Ask Me Anything Part II – With Dr. Stephanie Estima

Dr. Stephanie
Mindy and Stephanie back for round two on the resetter podcast and on the better podcast. We are doing a one two hit here, Mindy. I’m so happy we’re doing this again.

Dr. Mindy
I know, I know. When I got off last time, I was like, Oh my God, I want to do that again. Yeah, it’s just you know, you and I always think like, we’re in the trenches seen what women are asking. And it’s just impossible to get to everybody’s questions. So it’s so fun to do a collaboration like this. So I’m excited for this discussion.

Dr. Stephanie
And we have to thank our Instagram followers, because it was a comment on I can’t remember what it is now. But it was some Instagram story. And someone’s like, can you please do something with Mindy? And I was like, Yes, I would love to do anything with Mindy.

Dr. Mindy
Thank you. feeling’s mutual. And I also just want to say that the geeky magic carpet ride, that is the statement before I hopped on there that I was about to go on a geeky magic carpet ride. I just want everybody to know that’s exactly where we’re going. Oh, yeah. And I’m so excited.

Dr. Stephanie
Oh, that’s amazing. Yeah, I am I’m excited to it’s going to be a lot of fun. A lot of questions came in a lot of questions about muscle and body composition and training around the cycle, a ton of questions around fasting. So I think that we and I tried to kind of amalgamate some of them, you know, that were similar themes. And I think we maybe we’ll start with some of the if you’re okay with it, we can start with some of the Muscle and Fitness Question.

Dr. Mindy
Yeah, one of the things that I would love to do, because these questions are coming up in like pieces is let’s go through the menstrual cycle and talk about like, when should you lean in on heavier weights? When should you lean in on cardio. And then what I’d love to do beyond that would be talking about the peri menopausal woman, and changes that need to happen to our workouts after 40. Because that’s another big one, I think really, is important for people to understand.

Dr. Stephanie
Beautiful. Yeah, so I would say for the woman in her menstrual, you know, her reproductive years, my over, like, the overarching comment that you’ll hear from me is that you should always be lifting heavy weights all through the cycle, okay. But it’s just how you structure the workout, that’s going to change based on the hormonal composition that you are experiencing that week. So as a general, you know, kind of back of the envelope, let’s say review, when you’re in your bleed week, first half of the week, estrogen is very low progesterone is not around, the only hormone that’s kind of really working hard is something called follicular stimulating hormone, which is as it as the name suggests, is there to stimulate the follicle because that’s the whole point of the follicular phase is to have one follicle that’s chosen, that’s going to develop the egg within it. So in the first, we’ll say it, let’s say you start bleeding, you know, day one, day two, some women get a little crampy, there’s, you know, there’s a little lethargy there, I feel, I’m like that, too. So the first kind of day that I get my period, I can feel like those uterine contractions, you know, expel, you know, trying to expel, you know, expel the endometrial lining. So I tend to take it a little easier, right, for me, I tend to just do a lot of walking, because I find that just that beautiful, you know, walking, when you think about what’s happening mechanistically in the hips, of course, you’re getting that beautiful figure eight in the sacrum, you’re, you’re lubricating the joints and the hip and the low back and the knees, which often a lot of women will complain about. So I try to get, you know, if I’m taking a day off of weights, I’ll try to get in something like 10 to 15,000 steps like long walks, gentle, slow movement, some women are like, let’s have at it. So you know you, there’s a lot of bio individuality there, I just like to be a little easier on day one. But kind of day to day three, I’m right back at it. So it’s heavy weights, but the rep range is what I would classify as moderate. So somewhere between eight and 12 reps. So let’s say you’re doing, you know, let’s say a squat, okay, just for ease of or a lunge or something, you’re going to do maybe eight repetitions, you know, three to four sets of that exercise before moving on, and maybe you’re combining into supersets or giant sets or whatever. But typically eight repetitions per group eight to 12 repetitions per exercise is where I find is is, you know, you have the least likelihood of injury, it’s kind of what you’re able to do and punch out really easily that week. When we move into week two, of course towards the end of week one and then kind of at the beginning of week two, we see this really big rise in estradiol right this is this big and like estrogen of course anabolic hormone, all about growth and it’s trying to really push that follicular like so there can be that one follicle that’s really developing. This is a week where I like to lift heavier so and I’ll also say the other hormonal. The other hormone to consider this week is is testosterone, testosterone peaks in Last week as well. So I love steel, again lifting heavy. But if the weight is heavier, that means that my set like the amount of repetitions I’m going to punch out is going to be less. Right. So let’s say on the squat just for an example 50. Like, let’s say I did 50 pounds on the squat in week one, well, now I’m only doing five repetitions I could do I, my number can be higher than 50. So maybe I’ll try 60 or 65, let’s say but I’m only going to be doing five to seven reps of it. So I really, really love a high high weight low rep count in this week. In terms of cardio, your question around cardio, I think was well, well placed here as well, this is a week where I tend to counsel women away from burst training. And it’s, it’s precisely because of the estradiol surge, estrogen, as you know, you know, creates ligamentous laxity. So in the ligaments, let’s say in the shoulders, and the knee and the ankles and the wrist, like everywhere, spinal, you know, all the spinal stabilizing ligaments, they tend to be a little bit more, we’ll say loosey goosey than they are any other time in the cycle, because you have this really sharp change the sharp concentration in estrogen in the body. So there is a higher incidence of or, or propensity for, for injury. When you’re doing things like sprinting, or hit training, or you know, any type of explosive like jumping squats, things like that. So I typically will say you can still do the cardio, if you know if that’s your goal, but I like to, I like to change the type of cardio in this week only. So this is where we might bring it down to like a low intensity, steady state. So that’s like if you’re if you’re a runner that just might be like a flat Hill jog, right? Or if you’re on an elliptical, it’s like the same tension, let’s say all the way through on your 30 or 40, or whatever, you know, minute cardio activity that you’re doing. And then all the other weeks really, there’s no, there’s no there’s no limitation in terms of hit. It’s just in that second week. Because we have this really, really big change

in estrogen concentration. Yeah.

