I'm joined by Dr. Stacy Sims. She is a forward-thinking international exercise physiologist and nutrition scientist, who aims to revolutionize exercise nutrition and performance for women. She's directed research programs at Stanford, AUT University, and the University of Waikato focusing on female athlete health and performance, and pushing the dogma to improve research on all women.
*She is also the author of the 2016 best-selling book ROAR: How to Match Your Food and Fitness to Your Unique Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body for Life, and her latest book, Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond. I have read both and I asked Dr. Sims here to discuss specifically menopause and weight loss. Dr. Sims, thank you so much for being here. *
Thanks for having me. I'm like, “Who's that person you are talking about?”
That amazing person is you. How do you explain how women and men are different when it comes to losing weight at a very high level?
At a high level, when we look at basic biology, we know that there are specific genes that are encoded for men to be able to survive well, lean up, and get stronger and fitter when there's low-calorie availability. For women, we have the genetic coding to put on body fat, conserve, and have our metabolism slowed down in the eye that women are responsible for carrying forward the species. We are responsible for having babies.
*As a woman, I feel like, “That's always on our shoulders.” When I was reading your book Next Level, you talk a lot about perimenopause and menopause. I feel that there are a lot of people that don't know that there is perimenopause as opposed to menopause. Can you explain what the difference between those two things is? *
The same as if we backtrack and think about puberty, it’s seeing personality changes and a little bit of body comp changes in young girls before they have their periods. We are seeing these changes in an upsurge of estrogen and some progesterone before the period starts. We move forward to the other end of the spectrum. We have changes in our hormones as they start to decline before we hit that one point in time called menopause.
Unfortunately, everyone's like, “Menopause.” Lump everything together, but perimenopause is anywhere from 5 to 10 years before you have that one point on the calendar menopause that marks twelve months period. Perimenopause is a time when we have the biggest changes in body composition. It's not after. It's before.
It can be 5 to 10 years long and that's when you are seeing all your body composition. A lot of times, I will talk to women and be like, “What's going on with you and in your cycle? Where are you in that?” They will be like, “I haven't hit menopause, so I'm good, but I'm gaining all this weight.” It's possible then that they might be in perimenopause and not even know it.
We start to see the biggest changes around the four years before menopause hits. Prior to that, we might regularly be cycling. They are having the same length of their cycle, but initially, they are seeing non-responsiveness to their diet and their exercise. “Why is this not working? A year ago, everything was great. I was doing all this stuff. I was losing weight. I was putting muscle on, but now I can't. What am I doing wrong?”
People will go through the checklist of, “I must be eating too much. I must be highly stressed.” It could be that pounds within a year where all of a sudden you have the ratio change of estrogen and progesterone. You might start to have more anovulatory cycles so you are not dropping an egg, but that doesn't change your cycle length.
We start to see initially changes in the bleed pattern. You might start to see, “My cycle is still the same length. That’s banging on 31 days.” Instead of having 7 days of bleed, now it's only 2. There might be some spotting and it's not as heavy, or you might be unfortunate to have super heavy bleeding, and then it tapers off. There's a change in your normal bleed pattern the more you get into perimenopause and then you might start to see changes in cycle length.
That all makes sense when you think about it. Your body's gearing up to shut things down. Why is it that women seem to have more trouble losing weight once they hit menopause? Is that because their body composition has changed and they don't realize that it's not necessarily that it's harder or is it a mixture of both?
When we look at what estrogen progesterone does, there are more than reproductive formats. They affect every system in our body. Estrogen is women's testosterone. It helps us build lean mass and keep lean mass. It's also responsible for bone mineral density. It's responsible for glucose homeostasis or regulating your blood glucose.
Progesterone is the same thing. Progesterone is responsible for activating parasympathetic responses within the brain to relax and allow your body to calm down, so cortisol is lower. We see that estrogen and progesterone work together for changing the way our body relates to blood glucose and how we store carbohydrates. Having changes in these ratios, every system is affected. We see a little bit more insulin resistance. We start to see less muscle mass gain and more muscle atrophy. We start to see more belly fat accumulation because of these changes in the ratios.
