and they'll try to hold their fast till noon and then they end up working out fasted. And the brain, especially the hypothalamus is like, what's happening here? There's no fuel for this exercise.
I'm going to start breaking down lean mass because I need some amino acids for some fuel and I can't support really metabolically active tissue when there's no fuel coming in. So when we start looking at what's the best way to counter the body comp changes that are happening in perimenopause, train smart, eat, eat during the day.
Stop eating after dinner so you don't have nighttime snacks and making sure that two to three hours before you go to bed was your last meal so that you can get into a deep reparative sleep. And I know sleep is fleeting for lots of people in perimenopause.
So we need to work on the sleep hygiene and maybe it's adding supplements like apigenin and L-theanine. Maybe it's cycling progesterone to help with sleep so that you do get into that deep parasympathetic activation so that your body knows that it can change body comp because you cannot create change without enough calories and without good sleep.
yeah but again another, another huge trend, as I'm sure you know, is this whole idea of fasting, fasting, fasting. And I don't understand how with hormonal issues and or just as someone who is someone who is active, how do you not eat and then also be active? If you're someone who doesn't move all day, right? Okay.
And I know that I think she was on my podcast. I think you did her podcast.
And she goes on about like autophagy and how it's actually really important for women to be fasting in their 40s. And this whole idea, like this is, it's actually much healthier to do it.

And we went back and forth because, you know, I see, I can see how it is for men. I see how men respond to the fasting differently than how I've seen women respond.
Absolutely. And from a physiological perspective, women have two areas in the hypothalamus that is very sensitive to nutrient density.

The two areas in the hypothalamus that is very sensitive to nutrient density. The two areas are the arc areas and we have what we call kispeptin neurons that get expressed.
When we don't have enough food coming in, we don't have all those kispeptin neurons being expressed. So we have a hit on our entire endocrine system.
So that's not just estrogen and progesterone. It's also things like thyroid and our appetite hormones.
Men have one area. So their sensitivity to nutrition density is not nearly as sensitive as it is for women.
And I'd like to scope it down to calories per kilogram of fat-free mass. Women need a bare minimum of 35 calories per kilogram of fat-free mass to be able to maintain some endocrine health.
Ideally, we want to see people up to 40. For men, it's 15.
When you start to drop below that 35, for women, we start to see a lot of subclinical disturbance in endocrine and sleep and body comp. For men, when it's 15 and below, we start to see that disturbance.
So there's a massive threshold difference. So when we start talking about fasting, yes, men are going to respond because their hypothalamus is not as sensitive to low calorie.
But from a biological standpoint, women are more sensitive to no calories because we're the ones that are or were responsible for reproduction, for carrying a baby, having a proper menstrual cycle, being able to support the ongoing aspect of survival of the species. So from a biological standpoint, there are specific sex differences in the brain that people don't acknowledge when we talk about fasting and fasting protocols.
And so you would recommend maybe a 12-hour window at best.

And how about protein?

I mean, what's your idea?

Because I know I think I also see that you're not someone who eats animal protein, right?

You eat plant?

You're not a... Yep, I'm primarily plant-based.

When I travel, because I travel so much, I'll use organic Greek yogurt and or whey protein

because it's readily available.

So that would be the only kind of animal product I put in.

For personal information, use organic Greek yogurt and or whey protein because it's readily available. So that would be the only kind of animal product I put in.
For protein, we see that there is an age and sex difference in the way your body responds to exercise and protein. We see that when women start to hit 40 onwards, we are more what's called anabolically resistant to exercise and protein.

So that means that we need more protein and we need a stronger dose of resistance training to get our bodies to build and maintain lean mass. For men, that starts about 50-55.
So when we talk about protein and protein intake, women really need to dial it up because that recommendation that is based on the bare minimum to prevent malnutrition is still circulating as the needs for people. If you're a sedentary person who's in bed all day, every day, then yeah, the recommended of 0.8 grams per pound, that might work.
But for women and men who are active and trying to rebuild and promote that body comp, we're looking at that 1 to 1.1 grams per pound as a bare minimum. And that is to stay healthy, maintain our endocrine system, and keep building bone and mass.
So I'm so surprised to hear that you are not an animal protein person because, A, you're so fit. I mean, it's insanely, you're insanely fit.
But I mean, just in terms of the satiation piece of it, right? Like animal protein, for me, is much more satiating. And plant protein, I found it harder to get enough of.
Are you saying it's just equally as okay in terms of building the muscle mass? Were you an animal protein person and you switched or what was? When I was 15, we took a field trip to a pig slaughterhouse down the five. That will do it.
Yeah. So I'm well beyond 15 now.

