What We're Still Getting Wrong About Women's Health & Fitness: Dr. Stacy Sims Live

Dr. Stacy Sims is an exercise physiologist and nutrition scientist whose mantra – "women are not small men" – has reshaped how women approach their health. Recorded live with a studio audience, we challenge the conventional wisdom around fasting, cardio, and calorie restriction. In its place, a playbook calibrated for female physiology – heavy lifting, fed-state training, circadian eating, and a new relationship with perimenopause. Stacy is a force. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors: Prolon: Get 15% OFF plus a FREE bonus gift👉🏼https://www.prolonlife.com/richroll Momentous: High-caliber human performance products for sleep, focus, longevity, and more. For listeners of the show, Momentous is offering up to 35% off your first order👉🏼 livemomentous.com/richroll Airbnb: Your home might be worth more than you think. Find out how much at👉🏼https://www.airbnb.com/host WHOOP: The all-new WHOOP 5.0 is here! Get your first month FREE👉🏼https://www.join.whoop.com/Roll EIGHT SLEEP - Use Code RICHROLL at eightsleep.com/richroll for up to $350 off the Pod 5 Ultra. Check out all of the amazing discounts from our Sponsors👉🏼https://www.richroll.com/sponsors Find out more about Voicing Change Media at https://www.voicingchange.media and follow us @voicingchange Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 1:05Speaker 01

  I'm gonna introduce our host, Mr. Rich Roll.

• 1:08Rich Roll?

  How's everybody doing? Are you having fun today? I think this promises to be a potentially life-altering conversation with one of the world's most renowned exercise physiologists and nutrition specialists. So, without further ado, let's welcome the wonderful Stacy Sims. Stacy, what a delight to have you here today. I'm so excited to talk to you. And I want to start with just, you know, the quote that gets the most traffic. This thing that you constantly refer to. This idea that women are not small men. So, what do you mean by that? What are you trying to communicate?

• 1:51Speaker 02

  Yeah, I think a lot of people don't really understand like the biological and physiological factors that make us XX versus XY. Because from a cultural standpoint, you go into any shop and you have like the men's section, the women's section, and it doesn't really matter. Like you just go where you want to go. But when we're looking at scientific research, we're looking at health outcomes, we know that most of the research in health and sports science has been done on men and generalized to women, even small things like aspirin for heart attack. There were no women who were in the original study. So they were looking at men and generalizing to women. Same with osteoporosis research. So when we start going, women are not small men, it's because we, as women, deserve to

• 2:33Speaker 02

  have research done on our bodies and our physiology. Because the dose of the X chromosome changes if you have a double X versus an XY. And we see this from in utero all the way through aging processes and into death. So the women are not small men kind of started as a funny when I was teaching in the afternoon and trying to wake my students up. And I was teaching sex differences in training principles and practice. And it's like, women are not small men, and this is why in the cardiovascular system. And then when I started a sport nutrition company way back, we started with a women's line and the tagline was women are not small men to differentiate. And then that just became a resounding mantra for so many people.

• 3:14Rich Roll?

  How did we get here? Why is it that so much of the fitness and dietary advice that you see out there is really oriented around men and not women?

• 3:27Speaker 02

  This is, this is more of a historical kind of question to ask. If we think about the origins of medicine and science, women were not invited into the room. Because they were, as much as I loved Darwin, I also don't like him because he said women had smaller brains. And when we're looking at the origin of scientific design, it was men in the room and women weren't even thought of as we need to include them. Because at that point, no one really thought that women could be different. They were just smaller versions of men. So the origins of the scientific design of medicine all came through the male lens. But as we've progressed and science has progressed, we realize that that's not really adequate. So now we're looking retrospectively, well, how do we really look at women in a different light? How do we really investigate their physiology?

• 4:12Speaker 02

  So we're going back and we're looking at methods. How do we actually nail methods down to accommodate for things like the menstrual cycle? Even that isn't really nailed down yet. We start looking at, it's 2026, we don't have an answer for PCOS or endometriosis. Why? Because of the patriarchal way that medicine and science started and how ingrained it is in all of society. So there is a little bit of a push now, I shouldn't say a little, a big push now to really look at scientific methods and make sure that we are including women not from a hormonal status, but from a biological genetic status of XX, as well as how different hormone profiles will affect the outcomes.

• 4:51Rich Roll?

  So your sense is it is changing, maybe not changing fast enough, but there is change afoot.

• 4:57Speaker 02

  Yes.

• 4:59Rich Roll?

  What is the main thing that we need to understand about the fundamental differences at play here? Before we get into the specifics, like how is it and why is it that women are different? What are those, what are those differences?

• 5:16Speaker 02

  So one of the studies that I was talking to Mary Claire about, and she didn't even know this, and she is an OB, is in utero. We see that a woman who is pregnant with a baby, an XX or a boy baby, is under high emotional and environmental stress, will have a higher chance of miscarrying than if she was carrying an XX. Because we'd see that some of the genetic coding that really protects an XX fetus is driven by some of the epigenetic stressors that the mom experiences. And then after the baby is born, we think that kids are pretty similar. But you'll see through development, there are just inherent things that boys will gravitate to versus girls. And then when we look at purity, the changes that happen at purity,

• 5:58Speaker 02

  we see that girls with the epigenetic exposure of their sex hormones, we see a shift in our biomechanics. So women's heart are... Hips will widen, their shoulder girdle widens to accommodate for the widening of the hips, and that happens because in a reproductive sense, you need wider hips to have a baby. With that, we also see a really fast lengthening of our extremities. So women become more quad dominant, and so they have to really relearn how to do all the fundamentals. And this is one of the play factors of why girls drop out of sport, because their body doesn't feel like themselves. Whereas, boys at puberty will get stronger and fitter, faster, more aggressive because of testosterone.

• 6:38Speaker 02

  And then as we go through our reproductive years, we have ultimate changes in the reproductive years. No one really has a regular menstrual cycle, and even within that, there's variation from month to month. If you're traveling, if you're not, daylight, that kind of stuff. Then we have things hormonal contraception, IUDs, then you might have PCOS, endometriosis, all these things that affect women. But inherently, even aging is different. We know that not associated with hormones, women have more dysfunction in one of their proteins for muscle contraction that makes them lose power and strength early, before they lose actual muscle mass. Whereas, men don't have that dysfunction, they just lose muscle mass. So when we're looking at aging from a biological sex difference,

• 7:23Speaker 02

  we have to really say, are you XY or are you XX? Because the aging factors differentiate not from a sex hormone decline, but actually from what's happening from a genetic code. And I mean, I could spend the whole time talking about cardiovascular system, how our lungs are smaller, we have less hemoglobin, we have less oxygen carrying capacity from a sports standpoint. We also see differences in mood and anxiety compared to men and women under the same stress. We also see that women become less, their bodies become less accommodating for cortisol stress, even if they're exposed to the same stressor, whereas men do. So they have less extremities of cortisol peaks when they're stressed with the same stress. So it becomes this whole big thing of, okay, it's becoming very complex.

• 8:07Speaker 02

  But if we just kind of look at male and male data, it'll be good enough. But it's not.

• 8:13Rich Roll?

  Well, maybe the easiest way into this conversation is to start with a very common question that a lot of women face when they enter perimenopause, which is, "Why is it that the things I used to do are no longer working? Like, why is it so difficult for me to like, lose weight? I'm gaining weight and everything that I used to do to manage my weight and my well-being seems ineffective all of a sudden?"

• 8:41Speaker 02

  Yeah, and this is, um, some new research is coming out that's really interesting. So, we're teasing out aging versus what's happening in perimenopause. So, we used to think that the symptoms associated with perimenopause was just based on hormonal dysfunction. Because usually, when you're thinking about what's happening in perimenopause, you're having more and more what we call anovulatory cycles. So, if you don't ovulate, then you don't produce progesterone. So, you start to have wild disruption in our ratios of estrogen and progesterone. Why that is important is because we have estrogen and progesterone receptors in every system of our body. So, as I was saying, at purity, how everything changes because of the epigenetic exposure of estrogen and progesterone. Same thing is happening because there will wind down and our body becomes very sympathetically

• 9:26Speaker 02

  driven. The other thing that happens with it is all of our metabolism goes down. So, our resting metabolism decreases, our sleep metabolism decreases, the energetics required for bone and bone turnover or muscle turnover also decreases because the body is under extreme stress. So, we see at any point when the body is under extreme stress, it starts to wind down its metabolic processes. So, this is attributing to some of the weight gain. We also see that about four years before that one point in time in menopause, there's an incredible decrease in our gut microbiome diversity, which then exacerbates the body's ability to store body fat because we start having an overgrowth of the phyla

• 10:09Speaker 02

  that is obesogenic or prefers to grab all of the energy out of all the food that we're eating and make you crave simple carbohydrates.

• 10:17Rich Roll?

  What is the root cause of the microbiome dysregulation?

• 10:22Speaker 02

  This is your drop of your sex hormones because we look at how sex hormones are metabolized and distributed through the body. There's a point where it is, our sex hormones are released and then they are bound with sex hormone binding globulin to be effective in their work. This is excreted into the intestines through bile and then unconjugated or taken off the sex hormone binding globulin and shot back out in circulation. So our gut bugs do that. As we start losing our sex hormones or having wide variations in estrogen and progesterone and to some extent testosterone, those gut bugs die off. And so what happens because the body is extremely stressed and sympathetically driven, the

• 11:05Speaker 02

  phyla that really thrives in those stressful situations starts to overgrow. And unfortunately, that is that obesogenic phyla, which is why when we start looking at what is one of the big things that women can do is increase the fiber and diversity in their diet to make sure that gut microbiome diversity stays.

• 11:24Rich Roll?

  And also downstream of this, of these hormonal shifts is, correct me if I'm wrong, is this signaling to the body that it needs to conserve its fat and its energy stores, right? So in conjunction with the, the, the kind of microbiome changes, is that hormonal signaling that's, that's, that's leading to a retention of that like visceral fat and belly fat?

• 11:51Speaker 02

  Yes, and we know that estrogen is a very strong anti-inflammatory agent. And so as that starts to decrease, we have a conversation that is happening between the liver and free fatty acids. And because there is more inflammation in the body, the way that the body responds is to change the molecular structure of free fatty acids to make them what they're called esterified. And esterified is stored as visceral fat. So it's, it's like, we have this very stressed body, we have all of these things that are happening that's causing inflammation. Our main driver of anti-inflammatory responses is decreasing. So then the response is we are in this tizzy, we have to be able to conserve things, have extra fuel. So we're going to down-regulate the things that take a lot of energy, which is bone and muscle.

• 12:35Speaker 02

  We're going to up-regulate the storage of things that will provide fuel, which is fat.

• 12:40Rich Roll?

  And how does that evolve as women age up into menopause from perimenopause?

• 12:47Speaker 02

  So it happens all across menopause. If we don't do anything, we're going to have significant body composition change. And we know that the like, the peak of all the changes is the two years before that one point on the calendar called menopause. In post-menopause, early post-menopause, we start to see some leveling out and then things start to get better on the other side. You're not going to have any real change in body composition unless you make an active effort to do things during perimenopause. And also, when you get to post-menopause, if you haven't done anything, it's not too late. So we always look at an exercise stress to create an adaptive response, as well as what kind of nutrition we're putting in to really support and kind of counter all the negativity that's happening

• 13:31Speaker 02

  in the body. Because we know that feedback mechanisms and some of the adaptation mechanisms from exercise stress really do increase anti-inflammatory responses, changes in epigenetic protein, or causes an epigenetic response within the cells to be able to pull more glucose in without insulin. So many, many things that we can do without pharmaceuticals, for the most part, to counter what's happening to the body, to improve body composition and mental health, to carry women through perimenopause and have a better baseline at post-menopause and keep building.

• 14:05Rich Roll?

  Before we tease out some of those specific counters, what in your mind is the biggest myth or misconception that gets propagated out there about this phase of life for women?

• 14:20Speaker 02

  That it's something you'd be afraid of, because we see now that there is so much fear factor in the marketing around it, that you shouldn't do high intensity exercise, you're going to get a cortisol belly, you're going to break your bones, you need to take this supplement, you need to take MHT, you need to do all of these things. And in the

• 14:39Rich Roll?

  You become fragile.

• 14:40Speaker 02

  Right, and you become fragile. And in reality, it's, we have to change that conversation. It's like, let's do the basics. Let's hit the good sleep, the exercise, the nutrition, the mindfulness and community, and then we build from there. But so many people get so afraid that they drop out of everything that they're doing because one, they don't know what's going on. And two, they feel awful. They don't want to exercise. And then they feel like they're letting their friends down if they're the slow person in the group, or they're not motivated, or they've had poor sleep. So it's like, let's change that conversation, empower women to understand what's going on so that they're not afraid. And they can still keep doing all the things they love, but with modifications.

• 15:18Rich Roll?

  So we're going to talk about nutrition. We're going to talk about fitness and then other just general daily lifestyle habits. But these things all overlap, like the Venn diagram overlaps. But let's, let's begin with nutrition. You have a very specific kind of take on how women should be eating as they're, you know, inching into their later decades. So what is your thesis on this?