If we have an anovulatory cycle, we don't produce as much progesterone so we come estrogen-dominant over that period of that one cycle, and then it might change again. All of a sudden, we have an anovulatory cycle so now there is more progesterone than estrogen. The body's trying to figure it out. In the meantime, periods are affected. We see this difference in our lean mass point down and our fat mass coming up with these changes in the ratios and performance.
When you hear it laid out like that, it feels depressing.
There are stuff we can do. This is a good thing. They will go to their GP or natural path and they will be like, “I don't understand what's happening.” They will be put in this category of rushing woman syndrome or you are highly stressed. You are not sleeping well. One of the symptoms of perimenopause is not sleeping well. People put it off, “You need to work on your sleep hygiene,” but we need to backtrack and go, “The primary basis of all the things are happening is because we are having these changes in our ratios, and we are having these fluctuations of hormones that our bodies not raised.”
We need to look externally. We need to find some external stress that we can add to the body so that the adaptations support the body with the hormone’s uses of the body. We do this through specific adaptations to exercise and nutrition. We can't do it with one or the other. We have to work together with both of them. If we look specifically at what estrogen does, we look at estrogen stimulates the myosin filament of our contractile proteins. I see you have a confused look on your face and I'm sure other people do. That's fine. We go to mega muscle contraction. We have two primary protein filaments and they work like a lab when you are going to have a muscle.
They are like a ladder where they come together to make a muscle contraction. When we look at a muscle contraction, we need both actin and myosin to grab onto each other to pull the fibers together for contraction. When we start to have a misstep in our estrogen, the myosin filament takes a hit. It's not as strong. It doesn't get as stimulated. There's not the synthesis or the messaging to keep that myosin filament going. This is why we start to lose mass. We start to lose our power and our strength. External stress is looking at, “How do we stimulate that myosin? How do we get a nerve stimulus muscle contraction?”
It’s to lifting heavy. It's not this bodyweight stuff. It's not the 8 to 15 reps. It's that power-based thing. That 1 to 6-rep range where you are doing 3 sets, 3 to 5 exercises, and lots of rest in between, because you are trying to stimulate the nerve-to-muscle connection. They are stimulating nerve-to-muscle connection with a heavy load. You are getting the nerve to try to recruit as many fibers as possible to contract simultaneously.
If you have that nerve stimulus, that means that myosin has to work. That means that there's another stressor or another signal to maintain that myosin integrity instead of estrogen stimulating it. For lifting heavy, we are replacing what estrogen used to do to the muscle. We are getting the stimulus to maintain contractile strength and lean mass, and to also develop lean mass.
The backside of it is as we do that when we get into perimenopause and we are becoming more insulin resistant, we’re losing a pathway for muscle protein synthesis, which comes from insulin and estrogen. We need to back it up with amino acids. This is lifting heavy and backing it up within 30 minutes of a good dose of amino acids. We know that for perimenopausal women, we are looking at around 3 to 5 grams of high-quality leucine with other essential amino acids which means around 35 to 40 grams of high-quality protein. It's a big hit, not a small dose.
We are overcoming the body going, “I don't want lean mass or anabolic resistance.” We need to hit it hard with that resistance training, back it up with protein so that we have a strong stimulus for muscle adaptation, and have the nutrition to support that signal. Otherwise, we don't get the main mass development that we want because estrogen used to come in and stimulate myosin, and then estrogen used to be like, “We can make things available to build this lean mass.” When we start having that flat, we don't get that signal. We need to look at what's heavy for that stimulus and back it up with protein to get that recreation and that muscle protein that's scaling.
Is that the only change women need to do? If I start lifting heavy and eating a lot of protein right after I lift, is that going to fix all my menopausal issues with gaining weight and not sleeping or is there more to it? You mentioned nutrition and exercise. Protein is the nutrition piece of it.
