310: Dr. Stacy Sims on Optimizing Nutrition and Exercise in Perimenopause

ELLA Hey, you're on air with Ella and I am very, very excited to introduce you to Dr. Stacy Sims, who I'm sure you've encountered before. Stacy, this is not your first rodeo, but welcome to your first time on air with Ella. You are where today? Dr Stacy Sims Mount Maunganui on the North Island of New Zealand. ELLA Yes. So a little time zone situation that we're that we're working through. And I just appreciate you talking to us at an early hour for you today. So thanks, Stacy, in advance. Not a problem. All right. Listen, Stacy, I would love for you first to tell everybody who you are and what you do. And then we're just going to jump in. Dr Stacy Sims So I always start this with I'm Stacy and I'm Jera's mom, because that always ends up being the first thing. But from a professional standpoint, I'm Dr. Stacy Sims. And I am an exercise physiologist and nutrition scientist that specializes in sex differences, really pushing to get women to understand that most of the protocols and guidelines that are out there are based on male data. And we're really trying to upscale people to understand female physiology and how we should be changing things to work for our bodies, whether we're 20 or all the way through up to 80 plus. ELLA And thank God for you and the work that you do. You wrote next level. You wrote the book Roar, which we've talked about before. I had your co-author for that book on the air, Selene Yeager, and she was an outstanding resource. But Stacy, we could not help even at that time talking about what a blessing it is to have you in the ether now, because generations that preceded us, Stacy, there were there were there were no data. There were there was nothing to go to when women were in the go to when women hit the ages of 40, 45, 50, 55, et cetera, and face this interesting journey that we're on, whether it's perimenopause or menopause or obviously postmenopausal. And I'm just so incredibly grateful for the mass of work that you are bringing into the ether, Stacy. Dr Stacy Sims Oh, thanks. Thanks. Yeah, I know. Like our parents had a hard time. Our moms had a hard time even talking about menstrual cycle. Let alone talk about what perimenopause or what their experiences were. ELLA Well, your earlier work, Roar, introduced me to the concept of timing my workouts to align in some way with my cycle. And if you don't mind, I'd love to start talking first to the active woman, say, over 35. I'd really like to talk to her first today, if you don't mind, if we can touch on exercise, because the concept of aligning my training with my cycle was completely foreign to me. You are the first resource that ever even introduced this concept to me. And I would just love it if you could overview for us what the rationale behind that even is, if you can do so at like 30,000 feet. Dr Stacy Sims Yeah, so I mean, like our menstrual cycle is really, you know, month ish time where our sex hormones are fluctuating and every system of our body is affected by how high estrogen progesterone is or how low they might go. So we look at our menstrual cycle and see that it goes from a low hormone and phase ovulet ovulatory phase where you have a surge of estrogen. And then after that, you have progesterone estrogen that come up. We see changes in our immune system. We see changes in our ability to withstand stress. We see changes in our ability to access carbohydrate, our ability to recover changes in neurotransmitters. And so when you're looking at how we can use these hormones to our advantage in training and we can push hard when the hormones are low and we're most resilient to stress. And then when those hormones start to come up, we are more steady state, maybe not hitting really high, high intensities, listening to our own bodies, though, you know, so we know how we feel across our cycle because we've been tracking is up to the point where people weren't paying attention. They'd go to like a hot yoga class to go, what is my problem? Why can't I deal with this today? What if I'm not hydrated? And I'm not. But it's not that it's their core temperature is up because progesterone is up. So it's just understanding what's going on. So you can pinpoint the days where you can really go hard and maximize things. And other days where you're like, my body is kind of fighting me today. So I'm going to schedule something easier or something different. And it works across the board with training, but also like in daily life. ELLA Yeah, I have to say that one of my biggest nightmares was as a triathlete was having to race if I were on my cycle, like that just sounded like an absolute nightmare to me. Can you tell everybody why that is not a nightmare? Dr Stacy Sims You know, I feel like all of the races I did in Xterra and Ironman, my period would come on race day and I'd be like, yes, fantastic. Because that means that your estrogen progesterone has dropped to the lowest point. And your body is more like a man so that you can access carbohydrate. Well, you have more power, more strength, more ability to push. And your immune system is fighting fit. So if you have a really hard race and you have immune system perturbations, your immune system is going to respond. So a lot of women are like, oh, I'm always afraid. I can never go really hard. And I am a delicate flower. Mike, no, no, that's a patriarchal model. Yeah, of course, we have heavy menstrual bleeding and nuances within the individual. And that's a whole different conversation. But for the most part, when those hormones drop, you don't have to be delicate. You can go and push it hard because your body is like, yeah, let's go. ELLA Yeah. Never mind that four days before that, I feel like I've never actually, you know, run or even put on running shoes in my life before. And I feel like a rhino rhinoceros strapped into like cement blocks. That's four days before. But on the day of I'm a beast. Yeah. And someone didn't feel fantastic like the day before because their hormones Dr Stacy Sims have dropped, but they haven't started bleeding yet. And so when you start to like understand your own cycle, you know, like I'm always, I'm one of those people feels great the day before and I'll be like, oh, angry. I'll go out and have this really hard workout and feel fantastic. I'm like, why did I feel so bad? I'm like, I'm not feeling good. I'm not feeling good. I'm not feeling good. I'm not feeling good. Yeah. ELLA But I feel like every day before I've started to really work out and feel fantastic, I'm