• 15:42Speaker 02

  I've been doing a lot of reading and have some colleagues who are in the chronobiological world of research. And what I really want women to understand is their circadian rhythm. So men and women have different circadian rhythms, where women's is a little bit shorter than a man's. And our circadian rhythm is tightly tied to different hormone pulses. So hormones don't rise and fall in a linear fashion. They're pulsed out throughout the day. So it's not only our sex hormones, but it's our appetite hormones, it's our thyroid, everything that is part of the endocrine system. So if we are doing something like holding a fast till 11 or so, and we are eating in a small window because we'll stop eating at six, because then we want to sleep well,

• 16:26Speaker 02

  we have effectively phased shift our circadian rhythm. Because the most powerful ways that you can change your circadian rhythm is light and dark and food intake. So if you wake up and you're withholding food, and maybe you're exercising or not, and you're going through a stressful day, the body is like, well, wait, what's going on? So we know that the hypothalamus comes into play because when a woman wakes up with her cortisol awakening response, that peak is higher than a man's. And with that comes, um, acetylcholin, which is the active form of our hunger hormone, and PYY, peptide YY, which is a appetite suppressant, so it's a counter. If you don't have food, then with the rise in cortisol, it kind of stays elevated, which keeps that, um, acetylcholin active.

• 17:11Speaker 02

  And the peptide YY can't make you not feel hungry. So the hypothalamus is going, wait, what's going on? So then we start having a cascade of responses that starts to down-regulate things like your incidental movement. We see less incidental movement, we see more of the wall-een in the afternoon, we see more of a craving for simple carbohydrate in the afternoon because your body, it feels like it's in such a fatigued state. And then in that smaller window of eating that women are holding a fast, um, they aren't necessarily getting all the micronutrients they have. But then we also see from population research, for those people who hold a fast later, they end up with no metabolic control that a fast is supposed to give them.

• 17:54Speaker 02

  So when we start looking at, how should women eat? It's like, let's work with a circadian rhythm. We know that you want to eat within a half an hour or so as you wake up. It doesn't have to be a large meal, but just enough to bring blood sugar up and signal that yes, there's some nutrition coming on. Then we look at having protein and fiber at every eating opportunity. So that's at every meal, every snack. We want to stop eating with dinner, don't eat after dinner, so that you have a good two to three hours before bed. And then you have your overnight sleep where you're having all your reparation. So if we're thinking about fasting, if you don't eat at seven, or you stop eating at seven, and then you wake up at seven, and then you don't have breakfast till seven thirty or eight, you're looking at a twelve, twelve and a half, thirteen hour fast, time restricted eating.

• 18:39Speaker 02

  So you're getting the benefit of having a break from eating as you are going into night, which is beneficial, is how your body works. But then you're not interfering with key signals throughout the day that your body relies on to be able to overcome stress and be stress resilient, to have cognition and focus, and to be able to understand what an exercise stress is and recover from it. And so I think that there's this whole disconnect of like, I need to fast and hold calories because I've heard about all this stuff, how fasting helps with autophagy and helps with parasympathetic and telomere length and metabolic control, but that's from male data. So when we start looking at the female data and looking at chronobiology, we see that

• 19:21Speaker 02

  the best way a woman can eat is according to eating during the day, fueling at hand, and then having that break overnight. So we're not phase shifting, we're not going to bed with a full stomach where we can't get into a deep sleep, and we are actually able to follow that rhythm, which improves our oxidative capacities, it improves our anti-inflammatory capacities, and by the way, it improves our sleep.

• 19:47Rich Roll?

  How does everything you just shared correlate with a woman's age? Does this become more acute the older that you get? Or do these principles apply across the board irrespective of age?

• 19:59Speaker 02

  Well, the circadian rhythm doesn't change with age. But what does change is sleep and sleep architecture. So the biggest problem that a lot of women have when they hit their 40s onwards is sleep and having a lot of difficulty sleeping. And we see, yeah, there's a change in serotonin and melatonin production, partly because of gut bug changes, but also we become more sympathetically driven. So if we're really trying to improve sleep, then we want to really pay attention to what we're doing in the day. Because if you're eating well in the day and front lining calories, then you aren't going to be sympathetically driven and unable to get into a parasympathetic response for good sleep. Why do we want good sleep? Because we can't have any kind of metabolic or body composition change if we have poor sleep.

• 20:42Speaker 02

  And that's the biggest fleeting factor, especially when women get into perimenopause with changes in body comp and the inability to sleep and then they're fighting back and they're trying fad diets or they're trying to hold a fast and it's interrupting sleep even more, which becomes this big cascade of events where it's like, just hold up, let's look how the body works. Let's look at that circadian rhythm. Let's work on sleep. Because once we get sleep nailed down, become more stress resilient, your body can start making changes.

• 21:09Rich Roll?

  It seems like those principles would apply to men also.

• 21:13Speaker 02

  You would think, right? But we see that phase shifting is more difficult in men because they are not as sensitive to calorie changes and nutrient density as women are. I pull a lot of the examples out of what we call low energy availability, which is really high in active women and men. And we see that the calorie kind of intake bare minimum for women before they start to have dysfunction is around 30 calories per kilogram of fat-free mass, but for men it's 15. So we're looking at the baseline level for nutrient needs, it's different. So men can hold a fast and they're not going to get dysregulation. They're not going to have necessary changes in their pulses because it's not as strong

• 21:57Speaker 02

  of a stimulus for change as it is for women. It becomes more of a protective factor from a biological standpoint. If there isn't a lot of nutrition around, women's bodies start to really conserve.

• 22:09Rich Roll?

  Right. So the translation is basically if men are undergoing some kind of fasting protocol, intermittent fasting or whatnot, they're able to lean out and still maintain or build lean muscle mass, whereas women's bodies, the signal is conserve and so they're going to retain, they're going to retain that fat. So the fasting is at cross purposes with the aim.

• 22:34Speaker 02

  Right. Granted, of course, there are outliers. Like, if you have a really significantly obese woman, then fasting can be beneficial because we're trying to get control and see, we see that fasting can be more beneficial than severe calorie restriction. But when do we break the fast is the question, right? So if we're looking at a woman who is obese and trying to get control, it's not breaking the fast late. It's breaking the fast early and then having the fasting window or the eating window in the day and then stop eating at like four. So you have a longer overnight fast. It's not about working in the morning because even in women who aren't active, they still have this circadian disruption.

• 23:13Rich Roll?

  Yeah, that was my question. I mean, obviously, if you're obese, that's a, you know, setup for a cascade of all kinds of lifestyle ailments. And I can understand why a fasting protocol would be efficacious in that regard. But what about, like, how much of this is applicable to someone like yourself who is super fit, very active versus, you know, the average forty plus or fifty plus year old woman who, you know, does enough here and there, but also is, you know, working full time and is a mom and has all of these other kind of stressors or pressures in their life? Like, is there a use case where fasting

• 23:56Rich Roll?

  might be beneficial from your perspective, or you're taking it off the board?

• 24:00Speaker 02

  I'm taking the traditional idea of holding your fast till eleven or twelve off the board. And that is, I'm like, I look like I'm really super fit and everything, but I'm not. I'm the mom who's rushing around and have a really hard time, like maintaining mass. I don't have a lot of time to train. But no, across the board, it's like-

• 24:18Rich Roll?

  Sun's out, guns out.

• 24:19Speaker 02

  Yeah, I wish.

• 24:22Speaker 02

  Yeah. No, I got harassed last weekend because I wore a jacket on stage and people were like, where are your arms? I don't know if it's a thing. But no, if we're looking at, like, the traditional case that I have that'll come see me and say, I really, really need help, is a woman who is in her mid forty's, has two kids, super busy, having intermittent sleep issues, highly stressed, exercises when she can.

• 24:49Speaker 02

  She's trying to, you know, eat clean, do all the things. And she's like, help. But then it's like she leans into, it's really easy not to eat first thing in the morning because I'm so busy. I have a training session with my friends or I go to the gym at five and I get home at six and then I get the kids up and get them out the door and then I have meetings and emails and then it's like 10 o'clock before I've had any food. The very first thing that I do is like, let's reexamine the morning. Yes, I'm not going to have you have a full meal before you go work out at five or six in the morning, but let's have something, something really small. We know that Abby Smith Ryan, who's a researcher at UNC, has done research in this and shows that just 10 grams of protein before strength training program significantly helps avoid phase shift and improves exercise

• 25:32Speaker 02

  adaptations. If you're going to do cardiovascular type work, like a strength circuit or putting in some metcon in there, adding 30 grams of carbohydrate to that does the same thing. So we just look, it's like, how do we support the body in the times of stress where it actually needs nutrition? Because then we're avoiding any kind of phase shift. And when women start to adopt that, and even if it is just the infamous protein coffee, they're like, oh, my gosh, I feel better in my workout. I have more clarity in the day. I have energy. Then when the three o'clock slump comes, I'm not craving simple carbohydrates. I can actually reach for something that's good so that when I get home, yeah, I'm stressed and I'm tired from the day, but I'm not at that tipping point where I just can't deal

• 26:14Speaker 02

  anymore. So it becomes really important for the normal, really highly stressed woman to acknowledge the fact that not eating is not good. It doesn't make you stress resilient. It actually exacerbates the condition.

• 26:27Rich Roll?

  But you can imagine the vicious cycle of, oh, my goodness, I'm putting on weight. I'm working out more than I used to and I still can't seem to manage this. So I'm going to eat less or I'm going to skip breakfast or and then, you know, that impairs appetite control later in the day and you have all these sort of, you know, kind of energy lulls, et cetera, and you're just compounding the problem.

• 26:49Speaker 02

  Hundred percent. See it all the time, especially in the age group of women who are in mid to late perimenopause, postmenopause, that grew up with the supermodels and the Kate Mosses and the ideal that skinny is best. And I hear the rhetoric all the time. I'm just trying to lose weight. But in order to lose weight in a highly stressed situation, or not even a highly stressed situation, you need food. So when I tell people, you actually need to eat more to lose weight. We need to look at the quality and not volume of training. You actually need to eat more. And it's a mind switch. And people are like, what? I need to eat more. I'm like, yes, but it's not like calories. We don't talk about calories in, calories out. We talk about the quality of the food and the timing of the food.

• 27:30Speaker 02

  And once we start getting that in place, then the body composition changes.

• 27:35Rich Roll?

  In the Stacy Sims hierarchy of needs, though, sleep, it seems, is at the top of that pyramid. Nutrition and exercise can inform your sleep hygiene, but first things first, you gotta dial in your sleep.

• 27:51Speaker 02

  Yep. Yes, you do.

• 27:54Rich Roll?

  Um, one of the things you, you have also said is that women are often more metabolically flexible than men. So what does that, what does that mean? I mean, you're, you're dancing around it and everything that you've just shared, but maybe just drill down on that.

• 28:08Speaker 02

  Drill down on that. So when we talk about metabolic flexibility, this is where a lot of the zone two stuff came out. Like, we need to be able to train our bodies to burn more free fatty acids. And we look at there is, this is where we have sex differences, not hormone factors. Sex differences that occur within the muscle itself. So women are born with more of the endurance type fibers or, or slow twitch fibers. We're also born with more mitochondria protein for mitochondria respiration. So that means a more robust ability to use free fatty acids. Um, this is why we see women can go really long and slow without so much fuel. Men, on the other hand, are born with more fast twitch and glycolytic fibers.

• 28:51Speaker 02

  And so they actually have to do more of the long, slow training to enhance their fibers to be able to build more mitochondria, to be able to use more free fatty acids. The other thing is when we look at our reproductive years for women, they go through times of relying more on carbohydrate versus relying more on fat, depending on ovulation and progesterone. Because after ovulation, the body is taking a whole bunch of carbohydrate to grow this really lush uterine lining in case an egg is implanted. So we have more glycogen being stored in the uterus than we do in the muscles. So when we start looking at carbohydrate versus fat and exercise adaptations with carbohydrate versus fat, women are already metabolically flexible by the nature of the sex hormone coming

• 29:35Speaker 02

  into play. So when we start looking at metabolic flexibility and the issue with that, it's, should we be telling every woman that we need to be doing zone two to improve free fatty acid metabolism? Not necessarily, because we already are metabolically capable of using those free fatty acids. Do we need it to become more metabolically flexible? Well, actually, no, because our body is already metabolically flexible. It's learned that. We start having hormone dysfunction. Yes, there is an uptick of not being able to use carbohydrate very well, becoming more insulin resistant. But if we do the right kind of exercise, then we are creating an environment where we become more metabolically flexible

• 30:18Speaker 02

  and can use that carbohydrate really well. So this is where we start getting into, how old are you? You're not getting any change. What you're doing isn't working for you. So yeah, let's look at how we can can modify what you're doing to create an exercise stress that's actually going to create an adaptation, the way hormones use to support, or the way that your training used to. We just have to look at what that stress is.

• 30:47Rich Roll?

  Let me just back up and say, basically, on this idea of like a cascade of wrongs, like, you know, you're in this phase of life, what you're, what you have done in the past isn't working, you're off your rhythm in terms of what you need to be doing nutritionally, but you're kind of, you know, literally and figuratively on this treadmill where you're just upping the cardio because that's the solution to the weight gain problem, right? And so the nutrition's off, the sleep's off, but, but, you know, you're doubling down on all, you know, like the orange theory and the F45 and like all of these kind of like fitness classes. What say you, Dr. Stacy Sims?

• 31:30Speaker 02

  So I'm going to preface it with, any movement is good movement, right? And I come from it from how do we optimize? So if I'm looking at a woman whose journey is, I'm just going to start exercising because I'm having all these changes and I don't know what to do, then yeah. Do what you love, but if we're looking to optimize, we want to make sure that we're really polarizing the exercise. So this is where we're very specific in our interval and interval training. We're very specific in the type of strength training we're doing. Because we know that any beginner is going to get massive gains. But as you are more and more trained, you have to really look at what kind of stress you're putting on the body to get absolute change. So if we're looking at someone who has been a lifelong exerciser

• 32:14Speaker 02

  and has been doing lots of running, doesn't really like strength training, starts to have body composition change. And it's like, oh, I need to do some high intensity work. And her friend goes to F45, hey, come join me. And this is the first time she's ever done any kind of strength training or anything like that. She might in the first couple of months see some change. But after that, it's not, there's nothing, there's going to be no change. Because it's not truly high intensity work. So we're looking at an F45 or an Orange Theory. You're sitting 45 minutes at an intensity that isn't high intensity. It feels that way because we've all been conditioned to come out of a workout feeling really sweaty and wasted, but that's not effective. And I say that because when we look at the intensity needed to invoke change has to be really, really strong.