There's more to it. The big rock right there is that if women were to do that, they would have so much better body composition outcomes and more control of their vasomotor symptoms and menopausal issues. We know that lifting and especially power-based training is so beneficial for women when they hit their early-40s onwards.
It helps mobilize belly fat. We see this. It doesn't stimulate belly fat mobilization in men, but it does in women. One of the things that happen with peri and post-menopause is that you get that deep visceral belly fat. We want to be able to mobilize it. Heavy lifting, resistance training, and protein do that. That's the big rock that I want everyone to take away.
If we are looking at all the other cascades of things that we have, we have more weight gain. We have poor sleep. We have vasomotor symptoms, anxiety, depression, brain fog, and feeling like we are tired but wired. All of those things that get put into like, “You are a stressed woman. Let's put you off to the side.” It's not true.
The other thing is that we need to remember that by the nature of being women, we are endurance-focused. We are very capable of going along because of our physiology from being XX, not hormone-induced, but by the nature of being born with XX chromosomes. We don't want to perpetuate that. We are already capable of going along and flowing. If we go long and slow, what does the body do? It reduces power, slows you down, and stores more fat.
The other thing about going long and slow is that it also increases our already elevated baseline of cortisol. This is why women feel tired but wired. We have an increase in our baseline cortisol. We can't get into a parasympathetic drive. If we are doing a lot of 45-minute boot camp classes, brisk walking, or 60 to 90-minute runs depending on what you are training for, that puts you smack in the middle of this moderate intensity zone that perpetuates you to go long and slow and put on belly fat.
It's not a strong enough stimulus to be that external stimulus we are looking for to change body comp and to improve fitness overall. We want to polarize our training. We need to go super hard from a cardiovascular standpoint. We want to do high-intensity interval training, but not an F45 or an Orangetheory type boot camp type class, because that puts you in that modern gypsy.
I'm talking about you doing 1 minute, maybe 1 minute 30 as your interval, as hard as you can for that 1 minute, 1 minute 30, and then you are recovering for twice as long. Even better, doing sprint interval training where you are doing full gas of 10 by 20 seconds on, and you are having a minute off. When you go back to do those twenty seconds, you are neuromuscularly recovered. Your heart rates go down and you can hit it hard again because we are trying to get you up there on that rating of perceived exertion of 9 to 10.
When you are hitting that for super high stimulus, the body is like, “I need to be able to overcome this stress. What do I need to do to overcome that stress? I need to have carbohydrates and glucose available. I need to be able to produce power and speed. I need to be able to regenerate quickly.” We are looking at the post-exercise and recovery standpoint as we have a boost in growth hormone. We have a boost in antioxidant status and we have a boost in anti-inflammatory status.
Those three things are super important for more perimenopause. We have increased systemic inflammation because our body's going through so much flux, and we have additional cortisol. We have a greater predisposition to soft tissue injury because we have systemic inflammation. We need a growth hormone boost. As we are under more stress with these changes, we have a higher oxidation status. We want that anti-oxidant. We are doing the work. We are getting more bang for our buck for body composition. We are also countering what's happening in the body with these hormones.
When we are looking at what do we need to do, stay on that long, slow, and moderate intensity stuff. You are polarizing. You are doing super high intensity, and then on other days, you are doing slow like 80-year-old people walking past you. You are time on the feet, enjoying, and relaxing, because when you are doing that super low intensity, it can help with the parasympathetic drop. We can activate our parasympathetic and have that relaxation. That helps. You have to focus on polarizing.
One question I have is about the sprint interval training. After I read your book, I have been trying to incorporate that. I have noticed that, especially when I'm running, I have a difficult time. If I do a 30-second sprint, I don't get to the 85% mark of my heart rate until like the last five seconds of a sprint. Am I doing any good at that point? As long as I'm hitting it within 30 seconds, does that “count” for the reactions in my body that you are talking about, or because I wasn't there the last 25 seconds, is it not helping? Does my question make sense?