like, why did I feel so great? Oh, that's why. Cause my period is coming. Yeah. I'm basically a meme, but it's great to know that I can reliably be a disaster. I will link to roar for everyone in the show notes. I really just want to connect the topic to that body of work, Stacy, because we have so much to cover today. So I really just wanted to introduce that concept, give a teaser and let people know where to go if they are active and they want to know more about that. So we will link to that. We'll make it super easy for everybody, but let's stay on exercise now and talk about, okay, so what happens then Stacy when our estrogen and our testosterone are all over the place and I understand that in your world, we call that perimenopause. Yes. Dr Stacy Sims In my world and sort of life, right. Should be in most people's language, perimenopause, but it's not, it's not even in, um, GP language, which is very interesting. It's not. There are a lot of GPS, like you'll have someone who like typical case scenario, someone is 39, 40, and they're feeling stressed, anxious, like, you know, like dead to the core fatigue and like, Oh, I got to get my iron check to feel awful. So they go to a GP and the GP is like, okay, we'll run some blood tests and they'll look for iron and it'll come back normal and they'll be told, Oh, well, your iron's normal and just must be, uh, because you're highly stressed and you need to, you know, learn how to de-stress and maybe we can give you some serotonin reuptake inhibitors to help with your mood. But the idea of perimenopause never enters their brain because either one, they think perimenopause is like two years before menopause, or they're just not that in tune with like, what are the signs and symptoms of perimenopause? Aye, aye, aye. Yeah. Well, it's slowly changing, but for the most part, it's still the status quo. ELLA Well, and that's why you're here. And that's why these conversations matter. And that's why this network matters. And that's why this community matters. So I want to just make sure that we've level set with folks before we go any further, perimenopause is what five to 10 years, what's the actual textbook definition five to eight years before your menses stops, generally speaking. I know it depends. Dr Stacy Sims Yeah. Around 10. Yeah. Around 10. Okay. Cause they say the average age of menopause is 52 and we started to see ELLA changes in our early 40s. Okay. And then we have covered on the air before Stacy that menopause technically is when your menses has stopped for an entire year. Then it's, and then aren't you really technically post menopausal? Isn't menopause like a thing, a milestone that you find out about retrospectively? Dr Stacy Sims Yeah. So menopause is actually like one day on the calendar. So, you know, you can celebrate it as a, yay, I'm now in a new phase of life because 12 months ago was my last period. But yeah, it is retrospective. We're starting to see more changes with that, looking at, um, timing of periods and FSH levels, because if you're just going arbitrarily retrospectively going 12 months, uh, it can be a little bit confusing to people, but yeah, it's a, it's a standard at the moment. ELLA Okay. Where we are today anyway. Right. Okay. Fair enough. So let's talk now to women who are somewhere in these ages. Guys, I am just, I'm making these ages up. What I'm trying to do is say you're generally post fertility. You're not, you're not in the heart of your child rearing or child bearing years, I should say. I don't mean it's impossible, but we're not, we're not talking about outliers here. So somewhere in between that period of note, you're not infertile, but not in the heart, in the center of your child bearing years, and then you are not yet menopausal. So we're talking to women in their late thirties, in their forties and in their fifties in very general terms. Dr Stacy Sims Is that fair to say? Yep. Yep. Absolutely. ELLA Okay. Well, that's who sent in the questions. When I told people I was interviewing you, Stacy, the questions started rolling in and I know these folks. Fantastic. So I am going to get, go through as many of them as that I'm going to go through as many of them as we can get to today. Let's stay on exercise. What changes when you are in this season? What happens when you're going to your CrossFit class or you're going to your Orange Theory class and you're not getting the results that you used to get or whatever you were doing before isn't working anymore. Dr Stacy Sims Why is that? Well, we're starting to have changes in the ratio of our estrogen progesterone. So our absolute values are not really something we want to go by. We want to look at the ratio because as we're starting to see more estrogen dominance and less ovulatory cycles, so that means that we aren't producing as much progesterone, our actual menstrual cycle length might not change, but we'll start to see changes in our bleed pattern. Right. And so that's kind of an early sign. And when we're having those changes in our ratios, every system of the body is affected. So if we think about puberty, right, and we see girls who haven't started their period yet, so they might be eight to 11, 12, and their bodies start changing, their mood changes, their sleep changes. And, you know, it's just kind of a mess. You're like, what is going on? And then their period comes, you're like, Oh, puberty. Okay. Got it. We're on the other end. So we're on the time where the hormones are affecting us in a different way than they used to because the ratios have changed. We're also seeing changes in our receptor sensitivity because we have a lower progesterone or a greater amount of estrogen or just because of those changes. And we're also seeing changes in our gut microbiome because when we have changes in the ratio of estrogen progesterone, it also alters how diverse our gut microbiome is. So if we're looking at how estrogen facilitates lean mass development, how progesterone and estrogen together help with blood glucose control, as well as high intensity, how their interaction with neurotransmitters come into play. So all of these things get compounded into poor sleep, mood changes, real irritability and rage. We see a lot of that just turning on the dime. Body composition. We're not getting what we want. We're starting to have a little bit more sticky body fat in places that we might not have had before. So all of those have to do with our sex hormones changing. Sounds like a great time. Yeah. And then the, I don't say it's the worst, but we start to