• 32:57Speaker 02

  This is a survival mechanism for the body. So if we're looking at high intensity exercise, 45 minutes is really moderate intensity. So it's not hard enough to be hard to invoke change. It's not easy enough to be easy for recovery. It's just kind of puts you in the middle. So then we start to see an increase in cortisol. We don't have a post-exercise response for growth hormone. And we don't have a post-exercise anti-inflammatory response. We are sympathetically driven, so that doesn't help with sleep. So it becomes a continuation of the problem that we already have. So when we start looking at optimization, we have to look at, okay, high intensity interval training is really good when we do it right. So the Norwegian four by four that everyone talks about,

• 33:39Speaker 02

  four minutes at about 80%, where those four minutes feel like four hours. And then your four minutes recovery where you're like, gosh, that felt like four seconds. Because we're really working to, one, develop lactate, which is really important for brain health. But two, we want more metabolic control. So if we're holding a threshold intensity for three to four minutes, then our body's like, I need carbohydrate. So it creates a response within the muscle and in the cells to what we say, translocate glut four proteins. So it's taking proteins from within the cell, it's pushing to the cell wall to open up the cell wall so carbohydrate can come in without insulin. And if we do the stimulus enough, then we are reducing our insulin resistance because now the body has more

• 34:22Speaker 02

  of these proteins, understands carbohydrate and glucose can come in without having to rely so much on insulin. And when we look at lactate, lactate is super important for women to produce because one, we have less glycolytic and fast twitch fibers than men, but two, it's preferred fuel for the brain. And we know that there's a massive sex difference in things like dementia and Alzheimer's. And part of it is our brain metabolism and dysfunction that occurs with glucose metabolism in the brain. So if we're introducing more lactate and the body understands what lactate is, it helps equalize some of that metabolism, which is a reduction in the risk factor for dementia and cognitive decline.

• 35:00Rich Roll?

  Did everybody follow that? You're going to be tested at the end of this.

• 35:06Speaker 02

  I need a flow chart.

• 35:08Rich Roll?

  Yeah, I have, I have plenty to say about that. But before I do, is, is anyone, does anyone want any clarification on that? Or do you have any questions that come up about what Stacy just shared?

• 35:19Speaker 03

  Just a question on interval training. You know, you say 45 minutes is, is too long, or sorry, maybe not long enough, but can you, can you do effective training in, in shorter months of time? Can you do like a 30 minute workout that's as effective as 45 minutes or an hour? And is it just like the intensity level and then the break level that you need to dial in?

• 35:39Speaker 02

  Yeah, that's more it. So I mean, like, if we're thinking about a 45 minute to an hour, in that you would have someone that warms up really well and then leads into really dialed in intervals. So we know it could be one to four minutes of variable, of variable intensity from 80 to 90% and variable recovery. So your whole work time within that might be 20, 25 minutes with your interval and your recovery. So then if you have a long warm up and a cool down, you could easily fill up an hour. But when we're looking at the classes, they don't do the interval part rate. So if anyone's ever been to an F45 or an Orange Theory, I know they already have targets

• 36:19Speaker 02

  on me, so I'm happy to talk about them now. They're all about go, go, go, go, go, go, and they don't really explain what you're supposed to be doing or how you're supposed to be feeling. It's all about the fast movement, it's about the sweat. It's like go, go, go from station to station to station. So you're not really doing the interval properly. So this is why when you're looking at those classes, yeah, it's a sweat sesh, but what did you really get out of it? For me, I don't want to take it away from people because it's their social connection. So I tell them, if you understand what you're trying to do, and you go to these classes, you can modify those classes for yourself. So you know, F45, instead of doing more reps with less weight, why don't you use that interval and lift heavier

• 37:01Speaker 02

  with less reps? So that you can make it work for you and your body and still get that social connection. And we're seeing that happening more and more and more in these classes where people are owning it and saying, I know I need this for my body, and I don't want to give up the time I have with my friends or the camaraderie that comes. It's just what are you doing specifically for that interval?

• 37:22Speaker 03

  Thank you.

• 37:22Speaker 02

  Yeah.

• 37:23Rich Roll?

  The TLDR of all of this is women need to be lifting heavy weight more. They need to be doing true high intensity training, and that should be mixed in with, you know, some polarization, some zone one, some walking. From my perspective, this gets translated, and help me clarify this, this gets translated on the internet to stop doing zone two and just lift heavy weights. And if I could translate a little bit what you just shared, which I'm totally on board with, basically what you're talking about is most people are, you know,

• 38:05Rich Roll?

  generally unbeknownst to them, engaging in like zone three. They think they're doing zone two or zone five. So they're in that gray zone where they're not really developing their aerobic capacity, you know, getting that mitochondrial density, recruiting those slow twitch fibers and... Increasing their ability to utilize fat for fuel. And they're also not going hard enough to get the stimulus to increase muscle mass and bone density and the like. And when you're in that middle zone and you're new to fitness, you will, like all movement's good movement. You will have, you know, you will have gains and you will get more fit, but you will quickly plateau.

• 38:50Rich Roll?

  And people who are in that zone either think they're doing the hard work or they think they're doing the zone two work and they're not doing either.

• 38:57Speaker 02

  Right. I, I mean, I've had people come after me and go, you're such an absolutist and you're telling women things they can't do. You can't do zone two, you can't do this, you must do lifting in the heavy range and you must do interval training. And I come back and like, look, to optimize women who have already been exercising, these are the things we know that work, but I'm not saying that's the only thing they can do. That's not what I do. I go to the gym three times a week specifically for lifting. It's taken me a very long time to learn how to lift heavy properly. And I'm also adding plyometrics in there because one of the other things that you really lose as you get older is proprioception and the ability for power. So it's like, let's work some plyo in there. On the weekend, you're not going to find me at home or in the gym.

• 39:41Speaker 02

  I'm either going to be out ocean swimming for a couple of hours because we have a seven K loop or I'm going to be on my gravel bike. None of that is zone two or zone five. It's my soul food. So when we're looking at optimizing and for women who have a very short amount of time, and let's face it, every woman and man who get up on purpose to exercise at, oh my God, it's still night, is an athlete in my mind. And I want people to think like an athlete. And you know, from being an athlete, that there's a specificity for every session that you do. So I'm like, I'm not going to tell you that you have to do high intensity interval training every day of the week and then throw in some heavy strength training. It's the only thing you can do. Let's look, how many days do you have to exercise in a week? Let's optimize.

• 40:25Speaker 02

  If we hit two high intensity sessions and we have two heavy lifting sessions, that's great. So what is that maybe? An hour and a half to two hours of your entire week. So what are we going to do the rest of the time? Let's move how you want to. I don't want to restrict anybody. But we're looking to optimize for brain health, for bone health, for muscle. These are the things we know that work inherently really well for women who are not only having an age factor that diminishes muscle power and capability as well as bone. We also have a fluctuation in our hormones that also affect those same systems. So let's look at how the body is aging and going through perimenopause and using stuff to optimize the body for change.

• 41:05Rich Roll?

  So women lifting heavy weight.

• 41:08Speaker 02

  I know.

• 41:08Rich Roll?

  Uh, wha- what do you say to the woman who says, "I don't want to do that because I don't want to get all bulked up"?

• 41:16Speaker 02

  I know, I hear this all the time. You won't get bulky. If you have a genetic predisposition for putting on a lot of muscle mass, then yeah, you probably will. But it's really, really difficult for women to get bulky. Um, and when we start looking at the power-based end of ranges, which is your 80% of one rep max, and we're looking at that heavy load. It's a neuromuscular connection that we're after. We're looking at how is the nervous system now going to come down and stimulate the muscle fibers to create a really strong contraction and a powerful contraction? We want to lift a heavy load so we have a neuromuscular connection because estrogen is not there on your side anymore. And when I talk about myosin dysfunction, which is you have actin and myosin is your two contractile proteins.

• 42:01Speaker 02

  The form of myosin becomes dysfunctional with age as well as a drop in estrogen. So with age, we want to do some heavy power-based stuff. When we lose estrogen, same thing. Because then we are changing the molecular or the isoform of myosin so that it will grab on to act in the way it used to. And this is why the basis of that power-based stuff is really important. But the other thing is we see from a randomized controlled trial that came out last month that those people who lift on the heavy end, both men and women, lift on the heavy end, get more prefrontal cortex neuroconductivity. So that means they're actually empowering the neurons in the prefrontal cortex more so than those people that are lifting moderate weight or body weight.

• 42:45Speaker 02

  Those people who are lifting moderate weight and body weight do affect other areas in the brain. And it's like BDNF increases. We have a little bit more connectivity. But only the heavy end of lifting really does affect the prefrontal cortex.

• 42:58Rich Roll?

  So there's a neuroplasticity aspect of this.

• 43:02Speaker 02

  Exactly.

• 43:02Rich Roll?

  And essentially, what you're saying is as estrogen goes down, you need to replace that stimulus with a central nervous system stimulus. And lifting heavy weights accomplishes that.

• 43:16Speaker 02

  Yes. And then you can look at, we get that increase in our neuromuscular stimulus in this pure strength and power. And then if you really want to try to put lean mass on, you have to eat a lot and you have to be in the gym a lot. And you have to look at what are some of the other rep ranges to cause hypertrophy? Because I think the confusion in this space is people are missing the mark when they're talking about strength and resistance training. Or people are thinking about building muscle mass is also strength. Yes, you're going to get strong, but you're not going to get as strong as if you were to stay at the lower end. And the way I try to get people to understand this is you can train to do 50 pushups. Are you going to have more strength? A little bit. Are you going to have a lot of muscle mass and endurance from that?

• 43:59Speaker 02

  Yes. I'd rather you train to do 10 pushups with a 20 kilo pound on your back or a 20 kilo plate on your back. Because then we know you're going to be strong. Are you going to have more endurance? Yeah, a little bit. Are you going to have more lean mass? Probably not that much, but you're going to be really strong and powerful. And that's the eye that we want for women because we know that power, strength is really, really important for longevity. It is a critical factor for how we age and appropriate reception. So I'm now at the point where I'm like, let's optimize women. Not so that they are in the moment now aesthetics. Yeah, that's part of it. But we know that women live for a much longer period of time than men, but in really poor state of health.

• 44:42Speaker 02

  So all the things we do now is kind of banking that we aren't going to get in that poor state of health. We're doing everything to protect our bones, our muscle, our brain, our heart. And these are the things that women need to start thinking about.

• 44:55Rich Roll?

  To get really specific, like how many, like you're going into the gym, okay? How many reps, like what is, how do I set the weight? How many reps should I be able to do? How many sets of those exercises? Like what, what would be a typical like routine? Like on this day, I do these muscle groups and I do this many sets of this and that. Like, what does that look like? I mean, obviously it's customized, it's very specific to the person, but in a general sense.

• 45:22Speaker 02

  Um, so this one is hard to answer. Every woman's journey is different and how they approach weight strength, strength training. If you are a woman who has a long history in strength training and you're like, I'm going to start to embrace this heavier lifting stuff. First, you want a periodized program. So if you're coming in, you're like, this is the, um, the strength, like the really hard base building part. Then we look at five by fives and that's five reps, um, five sets at about an eight on a scale of one to 10, more talking about our rating perceived exertion. You're working hard.

• 45:55Rich Roll?

  So meaning you could probably do two more reps or so.

• 45:59Speaker 02

  Yeah.

• 45:59Rich Roll?

  You're not going to failure.

• 46:01Speaker 02

  Correct. But you probably are by the time you get to that fifth set and maybe the third or fourth rep. So you are pretty much going to failure, but that's not necessarily the end goal. And you're not doing a lot of every muscle group. We talk about compound lifting because you have your stabilizers as well as the actual major muscle groups. So maybe Monday you're doing a squat focus and it's that knee hinge type focus. And then you do some subsidiaries around it. So your main focus is your compound squat focus and that's your five by fives. Then maybe you do some residual Brazilian squ- or some splits Bulgarian split squats. So you might be doing eight to 10 reps, but it's more about further fatiguing the muscle

• 46:44Speaker 02

  and getting more of a stimulus for the strength as well as some of the muscle hypertrophy. Maybe Wednesday's a push pull. So it's upper body, you're doing overhead press, maybe you're doing bench press, maybe you're doing a pull. So it's all the push pull. And then Thursday or Friday, you're doing posterior chain. So it's all like, these are the major muscle groups and the compound movements we want you to do, but how do you do it? We need you to have a program. We need you to go, okay, I'm going to do this for six weeks and then I'm going to have a deload and then I'm going to move into this. So we're continuously adding. Load and we're recovering from it and then we're changing up the loads because the body likes to have a challenge. So to see progress, we need consistency and we need to be able to challenge the body.

• 47:27Rich Roll?