It makes total sense, and the answer is yes, it is helping. The more you do it, the faster your body's going to respond. As you said, you started incorporating that. It doesn't matter if you are a slow or fast runner. It's all about the activation and the muscle recruitment, and then getting your heart rate up. As you get more proficient at doing it, because you've been doing it more often, your heart rate is going to come up a lot faster and it's going to drop a lot faster.
It's the aspect of getting a bit fitter because, for the most part, most women haven't tried to do that unless they have been training specifically on the track for something. When we are talking about people who are running recreationally to hit a 10k, 5k, or half marathon. No one ever tries to go that fast. It takes coordination and your body is like, “What's going on?” It takes time for your body to adjust. It might be 6 weeks or 2 months before you start to be like, “My heart rate gets up there fast.” This is why we start off slow. You might start out with 3 or 4 of those and then you can build up.
You mentioned that polarizing, which I have been trying to do myself. I have trouble. On one of those days, I'm good with the sprint interval training, but if I try to do two of those days, I find that I'm exhausted. I don't know if that requires more time, my body needs to get used to that or if I'm going too hard on the other days. I'm trying to figure it all out.
The idea that everyone should have is less volume and more intensity. The more intensity you do, the fewer days you have to work out. Although a lot of us want to do something every day. It's stress release. It's getting outside. It's our own time. We have to reframe what we are thinking and what we are doing. If you know that anything over 2 days in a week knocks you for 6. The other days are super low and you are working on mobility. You might be exploring something.
One of the other things, instead of doing flat sprint marks, maybe you are finding some stairs or you're doing stair bounding. Maybe first it's 1 step at a time, and then maybe the next time, it's taking 2 at a time, but pushing through. You are not running up, but you are pushing through it to get your heart rate up. You push through the heels. It's like one is up the stairs.
There are lots of different types of ways that you can put that intensity as well as in going, “I'm exploring. I'm back at any of that.” Getting that fresh commitment is always important. It's like, “What is my week? How much I'm going to take in this week?” We also look at it as you do 2 weeks of that stuff, and then you have one week of complete deload.
Deload is that full recovery where you are relaxing. You are doing some yoga or some hikes. You might take it leisurely. Spend to the pool, whatever it is, but you are trying to get the body to absorb that hard training so that they are adapting to it, and then the next two weeks you can focus again. That was about getting that full recovery, not necessarily the day-to-day, but across the month. Get that full recovery so you can have some good follow-up blocks.
The other thing that we tend to think about is the way that we have all grown up is the calories in and calories out. You have to work out every day if you want to lose weight, and it's not true in this timeframe. We need to have those days where we are fully invested in mobilization recovery with the eye to, “If I do this, when it's time to hit it hard, I'm fully vested and able to hit it hard.” It takes up time to phase in to be able to do that high-intensity work as well as to take the time to phase it in to be able to do the heavy lifting. It's not like, “Everyone, go to the walls. Let’s do this right now.”
Let's take some time. Let's phase ourselves in first to the sprint stuff, because most people can understand what sprint is and we might do one session a week. We are looking at, “What are the other things I'm doing this week? I'm not supposed to be doing modern intensity, but maybe I'm doing some hits. Instead of 30 seconds on, I'm going to do 2 minutes on my other high-intensity day.”
You are lengthening the length of that interval session. It's a little bit lower intensity, but it's still hitting that polarization. When you get through that block and in that recovery, you are starting to look at your mechanics. How do I move? What do I need to work on? What drills do I need to do? If I'm going to get into strength training, how do I move?
Maybe I need to invest in a PT for one day to look at my mechanics and give me hints on how to move. Understand that you have to have good mechanics before we start adding a lot of loads. It does take some time. If we think about it, it's not a quick hit to get fit for rates. We want to spend the time because this is how we want to be able to train and move for the rest of our lives.
You mentioned perimenopause. That's the key time to start focusing on these things. What if you have already reached menopause, is it too late to incorporate these things?
No. There's a hesitancy for a lot of the medical community and PTs to tell women who reach menopause to lift heavy and do high-intensity work. We have this social stigma that all of a sudden, women are frail and can't do any of that. Wherever you are in this whole menopause transition or you transition already, and you are in post-menopause, it's not too late.