Dr. Mindy
Do you think one thing I’ve thought about with ovulation is it this is really the time that we’re going to get a massive surge of testosterone like this is our testosterones like, Glory moment is in that ovulation window? So do you feel like when testosterone is on the scene, our ability to build muscle is going to be enhanced? Or is it going to be more that our craving to build muscle is going to be more enhanced?

Dr. Stephanie
That’s a really good question. I think with the testosterone and estrogen peaking, what we know is that those are very stimulatory to the motor cortex in the brain. So in some ways, we’re like firing on all cylinders, right, so the motor cortex is more activated. So of course, the motor cortex in the brain, for those of you that are maybe unaware, this is the this is the area in the brain that controls movement. So you are going to be very well primed to be lifting heavy in this week, because of the brain activation, let’s say under the influence of testosterone and estrogen. And to your question around, can you build more muscle because testosterone is surging? I think that there is some truth to that. So you know, one of the things that we want to do is we want to, you know, many other areas in our lives, we want to get out of vicious circles. But this is a this is a circle that we kind of want to get into where it’s like, the heavier you Yeah, the heavier that you lift, the more testosterone is going to be produced as an indirect consequence of having to maintain that muscle. So I think that the mechanical stimulus of lifting heavy all through the cycle is justified, but in particular this week, because you have that spike in testosterone, you’re made potentially your capacity under the influence of having that motor cortex activation for new muscle patterns, or heavier or, or a heavier load is going to be augmented, and you have the energy, right, you’re gonna have sort of the energy to put towards doing a much more vigorous or rigorous workout. So I think that there is some truth to what you’re saying in terms of because we see testosterone spiking, we can actually go harder at the gym because of the influence that it has in maintaining muscle mass.

Dr. Mindy
Yeah, and one thought I’ve had and I’ve talked to several trainers about this is that when we look at exercise, we typically look at it in a weekly way, like three days a week or this one day a week of that. And when you start to look at our hormones, I think women should be looking at this in a monthly basis. And when I look at that five day period, there’s a part of my hormonal brain that says, Well, what if one day you go in and you You do biceps, and then the next and you go hard like heavy weights, low reps to your point, the next day, you do a bunch of squats. So you’re gonna really work on glutes and, and, and, and your, your quads. Next day, you’re gonna go in on pecs. So you could take that five days, and really chunk it down into specific body grips, and really target them with heavy weights. It’s just a thought I’ve had i, this is where I wish I had a regular cycle again, I’m like, I want my son

Dr. Stephanie
would love to experiment with that. Yeah. Yeah.

Dr. Mindy
So as a cycling woman, I mean, what do you think of that?

Dr. Stephanie
I think that we want to be trying to, to your point, I think that we want to be trying to hit different muscle groups several times a week. So I do like, after there’s been, you know, after we’ve established, like, a foundational, you know, let’s call it foundation of strength in an individual in a woman. So, you know, I know, there’s a question in, in our, you know, that came in, it’s like, I’m 55, and I want to start lifting weights, well, the first thing is, we’re not going to give you kettlebells. And in barbells, we’re gonna, you know, you’re gonna go to the machines, and you’re gonna learn the pattern of movement. So once we have a foundational kind of neuro musculo, skeletal basis of strength, you have that connection from the brain to the body in the body to the brain, then we can start playing around with what you’re talking about, which is like hitting muscle groups several times a week. And it looks like the research shows that as long as you get too close to muscle fatigue, so it actually doesn’t, you know, when when I was in school, it was like, you have to lift heavy and that’s the only way that you’re going to build muscle. And that’s not necessarily true. So that’s why I love the manipulation of the sets over the course of the cycle. Because as long as you get close to muscle fatigue, or muscle failure, whether that is 15 reps at a lighter rate or five reps at a heavier weight, you are going to be able to contribute to muscle hypertrophy. And this is I’m gonna say his name wrong, but it’s Brad Schoenfeld is the researcher that has really kind of brought this about as well as this idea of getting to 10 sets per muscle group per week as a as a means for hypertrophy. So if you like, let’s say, in that five days, let’s say let’s say you train four times, it’s like to upper body to lower body, well, you’d want to make sure that you’ve you’ve had at least 10 sets of over the course of those two training days, 10 sets of squats, right. So you want to or, you know, let’s say the glutes that you’re trying to build. So it might be a squats, lunges, hip thrusters, you know, Bulgarian split squats, whatever. So you want to make sure that you’re hitting that muscle group at least 10 times in about a week period. So you know, to your point around five days, in order to kind of hit that point of building the muscle, building the muscle up and having hypertrophy there.