  It's very difficult to adhere to a truly periodized program without a plan and you know, in the best case scenario, like working with somebody who's monitoring this. The typical experience, and this applies to men and women, you go to the gym, you kind of have your thing, you do your routine and that's just what you do. And it's the equivalent of zone three, I think, you know, in, in, for endurance athletes, like, and you just kind of hit this ceiling and you never really see the gains because you're not taking those deload weeks off. You know, you periodize, you know, daily, weekly, monthly, yearly, right? To really be able to figure out how to like optimize what you're doing. And you need somebody guiding you.

• 48:12Speaker 02

  Yeah. And for a lot of people, it's hard, right? And so one, well, there's two things I tell both men and women when you're looking at a periodized program. If you don't have a coach and you don't have a plan, then we're kind of wasting time, but not really. So if you want to do a quick hit, let's deload during school holidays. So, you know, your kid has a week off and instead of focusing on going to the gym, let's spend more time with your kid or know that that's a point where you need to deload because the school year is broken up into pretty good breaks where you have a week off and then maybe two weeks and then you have summer break. So you can use that as like a baseline for how am I, I'm going to focus for this before the next school break. Just gives you an eye to a calendar. And the other thing I have for, for women, because they're more afraid

• 48:56Speaker 02

  to push themselves to lift heavier. I go, okay, I want you to go pick up the weights that you're going to use for a Romanian deadlift. And I want you to tell me how many you can do with that weight. They'll go pick up some lighter weights. They might do a set of 20. I might, that's way too light. Let's go pick up the next set. They'll go to from like the 10s to the 12 and a half, might skip the 12 and a half, let's go to the 15. And they're surprised that they can still do 15 reps without an issue. So it's like really trying to challenge yourself. Instead of doing more reps, let's pick up a heavier weight. And it's getting that mindset of, okay, for this block before the next school break, let's focus on lifting up a heavier weight, even though you're doing the same routine. Let's just change up what routine you're doing by increasing the load.

• 49:40Speaker 02

  Or maybe we're doing resistance bands and some pogo's as a warm up instead of a static stretch. Just small little things because I don't want people not to go to the gym. I don't want to break up their consistency, but it's just reframing what they're doing by adding a little bit or taking away a little bit and breaking up the calendar in something that makes sense.

• 49:59Rich Roll?

  On the other end of the spectrum, we have the high intensity work. You mentioned the Norwegian four by four, like everyone likes to talk about that. That's just one example of, of, of, yeah, of many, of course. But what is something else that somebody should, like, what does that look like? Like, you're talking about like all out efforts with plenty of recovery other than, you know, some kind of indoor cycling or treadmill sprint situation. Like, what is another type of high intensity sprint based workout? Is the circuit training like fall into that category? Yes or no? Like, what are some other options that women can think about?

• 50:43Speaker 02

  Yeah, so if we think about circuit training, I tell people we can go on the, the aspect of every minute on the minute or every two minutes on the, on the two minute where one minute you're doing one exercise and you might have 20 seconds where you get to the next one. So you have four exercises and then a minute of recovery. And then you might do that two or three times and you could do that outside on the playground. Right? You could do air squats and then you can go into a, a hang on the, on the monkey bars. You can do walking lunges, you can do some sit ups. There's lots of availability. Rebecca Rush, she goes and she lifts rocks on a run. So there's lots of things you can do outside of the gym. And it's it's about the intent and the intensity. It's not necessarily where you are

• 51:26Speaker 02

  that you have to do it. So there are, I mean, gym intimidation is real. I get gym intimidation depending on where I am and some things. And I've been in and out of gyms since I was 16. So I know gym intimidation is real. So I'm not going to push every woman to go to the gym. Might not be time effective. Also, fear factor. So let's look. Okay, maybe we start with 10 minutes in your house and we're just doing body weight circuits where again, we're doing 30 seconds on, a minute off, maybe we're doing a minute on, a minute off, just starting slow. So it does become more feasible when people start to think about that. It's not about running for two minutes on the treadmill, jumping off and doing 30 second kettlebell swing, 30 seconds off, and then getting back on. Like, that's more personalized and really

• 52:08Speaker 02

  high intensity. But if we're a woman who's just starting this journey and she's just walking for five miles in the morning or three mile loop, during that walk, let's pick up the pace. Or maybe you have some stairs. Instead of avoiding the stairs, let's do a couple of ups and downs of the stairs. So that becomes an intensity factor. Or you're meeting your friend in the park to walk your dogs. Well, let's see, let's do a body weight circuit while we're there. You walk to the end of the, you're going around the lake, you get to a certain point in the lake, and both you stop and you do some jump, some air squats, or maybe do some jumping lunges. There's lots of ways that you can fit it in. But I think we've all just been so conditioned that high intensity means XYZ in the gym.

• 52:51Speaker 02

  And strength training has to be in the gym, or has to be, I know, in a personal training session. But it isn't like that. It's like, it's available to everybody. We just have to know who the person is, the personality, do they need a buddy or not, would they like an app or not, do they want to go to the gym or not, are you more of an outdoor person? I go to the gym so that I can be strong enough to do things I love to do outside. I didn't go to the gym because I love it. I go to the gym for protection against injury. So there are a lot of people like, I don't want to go to the gym, I want to be outside. Great. Let's see, what can we do outside that's going to hit these marks?

• 53:27Rich Roll?

  You mentioned jump training and when I hear that I think about bone density. You know, obviously when women age up, you know, we hear a lot about osteoporosis and bone density loss. What are the exercises that drive bone density retention or improvement the most? And what are some myths out there about that?

• 53:49Speaker 02

  Myths are rampant. We're running improves bone density. We think about yoga, like all these modalities, they don't. They're not a strong enough stress. If we want to improve bone density, we need a multidirectional stress coming up. The ground doesn't move, our body does. So we want something that's really hard to come up through the skeletal system to invoke that stimulus for bone turnover and bone strength. When I talk about jump training, so many people, especially perimenopausal women, like, I can't, my joints hurt. It's like, I'm not talking about plyometric high box jumps. It could be something as simple as a toe raise and a hard heel slam. Because you're dropping hard in absorbing all those forces, that's a multidirectional force through the skeletal system.

• 54:32Speaker 02

  There's a fantastic research program over in Australia called Liftmore and they look at strength training and proper jump training where it's hard landing. And they're getting significant improvements in women who've had osteoporosis into the bone density of normalcy and men as well. Out of New Zealand as well, osteo gains. It's all about the kind of jumping and hard landing that you're getting, not soft landing that we've all learned to absorb the forces. And it's three minutes, a few times a week to really improve bone density over the course of three or four months.

• 55:05Rich Roll?

  You mentioned plyometrics earlier. I don't know that I even know what that means. Does that include things like yoga and Pilates?

• 55:16Speaker 02

  No.

• 55:16Rich Roll?

  And where do those?

• 55:17Speaker 02

  Where do they fit?

• 55:18Rich Roll?

  Fit in.

• 55:19Speaker 02

  Yeah. So plyometrics is power-based training, explosive training. So this is your box jumps. This is your counter movement jumps. So all that stuff that's really fast and reactive. When we talk about Pilates and yoga, there's a whole subgroup of people who are Pilates lovers that hate me because they think I hate Pilates. I was in a Pilates class before I got here, not today, but a couple of days ago. I don't hate it. I think it's really good and people should look at it as. Really fantastic for proprioception, for balance, for isometric hold. We need all this stuff, especially for tendons and ligaments. Same thing with yoga. If you heard Keith Barr talk about tendons and ligaments, he really does like yoga in the last bit of the hold

• 56:01Speaker 02

  where you're shaking, because that gives you a stress in the ligament, in the tendon, to instigate more plasticity and strength within those tendons. They're complementary. They aren't strength training, in the way that we're viewing strength training for brain health and neuromuscular connection. They all can all fit together. So if you're someone who loves Pilates, you don't have to give it up. But add one day of pure strength training in. If you're someone who loves yoga, same thing. You don't give it up. It's like, how are we going to change what you're doing to optimize your life? I don't want anybody to give up their love. It's like, how are we going to look at what you're doing in the time in the week? And strength training doesn't have to take a long time. It could

• 56:42Speaker 02

  be 10 to 15 minutes if it's focused. It's not an hour and a half in a gym that you don't like. So again, it's the individual, and how do we look at it? And what are we looking to do? I think yoga and Pilates are really important as we get older, because we lose proprioception, we lose the ability for flexibility and mobility. And those two modes of activity really do help with that. But again, it doesn't tax the bone and the muscle the way we need to, to age well.

• 57:16Rich Roll?

  From a weight management perspective, what is your message to the person who says, "You're asking me to dial back my favorite aerobic exercise that I've relied upon for decades to keep my weight in check, and you want me doing three to five reps of these heavy weight?" Like, how is that going to impact, like, my bottom line, which is like, I gotta keep, I gotta keep the weight, you know, down?

• 57:45Speaker 02

  I like to talk about what we stand to gain, not what we stand to lose. Because in the diet culture, it's all about weight loss and fat loss. I'm very conscious not to say those words. I don't use them on my YouTube channel. I don't want to instigate anything about loss. I want to think about what we're, what we stand to gain if we get into the weight room. We stand to gain muscle. Muscle is a very active tissue that helps regulate all sorts of things. Body weight, our blood glucose, our immunity, just so many things. We get in the gym, we're also protecting our bones. So we stand to gain so much more from those few times in the gym than we do pounding and increasing cortisol, doing our favorite aerobic 90-minute aerobic session.

• 58:30Speaker 02

  And when we start thinking about what do we stand to gain, or to gain when we're in the gym, and gaining all those things for brain health and muscle health and bone health and longevity, versus what we stand to lose if we stop doing the 90 minutes. We actually aren't losing if we stop doing the 90 minutes. We're gaining so much more because if we're looking at the more muscle that we have and the more muscle-centric we are, the more that your body composition is in a better place. And it is, it's really hard for all of us that grew up in the idea of 90-minute step aerobics and going for a massive long run on the weekend and all of these things to keep our weight in check. Or doing fasted training because it keeps our weight in check. When we get this mental shift of being in the gym to help with all of that,

• 59:14Speaker 02

  it's time-effective and we also see significant body composition change. But it is a significant work on the brain to do that. A lot of times, a buddy system is really helpful because you don't want to let a friend down if you're both starting on this journey. Sometimes I'll have run groups. I'm like, "We're going to start the run with doing some strength training and then we're going to..." Now, we've prepped the muscles that you're going to run more effectively and more economically. So it reduces injury risk. So then we can lean in on, "We want to reduce injury. You want to improve your running form for the things that you love? Let's get in, let's do these, these preps and let's stimulate the muscle in a way that it does."

• 59:55Rich Roll?

  I made a big to do about this being participatory. I don't think I've actually lived up to that. So like, let's get some questions. Yeah, there's one in the back there.

• 1:00:04Speaker 04

  I was just curious regarding what you were saying earlier regarding circadian rhythms and how it pertains to the optimal time for women to fuel and, you know, start their day with nutrition and everything else. How does that factor into training schedules? Is there an optimal time of day for women to train? And how does that compare with men?

• 1:00:27Speaker 02

  I don't know. That hasn't actually been done from a research standpoint. We know from behavioral standpoint that anybody who exercises first thing in the morning is probably going to stick with what they're doing. We also see at the end of the day tends to drive a little bit more low energy availability and sleep disruption because people are going into a session not that well fueled, or they come home and it's too late. They don't feel that hungry, or they feel hungry an hour before bed, so they overeat. And that's both men and women. So from a behavioral standpoint, we always try to say, let's do more in the morning if we can, but really fit it in. And if you have to do it at night, there are things that we can do to help mitigate metabolism and help with refueling and help with sleep.

• 1:01:12Speaker 04

  Thank you.

• 1:01:12Rich Roll?

  We need some women questions. Yeah.

• 1:01:16Speaker 05

  I have a question. This is Sarah. Thank you for basically outlining my upcoming nutrition and workout plan.

• 1:01:22Speaker 02

  You're welcome. That'll be $1,000.

• 1:01:24Speaker 05

  Yeah, thank you. So for the interval piece that you're mentioning, you just kind of mapped a few different versions of that. Are there specific modalities or movements within that interval plan that you would consider more optimized than others? Right? You mentioned a few, few movements in there, but like, is cycling versus running versus mixed movement more optimized?

• 1:01:47Speaker 02

  Whatever you like. Whatever's going to motivate you. If you're learning how to go super hard, I always tell people to get on the assault bike with a friend next to them, telling them, go, go, go, go, go, because you cannot cheat on an assault bike. Once you know what that feels like, then anything goes.

• 1:02:02Speaker 01

  We are very behind on the research and women's bodies are complex. How do we get there faster so that we can know more and make more advances in women's health?

• 1:02:14Speaker 02

  This becomes a group of people working together because we see especially in academics or in academia and in the research world, there's lots of silos and people are like elbows out, this is my realm. But there is quite a group of us that are coming together to really try to close that gap, finding that I'm an expert in one thing, but I'm not an expert in all things that Emily's an expert in. So it's like, let's gravitate and bring all of us together because we can really put an impact on and have a louder voice and find money and grants and distribute it. And then part of it is we're launching a company about that same thing where we're going after AI and we're really vetting research

• 1:02:56Speaker 02

  to be able to give output and insight for women that's going to drive research and improve the touchpoints. So there's behind the scenes, we're all really trying to close that gap and address the funding issue and find innovative ways to actually go after that. But it isn't, it isn't an individual, it's a team. And we're finding that there is a really good group of men and women who are doing research in the space that are coming together and being complimentary to really hone in and try to close that gap. And in the different areas, we have the oncology area that is, is really booming with all sorts of different techniques and, and you have a lot of researchers coming together

• 1:03:37Speaker 02

  to help each other. Same in the sports space, same in the reproductive rights and reproductive research space. So it's an exciting time.