And that was the first like four way into it.

I had issues back in the day because there was no such thing as plant-based.

And so I've kind of fought my way through,

but I've been plant-based for a very, very long time.

And it's, you go through the whole,

you have to have complete proteins at every meal.

You have to have X this, X that,

but it's not about that.

It's about the total amount of protein you have through the day and making sure that you have all of your

essential amino acids. And the important part, yes, is leucine content post-exercise.
And if we

look at pea protein isolate, it's just on the cusp of having enough leucine. So you have a little bit

of a bigger dose of the pea protein than you would with whey. But when we're talking about meal and

protein in a meal, if you're taking adenami, green peas, nuts, seeds, other beans, maybe some tempeh,

then you're going to get your 40 or 50 grams in one meal. And it's going to be a mix of all your essential amino acids and your golden.
It's just really understanding nutrition. And I think that's one of the lacking points is the education around it.
That's right. Well, because even when you said that, I'm like, well, aren't you also getting a lot more carbohydrates, a lot more fat when you're saying you're eating edamame and all these other things? It's easier to eat a piece of chicken, let's say, than to...
Absolutely. Right? And so, but you said that.
What's the best sources of protein that you find for people who are not animal protein eaters? The big ones that I try to get people to put in are tempeh spirulina, pea protein isolate. Yeah, spirulina is really good in iron and protein.
And so for the supplement is pea protein isolate. We look at some of the fortified almond or coconut yogurts.
They can be highly fortified in protein as well. So there's lots of different options.
But when we're looking at carbohydrate and fat, women are afraid to eat carbohydrate. And for the most part, they don't eat enough.
And if we're looking at the plant-based proteins, we're also getting a lot of fiber, which is really super important for our gut microbiome. So when we're looking at all the animal sources, yeah, they're high,

high in protein, which is a great hit. But we also have to look at how are we keeping that

gut diversity and also getting enough carbohydrate. So it's not one or the other.
Ideally, it would

be a mix. But for me, I've been plant-based so long.
And through the years, I've tried to put

in egg or fish and I just can't do it. It just brings me right back to my time when I was 15.
At a pig slaughterhouse. Yeah.
It's crazy. That would happen to me, too.
What about supplements? Right? Like, gross. Well, what would you say are supplements that are fundamental for women's health? Or are you somebody who don't believe in supplements? Because supplements people think is food.
It's not. It's a supplement to what you're actually eating.
To the things that you're eating, right. Yeah.
So there, I would say the big three would be creatine monohydrate for sure, because you can't eat 22 chicken breasts in a day to get enough creatine to support brain and gut and heart health.

There's so much evidence about creatine being so beneficial for men and especially for women, even in pregnancy. So that is probably my number one.
Omega-3 fatty acids, really, really important, especially for perimenopausal women who are active to help with the antioxidant capacity as well as the actual cell membrane and cellular capacity and vitamin d3 because we live in a global community of you know sunscreen hats clothing avoiding the sun and we live in the you know i live in the, very southern part of the world and we don't get a lot of sun in the winter time. And vitamin D is so important for every system of the body, including things like iron and iron absorption.
So if we look at vitamin D, that's the third one. So those would be the top three.
And then of course you can add things like your adaptogens if you want, your protein powders are good. We talk about the extremes of performance enhancement type supplements.
There's no real evidence for women. Things like beet juice, where beet juice became a thing a few years ago.
For postmenopausal women, sweet. It works well.
It helps with vasodilation, it helps improve VO2 max. But for premenopausal women, including perimenopause, it has a backwards effect because we have estrogen that's tightly tied to our vessels.
And that's part of the nitric oxide cycle that causes vasodilation and constriction. So if you're introducing nitrates, it interrupts that system and you end up with a disconnect in what we call orthostatic hypotension or poor blood pressure control.
Kate Wickham out of, where did she do it? She's in Copenhagen now. She did research on this, looking at the differences between pre-menopausal and post-menopausal women in nitrates and saw that, yes, it's beneficial for post, but not for pre.
And then things like beta alanine, it may or may not have an effect for women. So it's kind of in the, there's not enough to elucidate the evidence for to be pro women.
So that's why I'm always like, okay, let's stick with the big three. And then we can do an individual basis.
Did you test low for magnesium? Maybe you need magnesium. Are you on a big training block and we need to look at how