Dr. Mindy
So you could do like squats, you could go after legs on a Monday. And let’s say you’re on day 10 of ovulation or day 11 of your cycle, you could do legs on Monday. And then on Wednesday, you come back to legs and glutes, again, with the with same kind of concept. Let’s go in strong with heavy weights during this time. But to your point, because estrogen is still very, very present during ovulation. We would want to go slow, we wouldn’t want to do a lot of burst activity, maybe not kettlebells you know, always scare my my brain a little bit just because they can be so much swinging movement that can hurt discs and tendons. But I understand that they can also be great muscle builders. So you would want to do those movements slower because of estrogen being in there but heavier because maybe you have testosterone and then alternate every other day, that same muscle group. Would you think that would be a really good way to go after ovulation?

Dr. Stephanie
Yeah, I do. And the other the other thing that I wanted to mention around estrogens impact is on the tendon. It makes it stiffer. So we’re actually so it makes the ligaments a bit more lacs, but the tendons get stiffer. So you’re actually very well suited to lift heavy, the, you know, to your point around the kettlebells. And like the swinging I think that there’s a lot of particularly when it comes to hamstring work, like deadlifts. And let’s say even kettlebell swings there’s a lot I mean, there’s some glutes and stuff in there as well. But you know, the the hamstrings are big primary movers there. I find that a lot of I would say people in general but women because we talked to women and our clients are women and my observation has been about women don’t activate their hamstrings well, so even on like deadlifts, let’s say like whether it’s a trap bar deadlift, sumo deadlift, it doesn’t matter the type of deadlift, what I find is that there’s a lot of we’ll call it I don’t know if this is the right term, but like escape through the back, like you’ll see people initiating the movement through the lumbar spine. Right. And I don’t know if you’ve ever seen this in, in clinic, we used to always test people, like, show me your squat. And it’s like, you know, like, people will get their chest on their knees, but they haven’t moved. And it’s like no, not a squat. This is just like a flexion of the, like, 100% flexion of the hips. So I think that there’s something to be said around. And I was actually just having a conversation about this. Earlier today around like Perri, maybe prehab is the right word, or like an activation circuit before you start lifting like everyone wants to get to the glamor muscles, everyone wants to start lifting. But can we maybe think about how we’re going to activate, let’s say, the hamstrings, like the posterior chain, if you’re doing like this, maybe you do squats and lunges and stuff on day one, and then you come back to it on day three, and it’s a lot of hamstring work, deadlifts, that kind of thing. But really thinking about creating that neural connection, because you’re right, sometimes in the gym, you watch people and you’re like, oh, no, oh, that disk is gonna blow if you keep doing that. Yeah, adding weights to that, to that those plates, like the amount of, you know, in when we look at, neurologically, if let’s say I were to shine a if someone’s had a concussion, let’s say, and we shine a light in the eye and like the eye, what the what’s supposed to happen is you’re supposed to have a contraction of the pupil, and it’s supposed to stay contracted. But if someone who’s had a concussion, what we see is something called sympathetic escape, right? So we see the parasympathetic contraction of the pupil. And then because the sympathetics are so activated, the pupil just blows out again. So I don’t know if this is the right term. But I’m using escape kind of in an in an analogous way, where sometimes I’ll see someone initiating a deadlift, from their low back, when it’s like, your butt isn’t low enough, and you’re not thinking about your hamstrings, you’re just thinking, Okay, I got eight to do, let me just go 12345678. You know, it’s like, stop lifting from your low back, get your butt down, straighten out and learn to learn how to stabilize the spine, and then initiate the movement.

Dr. Mindy
And that if so if we tie that into what I heard in that as improper movement with you, as you’re doing your kettlebells, or you’re doing your workouts, do you feel like in the cycle, that lack of attention to detail around how you’re actually doing that exercise? You’re going to be more prone to injury at ovulation because of estrogen causing those tight tendons? Do you feel?

Dr. Stephanie
Yeah, I think that I think that if there’s a time in the cycle, where you’re maybe more prone to injury, it’s probably going to be in the luteal phase of the cycle, because the motor cortex is not as excitable. So this would be and that doesn’t mean ladies that you shouldn’t train in the second cycle. Do not take that as the conclusion of the statement. But if you are doing a new program, let’s say the luteal phase is not the ideal time to start it, you know, because your motor cortex is not as activated. That doesn’t mean that you can’t do movement patterns that you’ve already primed the neuro muscular skeletal system to do but starting a new program in the luteal phase is less than optimal.

Dr. Mindy
Yeah, yeah. And you don’t want to bring cortisol in in the luteal phase either. You don’t want to a lot of that. So otherwise, you’re going to tank progesterone, which we see in I mean, as a athletic woman, I mean, I was in my 20s, I was a competitive tennis player and the amount of stress and strain that I went through training, and many of the women on the tennis team, we all lost our cycle. Be very common. Yeah. Because we are just being pushed to that limit. So So then, do you feel like in this is another thought I’ve had is, is there a better part of the cycle to do more endurance, like, what do you do with the woman who wants to run a half marathon? Are there parts of the cycle where we can actually do better with longer runs?