• 1:03:46Speaker 06

  Hi, thanks, Stu Ambrose. I'm the dad to a 14-year-old young woman and I want to be the best parent, I want to be the greatest parent I can to her. What are some habits that I can help instill with her and support her in? And she's, as she's in this part of her, her growing up?

• 1:04:04Speaker 02

  Girl dads, I love girl dads. My husband's a girl dad. Uh, so it, it, one of the biggest things is communication. Um, a lot of times, girls will shut down, especially with their dads. So if you just have a, like, we still instigate family dinner every night and have conversation. So it's like, how was your day? What were some of the high points? What were some of the low points? Um, and then at night, having conversation with her and I, she'll offload and like, just vent. I'm not gonna fix. So when they know that you're a safe place to vent and not looking for solutions, or they know that they can come to you and say things and not be judged, it's really important, especially as they're going through their teenage years. There's gonna be ups and downs, they're gonna have all sorts of mood swings.

• 1:04:47Speaker 02

  But if you're just consistently there as someone who's not judging and they can vent, it's like, I tell my daughter, when you get to the point where you, you might be going to parties and you feel unsafe, call me. I'm not gonna judge, I'm not gonna get mad until maybe the next day. But I don't tell her that. She'll know now, cause she'll watch this. But it's just really important to understand that both physically and mentally is an enormous change right now. And we wanna do everything to foster a positive environment. So it's like, we don't have, um, any kind of body language in the family. So we aren't, we talk about being strong and how fast you can run and all the things that she loves for soccer. We don't talk about, um, food in a negative way. If you want chocolate, you can have some, it's a sometimes food.

• 1:05:31Speaker 02

  Just remember, your soldiers don't want to grow on sugar. Her soldiers are your immune system. So just really coming to a place where, I understand you, I got ya. I'm not gonna judge you unless I really have to because I'm the parent. But for the most part, that undercurrent of just being supportive goes immensely far. And then the other thing that, um, is really important is your phone. Put it in the phone jail when you first walk in the house. That way, you're not on the screen all the time, which becomes a habit for all of us. And then they lead by example. Because if everyone puts their phone in the phone jail, then you end up with a very safe environment in the house. Thank you. You're welcome.

• 1:06:11Speaker 07

  Hi, I'm Meredith.

• 1:06:14Speaker 07

  I guess my question is about sleep. I am chronically a terrible sleeper, always have been. And in the last probably 10 years, it's gotten so bad that I am well, and people around me are also like looking for ways to get through the night, to stay asleep, to go to sleep. And so it's like, there's pharmaceutical options, there's herbal options, there's, you know, friends that can't go to sleep without a glass of wine. And I'm just curious, is like, is sleep, sleep? Or does it have to be good sleep? Does it have to be like sleep that naturally comes to be able to have that recovery?

• 1:06:48Speaker 02

  We want to see that you have really good sleep architecture because you need REM sleep, you also need slow wave sleep. We know that if you're using alcohol, then you don't get into slow wave, which is your deep reparative sleep. One of the things that is really effective is cognitive behavior therapy. There's a group out of the Veterans Association that has eyesleep. And it is, was designed to help people with PTSD coming back from Afghanistan to be able to sleep. And it's really effective. So one of the, the most effective ways is like cognitive reshuffling or some other cognitive behavior therapy with things like L-theanine and magnesium threonate that cross blood brain barrier to have an active part in parasympathetic responses.

• 1:07:33Speaker 02

  It does take some time and it's, it is a bit of a frustration when we first start, but stick with it because it significantly improves sleep and sleep architecture.

• 1:07:45Speaker 08

  Hi, my name is Emily. Thank you so much. I'm getting so much from this. As a 34 year old woman, you realize how little education you have on your own body. And so I'm all here to optimize everything you're saying. One thing I'm coming to is working with the cycles of my body, especially as someone who has endometriosis and is on a fertility journey. So I hear about these three to five workouts a week. And then I think about how I might be during my period or something like that. What are some of the ways that we can help to support ourselves instead of looking at every week as the same? I know that that's where I'm going to drop off with that consistency.

• 1:08:22Speaker 07

  Yeah, so it's.

• 1:08:25Speaker 02

  It's knowing that three times a week, you should be doing strength training, right? So, doesn't mean you have to go do the same thing every Monday, every Wednesday, every Thursday or Friday. No. You have your periodized plan, but sometimes you go, you're like, "I just wanna lift really heavy," or "I don't, I just wanna work on technique." It's feeling how you are, and I tell people, when you go to do a session, there's two things. You have a physical and a mental. And if you show up at a session, mentally, you're a two, but physically, you might be a six. Let's do a little bit of a warm-up with mobility. Maybe we do a couple of heavy lifts to stimulate central nervous system. See here, mental goes. If your mental doesn't come up, call it. Have an active day. Just do what you love.

• 1:09:06Speaker 02

  But most often, that mental comes up, and then you're like, "I'm super motivated, I feel great." So, maybe your physical now comes up to an eight, and your mental comes up to an eight. And people usually will give up within the first 10 minutes when they come in feeling that way. But if you are doing specific things to kind of boost mental in those 10 minutes, you're like, "I'm here, I feel great, let's go." And then, again, listening to your body, because I think that so many people disregard how you feel and the mental aspect of how you feel. So, if you are suffering from severe endometriosis and the symptomology that comes with it, then you're not gonna push yourself.

• 1:09:45Speaker 02

  And that's fine. It is absolutely fine not to push yourself. We know that the inflammation that comes with endometriosis can be very systemic and be very impactful. So, then, maybe you wanna look at environmental stress. So, we look at heat, and we look at cool water, not ice water, but cool water, because those both induce a massive anti-inflammatory response that helps with endometriosis. So, instead of going and pushing yourself through exercise, maybe you just look at an environmental stress. One, it brings more mental and parasympathetic activation to calm, but it also does great things for inflammation in the body.

• 1:10:24Rich Roll?

  In furtherance of that, how do things like birth control and hormone replacement therapy impact training, how a woman should think about their nutrition, and just overall health and energy levels?

• 1:10:43Speaker 02

  I'd like to say we have solid answers for that, but we don't. Because with hormonal contraception, there's so many different variations of the formulas, and a lot of research hasn't been done on it. We do know that, in general, combined oral contraception, knowing that we have estrogen and progesterone, and it increases oxidative rates. We see it increases inflammation. So those are factors to consider if you're trying to adapt. So we look at having more anti-inflammatory foods. We look at what can we do to calm post-exercise inflammation and recovery.

• 1:11:23Speaker 02

  But for the most part, how does it truly impact training and adaptation? It's an individual response and depends on the formulation. When we get to menopause hormone therapy, part of it's the Wild West because we had the Women's Health Initiative in the States versus the UK Million Women's Study in the UK with vastly different outcomes. So depending on where you are in the world, you hear mixed messages. What we do know is that when you're using menopause hormone therapy, it slows a rate of change, but doesn't stop it. So if you're looking at body composition, it isn't going to help just on its own preserve body composition. It will slow the rate of the laying down of visceral fat.

• 1:12:08Speaker 02

  It will slow the rate of muscle loss, but it doesn't stop it. The only thing it does help, we know emphatically helps with, is bone and bone density. It's very protective. So when someone's considering hormonal options, it's like, yes, have an informed choice, but you can't neglect the lifestyle parts that come with it. And if you, I have younger reproductive year clients and athletes. And if they're changing their pill, or they're going from a pill to an IUD, we want to track how they're feeling because symptoms really will dictate how they're responding. Because if you feel awful, you're not going to be able to put in a good session. So we want to know what the patterns are over their hormonal contraception or their

• 1:12:51Speaker 02

  IUD, and if they change it, how that affects them too, so that we can dial back and we can push forward when we know that we have the opportunity.

• 1:13:01Rich Roll?

  You opened answering that question with a sort of, we don't, you know, we don't know enough. Like, so what I take from that is like, how is it possible that these aren't studies that are being done? Like, is there, there's clearly not enough research being performed on this.

• 1:13:16Speaker 02

  No, but I will borrow from Lisa Moscone. She's like, we don't know this yet. We have studies that are down the track and we're planning for them. And she has a massive grant to really look at menopause hormone therapy and the way it affects the brain. There are other people that have a long, there's the menstrual cycle research group that's doing, it's collabing across the world to really nail down what's happening with hormonal contraception and the different formulations. So it's in the pipe, it just hasn't been done yet. It's in the process of. So hopefully in two to three years, I'll have more definitive answers.

• 1:13:50Rich Roll?

  You mentioned hot and cold water. So let's talk a little bit about that, like sauna, cold plunge. Everybody loves to talk about their protocol, their routine. You know, where do you stand on this from a women's point of view, women's health point of view? And what's different about women with respect to men when you're thinking about these activities?

• 1:14:14Speaker 02

  So this is where I bring it down to sex differences, not hormonal differences. There is an inherent sex difference in thermoregulation where men will

• 1:14:25Speaker 02

  start to sweat and they'll really offload heat through sweating when they get hot. But women will vasodilate first before they start sweating. Women's thermoregulation baseline also switches across the menstrual cycle because progesterone increases your core temperature and the body adjusts to accommodate for that. So if we're looking at the sauna, women will have more robust responses from being in the heat because their bodies used to change. So when they go there, the body's like, hey, I know what this is. And it will really improve our metabolic control, improve heat shock protein responses. Men will still have the same, but they have to have higher, or I guess more times in the sauna

• 1:15:06Speaker 02

  for that actual longevity. If we're looking for heat acclimation, it takes women longer because the body is used to the perturbation of the temperature. So we see men who are Doing sauna exposure for performance, they need less time in there because they get a big boost to cardiovascular responses faster than women. So when we're looking for health outcomes, women, they can tolerate the heat more, they can get in there, they can stay in there longer, and they get more robust responses than men. Cold's different.

• 1:15:36Rich Roll?

  Staying on sauna, just to be really specific, like, how long and what temperature, is there a temperature threshold? Like, where do you, where do you set the thermostat? And where do you set your kind of timer on how long you need to be in to get that response?

• 1:15:52Speaker 02

  Yeah, the response. So, in research, we can't keep people in heat when their core temperature goes up above thirty-nine and a half degrees. So that's about a hundred and four degrees Fahrenheit. So when we're looking at how does that play into responses, you get responses well below that. Because I'm saying that because I think Brian Johnson was like, I have to keep my core temperature.

• 1:16:15Rich Roll?

  That's why I'm asking.

• 1:16:16Speaker 02

  Yeah. It's like, no.

• 1:16:17Rich Roll?

  He said, I hadn't, I wasn't in long enough, I didn't have it hot enough, I had to stay in there crazy long.

• 1:16:22Speaker 02

  Yeah, no, that's, that's hazardous. Like, we can't get ethics to drive people to get their core temperature up. So thirty-nine, five, you're out. So when we're looking at all the responses that we're seeing, it's well below that. So we see about thirty-eight and a half degrees. So what is that? Uh, I don't know. Quick, do, do the math.

• 1:16:42Rich Roll?

  Somebody do the math on that out there.

• 1:16:44Speaker 02

  Because I'm just gonna stay with metric. As a scientist and someone who's an expat, we talk metric all the time.

• 1:16:51Rich Roll?

  One-on-one.

• 1:16:52Speaker 02

  Okay, one-on-one.

• 1:16:53Rich Roll?

  Temp, yes.

• 1:16:54Speaker 02

  We'll do time of day.

• 1:16:55Rich Roll?

  Time of day, duration.

• 1:16:57Speaker 02

  Okay. Time of day, ideally, if you can do it after training for ten minutes, it extends the training stress. So you actually get more out of your training than if you were not to go in the sauna. But if you're timing it generally whenever you can, right? We know at the end of the day, when you're passively dehydrated and your core temperature's a little bit more elevated, then that can promote more red blood cell responses. But for general health and continuing aspects of actually getting that heat exposure.

• 1:17:31Speaker 02

  Ten to fifteen minutes, three times a week, tends to be the minimum. And we're looking at eighty degrees C because some people crank it all the way up and it's way too hot. And so it's, it's pretty moderate. It's like we sit in an environment that's so controlled all the time. We have central heat, we have central air, we get in our cars, we turn the air on or roll the window down. We're not really used to being above eighty degrees because we become very uncomfortable. Women find eighty degrees super comfortable, men start to find it a little bit too warm, but that's beside the point. So we're looking at heat exposure. It's a moderate dose more regularly and we get really good health benefits from it. We're talking about heat acclimation.

• 1:18:12Speaker 02

  We know that five days in a row at that eighty degrees C mark for up to a half an hour is what your body needs as a man to get cardiovascular, meaning blood volume expansion, sweat rate changes, to be able to perform well in the heat. For women, it's nine days because we have to extend it because our bodies are really used to that fluctuation. For health, it's not the same thing. So we look, the minimum dose is ten minutes, three times a week.

• 1:18:43Rich Roll?

  Cold plunge.

• 1:18:44Speaker 02

  Oh, yeah. I caused an international shitstorm with this one. And it wasn't my opinion, I was just reading the research that's been around since the nineties, where again, we look at sex differences in thermoregulation. So the ice water, the ice bath that comes along is way too cold for women. It causes more of a sympathetic drive. And once we get over that sympathetic drive, then the responses for parasympathetic still are not as robust as we see for men. So men can do fine in ice water, but for women to garner parasympathetic changes and metabolic changes, cool water. So we're looking at fifty-five degrees Fahrenheit, around fourteen to sixteen degrees Celsius.

• 1:19:29Speaker 02

  It is in the research, women do well in that, where it's cold enough to create a stress where the body will adapt, but it's not icy cold that causes an opposite response.