stay sympathetically driven. So this is our baseline level of cortisol is elevated and we have a really, really difficult time getting into a parasympathetic response. So that really like chill response, which then we see as a decrease in our heart rate variability, increased issues, having to sleep more wake times. So it really plays with the other side of things, but we need to be able to ELLA just like, well, I want to talk to you today about what we should be doing to help counteract some of those changes, or at least to feel optimally, given what's going on. I want to talk about what we can eat, sleep, do drink, et cetera, because the one message, and I believe that I share in this point of view with you, Stacy, is that this is not a catastrophe. The catastrophe is the dearth of information. The catastrophe is thinking that this is your future and it's inevitable. And the catastrophe is just going meekly into the dying light. And I, I don't subscribe to that belief. I am here to live out loud. Yeah, exactly. Yeah. I mean, there are other cultures. Dr Stacy Sims Yeah. There are other cultures that don't even have a word for hot flash that they don't understand like why Western society is so up in arms about women getting older because in more Eastern philosophy, Eastern cultures, Asian cultures, getting older is revered. And so women don't report having hot flashes because it's not something that really crosses their mind as an aging process. So when we're looking at how Western society and the patriarchal idea of what a woman should be has come down on us. You know, women die at 40. We see it in research. Like there's a huge misstep. There's not a lot of research done on active women between the ages of 40 and 55, because they don't really fit into the category of reproductive years. And we know there's not enough research there. And then they're not postmenopausal. So they're not getting the funding to look at postmenopausal issues. So they're, like I said, there's a small group of us that are doing specific research in that area because you don't die when you're 40 and they get reborn when you're 60, right? And you shouldn't struggle through all of these changes thinking it's just you and not understanding what is going on. So every woman goes through it. There's no denying it. It's part of like, you have to go through puberty. You have to go through peri and postmenopause. It's just part of life. And when you put this black curtain over it and don't talk about it and your ELLA GP isn't aware of it, it puts us back in the 1800s. Yeah. And I'm just going to share an anecdote that I just shared on Instagram after a race that I did this weekend, Stacy. And I thought this was super cool. First of all, it was a triathlon, which is swim bike run event for those of you, not indoctrinated, not in this cult yet. I'll get you. And the person that won the race overall was a 17 year old girl, which I just think is just absolutely spectacular. Yeah. Absolutely spectacular. But what was so cool and inspiring and just blows this narrative out of the water, the one that I'm rejecting with you. Yeah. 50% of the top 10 women were over 44. 50% of the top 10 women were over 44. I got beaten. I got smoked by a 50 year old and a 47 year old. And I have never been happier. I, so I just, I just, there is so much that we can do. There's a lot that we can control. There's a lot that we can influence. And that is something that I like to remind people of. And now I'd like to lean very heavily on you to tell us some of the things that we should be doing to give us a fighting chance. And so one of those, when it comes to exercise, tell me something I'm guessing I already know, and we've established on this platform that we have got to start or continue or improve our resistance training, like headed into this phase of life resistance training. If you're using the word optimal living or intentional living, I don't know how you do this without any resistance training. Do you care to comment? Dr Stacy Sims Yes, but it has to be specific, like not orange theory, not necessarily crossfit. I know people are like, what? Like, that's not what I mean by resistance training. I'm not saying eight to 15 reps. I'm not saying body weight. When we get to this point, we need to look at power-based training. Because if we're looking at our sex hormones and how they change, estrogen is, is our anabolic hormone, right? And so as we start to lose it and change the ratios and our bodies like, Hey, what's going on? We have to find an external stress that's going to cause the adaptations that estrogen use. So if we look at estrogen and how it affects the actual satellite cell of our muscle. So it stimulates muscle protein synthesis development. It also stimulates how strong one of the proteins, myosin interacts with the other protein actin that come together to create a muscle contraction. So it's kind of like a ladder, a sliding filament where myosin grabs onto actin and pulls it closer and that's your muscle contraction and estrogen's responsible for how hard those two come together bond to contract. And then the third thing that estrogen is responsible for is when you have a nerve that's that stimulated to do a muscle contraction, that nerve impulse has to jump this gap and the way it jumps a gap is through our, a neuro, a transmitter called acetylcholine. So right at that gap, there's these little holding patterns of acetylcholine and estrogen's like, Hey, we need lots of acetylcholine here for this nerve. When we lose the estrogen stimulus, we have less acetylcholine. So that nerve conduction isn't as strong. So we don't have a really strong connection for muscle contraction. So this is why we start to see a loss in power and strength, like even running pace decreases, right? We see running pace decreases. Why? Because we're not as strong or as powerful because we're not getting that stimulus. So if we do heavy resistance training, so we're doing zero to six reps, we're doing a five by five where you might be doing cluster sets at 80% one rep max. This is a central nervous system response. So you're stimulating the central nervous system to create a nerve response that we need to have more acetylcholine. We need to have faster nerve conductance. We need to be able to stimulate those muscle fibers to strongly contract, to lift that load. So we don't need estrogen anymore. We have a central nervous system response. So this is why we look at power based training. ELLA Okay. So when you talk about power based training and you