Dr. Stephanie
I think that all through the cycle is great for steady state. So if she’s an endurance runner, I think there’s no time that she can stay away from it. I will caution that I find that you know, especially the endurance runners, they tend to my marathon runners, they tend to, we’ll say only train in that realm, like in that vertical, which is like steady state cardio, and then they will forsake other things like the lifting like the weight training, and as we’ll get to, I think, in perimenopause, this is an incredibly important consideration where we need to be lifting weights. So for an endurance woman, someone who loves to run my cardio bunnies that are listening, I’m not taking it away. I’m just saying that the hit this just lay off the hit in week two. Because of the will say, tendency, it’s not all the time, but there’s a tendency for the ligaments to be a little bit more loosey goosey. So we do tend to see in the literature that we see more, you know, have catastrophic blowouts of ligamentous injuries like in you know, I talked about this in my book and the body body, but in the ACL ligaments in the in the knee, which is a very important stabilizing set of ligaments in the knee, tend to be blown out in female athletes or in that week too, because they don’t, they don’t, you know, if they’re athletes, they’re just training all the time. And there’s no consideration really for the cycle. So I do like to stay away from explosive types of movement, like cardio types of movement, like the sprinting, and the whatever, you know, the pellet, the orange theory, and all that kind of stuff. In week two,

Dr. Mindy
which, which I just want to point out like, this is mind blowing when you stop and you think about it. Because I mean, I joined Orangetheory years ago, and I just went, I didn’t think like, oh, maybe I shouldn’t be doing this during ovulation, my ovulation window like this is this is why I love conversations like this because women get injured and I and I want to go into the peri menopausal woman especially gets injured. And we don’t realize that there’s a hormonal connection to that. So also my thought, What do you think about the week before your period when progesterone is coming in, and I, progesterone really makes us feel inner. And we are not, we don’t have that same drive to go after the marathon to up our weights. I really feel like that’s the time that we should nurture ourselves more and go into yoga, more hiking. But as women we push through that fit that week, so in so many different ways and working out as one. But what do you feel about for cardio and weights during that week? I personally am a huge yoga like up your yoga that week. But is there anything else we need to consider on those two things?

Dr. Stephanie
Yeah, sure. So that actually is beautiful. Because that finishes up the menstrual cycle like how to train Exactly. So in week three, you know, so you have this ovulation that you know, ovulation happens, egg is released, hopefully. But right before ovulation, of course, estrogen tanks, right comes right back down. And then in week three, it starts to rise again. So it doesn’t rise as high as it does in week two. But it does come back up for that secondary rise. And then it’s like a sustained sort of peak for about a week. So in week three, it kind of looks hormonally like week one where we have low estrogen at the beginning, and then we have a rise in estrogen towards the end. So I like to return if you’re lifting weights back to that eight to 12 rep range, like a nice moderate range. And then in week four, and then like any type of cardio that you like, and then in week four, for the weights. This is where you know, to your point around kind of taking it easy, I like to drop back on the weights but of the reps. So it’s a lighter weight, but it’s a higher reps like 15 to 20 reps, something even 30 reps, something like that. Again, you’re still trying to get close to fatigue, but it’s a different way of fatiguing the muscle. And the beautiful thing about a high rep low weight workout, particularly in that week for is a lot of women do as you said like they feel like kind of slow and lethargic. Maybe they feel inflamed, maybe they’re moody, they feel a little, you know, holding on to a little bit of like water and like maybe their breasts are a little tender. So as we are the night the nice thing about every time you contract a muscle, and this is very true in week four, if you’re training this week with a higher rep count is your release something called a myocardial which is part of the immune system and it has anti inflammatory properties to it. So you can still through your exercise regime help to modulate and help to improve some of the symptoms of PMS, if you’re experiencing them, and you’re not pushing. It’s not like you know, it’s like tits up and we’re doing like crazy. You know, we’re doing like 100 pounds or whatever on the squat, it’s a little bit easier, right? So you might say, Okay, I was doing 65 pounds, I’m just making numbers up here but 65 pounds in week two for a squat and now I’m going to do 20 pounds, right so I’m going to hold 220 pounds or 210 pound dumbbells, let’s say and I’m going to do 30 reps of that right every time you punch that out you are going to be helping to reduce the inflammatory response there. So I do like other forms of exercise as well like some women don’t feel like working out like let’s just say some people are like I if I look at a weight room I’ll kill someone. Yeah, so I do like to honor the you know the individual kind of preferences of of you know, if you are someone who loves yoga, and that really helps with your mental state your clarity and let’s be honest, like some yoga like yoga is a workout like I’m always after yoga. So I think that there’s there’s a time and a place for that as well. If that really makes you feel good and you sort of feel like you’re getting the energy flowing and you have a nice there’s a lot of isometric holds in yoga that are really, really great. I think that that’s there’s absolutely a place time and a place for that as well. What I what I typically what I like to push for, and again with some leniency to the individual and the prayer and the preferences of the individual is to wait train as often as you can through the cycle, but just, you know, alter it based on where you are and how you’re feeling. So we can do lighter days, we’re maybe in the luteal phase as a whole, the goal is not to get any personal records, we’re not punching out any new PRs here, we’re just maintaining what we’ve developed. And then when we get back to the follicular phase, that’s our push, that’s the gas, that’s when we can be a bit more aggressive with our weight training in that, especially in that week to where we’re trying to up the weight a little bit. And then we can kind of just maintain, develop the, you know, develop the strength and all of that that happens in the luteal phase in the adaptation, and then again, push when we’re back into the follicular phase again,

Dr. Mindy
which is exactly the way we do it with fasting. That’s like exactly the same thing, right? Yes, yeah. Like when those hormones go low, we can push things a little bit more. But as they’re high, then now we like they show up, we got to know their personality, and how to match whatever food fasting workouts, social engagements to that. And to your point, on the week before your period, the thing that I have found, to be the most mind blowing for me as a woman, is that I pushed through that weeks in so many ways for so many months for so many years. Every time I had a carb craving, every time I didn’t feel like doing something, I would create a story in my head of laziness, and why can I do that. And I really want women to understand that you are a different hormonal beast that week before your period. And once you understand the pattern that’s right for you. It’ll blow your mind that once your actual cycle starts, you actually start feeling better, like even on day one, like, yeah, you start bleeding, and you’re like, Oh, hallelujah,