• 1:19:40Rich Roll?

  Why did that cause a shitstorm?

• 1:19:41Speaker 02

  Because of the entire-

• 1:19:42Rich Roll?

  People love their-

• 1:19:43Speaker 02

  Their ice baths, yeah, their billion dollar ice plunge.

• 1:19:47Rich Roll?

  Yeah. Where's Julie? Julie should be happy, but yeah, there she's-

• 1:19:50Speaker 02

  Oh, good. No ice for you.

• 1:19:52Rich Roll?

  No, no, she's, she's not into it. Um, let's talk a little bit about, a little bit more about nutrition. Uh, fair to say you're a pro protein person?

• 1:20:03Speaker 02

  I am, yeah.

• 1:20:04Rich Roll?

  Uh, underscore your perspective here.

• 1:20:08Speaker 02

  So when we look at protein, I'm glad it's making the heyday, right? So we look at it as, when you're looking at the initial RDAs, people have to remember that a recommended daily allowance is the bare minimum someone needs to prevent malnutrition. So when we start looking at protein, the recommend- recommendation that is there in general for women in the US guidelines is enough just to exist. But when you start adding activity and you start adding age, we need more. Not only that, higher protein diet is satiation because we're in an ultra-processed world where a lot of people are gravitating to really fast foods, meaning not fast food, but fast to grab and eat. And as ultra-processed, they don't really feel satiated.

• 1:20:50Speaker 02

  But if we have a higher amount of protein, not only are we able to contribute to more muscle generation and, and bone building and all the things that we think about with protein, we also get better appetite control. So we start looking at the guidelines for protein. We know from the research that 1.6 to 2.2 grams per kilo, which is about that 0.8 to 1 gram per pound, is optimal. As we get older, we become more anabolically resistant. So that means our body doesn't use protein as well, doesn't respond to strength training as well. So we really do have to make sure that we stay on an upper end of intake. There've been some research recently that shows that it doesn't matter what time of day you take it or how much you have at any meal,

• 1:21:32Speaker 02

  as long as you get what you need in the day. There's a caveat for that. Because as you get older and you're more resistant to protein intake, try to get it as close to the end of exercise as you can, because that's going to really enhance this post-exercise mechanisms for muscle repair, tendon repair, all of the things that we think about with protein intake.

• 1:21:56Rich Roll?

  And that's more particularly acute for women versus men?

• 1:21:59Speaker 02

  We see, yeah, because the metabolism aspect for women post-exercise comes back down to baseline way faster than men. We see that for women, we're back down to a ugly cemic or a blood glucose control of baseline within about 90 minutes. For men, it's two to 18 hours, depending on what they've done.

• 1:22:17Rich Roll?

  So more important to make sure that you're replenishing your protein post-workout in that 30 to 60 minute window than it that that's more important than it is for men?

• 1:22:30Speaker 02

  Yes. And the other thing is women tend to under eat anyway. So if we're looking at, let's nail food before and after exercise, then we can make sure we're keeping you out of signals for low energy availability. I know Emily, Dr. Emily Kraus is here and she does a lot of work in red S and low energy. And the eating opportunities that are available, we look at every eating opportunity. Most people are like, yeah, post-exercise is shitty. What do I eat? When do I eat it? It's like, okay, well, let's make sure we really maximize that post-exercise eating window to help eliminate low energy availability.

• 1:23:07Rich Roll?

  No fasted training.

• 1:23:09Speaker 02

  Correct.

• 1:23:10Rich Roll?

  Say you.

• 1:23:10Speaker 02

  Yes.

• 1:23:11Rich Roll?

  Yeah, this is another controversial flashpoint for you, at least as far as the internet goes.

• 1:23:17Speaker 02

  Oh, yeah.

• 1:23:17Rich Roll?

  Yeah.

• 1:23:18Speaker 02

  Yeah, exactly.

• 1:23:19Rich Roll?

  And that's, that's, that's sort of flies in the face of somebody who's thinking, well, if I'm trying to lose weight, like if, if weight loss is like what's guiding those decisions, like, I should just get up and get after it without eating anything and then just, you know, try to manage portion control throughout the day. Of course, your appetite is going to spike in the aftermath of that and you're depriving the body of the nutrients it needs to basically create like a stasis point, right?

• 1:23:48Speaker 02

  Exactly.

• 1:23:48Rich Roll?

  And repair itself.

• 1:23:49Speaker 02

  Exactly. And I mean, when you think about why are you going to do exercise? You're not getting fitter in the exercise session. You're trying to create a stress. And the stronger that stress is, the better your body adapts. So if you're going to create a stress without food, you're not going to create a really strong stress. You feel like you are, but from the body, from a cellular level, it's not as strong. Of a stress to create the adaptation that you want. You're going to have more catecholamines, so that's your cortisol and your breakdown hormones that are being produced so that it can fuel your workout. But let's just take that negative stress away by putting a little bit of food in before you go training so that you can really maximize the exercise stress and then get the adaptations

• 1:24:33Speaker 02

  that you want from the post-exercise recovery.

• 1:24:37Rich Roll?

  Your critics out there say that your position on fasted training or just intermittent fasting in general for women is not supported by the evidence. So I wanted to give you an opportunity to respond to that. Like, what is your, what do you say to that?

• 1:24:57Speaker 02

  Yeah, there's also the rumor that I only cite rodent studies, and that's not true either. So when we're looking at the evidence for fasting and fasted training, most of the stuff that people are coming out with, yeah, you should do fasted training, it doesn't matter, you should do intermittent fasting, is still guided by male data. You go into ChatGPT, it tells you the same thing. Why? Because there's this echo chamber in the bell curve that's just pulling up the rhetoric that everyone is talking about. When we go into the research and we're looking specifically from things like endocrinology and we're looking at fertility and we're looking at population research with appetite and appetite control, it all gravitates to women do better in a fed state. We look at the studies that have been done in the sports science world, there aren't

• 1:25:42Speaker 02

  a lot, but there are ones that are done, it still points to women do better in a fed state. We have this variation in appetite, appetite control, like I was talking about with chronobiology. We look at the exercise stress points and how people adapt, and we see that women, their bodies respond when there's fuel onboard. We look at the people that are pushing out, well, she's not based on evidence, it's because they're looking at that bell curve of just sports science evidence. There's so much more to exercise, training, appetite than this really small amount of sports science research. So I'm always like, here's the evidence. It's not coming from the Journal of Sport and Exercise Science, no.

• 1:26:22Speaker 02

  It's coming from endocrinology, or it's coming from this population, but these are randomized control trials. This shows the variation of exercise versus fed, and here is the evidence. And I give that to them, and they'll still critique.

• 1:26:40Rich Roll?

  So maybe just walk us through a day in your life of eating. Like, what does that, what does that look like? You're like, oh, you should feed before you work out and after and all of that. But like, what are you doing specifically?

• 1:26:53Speaker 02

  Yeah, so there's the ideal and then there's reality. And I'm more than happy to share reality because I'm, I'm here. And I don't eat very well when I'm stressed.

• 1:27:02Rich Roll?

  This is real, this is reality, Stacy.

• 1:27:04Speaker 02

  This is reality.

• 1:27:05Rich Roll?

  We're having a real moment.

• 1:27:06Speaker 02

  I know, we are. So regardless where I am, I do get up and I have something first thing in the morning. That's where the protein coffee thing came in. Cause people are always asking me, what do you have first thing in the morning? If you're gonna go swimming or training? I'm like, I'm not hungry. I know most people in the five and six AM club aren't hungry, but I love coffee. And I wanna maximize that. So I'm also gonna put in some protein and some almond milk. So I'm getting some protein and getting some carbohydrate. And that's how the protein coffee thing became a thing. It doesn't mean that you have to do it. There's no evidence behind it, but it's what I do. Because then I get a boost of protein, some carbohydrate. I'm going into a training session. I can maximize my training and I have caffeine and everyone loves that. Well, for the most part.

• 1:27:48Speaker 02

  Then I come home and I have real breakfast and I try to have it with my daughter before she goes to school. I'll have a bowl of overnight oats with some chia seeds and some nuts. Um, I put in some protein powder. I'll have another espresso. And then I get off my day. Lunch is a variation of a bootable. Afternoon, as we call it in New Zealand, afternoon tea, when you come home from school. Um, is another variation of nuts and veggies, crackers, hummus. And then we have dinner and my husband isn't plant-based. My daughter isn't either, but we all start with the base of the same thing. So it is more of the bootable where you're having different grains. You're having different veggies. You're having different greens.

• 1:28:31Speaker 02

  Um, then I put in some roasted, uh, sweet potato or other roasted veggies, some tempeh, edenami, some garbanzo beans, and then I'll put tahini on top as my dressing. Because I'm not a big fan of salad dressing, but I love tahini and then mix it all in some avocado. And then there's a bowl of about 40 grams of protein and some fat and it's great. And then later I'll have some dark chocolate because I love dark chocolate.

• 1:28:56Rich Roll?

  I mean, that all sounds like very doable and reasonable.

• 1:28:58Speaker 02

  Yeah.

• 1:28:59Rich Roll?

  You know, and I think when you see a 1.1 grams of protein per pound of body weight, like that's intimidating. That sounds like a lot, but walking through like what you eat in a day, I'm like, yeah, that sounds basically like what I do.

• 1:29:16Speaker 02

  Yeah.

• 1:29:16Rich Roll?

  Without really thinking about it. It's not like it takes some kind of ultra focus on the protein aspect of this to meet that requirement.

• 1:29:24Speaker 02

  No, and also leaning into like fiber and 30 different plants a week. Right. And so it's like, if we can get protein and fiber at every eating opportunity, people get what they need in a day. They get the higher protein intake. They get the diversity. They get the fiber. Let's not make it difficult. I quote the research and those are all in numbers, but the reality is it's pretty easy. If you're thinking, I just want regular, normal food.

• 1:29:50Rich Roll?

  I know, but people like to make it difficult.

• 1:29:52Speaker 02

  I know.

• 1:29:52Rich Roll?

  They want to make it difficult.

• 1:29:53Speaker 02

  People like to pick fights. They like to make it difficult.

• 1:29:56Rich Roll?

  Um, supplements.

• 1:29:58Speaker 02

  Yeah.

• 1:29:59Rich Roll?

  Let's talk about creatine. This is another topic that's, there's a lot of discourse happening right now around this. This supplement that's been around forever kind of began in the bodybuilding world and now has made its way into mainstream discourse. Uh, uh, and there's a lot of discussion around amounts. So first, maybe explain what creatine is, what it does and how women should think about, uh, using it.

• 1:30:29Speaker 02

  Yes. So creatine, if we were thinking, and I'll get a little bit biochemical right now, we're talking about the fast energetics. The first zero to 20 seconds of inner, any cellular process requires creatine because we have.

• 1:30:44Speaker 02

  ATP and CP, so that's adenosine triphosphate and creatine phosphate. So when ATP splits to produce energy, you have this floating thing that then gets taken up by creatine. So when we're looking at why we need creatine, we need it for every fast energetic in the body. Anything about the brain, the heart, the gut, the bone, everything requires creatine. For women, by the nature of being women, we have less lean mass than men, for the most part. So we have less stores, just by the lean mass part of it. We also tend not to eat as much creatine-containing foods, which we think about.

• 1:31:25Speaker 02

  You have to eat five chicken breasts to get your, you know, dose of five to six grams of creatine. If we're looking at supplementing, we know a lot from Darren Candau's work and Abby Smith Ryan's work that it takes about three weeks to saturate the body with three to five grams. So what does that mean? When you're fully saturating, your body has more availability for those fast energetics. The brain works better, the heart works better. We see that we have better mucosal lining integrity. So the very first thing that erodes when you start exercising or get stressed is the mucosal lining of our intestinal cells. And if we don't keep that, then we know that we get some endotoxin release, which people call leaky gut. We see more of an IBS situation for women that are running.

• 1:32:08Speaker 02

  So for just boosting the levels of creatine and have more available for all the fast energetics, then the body works a little bit better. You can not use it, and that's fine. Your body naturally produces one to three grams a day from the liver, but we want to maximize and optimize. And that's where the research is coming. We're like, okay, every fast energetic works really well. We see now from brain research and TBI or concussion research that creatine becomes really important for improving brain metabolism and helping getting over the concussion. Why is that? Because it's trying to repair itself as well as still function. So improving the amount of creatine that's available, it can do all the fast energetics it needs.

• 1:32:49Speaker 02

  We see that for building bone, we need some creatine as part of the fast energetics. So we're starting to see all this research come out and there's a systematic review that was published two weeks ago that was looking at all the studies, not in the fitness world, but actually in the health world of the studies that have come out to synthesize who should optimize their health by using creatine. There are 153 studies in the systematic review of it. The conclusion was women 18 to 60 should be using three to five grams of creatine supplementation to optimize and improve overall health. And so that's where the research is leaning into. Yes, you have outliers, like if you're a shift worker or jet lag, or if you have overnight

• 1:33:33Speaker 02

  combat missions, then there's a time and a place to use higher doses. I think the circulation is 0.38 grams per kilogram, which ends up being about 20 grams for 130 pound person. So there's variations within it, but for the baseline to improve fast energetics and overall mood, heart, brain, all those things, it's just three to five grams.

• 1:33:55Rich Roll?

  Yeah, the, the, the conversation now is sort of creatine maxing, you know? Like, oh, if you didn't sleep well or you're jet lagged, take 20 grams and it will compensate for that. It will give you some degree of mental acuity to overcome the, the lag in your sleep.