we're going to adapt to the heat or how we're going to adapt to altitude? There's some things that we can do in there from a supplement standpoint. But for the most part, it's those big three and then some protein, and then we can kind of pepper other things in on an individual basis.
I heard that quercetin is really popular and really not popular. Keep it saying popular because it's popular, but it's really good and CoQ10.

And what is your, but you didn't mention those two. You're saying those are not foundational.
They're like maybe a nice little add-in, but not foundational. Right.
CoQ10 has more evidence to support it being used in peri and postmenopausal women for cellular health than it does for premenopausal women. But again, it would be one where I would look on an individual basis.
How are you struggling with energy? What is your exercise performance? How is your sleep, your oxygen carrying capacity? So these are a lot of things where I'm talking about it's the individual, let's pick and choose, but not a blanket statement that use it and that's what you feel about NAD as well yeah yeah because that's very popular too as I'm sure you know I know yeah yeah and so are peptides so that was my next question about peptides it's like the again a huge thing what's your take on peptides do you believe in in them? Some of them for specific healing properties.

So if you look at the BPC-157, which is your, right? Yeah. So if you're looking at that for tissue healing, there's a lot of rodent data out there and a little bit of human research out there that shows it's beneficial.
but when you look at something like WADA and informed sports saying it's a banned substance