We see more research coming out showing that high-intensity work, power-based training, and early post-menopause do help with body composition and bone mineral density. We are looking at, “How are we getting our muscle integrity back? How are we maintaining our bones?” Not only does it do that, but it also improves balance and coordination.
When you get older or even if you are in late or post-menopause you start doing this, when you are doing power base training or high-intensity work. Let’s say you are walking and you accidentally slip off a curb, you can catch yourself and you don't fall. This is the other benefit of doing that. Proprioceptive, heavy lifting, recruiting fibers, and understanding where you are in space and time because it helps prevent fall risk and other injury risks as we get to the later stages of our life.
That is so important. If you get injured and you can't move, it's going to reduce your quality of life so fast. I hear what you are saying about keeping the polarizing of the different loads and stuff. When you are talking about weightlifting, I'm a big fan of Tonal. There are days that the programs on Tonal don't all have that 1 through 6 reps that you are talking about. If you wanted to incorporate a couple of days of the powerlifting that you are talking about, but also incorporate other kinds of weightlifting, are you still getting any benefit from that as a woman who's going through all these changes? Are you still getting a benefit from it other than I love it?
It's a hard question to answer. From a physiological standpoint, any resistance training is for resistance. The understanding that you can also overdo it. If we are looking at heavy power-based stuff and you are doing that for 2 to 3 times a week, then the other days because you love it, then you are lightening the load. You are not doing your 70%. Maybe you are doing 50% and you are working on technique.
You are working through it, you are doing the programs, but you are looking at it as more of a technique and a recovery type session instead of a cardiovascular or weight loss. Use effort. There's never a wrong time to work on technique because we can all do it all the time. Even the Olympic lifters who are gold medalists at the Olympics are still working on technique.
If we are looking at, “Tonal has this fantastic system and this great program that I love, and I love the coach. I'm going to do this program because I love it and I want to be involved, but I'm going to drop my weight significantly and make sure that I'm spot on form. I'm engaging the core. I'm getting lower in my squat. I'm working on all of that mobilization and technique within the session.
I didn't think about the benefit of working on your mobilization from lowering the weight. That's an excellent point. Is there anything else that as we have talked through all this you feel women should specifically know about losing weight, menopause, or perimenopause that we haven't covered? I know there are 1 million things.
When we talk about it from a nutrition standpoint, the other thing that's super important is the timing of your food intake and protein intake in your meals. When we are looking at losing weight, especially in this time period where our body's fighting it and going, “We need to conserve because I don't know what's going on.” We need to make sure that we don't do fasted training because if we do fasted training, it increases cortisol. We already have enough. What does cortisol do? It is the stimulus for conserving, but it also doesn't allow you to hit the high intensity because your body is already stressed with cortisol. It's not going to let you polarize that.
In a moderate zone, even if you are trying hard, you still aren't able to get to that high intensity because the cortisol is like, “You are already stressed.” A little bit of food. That 15 to 20 grams of protein before resistance training significantly helps with that session, but it also helps keep your resting metabolic rate elevated after resistance training.
If you eat the protein before, it also helps your RMR after.
Carbohydrates are not the same. If you are going to do a cardiovascular session, it's 30 grams of carbohydrate added to those fifteen grams of protein because that helps get through the cardiovascular successive cortisol and helps your arm markers because cardiovascular work is different from strength work. They use different types of fueling. If you are doing the strength stuff correctly, it's all neuromuscular and it's not cardiovascular at all, it's strong neural and muscle aspect.
You are looking at ATP. You are looking at the need for amino acids soon after and also the central nervous system. If you are looking from a cardiovascular standpoint, it's breaking down carbohydrates and fatty acids for fuel availability. You need that extra carbohydrate in order to get into the right fueling mechanisms for that top-end work.
I have to go back for a second. You mentioned that if you have that cortisol level, you aren't necessarily getting into those super high intensities. How do you know if you are? I have always been like, “If my heart rate is at that 85%, I'm doing that.” If you are lifting, it's not cardio. How do you know that you are doing as much as you can?