• 1:34:13Speaker 02

  Yes, but it takes more time for the creatine to cross blood brain barrier. So an acute dose actually isn't effective on that acute time. You need to do it dosing up to knowing when you are going to be traveling.

• 1:34:24Rich Roll?

  So you have to, you have to, you have to predict the future and take it before you have the night of sleep where you're not going to sleep.

• 1:34:31Speaker 02

  So consistently, consistently take low dose so it helps, but yeah.

• 1:34:35Rich Roll?

  Is this something that should be cycled or is it safe to just take, if you're taking like five grams a day, just do that?

• 1:34:43Speaker 02

  Keep doing it, yeah. We look at cycling creatine in the higher doses and that's a lean into the bodybuilding, muscle performance side of things where with five grams, four times a day with 20 grams of carb to really maximize what's in muscle, then cycle it off to lose some of the water weight and then cycle it back on for different training modalities. So when we're looking at cycling on the lower doses, it's, it's a kind of a moot point because when we look, it takes three weeks for your body to fully saturate. And then if people cycle off it, then it comes back down to baseline. So if you're just taking the continuous low dose, your body fully saturates and then stays there.

• 1:35:22Rich Roll?

  The same woman who has the concern about getting too bulky from lifting heavy weights may have this concern around creatine that it's going to lead to bloating and water retention. And there's, you know, there's some other things that come with that. You can get, you know, like some diarrhea, some stuff like that. So what do you, what do you say to that person?

• 1:35:44Speaker 02

  There are two things that we want to kind of nip in the bud here. First is how much is she starting with? Because a lot of women who start with a five gram dose and they're smaller in physique, then they might have retention because with creatine, you're also storing more water in the muscle. So that's a given. It's transient. It, it will go by the wayside within two to three weeks. And most women who are freaking out about bloating and, and water retention are, they don't want to wait the three weeks. So let's start at a smaller dose. Let's start with one to one and a half grams and work our way up to the five grams over the course of a month. That way your body is starting to saturate, it's getting used to it. You don't get the bloating and the side effects.

• 1:36:26Speaker 02

  The other one that's really critical is the quality of the creatine that you're using. The cheaper versions of creatine use more of an acid wash. And so we're looking at the residual acids that are in there. It's not that great. It causes side effects. So the higher qualities, like our good friends Momentus, they use a water wash. And that reduces any kind of the residuals that cause side effects. So first make sure you have a high quality. And two, let's start with a lower dose and work our way up. Because we're not looking for an acute hit here. We're looking at how are we going to saturate and really improve and optimize over time.

• 1:37:06Rich Roll?

  Any burning creatine questions out there?

• 1:37:09Speaker 09

  I have a question about creatine in different stages of your life. So you know, you talked about perimenopause. If you're on a fertility journey, if you're pregnant, like what is like the optimal time and are there times to avoid using it?

• 1:37:24Speaker 02

  So there's even been pregnancy research that shows that supplementing with creatine is beneficial. So we look at creatine is beneficial across the whole lifespan. There are individual cases where it's like, if you're iron deficient with endometriosis, it's probably not a good idea because there's an interplay between some of our ferritins and, and, and things that affect iron absorption and increasing endometriosis cell proliferation. So there's some small research that suggests that. So then that becomes more of an individual case by case. Let's see, what are your symptoms? Are you iron deficient? How severe is endometriosis?

• 1:38:06Speaker 02

  So yes, there are causes and cases within each that we have to be aware of, but in general, you are safe to take creatine across the lifespan.

• 1:38:16Rich Roll?

  Other than creatine, what are the other supplements that you would suggest women be taking? And maybe some supplements that they should be avoiding?

• 1:38:30Speaker 02

  So I will also say vitamin D3 is really important. For those of us that live in the extremities of the hemispheres, it's really important in the low light for people who live in places like Seattle, where you have winters that are super gray as well.

• 1:38:46Speaker 02

  And just in general, get your vitamin D levels checked because we know that low vitamin D is associated with more severe PMS and PMDD in women, more severe perimenopausal symptoms. We also see there's a suppression in immunity. We also see vitamin D is really important for things like bone and bone density. So it is pretty important. It works as a hormone within the body to facilitate a lot of the responses. We also see that women who have low iron and low ferritin also tend to be low in vitamin D. So in general, I tell women, just taking a vitamin D supplement will help boost. If you are worried about having super high vitamin D levels, get tested first. Then we start looking at what you should not take.

• 1:39:29Speaker 02

  We see that there that like nitric oxide is a very widely used one for sport performance. We see, oh yeah, it's a vasodilator. We know from the research that it doesn't work in premenopausal women, but it works really well in postmenopausal women. Because estradiol or estrogen is really tightly tied to endothelial cell function. So that's the lining of our capillaries or our blood vessels. And so when we start introducing nitric oxide, it interferes with the natural response. So premenopausal women who have adequate estrogen will have a negative response. They don't have as much vasodilation. They might end up having more of an orthostatic like stand up with head rushes.

• 1:40:13Speaker 02

  So orthostatic hypotension, so low blood pressure. But women who are postmenopause, who don't have estradiol on board, benefit greatly. They have improvement in circulation. They get really good vasodilation. We see women in late perimenopause with severe hot flushes can have some benefit by using nitric oxide because it helps with the vasodilation constriction. So there's like, this is the efficacy of knowing that there's been research done in women in this supplement. A lot of the other supplements haven't been studied in women. So we're looking at beta alanine. There has been very few studies done in women. So a lot of the sport performance supplements haven't been studied, but we know that protein supplementation has been studied. It's beneficial for women.

• 1:40:56Speaker 02

  We know that vitamin D has been, omega threes have been. So most of our general health ones that are promoted have been studied in women and are beneficial.

• 1:41:04Rich Roll?

  On that topic, of all the things that you shared today, what, where is like the strongest evidentiary basis and where is the evidence like more emergent, where we need more research?

• 1:41:21Speaker 02

  For women?

• 1:41:22Rich Roll?

  Yeah.

• 1:41:23Speaker 02

  Across the board, I'd say we need more research in everything.

• 1:41:29Rich Roll?

  With that as a baseline.

• 1:41:30Speaker 02

  Okay, as that is a baseline.

• 1:41:31Rich Roll?

  Yeah.

• 1:41:32Speaker 02

  Yeah.

• 1:41:32Rich Roll?

  Within that world, um, you know, you've shared a lot of insights today. Uh, and I'm sure there's a spectrum in terms of like, what's, what's, you know, where there's enough kind of evidentiary basis and where you would like to see more studies being done.

• 1:41:48Speaker 02

  Yeah, I think, um, for the most part, I really want people to understand there's a significant division line between what's clinical and what's health and fitness. And there tends to be this blur. So if we're like dividing the line down and going, okay, from optimization, health and fitness, everything that I've talked about has evidence behind it.

• 1:42:08Speaker 02

  What do I want to see more of? I want to see more research in, um, strength training. And how does the methods within the health and fitness world cross over to the clinical? Instead of everything in clinical crossover into the health and fitness. So, uh, for example, I won't say who has given us the grant because it hasn't been announced yet, but we now have a grant to look at strength training and Alzheimer's prevention and the heavier end of things. So like that kind of stuff, I want the merger from high performance to come over, especially in women. So we have some pretty good, tight controlled studies in high performance because when we're in that world, we can really garner and leverage. We're in the clinical world with randomized control trials. We can't really generalize.

• 1:42:52Speaker 02

  We can say in this population of, of pre-diabetics, we know that this works in women like here. But then the biggest thing is we need more diversity in all research. I was on the stage this weekend at a longevity and women's health summit. And someone stands up and says, as a black woman, my symptomology is, is more apparent. And I've heard that it's worse for perimenopausal symptoms in black women. And there is Jessica Shepherd and she's like, yes, this is true, but no one really knows it. And I'm like, I'm a white woman and I know that most of the research that's been done has been done on white, upper class women. So regardless of if it's clinical or if it's health, we need to be able to look at other populations.

• 1:43:36Speaker 02

  The idea of a human or a naturally cycling woman with really spot on periods and menstrual cycles, no pun intended, is rare. So when we start saying we need to do really tight controlled trials on women with menstrual cycles that are X amount of days and we know that have specific phases, it's a very, very, very, very, very small population that can't be generalized out. So we have to look at those nuances too. So what is the big foundation of evidence? We look and say, okay, well, let's look at the methods first. And what is that? And where does it come from? Can I say what has a lot of robust research? A lot of the stuff that has the, the population research

• 1:44:18Speaker 02

  and the anecdotal studies as well as some of the randomized control trials. So we see that in muscle development. We see that in bone development. We see that in sleep and mood. But every area needs more research and every area needs to be more diverse in the population of the research.

• 1:44:34Rich Roll?

  If funding wasn't an issue, there's no budgetary constraints, what is the dream research project that you would like to see happen? Like, how would you design a study that would answer your most pressing questions?

• 1:44:51Speaker 02

  Oh, I don't, I have so many pressing questions. I don't think there's enough money in the world to answer them. Well, no, there's money.

• 1:44:58Rich Roll?

  Just pick one.

• 1:44:59Speaker 02

  There's money in the world, but it's the time factor. So, um, I, I think it changes. Like, right now, I'm really interested in heat and how we see an increase in ovarian function after controlled heat exposure. So I'd like to do a really large study on a whole bunch of different ethnicities and cultural nuances in women who are having fertility issues. Because if we see that post-controlled hypothermia, we have an increase in estrogen, luteinizing hormone, and both of those stimulating hormone, can we get that to a point where

• 1:45:40Speaker 02

  we can use that as fertility treatment? So that's one really massive pressing question I have right now. So if anyone wants to fund that and has a team that could research it. So it's like looking at those environmental conditions that the world is now entering into. We have severe heat, we have severe cold. How is that affecting different pockets of populations with the big fertility issue? Like, that's not something that someone like me coming from high performances as an environmental exercise physiologist would really come out with, but I'm really concerned. I'm like, okay, well, we know this happens in controlled heat, but we also see this whole change in the global environment and this uptick in infertility. Well, let's see what happens if we're using these little things to our advantage.

• 1:46:23Speaker 02

  So that would probably be a big pressing question because if we're killing off the human race because of things that we're not doing right, well, is that a good thing or not? Maybe that's the bigger plan for whatever is out there. But right now I'm like, I want to be able to make an impact and really investigate this with regards to what's happening from a global impact as well as a population impact.

• 1:46:47Rich Roll?

  I don't know if you all know this, but last year Stacy appeared on some of the biggest podcasts in the world, Diary of a CEO, Mel Robbins, Hubert Mendel. So yeah, and not only was she a star guest on these shows, your episodes on those shows were the most viewed or listened to like for that show for that year, which is kind of an amazing thing, right? So it, it really catapulted you, you know, into like this different kind of sphere of influence in your areas of expertise. But I'm curious, like, what is the, what is the question that you're not being asked

• 1:47:27Rich Roll?

  or that you wish you were being asked that, that just doesn't come up in these sorts of scenarios?

• 1:47:35Speaker 02

  Yeah. One, I can't believe that that's happened because I'm still like Jara's mom and I still like to like do research and I like to help people. So when I'm stopped in the bathroom washing my hands, oh my God, your doctor says, I'm like, who's that person? And so it's just been like this big push. I think one of the conversations that has been had is the optimization versus general. And we had that today. So I thank you for that. It's like, what are we doing to optimize health? And what are we doing just to improve health? And those are the nuances.

• 1:48:06Rich Roll?

  Performance and longevity and general health are, are, you know, sometimes contradictory.

• 1:48:13Speaker 02

  Right, exactly. It's like what you do to Help someone win an Olympic gold is completely different than what you would do for someone who's just trying to optimize their health for a long period of time. But a lot of times that research and those conversations get blurred. So again, thank you for asking about optimization versus general because that is something that hasn't been asked.

• 1:48:37Rich Roll?

  One question I want to ask you is, what can you share with men to help them understand the women in their lives to support them? Like, this is a mystery box, you know, for someone like myself. And, you know, it's just like, there should be a woman up here talking to you about this, not a guy. But I want to understand and, you know, just as a sort of an avatar of all men out there, like, help me understand how to, you know, be as supportive as possible. And that comes with greater understanding, of course, but, you know, help us out.

• 1:49:10Speaker 02

  Yeah, well, first, we need men in the conversation. So you should be in that chair interviewing, not a woman. So I appreciate that, too, and all the men who are in the audience. Because the more we understand, the more we can be supportive. It's like, if your wife comes to you and is like, I'm having this horrible time, I have severe anxiety, it's like, just listen, just like I was talking about with his daughter and being a girl dad, it's like, listen, don't try to fix, because that becomes a problem where women feel like they go to talk to their partner and their partner is listening to fix something, not listening to be empathetic. And I also want to, I'm not doing this to promote, but I'm doing it to say that Joe

• 1:49:54Speaker 02

  Warner is a guy in the UK who used to work for Men's Health, he's a journalist, and we had a podcast episode, and he was really like wanting to know more about the perimenopausal journey for his partner. And he interviewed a whole bunch of experts and he just released a book. It's called Frozen Out and Burning Up. And it's to help men understand what's going on and how to listen to their wives and help them. So there are more and more resources coming up, too, but I think the bottom line is listening, understanding, and trying to be empathetic and not trying to fix.

• 1:50:27Rich Roll?

  Awesome. Let's put it out for any questions before we wrap it up.

• 1:50:33Speaker 10

  This is a little bit of a follow-up to the creatine conversation. I have two daughters and they are athletes. So I think my curiosity and question really is more about what, how should we guide female athletes, young female athletes on this journey in terms of supplementation, nutrition, understanding? What would be your suggestion there?