Dr. Stephanie
it’s like an orgasm. It’s like, it’s like, Oh, it’s here. And one more, one more thing, I will I will say in my in my quest to inspire women to lift weights, at whatever age they are in the luteal phase, we are also a bit more insulin resistant, right, just typically a bit more insulin resistant than we are in the follicular phase. So one of the things, of course, that you can do is whenever you are weight training, and you were putting on more muscle, taking up glucose from the system, isn’t it at least into the skeletal muscle is an insulin independent process. So you can, the more muscle that you can put on over the course of your life, the better glucose disposal agent you will be and you don’t need insulin to do it. Because in the muscle we see glucose taken up by a different it’s like a pat it’s called Blood for so we see this passive movement of glucose from the from the plasma into the into the into the cell. And it’s done without insulin. So the more the more muscle that you can put on, the more insulin sensitive, let’s say you can stay in that luteal phase.

Dr. Mindy
Amazing. Amazing. Yeah. And I think that the trend towards muscle I hope for women like I hope the women listening to us understand that. You got to build muscle you got to and I really think in which leads us to the next topic, which is after 40. Pick those weights up girl like Yeah, but put the running shoes down, pick up the weights, your menopausal symptoms will be dramatically different if you do that. So let’s talk a little bit about what happens after 40. Because I can tell you as a 52 year old woman, nobody tapped me on the shoulder and said, hey, guess what, in your 40s Everything’s gonna hormonally change. And so every part of your lifestyle needs to change.

Dr. Stephanie
Yeah, I think it really starting at about 35 We start to see changes in the concentration and the amount of progesterone that we that we produce every month. So progesterone only shows up in the luteal phase, helps us with our sleep helps us chill out activates GABA receptors, it turns into a neurosteroid Allah pregnenolone and then activates the GABA receptors, which is why sometimes in the luteal phase, at least in week three, you’ll find that you get really towards the end of week three, when when progesterone tends to peak is you’ll you’ll have some of the best sleep of your life and you’re a little bit more like it helps to kind of alleviate it should help to alleviate anxiety, feelings of nervousness, depression, that kind of thing. So in our 40s as we are just naturally as just as a natural consequence of aging starting to see this sort of stepwise decline in progesterone over the years, one of the first things that all usually ask and people have a lot of pushback on this because no one wants to admit that they’re anxious or depressed is they’ll say yeah, like I’m feeling I worry more. I have a hard time turning my mind off it. Like I I’m at the ended the day like replaying the events or like, I’m just this constant like it’s this worrier kind of mentality and this inability to shut off the mind in the evening. That’s usually kind of a clinical indication that maybe the progesterone is starting to decline.

Dr. Mindy
Yeah. So that was so politely said. I’m like, I like where did fuckin progesterone go like, like, if I could go back to my 25 year old self, I would just love on progesterone. I would thank her every day because my forte when I was 45, and she wasn’t there for me.

Dr. Stephanie
I fell. Where did you go? bestie. We’ve been best friends for so long. And you just dumped me? Like a girlfriend breakup? Yeah. Yeah, it’s hard. It’s hard. And I think that it’s, and then and then you and then kind of as you progress through your 40s, there’s almost like, kind of three or four stages of perimenopause, right. So you start to see this like contraction of the cycle initially, where let’s say you’ve been like a, you know, I’ve always been like a, you know, 29 and a half to 30 day girl, like, I’ve kind of always, you know, and then like, now I’m noticing I’m kind of approaching mid 40s. Now, like, Oh, I’ve lost a day, like, I’m 28. Now like, I’m, I’m still within normal range, but it’s like, oh, I’m shorter, like a day shorter now. And then actually, I have I think I mentioned to you last time, one of my ovaries is a little, like, a little shorter than mine. So like some like every other month legs? Yeah. It’s laggy one. So it’s like every other month, it’s like 27. And then and then it’s 28. So my, my I can’t remember which one it is, might be my right ovary.

Dr. Mindy
So does that mean like our ovaries are like our children? Like, just because we have them doesn’t mean their personalities are the same?

Dr. Stephanie
They’re sisters. They’re not twins. Yeah. They’re a little different. But

Dr. Mindy
yeah, I never thought of that. But you’re right. You know, and sometimes you feel a little bit of pain in one and then not in the other.

Dr. Stephanie
Yeah. Yeah. And I actually, I know when I’ve ovulated I feel it. It’s, there’s like a little bit of cramping for me that not everybody has that. But you know, and I remember when I was having my, you know, when I was trying to conceive my children, like I felt I was like, I’m pregnant. Like, I knew it. I knew the moment it happened. I was like, I’m pregnant. I know what even before you know, all the tests or whatever could tell me that I was pregnant. I knew it.

Dr. Mindy
Yeah, me. Me too. By the way, with both of them. I was like, boom, like, within within days. I do so very true. Yeah. I love that. It’s okay. But here’s what I see in Peri menopausal women. Is that as estrogen goes down, collagen goes down. Yeah. And and yeah,

Dr. Stephanie
in texture. And yeah, hair and

Dr. Mindy
skin hair, you’re more prone to injury injuries hang around a lot more. So do you feel like women over I say over 40 I agree with you that 35 We’re starting to see a lot of perimenopause symptoms. Do you feel like that’s the time to up collagen and up it throughout the whole cycle?