said zero to six rep range, I believe, what is zero range? That means it's so heavy that you can't complete one motion. Dr Stacy Sims We look at it usually as six to zero. So you might start with six really good form. And then by the fifth set, you can't finish that last one or last two. So you've reached failure. ELLA Okay. Dr Stacy Sims So that's what that zero rep range is. You could also do really heavy. Yeah. You could do really heavy isometric where you're like holding it like you're going to pull up on the deadlift bar, but it's so heavy, you actually can't, but you're pushing your feet into the ground and you're like contracting all the muscles and ready to pull. And it's a really strong, heavy load. And your body responds by, okay, I'm going to try to lift, going to try to lift. Oh, I can't do it. ELLA Okay. So there's good news and bad news here. And when I say bad news, that's tongue in cheek. That's like, you know, this is harder. This is something that a lot of people aren't accustomed to, but there's a lot of good here. And one of those things is you are saying, we're not talking 12 to 15 reps and, and sort of the old model or that honestly, like the traditional model, if you go to one of these classes that we've described, you're talking about. What sounds like to me, shorter workouts with denser weights, like that's actually more accessible. Dr Stacy Sims Absolutely. So like you, you know, if you are looking at, uh, three times a week max in the gym, but you're not going and spending hours and hours there each session. You're not going for hour to 90 minutes each session. You go in, you're like, okay, I'm going to work posterior chain. So I'm going to go in and I'm going to work my squats. So I'm going to do five, five, five cluster sets. So it would be two reps, pause, two reps, pause, one rep. And then you do that every three minutes, nothing in between. You're just doing five reps on the three minute, nothing in between. So it might take you 30 seconds, maybe 45 seconds to do those five reps. And then you're resting the rest of those three minutes. You're not supersetting anything else. You're resting because it's a central nervous system response. It is not a metabolic response. So you need your central nervous system and the nerves to regenerate, fully recovered again. Then the next little section, you want to kind of like compliment those squats. So you might do every minute on the minute, four rounds. The first minute might be step back lunges as many as you can in that one minute. And then the second minute might be an air squats or banded monster walks. And then the third would be like a plank or a plank pushup. And then the fourth minute before rest. So that's all you do in and out. So the heavy lifting is one focus and then you're complimenting with the next. ELLA What do you say to the people who enjoy cardio, who really enjoy swimming or biking or running or whatever they might do? Dr Stacy Sims Right here, long term endurance athlete. So it's not the bread and butter because we look at endurance stuff in triathlon, especially it's all about volume, volume, volume, volume. I have ultra runners like I want about time on the feet. Women are already naturally able to go long and slow when we get to this point and we're losing power and you don't want to do things that's going to encourage us to go slower and get injured. So we need to look at polarizing our training. So we're doing our heavy resistance training two to three times a week. And then we're doing true high intensity work. We're not going to an orange theory because that is not true. Hit that puts you squarely in moderate intensity, brings cortisol up, makes you tired, puts you in a breakdown state. You lose more lean mass. You have poor sleep. So when we talk about true hit training, it is five minute mobility, five minute progressive warmup and whatever mode you're going to do. And there'd be 90 seconds at 80%, 90 seconds off. You do that five times and then done and dusted. And for people who are like, I'm endurance oriented. Okay. Yeah. On the weekend you do long, slow, super easy. Some people call it zone one and a half type training where it is like, you feel like you're almost doing nothing, but you feel good at the end. So for my ultra runners, it could be a three to four hour jog walk on very terrain, not going over an RP of four. And you might do that Saturday and Sunday because they need more time on their feet. For my triathletes, we do a two week block of that really good intensive work. And then on the weekend, we might compliment with a really long, slow, easy coffee ride, riding with people who are slower than you. And it's all about the social and being out there. But then you're doing your high intensity quality work during the week. And so when you put those together on race day, boom, you're fighting back. ELLA So instead of running 15 miles a week for, which by the way, I used to grossly over train and I cured myself of that by not being able to do it anymore. That took care of myself, but even running 12 to 15 miles a week. Sounds like that's not helping me as much as it would to do the shorter sprint workouts that really, I mean, I can do a sprint workout in 12 minutes. I mean, very, very easily, meaning I don't mean the workouts easily. I mean, it can easily be eight minutes. Dr Stacy Sims Because when you're doing it right, it's hard, right. Doing it right. It's hard. So like one of the workouts that I do, I live in a very flat area, but they have one hill called the Mount and it's a thousand meters up and it has steps. I mean, a thousand feet up and has steps. So I'll go and I'll run as hard as I can, working on bringing my knees up, like running form up three flights, recover for two up three recover for two. And by the time I get to the base of the Mount run up and down, up and down and back, it's 5k only, but it's been a super hard workout done and dusted. And I do that twice a week. And then I might on the weekend do a, you know, an eight to 10 K super easy, easy run that takes an hour or so. So it's not fast. And that's all I need to do. ELLA Well, we had someone come on the air recently who is not a specialist in the same arena that you are very credible. And I don't want to detract from what she was saying, but she was promoting zone two workouts. And for those of you who don't, aren't familiar with that language, it means like your, your heart rate is what slightly elevated, but you're still conversational, you're still conversant. Is that a fair way to describe