you know there's something there makes it work. As for the other peptides, they're kind of like floating out there with not a lot of science behind that.
Yeah, so that's another one to be a case by case. It's like, why do you want to use it? What do you think you need it for? What are the other things that we can do to invoke the same change? But for tissue healing, yeah, maybe we'll look at the BPC.
Right. That's the most benign one of the ones that we're talking about.
I need to ask you about Ozempic, right? Because it would be remiss if I didn't. What is your take on the Ozempic craze? Yeah, I think I got slammed from another podcast about talking about this, but I'm going to say it again anyway.
So when we look at Ozempic, there's a little bit of a disconnect. It's starting to get a little bit better because there's more education around it.
When it first came out, there was no way that there was enough education to tell people that when you start using it, the very first thing to go is lean mass and bone. So you're going to become a very sarcopenic, chalky skeleton type person, and you're going to be on the stuff for life.
When we start looking at Ozympic as a tool in the toolbox for losing a significant amount of weight, not our vanity pounds of 10 to 15 pounds, but that significant amount of weight that plagues two thirds of American population. Yes, it can be a tool.
It can help with appetite control to dampen the noise, the food noise that happens so much around the ultra processed food and the cravings and gives you the opportunity to put healthier habits into play, like learning how to lift, what are wise food choices? So you finally can dampen that crazy food noise to put in strategies to help maintain weight loss and to build lean mass. That's how I view Ozenpec as having a role in trying to combat some of the obesity epidemic.
I have problems when women who come to me and go, how can I microdoses impact because I want to lose my 10 to 15 vanity pounds? Like, no, we don't do that. There are other things.
And maybe you are learning to live with an extra five pounds on your body, which is probably beneficial as you get older because we want a little bit more weight as we get older. So we don't have enough reserve if we get sick.
So there's nuances within it as well. I feel for people who really need it for diabetic control because of everyone now using it for weight loss.
I'm interested in the research that's coming out about Parkinson's and Alzheimer's, about Ozempic and the GLP ones helping with that. So that's early day research.
so right now it's a tool in the toolbox and we have to really look at lifestyle to accelerate that tool you know it's funny you mentioned the micro dosing right that was my next part of the question because that's what i'm noticing a lot of people who like people who are doing that people in the health and wellness longevity space claim that the microdosing is really good for inflammation and all these other health benefits. And so they're microdosing.
And these are people who don't need to lose anyway, really. Maybe like you said, five pounds here and there.
What do you say about that? Like, do you believe the microdosing for the inflammation and all these other longevity reasons? Is there any truth to that at all? Or is it just people just having misinformation and just jumping on the bandwagon because they're a little thinner? Yeah. Part of it's misinformation.
And part of it is people become inherently lazy and don't want to. And I say that and i'll take full ownership of that statement i because when we look at exercise regardless of intensity duration mode whatever it is it's a super powerful stress that gets put on the body and the body responds in kind so yes you're going to have inflammation after exercise but the subsequent response is your body upregulates its anti-inflammatory and anti-oxidative responses.
So the chronic use of exercise improves oxidation and inflammation. It also improves autophagy.
So all the things that people are talking about by using pharmaceuticals for longevity or trying to biohack by using micro doses of this and peptides and stuff, you can use exercise. And it's just understanding what kind and dosage.
It's not the blanket ACSM 150 minutes of moderate to vigorous activity, which is based on male data, right? So we have to be very nuanced in what we're talking about. You know, also when it comes to Ozempic, if someone were to compound that with strength training, would that offset the problem of bone density loss and the muscle mass? Would it actually balance itself out? You have to be very dedicated to the strength training and eating protein.
Because when we look at protein, protein in a high-protein diet induces satiation and increases our natural production of our GLP-1s. So if we are looking at using Ozympic as well as strength training and high protein, you're going to get better body composition, better appetite control, better appetite hormone regulation, and it's going to allow you to get off the Ozympek when you get to a certain point, which is decided by you and your doctor or whatever your lifestyle choice is.
So, okay. And then I, by the way, I just remember something else to going back to the other part about training.
We talked about menopause and perimenopause training. What about if you're not at that place, what type of training should someone actually do if they're in their 20s or 30s? That's different than when they're 40s, 50s, 60s.
We missed that part. This is a time.
Yeah. Well, this is a time where you can play.
You can play a little bit. You can try a lot of things.
It depends on your hormone profile. It's like what kind of, if you're using hormonal contraception, what kind is it? Is it oral contraceptive? Is it a Mirena? Is it a copper IUD? All of those have different responses within the body, which is going to affect the kind of training and how you feel about training.
Naturally cycling, are you finding changes in your bleed pattern? Are you finding changes in the length of your cycle? Well, those are beginning stop gaps and warning signs that you're putting your body under too much stress. But for the most part, you want to

find a goal. And the basic idea of periodization of both cardiovascular and strength is beneficial.
If you're someone who wants to go the endurance route, sweet, you can. But put some strength training in there.
You don't have to put it your mainstay, but you want to to have a strong resilient body regardless of where you are in your life and you can pepper it in your 20s and your 30s with different adventures so yeah so how do you train give me a day in the life of you like what's your day today what's what kind of habits do you do beyond i mean obviously you look great so i want to know what time you wake up you're sleeping you, what are all your habits and routine? My habits. Well, full disclosure, I tried my very first high rocks on Sunday here in Auckland.
Yeah. Was it good? It was super fun.
Yeah, it was super fun, super hot. I did end up tearing my meniscus.
Really? Oh, no. Yeah.
And I'll share the story is i was not strong enough in the posterior chain to do the sled pull and then run and i went into it after being in the states under a high amount of stress and not having been able to train on the sled very much i came back i had 10 days before the race. So that's my full disclosure.

But I'm now at a point where, oh, it's all right. It'll heal.
How long will it take to heal, do they say? No, I haven't seen a sports doc or surgeon yet. So I'm like, I'm doing all the rehab things that I know.
And I have to get on a plane next week and fly to the States and be gone for a month. So we'll see what happens.