Dr. Stephanie
Oh, that’s a really good question. You know, I think in the context of muscle building, collagen is a terrible form of protein. So it doesn’t do anything, it’s not anabolic to skeletal tissue, but it is as your to your point, very important for skin, hair and nails. I, you know, I don’t know, if I have a cyclical cadence around collagen supplementation, I typically will have some collagen, you know, I’m 44. Now, so I will have collagen almost every day. So I’ll usually but I don’t count it to like if I usually will, like, you know, train in the morning. That’s kind of the time I get to train. And I’ll put some whey protein because I know that that’s anabolic to skeletal muscle, meaning it’ll stimulate growth. And I’ll also put a little scoop of collagen in there. Because I know that you know, I’ve been sweating. And it’s just like the time that I’m going to remember it. Do I don’t cycle it in any way. But I do think that it is an important consideration for women, because that’s one of the things that I hear. They’re like, you know, I’m 45 I’m 48. And like, my skin is just not the same. Like I can pinch it now. It’s like it doesn’t have the same suppleness. So I do think that collagen is important for and even just our joints, right and our ligaments. So this is also like from an intern, like, we can talk about it being vain, and I’m totally vain woman. So I’m like, Yeah, I want good skin, hair and nails. I’m totally taking the collagen, but also the structural elements that allow for the for the muscles to move, right? It’s really important for our discs, it’s important for our cartilage, it’s important for our bones important for everything. So I typically take a scoop and I don’t I’m trying to think of what the scoop is. Now I want to say maybe 20 grams hydrolyzed collagen, maybe

Dr. Mindy
the powder I use, I only know the protein is like 17 grams of protein, But your point is really well taken that just because it’s 17 grams of protein doesn’t mean that it’s the best protein source.

Dr. Stephanie
Well For your muscles for your muscle, but it is a really great, it is a really great source for your ligaments and your collagen and your discs and your skin and your hair and your nails. So we want to be thinking about different proteins for different goals, right? We want, like, in my opinion, animal protein, and the derivative of it, whey protein is going to be the most bioavailable, full complement of amino acids for musculoskeletal repair and for muscle protein synthesis. Collagen doesn’t do that collagen does not do anything for our muscles. It’s just really all about kind of structural elements that we care about with collagen.

Dr. Mindy
And do you think this is another thought that I’ve had when I watch 48 year old women or women in there after 45, they’re getting injuries, perhaps athletic injuries, and they’re not resolving as quickly? Yeah, that is that is a trend that I see over and over and over again. And so what I noticed in clinical practice was if we could bring in some collagen and even megadose with collagen, like two, three scoops of collagen a day, we could start to help resolve these injuries. I mean, next week speaking at a chiropractic conference here, the wave, and I’m going to show chiropractor. Yeah, I’m gonna show chiropractors how we need to pay attention to the changes in collagen and the changes in hormones around even something as simple and as powerful as a chiropractic adjustment, because it really makes a difference for overall integrity of the joint. So I’m

Dr. Stephanie
curious when you’re talking about injuries, you’re talking about, like ligamentous, injuries, joint injuries. Yeah. Okay, that totally makes 100% sense. Yeah. And one of the things that we know about those, those structures, unfortunately, particularly ligaments, very poor blood supply, right. So if you have a muscle, you have a muscle injury, we know that like there’s a lot of blood that feeds that muscle because it’s functional contractile tissue, it’s how we move. ligaments, unfortunately, don’t have a really great blood supply. So they often take longer naturally, anyway, whether you’re 25 or 55. But your to your point, when you’re older, of course, we have, let’s say an especially in our in our menopausal years, we start to behave, at least our cardiovascular cardiopulmonary system starts to behave more like men so that, you know, under the influence of estrogen in our reproductive years, that does positively influence the vasoconstriction and vasodilation of our arteries, which is why actually, when we just look at cardiovascular disease, we see that most like men will get it earlier than women, there’s a kind of this phasic shift like men will get it tend to 15 years earlier than women. And it’s partially because women spend about 40 years or so menstruating. Right, so we have this constant turnover. And under the influence of estrogen, we keep these we keep the ability to vaso dilate, and vaso constrict, more active. And then in a sort of lower estrogen environment, like you see in menopause, we do start to behave more like men. So you know, when you say, you know, there’s women that in their 40s and 50s, let’s say who have these injuries that are just these niggling injuries that don’t seem to clear up. Part of that is because of the we’ll say reduction in blood flow, generally to most structures, which is why things like you know, making sure that you’re going for low level like low level activity all the time. I’m a huge fan of like going for walks and you know, steady state cardio and even the burst training and the weightlifting like all of that is all good for circulatory flow yoga, as you mentioned, pilates, all of these things, these are all very, very important for injuries, like let’s say of the ankle of the shoulder of the knee, where there’s a lot of ligamentous structures, I do like to do things I would love your your thoughts on this too. Just knowing your training and your background and expertise. I love to try to bring as much blood flow in there as possible. So the collagen is really important and I would also layer on things like red light therapy, oh and heat and trying to just as much as we can bring blood like it’s almost contrary to the rice which we know like the Rest Ice Compression, which we I was taught in chiropractic school, which has now been completely outdated and we don’t do it anymore. Bring more heat into the area to try and get the blood in the area to try to clean up and he’ll the you know the the problem that’s in them like well, all you’ve got

Dr. Mindy
to do is take a 47 year old woman and put her in a hot yoga class not like a crazy hot one. But I can tell you when I first go into a hot yoga class, I feel like I’m 25 again because of all the warming up now too hot and I’m gonna tear people’s heads off because I’m like, you know, I could go into like a more hot flash kind of place but I do believe to your point warming up is really important, the other than getting heat and circulation in there because you don’t have as these hormones that are supporting really good fluid movement of the joints. And there’s a whole a whole bunch of reasons behind that. Second thing that I would say is that, I feel like you, as you get older as you go through the peri menopausal years, and those ovaries are starting to switch, shut down and switch the job of making sex hormones over to the adrenal glands, we have another challenge, which is if you’re pushing it too hard, you’re double stacking stress on the adrenals. And now all the hormones go away. And, and that is something that I absolutely dealt with throughout all my 40s. I mean, I kept modifying and modifying and modifying my workouts because I was watching these hormones change. And if I didn’t change my workout with them, the injuries kept piling on top of each other.