it? Stacy? Dr Stacy Sims Yeah. Yeah. ELLA Really low aerobic activity. Okay. And, and longer term, can you tell us why that's not serving us for this group of women that we've already identified? Dr Stacy Sims Yeah, absolutely. Because when we look at the reason for doing zone two, like the research and how it all became conversed to like a conversation to zone two, it's for mitochondrial health and it's for increasing free fatty acid metabolism. Okay. When we look at women who are XX, so biological women, XX, we are already there. We are already more metabolically flexible. So we, you blood sugar and then free fatty acids, we really spare our muscle glycogen. We have better mitochondrial activity because we go into free fatty acid use before really tapping into glycogen. And we also have more of the proteins within our muscle for stimulating mitochondrial health and free fatty acid utilization. So when we're talking about zone two training, and we also talk about metabolic efficiency training, it's all based on male data because men are not as efficient as women. So I'm like, Oh, you're a dude. You want to become more like a woman, become more efficient, do your zone too. Do your metabolic flexibility training. Women were already there. Our bodies are already designed to do that. And for, for mitochondrial health, it's more about doing that high intensity work and then recovering for cardiovascular health or better blood glucose control. All about that top end really polarized training to benefit us from a health and performance. ELLA Okay. To put a wrap on exercise in general for now, what is your best resource that I should be directing people to if they want to really dig in here, because there Dr Stacy Sims is so much more to learn. Well, Abby Smith Ryan out of UNC, she has published a lot and her lab website has a lot of really great information about the changes that perimenopause women go through, the protein that you need, the kind of strength training you need. And so do I on our website, we have blogs and we have resources to that kind of stuff. And if you can't find what you're looking for, you can always email support a Dr. Stacy Sims, and then we can direct you to where you want to go. ELLA Does next level have as much detail about exercise physiology, that sort of thing as, as roar did for the general female population? Dr Stacy Sims Yep, absolutely. Okay. ELLA I cannot wait to get my hands on that. Okay. Dr Stacy Sims So the whole book is geared for this conversation. Like, what am I doing? Do I need hormone replacement therapy? What are some alternatives? What kind of exercise should I be doing? And then we go through different, we have like eight or nine different case studies from women who are climbers to Olympic lifters, going through medical menopause, all of those things, really trying to empower women who are in this 35 plus bracket, understand what they need to do to change their training and their nutrition to keep getting stronger. ELLA Okay, fantastic. So I will list out these resources, but I asked that largely because when I asked you what your best resources was, were, I thought you were going to say your books. So that's so nice that you gave Abby Smith Ryan a shout out, but I got to be honest with you, your books are like manuals for this population. So I'm going to pimp them out if that's quite all right. Yeah. Dr Stacy Sims But I love Abby. She's a great colleague and she does some really cool research in this space. ELLA And she's one of the only other people that does the research. Yep. Okay. All right. Very, very good. Now we'll take, we'll take anyone we can get. Thank you so much. Okay. Let's broaden some of the questions. Now, again, we are, we are primarily talking about women in this season that we have described as perimenopause, but, uh, you just tell me if, if we need to broaden any of these questions, let me know. I am taking these straight from my listeners, Stacy. The first question is what do we do about feeling overwhelmingly achy and tired? And I understand this because I was nutritionally in a slump, which I did not realize till I got some blood work done. And I was so, so tired, which is very unusual for me. So I have a lot of empathy for this listener. What are some of the first things we should do, Stacy, if we are experiencing Dr Stacy Sims extreme achiness or tiredness or both? Yeah, this is common. Perimenopausal, um, women experience this. And this is what I mean, like we're tired, but wired and no matter what kind of sleep we get, we just can't get out of that feeling. So that it's, it's kind of a compound, um, treatment to say. So we want to first, of course, look at our sleep hygiene. So we tend to do a three to one rule. No food three hours before bed, no screens two hours before bed, and then low light and, um, you know, really trying to wind ourselves down for the hour before bed. So we get into parasympathetic. We look at adaptogens using ashwagandha or rhodiola because that helps mitigate cortisol, helps us get into more of a parasympathetic drive, helps us able to cope with stress a lot more because it's not a pharmaceutical that's going to tell your body to stop, but the plant compounds and the adaptogens actually work with your body to either decrease sensitivity to cortisol, increase estrogen metabolism, hold onto it. So it's working with your body. It's not replacing anything. And then for like the overwhelming anxiety type feeling, this is where we really have to work on that mindfulness. And I know it sounds very Yogi, but it could be 10 minutes where you're just sitting and going, okay, I know that if I don't get up before my family and have. 20 to 30 minutes of no noise. It sets me off for the day. I'm anxious. I can't like focus because I don't have that opportunity to just find that feeling reset and then be able to draw on that feeling throughout the day. So it's finding what a trigger is. Some people it's noise. Some people it's being alone. So finding what that trigger is and be able to counter it and then tap back into that and if those don't work and the severe achiness and fatigue and just to the core, just really interfering with your daily life. Can you talk to an endocrine specialist and they might recommend serotonin reuptake inhibitors, they might recommend, um, going on low dose menopause hormone therapy just to attenuate the symptoms. But that would be like one of the tools on the table. It's not the first stop. ELLA Yeah. I have to say that even just doing a blood test when I found myself there was