If you are lifting, it's not about heart rate. It's about load. We'll look at the lifting part if you are looking at 1 to 6 reps, and we are lifting heavy. By the time you get to the set, you can't do six. If you can do six, you haven't lifted heavy enough. You are looking at proper form throughout all of the sets. We want to look at failure or fatigue, and we want to try to get to that failure fatigue point by the 3rd or maybe 4th rep in the last set.
You should work to failure when you are trying to do powerlifting. That is the goal.
From a cardiovascular standpoint, heart rate isn't always the best metric. This is why we look at the rating of perceived exertion. If we are pushing ourselves to that 9 or 10 and our heart rate isn't quite following, we are still pushing and going as hard as we can and the heart rate will catch up, or maybe it won't like what you are talking about with your sprints.
Your heart rate takes a little bit of time to get up there, but if you start like, “I'm going as hard as I can,” then you are going as hard as you can, and that is what we are after. We want to rely more on our psychological and intuitive feedback. If we are looking at heart rate or respiratory rate, there's a lag time and it's more of a tool. If you've had poor sleep, which often happens, or caffeine or you are dehydrated, all of those can affect heart rate metrics.
This is for me personally. Whenever I'm trying to run that fast, I have always been looking at how I'm breathing and what my heart rate is. Technically, I could go a little bit faster, but I can't keep it for very long. I can't stay at that. What should I be focused on then? Where should I be like, “If I need to turn the speed down, that was as far as I could go.” That's where I hit the button. That's where I need to slow down, not paying attention to my heart rate necessarily.
Imagine you are watching a whole bunch of kids on the playground and they are like, “It’s Ted. Get away from him.” They go as fast as they can, and they don't care about how they look or how they are breathing. They are like, “Get out of here.” That's what you are after. You want to pretend you are a kid, trying not to get tagged. Pretend you are getting chased by a big bully dog. You are like, “Get out of here.”
Even if I can only do that for ten seconds, that's as fast as I should go. Anything else we have missed? This has been so beneficial. There is so much information here. You have so much knowledge in your head and I'm asking for you to narrow it down to ten seconds of information.
It's the fueling before and after. Make sure that you are getting between 20 and 30 grams of protein at every meal and 15 grams at every snack that you have because that keeps us even levels of amino acids, which we need at this point in our life. We need it for brain health and we also need it for our muscles and muscle turnover.
We talked about carbohydrates and because we are becoming more insulin-resistant, we need to look at fruits, veg, and whole grains. We are not looking at quick hits or processed food and not reaching for the protein bar because they are still quick hits of carbohydrate in that unless you are going and you are like, “I haven't eaten and I need to eat something right before training,” then that's something you need to do. We need to have lots of fruits and veg. We got health as well as helping with instances.
Choosing things like sweet potatoes over potato chips, for example.
Potato chips are okay every once in a while.
We talk a lot about that in MetPro. It's still life. You aren't going to eat 100% clean all the time. That's ridiculous. Nobody can do that.
We call that an eating disorder. It's called orthorexia where you are eating to clean all the time and are afraid to try to get into some of the more pleasurable types of foods that give your body a sense of pleasure.
We don't want that. Dr. Sims, thank you so much for your time. What's the best place for readers to find you, your books, and all of your amazing information?
The website, DrStacySims.com, has everything that we are doing. It has our courses. It has our little micro-learning blurbs. It has links to all the research that I'm doing, and other things that are upcoming. That's the big hold pattern. On social, Dr. Stacy Sims on Facebook and Instagram where we post little tidbits of information, hopefully, to help people and keep people proud of all they are doing.
It's a lot of great information. I follow you in all the places. That's all for this episode. You can find all the MetPro method episodes anywhere you get shows, or you can go to MetPro.co/podcast. Please be sure to follow the show and rate and review. That lets other people know what they can expect. You could also learn more about MetPro at MetPro.co. I will be back next episode. Until then remember, consistency is key.