Dr. Stephanie
I love that you brought this up, because I think that this is such a big consideration in, you know, oftentimes in our 30s 20s and 30s. It’s about child rearing, and marriage. And then in our 40s and 50s, like those children are getting older, are, you know, they’re they’re teenagers, which is a whole set of different challenges that you as a parent that you have to sort of go through. And then you also have other stressors like aging parents, let’s say or fat, like death of, you know, important people in your life, that starts to happen, unfortunately, with more and more frequency. So it is, to your point, very important to be paying attention to stress management, in your 40s and 50s. Because as you said, the ovaries are like I’m done, I’ve been here working hard, like a maniac, I’m ready to retire, I’m going to hand over my job description and my you know, my, my, all my duties over to the adrenals, who are now going to be tasked with making, you know, making the majority of our sex hormones going forward. So if you already have sort of a higher sympathetic load, let’s say, you are going to be at a will say, you know, a disadvantage, versus someone who is, is managing their stress really well. So there’s a couple of couple of strategies that we might talk about, around how you might how you might mitigate some of that stress. First would be from a nutritional perspective, one and this was a question like is a refeed day important. And this is actually a really beautiful time, like if you are getting injured, and it’s not getting better. And you’re like, oh my god, I’m gonna kill everybody. Like I’m moody, I’m anxious, my performance in the gym is starting to tank, my energy, my sleep and my libido. It may be time for a refeed and a refeed day. What we mean by that there’s a couple of different definitions. So if you are doing kind of like a low carb ish diet, a refeed can either be a like a carb, or keto refeed, meaning that you don’t change the macros who just eat more of everything. So it’s more of like a caloric bump. Or you can do a carbohydrate refeed. So you completely switch over the macros. Whereas before, you might have been doing much more low carbs, much higher fat, that kind of thing, you switch it over to, I prefer to do like a high protein, high carbohydrate refeed. And that tends to help a lot with the sleep, especially if you backload it in, in later in the day. If you have a lot of the carbohydrates, let’s say most of your carbohydrates towards the end of your day, that tends to you know, elicit the serotonin production, which helps you feel sleepy, and then you’re giving your adrenals enough substrate to be able to kind of last the night because one of the things I hear this all the time, I would love to know if this is the same for you Monday is that women will say I wake up all the time between like, like I wake up in a shock between like one in four in the morning like that, when they wake up. And usually what that means is that the adrenals have kind of run out of fuel, right? So we have this stress response, this sort of sympathetic response, that response where we have adrenaline and cortisol and all these other things noradrenaline lava, kind of increasing in their concentration which brings us out of our sleep prematurely. So you can help by having a bit more carbohydrates so in you know to the question about is a refeed day important you know you want to answer the question Do I am I seeing any dips in my performance at the gym? If yes, maybe weren’t we weren’t a refeed day dips in non scale you know I call them non scale victory so like is your energy dipping sleep dipping libido dipping? You know, you feel like you’re stressed like you’re waking up in the middle of the night you can’t initiate and or maintain sleep a carb refeed might be warranted there as well.

Dr. Mindy
Yeah, I would say I also strongly like it pattern to your hormonal cycle to your menstrual cycle. And I’ve you know, we’ve talked a lot about the week before your period and how important you’re more insulin resistant. There’s a reason for that your body wants glucose to be higher. You Definitely don’t want to be doing fasting and keto during that week here and a lot of women who get obsessed with fasting and keto forget that or they don’t know that and then that’s where we got a problem. But the other part that I’ve been really playing with is during ovulation, because I’m seeing in the women that I’m working with that a lot of times we need more carbs than and when we add in more carbs during ovulation that ovulation goes a lot smoother. And for all the women out there, they’re like, but you know, when do I use keto and fasting to lose weight, you can use it in week one, and you can use it in week three. But but the thing about ovulation is that you definitely when you up your carbs, if you are going into ketosis during that time, which I’m seeing a lot of women do they up their carbs, and they wake up in ketosis. That is their body saying, hey, you need to give me more carbs during this time. So I feel like we can use blood sugar, we can use ketones and map that and know ourselves. And if you go into ketosis on a higher carb diet during ovulation, that’s what your body is telling you. Your hormones are telling you you need.

Dr. Stephanie
Well said I could not agree more because one of the things of course, that we know is that the you know, if you are too aggressive, let’s say in your fasting or keto or whatever, in that week, your mitochondria and your ovaries are gonna be like we can’t she can’t get pregnant right now. There’s not enough food. So we’re just going to hold off on this this egg and we’ll just wait and see next month so there’s if you’re too aggressive with the fasting too aggressive with the Keto, let’s say in week two, you can absolutely impact ovulation so I do I really appreciate what you’re saying. Because I think that there’s an I used to do this too. So I’m not Pooh poohing on anyone like I agree in my own journey to I used to white knuckle my way through the whole cycle is like, I have to do it this way. Because this is how I’m supposed to do it. This is what the guys are doing. And this is what I got to do. And I think that there’s such a freedom in in saying, okay, like, I’m just gonna give myself more carbohydrates to make ovulation a pleasant experience, because there are a lot of people who have that middle search, they have that pain in the middle of the cycle, or they become anovulatory. They skip it, because they don’t have enough carbohydrates to drive the process of the follicular and egg development.