so, you know, in a nutritional profile was just terribly enlightening. I didn't realize that several of my tanks were empty. Yeah. So it was small wonder that I was feeling like all my batteries had just died. Dr Stacy Sims Yeah. Cause this is also the time where a lot of women will fall into low energy availability, where you're super busy. You want to train, you get up, you might grab a coffee, do your training, come back, have to get the kids out the door or you have to get ready and get out the work. So you don't really eat, you don't, and you delay your food intake to like lunchtime, you have something on the go, get home, you're starving, you're trying to eat something, make dinner. You're rushing around, getting things ready for the next day. And then you collapse into bed and you can't sleep because you bookend your calories on the wrong end of the day. You're not working with your chronobiology. So you're not really bringing yourself out of a breakdown state. And when we're looking at what's happening, especially in this age group, if you're not fueling for what you are doing and recovering from it, your body goes into and stays in this catabolic state. The first thing to go is your lean mass. So you might go to the gym and you're lifting heavy and you think you're doing all the right things, but if you're not having any protein to support it around training, your body stays in this breakdown state, you don't get any change. Your cortisol comes up, you stay tired, but wired, and you just keep getting into this really bad catch 22. ELLA Yeah. Let's talk about both carbs and protein while we're at it. And why we should be avoiding neither. So I'll confess to you that as a vegetarian, an active vegetarian, I really struggle with getting enough protein, but everything I'm reading and everything I'm learning in this journey is that that's not an option. Like I need to figure it out. I need to get it sorted. Can you tell us why protein is so critical to us again, like, you know, USA today version, but generally speaking, why we cannot be skimping on the protein at this in the season. And I would also love if you would give carbs the same treatment here, because as you know, we are the generation that was told we would get fat if we ate an entire banana. Dr Stacy Sims I know carbs are good. So I'll start with protein. So as we get older, our body becomes more resistant to the effects of protein and exercise. So we become more anabolically resistant. Right? So if we do our activity and we're like, I need to build me a mass. We have to back it up with a good hit of protein. And because our body is less responsive to the amino acids in protein, we have to have a bigger hit. So we're looking at, you know, 15 grams before and 25 after each session or 40 grams after each session. And then regular protein doses throughout the day, looking for palm size or palm size and a half for every meal. And this is because we need to keep a certain amount of amino acids in our blood in order to keep our body functioning well from neurotransmitters all the way down to gut health, as well as building lean mass. So protein super important and regular doses, because that's how our body works. ELLA So it's actually important to space out the protein throughout the day. Yes. Okay. I was shocked to learn that you are either vegan or vegetarian. You tell me which. Dr Stacy Sims So for the most part, okay. I will say that I'm a vegan until I travel, and then I will use whey protein and Greek yogurt to up my protein when I'm traveling. ELLA I am a non-flag waving vegetarian who just doesn't eat animal proteins. And it's an enormous pain in the ass, like just to be clear. So I am dying to know how you get enough protein. Dr Stacy Sims Well, so I look at everything across the board that has protein in. So it's from chia seeds, adenomy, green peas, pea protein, isolate, tempeh. Um, I look at my nuts and my nut butters. I look at, uh, what are some of the other things? Sprouted grain breads. Everything has some protein in it. So if you're putting it all together, you're like, Oh, look at that. So after a workout, I will have chia seeds mixed in with quinoa and, um, almond milk and a little pea protein. Sometimes I put in some blue spirulina cause it's high in protein and iron and doesn't taste grassy and I get my 40 grams that way. So it's just really being cognitive that there's so many different options of protein. It doesn't have to be like animal protein. ELLA Okay. I always forget about spirulina and you're saying blue spirulina. Oh my gosh. Spirulina. Yeah. Blue spirulina is so nice. Okay. Noted. And then it doesn't matter if you eat eggs or not. I was about to say, do you eat eggs? But that doesn't matter. I need to eat more eggs. It's one of the purest proteins that you can get whether you eat them or not. Dr Stacy Sims Can you, can you cast a vote for eggs? Yay or nay? Absolutely. And you don't have to take the yolk out. Like the yolk has good protein and fats in it. Absolutely. Yeah. ELLA Yeah. It's just, we have, we are still debunking Stacy. We're still debunking Intel from the eighties and the nineties and the two thousands. That's like, you know, you gotta eat egg whites and only half that banana and carrots have too much sugar, et cetera, et cetera, et cetera. I know. It makes me insane. I'm like, show me the person who trashed their health because carrots. Dr Stacy Sims Right. And I look at it as the big cornerstone for everyone is taking care of your gut microbiome. And so when you have all these eliminatory diets, you're directly affecting the diversity in your gut. And the lack of diversity is responsible for so much of the obesity genetic outcomes that we have. So if we're looking at cute, a really good diverse gut microbiome for brain health, for gut health, heart health, hormone health, we need to have carrots. We need to have all the fruits and veg and the whole grains and all the fibrous foods and stick them in the gut because that's what feeds our gut bacteria. ELLA Okay. Before we get into carbs and how differently useful they are actually in this season, can I ask you a quick question about amino acids, which you mentioned as a plant eater for the most part, I don't think I'm even getting enough amino acids. So I'm now, you know, I used to drink BCAAs or branch chain amino acids. And then I started reading a bit more and now I believe I'm consuming a more complete amino acid drink, but these are manmade. These are factory amino acids. I don't even know if they're doing me any good. Can you tell