• 1:51:00Speaker 02

  I would refer to the Fester Women's Program at Stanford. But in general, when we talk about it, we want to change that diet culture. Like, we don't want to introduce that. So we're talking to our young female athletes. It's all about fuel for what you're doing. If you are fueling your body, you're becoming stronger, you're becoming more resilient. And then we also have to think about the mental, mental stress of trying to grow, develop, understand your personality and become part of this world. So it's also having the eye to what is the mental status today? Like, how am I talking to my daughter? How am I using empowering language instead of negative language?

• 1:51:43Speaker 02

  When we're looking at a sporting culture as well, unfortunately, the default is to be compared to boys. We see this in coaching and, and it's really disheartening for girls to always be compared to that norm. So if we're trying to change the sporting culture, we're trying to encourage our girls. It's talking about being fueled, it's talking about being fast and powerful and strong. And all of that positive language and not talking about, oh, calories. Oh, you need to eat this. It's not about that. It's like, let's put it in that performance space. Let's talk to them like they are athletes, because they are. You need to eat enough, you need to fuel for your training, you need to fuel for your brain, you need to fuel for your endocrine system.

• 1:52:26Speaker 02

  It's all about fueling, because your body is growing, you're learning. You want to be the best that you can be in your sport. And you want to do all of these things. We need fuel for that.

• 1:52:38Speaker 11

  Would you suggest supplementation as they start to get more serious about their sport, depending on their sport?

• 1:52:45Speaker 02

  I would hesitate to say yes. It's trying to do real food first because the problem with it, even though there is some evidence that creatine helps in young girls and protein supplementation helps, but then it opens the whole Pandora's box. And we want to not, we want the training to come through for adaptation. We want the fuel to come through for supporting that adaptation. I always think about when I was, back in the day when innerbike was in Las Vegas, I was sharing a cab back to the airport and this guy got in and he didn't look healthy at all. And he was talking about how he's going to go to a bike, on a bike ride, but he had to use his beta alanine and beet juice first. And I was like, what are you talking about? And he goes, oh yeah, well, that's how I can go hard on my bike. I was like, have you

• 1:53:29Speaker 02

  tried training without it? He goes, why would I do that? And I was like, okay, where do I start? Because that is an enhancement. We want your body to understand first before you try to enhance.

• 1:53:41Speaker 11

  Hi Stacy.

• 1:53:42Speaker 02

  Hello Dr. Kraus.

• 1:53:44Speaker 11

  Thanks for the shout outs. I am surprised this question hasn't come up yet, but wanted to ask about wearables.

• 1:53:51Speaker 02

  Oh yeah.

• 1:53:51Speaker 11

  Oh yeah. There are a lot, there's a lot of data out there and it can be overwhelming for women to interpret, whether it's sleep, whether it's recovery. Sometimes some athletes have unhealthy relationships with data. So what do you recommend as far as wearables and how we can interpret wearables as, as girls and women?

• 1:54:15Speaker 02

  So first and foremost, when we look at wearables, the algorithms are based on male data. And I like to use the example of heart rate variability. How many people have a wearable and pay attention to heart rate variability? Yeah, okay. So there are a lot of women who are like, what's going on? My garment's yelling at me. You're in the red. What's going on? What's going on? You're sick. You're sick. But actually, they just ovulated. And these algorithms are not picking up the fact that when we look at physiology for women, there's an inherent change across the menstrual cycle with regards to autonomic nervous system. So we know after ovulation with progesterone, our respiratory rate comes up. Our resting heart rate comes up, our heart rate variability goes down.

• 1:54:59Speaker 02

  The algorithms read it as you're not recovered. So when I tell women with the wearables, look at it trends over time so that you can compare your follicular to follicular or in perimenopause, you can see things going all over the show, knowing that after you get through perimenopause, you have a new baseline. So really, you're just looking for trends over time. With sleep and sleep architecture, they're not fine enough to actually pick up sleep architecture. The benefit of using a wearable overnight that I find for women is if they don't eat enough, they have a lot of awakenings at night from hypoglycemia. So you're having a lot of poor sleep and you're like, oh, I've got a lot of awakenings. It could be you haven't fueled well enough in the day and getting hypoglycemic when you're sleeping.

• 1:55:43Speaker 02

  We see this in some of the continuous glucose monitors, CGMs, that are being used. So there is usefulness in them, but only for trends over time.

• 1:55:55Speaker 05

  I really appreciate that you spoke about not fearing perimenopause. I'm definitely still a little scared of it.

• 1:56:02Speaker 02

  Don't be.

• 1:56:04Speaker 05

  How can women know that they're entering that phase? Like, what are the signals that will specifically tell you that you've entered that? And if you could boil it down to one thing, like, what's the first thing to tackle when you do enter that phase?

• 1:56:20Speaker 02

  There isn't any one, like, bell that goes ding ding ding, you're in perimenopause. It could start as early in your mid 30s. Maybe it doesn't start until you're in your mid 40s with regards to symptomology. But we do know that you have more and more anovulatory cycles as you get older. So we generally say that once you hit 40, then we know you're in perimenopause. And it's a rough guide. Some people have really severe limiting symptomology. Some people breeze through until like the last couple of years before that one point in time menopause hits. But it's a significant individual journey. And although everybody who's born with a uterus goes through it, we're still not sure why.

• 1:57:04Speaker 02

  Why do we have this ovarian wind down? Why are we having all these changes? And what are the definitive tests that we can do? We don't have those. So it is an individual journey. If you're like, I'm starting to be really anxious and I'm not sleeping. That's probably perimenopause. You are finding more soft tissue injuries. That's most likely perimenopause. One of the big tells for runners is they start getting more and more plantar fascia issues. Because we start having disruption in tendon, tensile strength. And we are getting weaker in our calf muscles because we lose strength and power first. So we start getting more and more tendinopathies and soft tissue injuries.

• 1:57:46Speaker 02

  So all of those are in line with, yes, you're perimenopausal. But don't be afraid because there's lots of things you can do.

• 1:57:53Speaker 12

  I'd like to follow up on these two questions. I'm Rachel. So I'm a researcher and I do a lot of diagnostic testing in my labs. So you've mentioned many of the tests, the blood tests specifically. And these are becoming more and more available in the commercial space. Everybody's talking about testing 9,642 biomarkers. Particularly hormones. And I'm wondering if you have blood tests that you recommend? And if you do, how regularly you think that you should be getting them? Thinking about the difference between what you're calling out as general health? And maybe some of the more sophisticated things that you or I might like do in the lab?

• 1:58:36Speaker 02

  Yeah, I'm not a fan of hormone testing. Because it's just giving a snapshot of that time of day. If you're really to optimize getting something like estrogen, you have to know day two. Well, women's cycles are all over the place. So I really don't put stock in getting hormone testing unless you have fertility issues. When we look at blood tests, I find it really useful to have things like ferritin. And to know your baseline cholesterol. We also look at CRP. So some of the basic inflammatory markers we want to keep track of. One of the tells for perimenopause actually is a change in your cholesterol. And you have an increase in LDL. So we see this, you haven't had any cholesterol problems all, and then all of a sudden,

• 1:59:19Speaker 02

  your LDL is elevated and your HDL is dropped out. And then you're told, oh, you need to eat more fiber. Actually, it's perimenopause. What do we do about that? So having a baseline of just your basic blood tests for trends over time is very useful. Because if you start having symptoms and you go get a blood test, that's just telling you that one point in time confirming something you already know, but you don't know what your previous norm was. So that's why I tell women, it's like, get a DEXA every year. Know what your bone mineral density is, know what your body composition is, hold on to that. Get your ferritin tested every three to six months if you have a history of low ferritin. Keep track of your cholesterol every year, see your CRP.

• 2:00:01Speaker 02

  Get your vitamin D tested at the beginning and end of some, um, the season, so end of summer and the beginning and end of winter. So just small things to be able to optimize, but you don't have to go spend $500 a month to get all these biomarkers, uh, because we just need to take care of the baselines first.

• 2:00:20Speaker 01

  I love cold plunging.

• 2:00:22Speaker 02

  Okay.

• 2:00:23Speaker 01

  Is it inherently bad for me if I'm doing it at like, I'll, normally it's like 45 degrees Fahrenheit, which is like seven degrees Celsius, but like, is that inherently bad?

• 2:00:32Speaker 02

  It's not, it's not bad for you. It's, if you've already calamitized to it, great, I'm not going to tell you not to do it. But for all the rhetoric of every woman needs to do really cold ice baths, it's intimidating because you don't have to. There are other things, like if you're already doing it, great. If you're a cold water ocean swimmer, it's really beneficial, so you keep doing it. But if you're someone who's looking to optimize health and you're trying to see what environmental stressors do, cool water, if you want to examine that. But for the most part, I try to push women to the sauna. But other people are like, I can't handle the heat. It's like, okay, well, maybe cool water plunge is good for you. If you're already doing ice and you're already doing cold, your body's adapted, it's fine. But maybe you also want to add sauna to get some better health benefits.

• 2:01:15Speaker 01

  Oh, I've got the sauna too.

• 2:01:16Speaker 02

  Perfect.

• 2:01:17Speaker 01

  Yeah.

• 2:01:18Speaker 08

  I find I have so many women in my life who have mysterious chronic illnesses or women's health issues and they're exhausted by it. They come into clinical settings where they are not believed, or it doesn't feel like the doctors are necessarily asking the right questions. What's your advice? I hear you speak today and I actually have so much hope and excitement for where women's health are going now that we're included in studies. But for today, we are still in that sticky period. What are ways that we can advocate for ourselves in these clinical spaces and advocate for ourselves outside of these clinical spaces?

• 2:01:57Speaker 02

  Yeah, so I come from a, because I don't live in the States, so I navigate a different kind of environment with regards to healthcare, where we can go and advocate and say, I want to get a DEXA. And you can either pay out of pocket for like a hundred bucks, or you can get a referral and wait three weeks to get it. Here's completely different. So when we're looking at advocating for ourselves, it's having conversations. It's empowering each other as women. It's talking to your physician and saying, these are things I have. I'm not Dr. Google, but I have been talking to other women that's similar. And you just really try to be on the level of the conversation. And there's not a lot of time. It's like

• 2:02:38Speaker 02

  maybe 15 minutes of an appointment. So if you can go in and have a more of an empowerment approach, because I'll talk to physicians, like 15 minutes isn't enough, because I don't know what the history is. I don't know what they've tried. I don't know if they've Googled it. I don't know. So the more information that you can provide, and you can bring in scientific articles or whatever, just to put them on the right track is very helpful. Both they learn and two, they realize that you're coming in with something that's genuine. You're not just coming in as a hypochondriac. The other thing is to look at the physicians that are available that are in the knownness space. So if you're looking for female fertility issues, you go to someone like Natalie Crawford, who's in Texas, but you can also see her

• 2:03:19Speaker 02

  list of friends and her network across. If you are an endurance athlete and you're having issues, you can, again, at Emily's program at Stanford and see what her network is. So we're all coming together and creating these networks. It's just trying to figure out who's the person to follow. And that's where the conversations can really be beneficial.

• 2:03:40Speaker 13

  Hi, I'm Julie.

• 2:03:42Speaker 02

  Hi.

• 2:03:43Speaker 13

  In the large world of peptides.

• 2:03:47Speaker 02

  Oh, yes.

• 2:03:48Speaker 13

  Do you have any input on that?

• 2:03:50Speaker 02

  We were just having conversations about this. So, in the large world of peptides, I really lean into there's no evidence for them. And it's a wild, wild quest right now. They're not regulated. I think someone was telling me that they just read a New York Times article that the peptides in general bought from repugiate places still had a lot of lead and things in them. So it's like, you don't really know what you're injecting because they aren't controlled. They're for research purposes only. Most of the research that's been done on the peptides are still rodent studies. They're very, very small, like in a five or six men. So we don't have any of the robust research. I'm hopeful because people are putting such stock in it that there's going to be more research.

• 2:04:35Speaker 02

  We know that GLP-1 is a peptide and there's lots of research going on because of all the benefits there. And that's kind of the push for all these other peptides. So the bigger demand there is, the more research is going to go into it. It's just kind of a holding pattern. But other people will be lab rats for themselves while you see what happens and then you can make a decision.

• 2:04:54Speaker 13

  Thank you.

• 2:04:55Speaker 02

  You're welcome.

• 2:04:56Speaker 14

  Hi. We talked about strength training as part of this conversation and you've expressed the need for women to really lift heavy. What is heavy? Like, how should a woman think about where they should be targeting with that?

• 2:05:12Speaker 02

  Yeah, so I often tell women, if they're first starting their strength training journey, I don't want them to think about lifting heavy. I want them to go in and just, just do any kind of strength training. Get the resilience, get the gains. And then when we start looking at increasing load and we talk about lifting heavy, on a scale of one to 10, the effort needs to be about an eight. Or if you go pick up a dumbbell or a barbell and you can do five or six reps really well with really, really good form, and you think maybe you could do one or two more, that's where you stop. Because it is very relative.

• 2:05:48Speaker 14

  Thank you.

• 2:05:48Speaker 02

  Yeah.

• 2:05:50Rich Roll?

  Stacy, I just wanted to acknowledge you for the tremendous public service that you are providing people. You're a powerful and important voice. We need more women like you out there who are advancing women's health, and I just want to commend you for the work that you're doing. And I appreciate you coming here and sharing so openly with all of us. So, thank you. Thank you. Yes. Let's hear it for Dr. Stacy Sims, everybody. Thank you. And thanks for coming. Yeah, thanks for coming.