I am going Houston and then Boston, Boston, D.C., D.C., Denver, Denver, L.A., L.A., San Francisco. Oh, my God.
Doing what? Just traveling? No, I wish. It's not a vacation.
Doing some podcasts and some board meetings and some filming for a project and looking for houses. Oh, okay.
Well, then, wow. I'm so bummed.
Like, why didn't we do this in person, by the way? I don't understand why we're doing this on a computer, if you were going to be coming here anyway. Because the LA trip was really fully booked until someone just canceled.
So that's why we're going to try to see what we can do when I'm there in LA. Okay, perfect.
But to finish your, I want to hear your, besides the meniscus, what else happened with your habits and your routine? My habits, yeah. So I am the kind of person that needs to get up before anyone else in the household so I can have 10 to 15 minutes of absolute no noise because that's how I can reset and recenter.
Then I'd like to do some training, either go for a swim in the pool or the ocean a couple of days a week. Strength training, definitely three to four times a week.
After training, come home, have food, do the email thing, go through all the meetings, have some quiet time, get some work done. Then my daughter comes home from school.
We do some stuff. Then I do some more work.
Then I take the dog for a walk, make dinner, have dinner, have conversations, and maybe read with my daughter. And then I try to be in bed by 9.30, 10 o'clock.
I get up maybe 6. I get up maybe 6 37 but I'm also the most fatigued person at the end of the day and I want to go to bed before everyone else but I make a priority like I need to go to sleep now yeah and I need to sleep I might do some reading before falling asleep make sure it's a cool dark room because I don't like to be hot when'm sleeping.
And I get very agitated if my sleep is disrupted because I'm like, I need sleep. I love sleep.
Yeah. Especially when you're active.
Do you train people still regularly or? No, I don't. I advise people who do train and every once in a while I'll take someone on, especially if it's a really complex, like sticky moment where people are trying to do all the things and they're stuck.
I wish I had the bandwidth to be able to get out there on boots on the ground to help more people on individual basis. But there's only one of me at the moment.
Right, exactly. What can I just ask you a couple more questions and I can hopefully see you when you're here? I want you to tell, can you tell me what you think the most underrated health tip would be and the most overrated health tip or most overrated health myth? Trend out there? Yeah.
I think the most underrated is the intuition. I think people have forgotten what it feels like to sleep well, to eat well, to have energy, because we've been told by wearables what we're supposed to be feeling and what we're supposed to be doing.
And people have lost that connection to themselves. So that intuition of actually understanding our body and using things like rating a perceived exertion without any of the tools, I think that's one of the most underrated, but one

of the most effective means of invoking change.

When I look on the other end of things, it's all those top end, like the 1% that you should

be looking at, like peptides or fasting.

Let's just bring it back to basics.

How are you eating?

What are you eating?

When are you eating?

How are you sleeping?

It's like the big four is the mindfulness, the sleep, the physical activity, and the nutrition. If we focus on those, then we can start to really see change.
It's when we start going outside the box and really focusing on all the biohacking and the bro science that's out there is when we start to lose sight of where we should be and get into the overrated trends that tend to take over everybody's mentality. What is your take on saunas and cold plunges, cold, you know, therapy? Saunas, I love.
I started as an environmental exercise physiologist. So I look at how the heat can invoke positive change on the body.
It doesn't have to be a large dose. It could be 10 to 15 minutes in a finished sauna three times a week because we start to see massive cardiovascular improvements, blood pressure improvements included in that, metabolic changes.
We have better blood glucose control, we have better gut health, brain health. So many great things happen with the heat.
When we think about cold plunge, for women, it's cool water. It's around 15 degrees Celsius, which is around that 56, 57 degree Fahrenheit mark.
Ice is too cold and we don't get the same kind of response that men do when we get into ice. It's too strong of a stress and the body rebounds with too much sympathetic drive, too much constriction, where if it's cool water, we're going to invoke initially a vagal response, which is that, and then the body's going to get that more parasympathetic relaxation response that we're looking for for cold plunge.
So what happens if we do the cold therapy? I mean, because I hate it, you know, but, and I won't do it. And I get a lot of, you know, slap for that.
But what does it do to the body in layman's terms? Like, what does it do to a woman's body when they jump into a cold plunge? Because I think it's good for them. Yeah.
So you're jumping into that icy cold water and you're getting that shock and that shock is a sympathetic so that you have your flight or fight sensation, which is your sympathetic drive. And you have that deep relaxation, which is your parasympathetic drive.
For women, we get that shock and that sympathetic drive, which increases cortisol, increases our blood glucose and our free fatty acids because the body's like, ah, what is this incredible shock? I've got to get out and run away. For cool water, it's not as intense.
So you don't get that sympathetic. You get the initial, and then the body's like, okay, I can deal with this.
I'm going to do some vasoconstriction.