us why amino acids are important and debunk some of the Dr Stacy Sims common thinking around them? Yeah. So amino acids are the building blocks of protein and we have our nine essential amino acids, so that means our body cannot synthesize. We need to eat them. And one of the critical ones is leucine. So leucine is the one that gets and saturates the muscle to really trigger it for muscle protein synthesis. But also we want more circulating leucine across the blood brain barrier to kind of help with tryptophan not getting in there and getting too much serotonin. Because tryptophan and leucine, both amino acids, they use the same carrier gate into the brain, but the brain preferentially uses leucine. So if we're having lots of mood issues, anxiety, depression, it's because we are hypersensitive to serotonin. So we want to have more leucine and more amino acids going so we don't get as much tryptophan because when tryptophan gets in the brain, it creates more serotonin and hyper activates serotonin receptors, which makes us go, oh my gosh. And then, oh, I feel awful. So amino acids are great. We get them a lot through food. And the way I tell people to think about using essential amino acids, like in a drink, is if you're going to go on a long bike ride or a long run, gaff your electrolyte bottle with it, because those amino acids are going to help with fatigue. And it's also going to help increase the amount of amino acids that are circulating. As women, we tend to oxidize more amino acids when we're exercising, which helps us preserve our liver and our muscle glycogen. So when we're looking at, oh, I got a fuel. You don't want to just think about carb, carb, carb, because our bodies don't use really more than 30 grams of carb an hour. We look at using a little bit of blood sugar. So that's what that 30 grams of carb does to really help us keep in a fat burning ELLA and not use so much amino acid. But we also do use some amino acid that boosts the fat burning. Okay. And what are the sources of plant protein that you identified? Are they also, are they equally sources of amino acids? I'm sorry, that must be a terribly naive question. Dr Stacy Sims They are, they are. So what makes, when they say that a plant protein is incomplete, it means it might be low in one of the essential amino acids. So if we look at some of the common protein powders that are out there, right. We see whey isolate, we see insulin. We see instantized or hydrolyzed whey. We see pea protein isolate. We see hemp, all of those. Pea protein isolate is almost the same as whey protein isolate. ELLA It's just lacking a little bit of leucine. So if we boost it by like having some branched-chain amino acids added to the pea protein, or you're combining it with hemp, it's the same as whey protein. Oh, okay. And hemp, like hemp seeds, adding hemp seeds to your smoothies or to your salads or to your soups, that sort of thing. Hemp seeds are an outstanding source of protein. Are they not? Dr Stacy Sims Yes. And Omega, Omega threes. ELLA Okay. Fantastic. Okay. Stacy, I have so many questions to ask you. Okay. Let me try and go rapid fire on a couple of these. So creatine, I started ingesting creatine three grams a day after my interview with Celine, and I don't even remember why I am not embarrassed to tell you that, like, I just knew that it was good for me and I started taking it. Stacy, why am I taking it? Dr Stacy Sims And am I doing the right thing? You are doing the right thing. And it's because women have 70% of the stores that men do, and it decreases as we get older. But creatine is responsible for all the vast bioenergetics in our body. So for brain health, heart health, gut health, as well as muscle performance. So if we're looking at improving our ability to lift loads and recover, we want to take some creatine. We look at mood and mood changes. We see randomized controlled trials that look at SSRIs. So your serotonin reuptake inhibitors and creatine and women who are having three to five grams of creatine a day come out of severe depressive episodes much faster than if they are just using a serotonin reuptake inhibitor. Wow. So super important for brain health. And when we're thinking about how, as we get older, especially women through perimenopause and we're having cognition and reaction issues, that creatine helps. It really helps with that. ELLA Okay. And what are the natural sources of creatine? Dr Stacy Sims So they're all animal products. Okay. Our liver naturally produces about one gram a day, but we're looking at eating three to five, if you eat a lot of chicken, you need a lot of beef, then you're probably getting it, but with the limitatory diets and not eating enough, and especially as vegetarians, you need to look at supplement. And it's the most widely studied supplement across the board. It's so safe. It's, you know, recommended in pregnant women as well, because their bodies need more creatine. And again, Abby's done quite a bit of research on it. ELLA So she has some good resources. Okay. We will deep dive into that. Okay. Thank you. All right. One more ingesting question. Is it at all useful to be ingesting collagen or collagen peptides? This one, I just, I cannot get an answer on this and I don't know if the data are there. Dr Stacy Sims We, well, we don't use it as a protein. Like people go, Ooh, vital proteins, collagen protein. It is not a dietary protein that goes for making muscle. It is target specific. And we know that if you are using 10 grams of collagen peptides over the course of four to five months, it does help with joint pain. It's not necessarily regenerating cartilage tissue, which people are like, Oh, take collagen cause it helps regenerate. No, but it does dampen the pain by sending more of those collagen particles to where it needs to be. So the full spectrum of what we need to do with collagen, still not out there. But if we look at collagen versus collagen peptides, they do two different things. You were taking native collagen. It causes an immune response where in your body's told not to break down cartilage. It's telling your body not to attack its own tissue. If we take collagen peptides and those peptides can be absorbed and then they go to the joint or the hair or the skin to help improve the production of ELLA natural part, natural collagen. So what is native collagen? Dr Stacy Sims I don't think I know. That is a whole collagen peptide. I mean, a whole collagen molecule. So that's your whole helical structure. So they might say undenatured collagen, but not collagen peptides. When you're buying something that says collagen peptide, that gets absorbed. Native collagen, which is an undenatured full molecule. That's what causes your immune response. ELLA So there are two different types. Okay. So it's not, should you take one or the other it's what problem are you trying to solve? Exactly. Okay. Got you. Okay. I'm going to try and squeeze in. We have a whole host of questions with regard to HRT that we are just going to have to do a part two on Stacy, if I can invite you back for that. Uh, absolutely. Okay. Yeah, that will be great news to the many, many people who ask questions. Let me try and squeeze a couple of questions in though, about, uh, the belly weight gain, you actually touched on this, but it is so common, it appears seemingly that gaining that weight and sort of that pot belly situation is so common during these perimenopausal years. What's the story there and what should we be doing differently? Dr Stacy Sims So like I was saying, our body is under that severe stress, right? And we have elevation in cortisol and we're having different signaling of estrogen progesterone because we're changing ratios or estrogen and progesterone receptors are changing. So one of the unfortunate signals is to put on the cereal fat. So that's a deep abdominal fat. And we start to see menopause. What we need to do is we have to have some cross talk between skeletal muscle and the cereal fat. So this is your resistance training. Really important because then the skeletal muscle is sending signals to say, yeah, we don't need you to cereal fat go away. And the other is that top end sprint interval training because that improves our glucose uptake and our insulin sensitivity. And it also causes an epigenetic change in the muscle where we are having more of a specific protein that allows glucose to come into the muscle without insulin. So when we have better control and better insulin control, we don't have a signal for putting in that the cereal fat. So it's that polarized training. We have to do that heavy resistance training to have cross talk. And we have to do that sprint interval or true high intensity work to have actual changes within the muscle to then further signal the body, not to put on that. The cereal fat. ELLA Okay. So this isn't about eating fewer carbs. This not at all. No. And I see this happen. I see lean women, you know, smaller framed women and they still get, did you call it menopause? Dr Stacy Sims Yeah. People call it menopause. ELLA I love, I hate it and love it at the same time. Okay. What is the correlation, if any, between DHEA, which you can tell us what that is. All I know is that it's a hormone that we produce and it's related to the adrenals, but what is the, what is the correlation between low DHEA or I want to say, and, and that menopause is there one? Dr Stacy Sims Not really. No. Okay. So DHEA converts into testosterone. So people are like, oh, if we have more testosterone, then we're able to build more muscle, but that's not true. For women, we can have a significant decrease in testosterone if we're in low energy availability and a lot of times that comes with low carbohydrate intake. So our body will perceive low carbohydrate intake as low energy availability, and it compounds hormonal disruption. Some really cool research that's just come out in the past month, month and half that's showing women who are low carbohydrate intake and low energy availability, end up with worse hormone function than women who are just in low energy availability. So carbs are super important and we need to, like, if we have more insulin resistance and we're a little bit like touchy around carbs, you have them in and around training when your body needs it. And then your carb focus comes more from whole grains, fruit and veg, not looking at like breads and white rice and potatoes and that kind of stuff. That's a little bit more fast acting. But carbs super, super important for one, gut microbiome, but two, for maintaining and helping with hormone function. Does it matter when you eat them? Well, when we're looking at how to eat, right? And we look at when should we be eating certain things? We want to work with our natural rhythm, our circadian rhythm. So we know that you want to have more carbs in and around training, a heavier kind of emphasis towards the beginning to middle of the day, and then kind of start to taper off and have more of that protein focus towards the evening. Because then your body's rhythm is working with it. It's working with cortisol responses. It's working with your body's ability to repair or recover. Yeah. And then you aren't going to end up hypoglycemic while you're sleeping, which is what happens with a lot of women if they are bookending their calories or they end up having a really high carb intake at dinner. And some of the awakening events we see is hypoglycemia. ELLA Oh, you're saying that hypoglycemia is actually one of the reasons for sleep disturbances? Yes. Wow. Yep. Dr Stacy Sims Yep. And it's really super common for women who are in low energy availability. So that's another reason to really try to focus on fueling your body throughout the day for the stress at hand, not bookending your calories, not skipping meals, not doing intermittent fasting, none of that crazy stuff because sleep is really important. And if you're in a low energy state and you're having low carbohydrate, a lot of the ELLA sleep awakenings at night are due to hypoglycemia. Stacy, this is what we're going to do. We are going to go do our homework and we are going to read next level. And then I am going to ask you to please come back, please come back, Stacy, so that I can get all of these perimenopause HRT hormone replacement therapy questions answered in detail from you in the near future. How does that sound? Dr Stacy Sims Absolutely yeah, it'll be fun. Okay. Yeah. ELLA So thanks everyone for sticking with us through part one. I know we've only scratched the surface, but Stacy, I'm going to make it dead easy for everyone to find you and to find these resources. Where is the best place that you like to be found? Dr Stacy Sims You can go to our website, drstacysims.com, and also Instagram, Dr. Stacy Sims on Instagram. So. Those are the two biggest places that you can find me. Okay. ELLA Stacy, thank you so much for your time. And to my pod fam, I promise you, I will deliver on this one. So stick with us. Let's go do our homework and have Stacy back on the air. Stacy, thank you so much. Dr Stacy Sims Yeah, thanks. I look forward to part two.