I'm going to put more blood sugar to the brain so that the brain understands what's going on and stimulates what we call the vagal nerve. So the vagal nerve is what that parasympathetic nervous system is attached to.
So it invokes that calming and you can stay in it, take some deep breaths. But that said, heat does so much more for a woman's body than cold plunge.
So if we're looking for increased parasympathetic drive, we're looking for better metabolic control, we're getting better hormonal control. It's all instigated by sauna work, not by cold plunge.
So a finished sauna is usually 200 degrees or 210 sometimes, right? If I have a sauna that's like this infrared that doesn't get hot enough, it's like it takes forever to get to 160 and even that takes four hours. Can I still do those? Because at the time it was, everyone's like, oh, the infrared is the best sauna for your body.
It doesn't warm my body. I'm like cold half.
I'm shivering in my sauna. Yeah, I know.
It's crazy. I mean, but do I, if I wait long enough and it gets to 165, I'm lucky.
Yeah. Do you still get the same benefits as you would in a finished sauna if it's an infrared sauna? So the thing with the infrared is it really bypasses when the initial thermoregulation control centers.
If you get to a point where it's hot enough and you get that sweat onset and you feel really uncomfortable, then you're hot enough. But you don't have to like stay in there for half an hour or more being uncomfortable.
You bring it up to your sweat response and then you can get out.

And I think that's what people don't like. They're like, oh, I get an infrared and I get warm, but I don't sweat.
I'm like, but you need that. You need that uncomfortable heat and uncomfortable sweating to invoke the change.
No, I wish I did sweat. It doesn't get hot.
These things don't get that very hot. Have you ever been in one? Like these things are like 50 degrees much much cooler than the finish saunas.
Yeah. My stepdad has one, but we have a finish sauna.
So I use our finish and then I go to my parents' house and I'm like, I'm freezing in your sauna. I know.
It's like a cold plunge. I mean, it's like crazy.
It's so not hot, but I don't know. I mean, so you believe that that's kind of all hype, the infrared sauna, because it gets maybe your skin a little bit warm.
Red. Maybe you put on one of those sauna suits they sell in like Kmart or Walmart and you wear the sauna suit in your sauna.
Or just get a new sauna and call it a day, right? Get a new sauna. Yeah.
Do that. That's the best way to do it.
Yeah. I think that's a great idea.
Okay. Well, again, Dr.
Stacey Sims, you've been a delight like I knew you would be. Thank you so much.
No, you haven't. Thank you for being on the podcast, even though I feel like it wasn't the same as being in person.
So I really hope we can do it in person next time. Yeah,

me too.

It's great to see you.

It's great to see you.

And,

uh,

yeah,

have a great day and give LA hugs for me.

I absolutely will.

And everyone should go check out Dr.

Stacey Stims.

What do you have?

The book is called Roar,

but it's a little,

when was it out that your book,

it was a while already.

The second edition that was just released last year.

Last year.

And then we have Next Level that is specific for peri and postmenopause.

Oh, perfect.

Perfect.

Okay, good.

Well, then you'll come back and talk more about the peri, all of it.

Yeah, perfect.

And I hope you feel better with your meniscus.

Yeah, it'll get there.

It's just, there's no pain.

It just catches. So there's instability there's no pain.
It just catches.

So there's instability, but no pain. I'll take that.
But you're not working out, correct?

I'm not running. I went for a swim this morning.
Okay, that's good. Because it was a happy place, but yeah.
Okay, good. Well, thank you again.
I appreciate you, and I'll see you hopefully in a