Dr. Mindy
Yeah, yeah. 1,000%. And I think, you know, for the women listening, there can be this moment of Wait, what am I supposed to do? There’s a lot of theories getting thrown out here. But this is the point is, the more you engage in conversations like this, the more you understand where the hormones are coming in and out, and then you play with these principles. The whole goal for every human on the planet, but especially women, is we have to be our own n of one, we have to experiment on ourselves. And this is why you grab a CGM grabba, measure your ketones know what those patterns are throughout the menstrual cycle, and then you’ll know where you need to refeed because I have watched more women who have white knuckled to your point themselves through the whole cycle using keto and fasting, and they’re not getting the ketone numbers that they want. And then we throw in a what I call nature’s carbs, where we just throw in a high carb day, and all of a sudden they go into ketosis. And they’re like, what, why did that happen? So we there’s a lot more ebb and flow for sure.

Dr. Stephanie
Oh, there was a question about ketones like How should I take ketones? I have a couple of, I mean, first of all, I like my own body’s ketones, because it’s so great. So I like to make my own but if I’m stopped do supplement with exogenous ketones.

Dr. Mindy
I will do it in the fasting window. So here’s what I think is that we can’t if you add in exogenous ketones, when blood sugar is high, you’re going against your physiology, your physiology is blood sugar goes down, you move into a fat burner energy system, and the byproduct of that is making ketones. So I would never eat a meal and take exogenous ketones. But now we use it a ton in our community where you’re at our 16 and you want to maybe go to a 24 hour fast, you’re not feeling so good. Okay, let’s throw some exogenous ketones in and see if that gives us a little bit of a burst to get through the rest of the day. I also don’t feel like it should be a daily habit. I feel like it’s a it’s a as needed, splash it in every once in a while because I to your point about I would like my body’s own ketones. I don’t want my body to ever stop making ketones. So if you give it too much of an exogenous resource, it may slow down how well it can make those ketones

Dr. Stephanie
hmm. And I Okay, so I love to so I’m very aligned with you there I kept typically will if I’m If I’m in the mood for a new record in the gym, you know, because I tend to work out fasted, so I will work out in the morning, that’s usually the time that I have to work out. So I’ll have some ketones with my water, let’s say as I’m, you know, 1020 minutes before and then I am like Wonder Woman in the gym like Captain Marvel strongest, you know, hero, I’m like pushing, you know, push punching it like new PR, so I love it as an Augment to my workout regimen. I also like it right before I record a podcast,

Dr. Mindy
because I, it’s like I play medicine. That is it’s like,

Dr. Stephanie
I have all of this access to words that I’ve forgotten. And I’m so much more articulate. So I really love. And that’s just my own little thing. Like I don’t do it all the time. But, you know, when there’s like a really important part, there’s a very technical podcast that I’m about to record or something I have a little bit of ketones there as well. Yeah, yeah. And

Dr. Mindy
I’m, again, I think these are all great times, the absolute time I’m opposed to it is when blood sugars super high. So when in a Fed state, yeah, in a Fed state, if I was to eat lunch, and then oh, I’ve got a podcast interview an hour from now. And then I take my ketones, you would want to make sure if you had a CGM on that your blood sugar was down to its pre meal moment before you would take those ketones. Otherwise, you’re going against your biology, and I’m not a fan. Well, you know what you brought up one, one thing that I really want to chat about, and I haven’t talked to anybody about this, but there is a lot of mixed messaging on Do women workout in a fasted state or not. A lot of people, a lot of hormone experts out there really feel that women should have protein before they go to the gym. I for my body, I do really well in a fasted state at the gym, and then I come home, and I power up on protein. So I’m curious what your thoughts are on that.

Dr. Stephanie
So there is a lot of discussion will say on on, how do you work out? And I think that the answer is It looks like it’s easier, or we’ll say more optimal to work out with some protein and carbs in the body. So what does that look like you have some proteins and carbs, maybe you have breakfast or something, and your core body temperature rises, right. So that’s also really good for your joints and your ligaments and your muscles. Because if you work out in the you know, in the morning, as I do, you have to be very careful not to injure yourself, because you’re stiff, and you’re not your joints are not quite lubricated yet. So there does seem to be some evidence that suggests that in a Fed state, you’re at least your performance in the gym, and you’re you know, which will translate to you know, hypertrophy and physique building, if that’s the goal seem to be better in a Fed state. That being said, not all of us can do that. So like the ideal time to work out is about two o’clock in the afternoon. Not everybody can do that all the time. Some of us are at work, we have school pickup and all and for me, the way that my life, you know, typically plays out is that if I don’t get it done in the morning, there’s a less and less likelihood, like, the longer that the day goes on that it’s going to happen. Because other things come up, like I got to, I’m gonna go for a bike ride with my kid, or I’m going to take them to soccer practice, or I have a call or you know, whatever. So for me, I get it done in the morning. It’s not optimal, I don’t think to be in a fasted state. That being said, I always make sure that I’m getting enough protein over a 24 hour period. So that, you know, the net net is is it’s, it’s, I think it’s kind of a wash. So I always make sure after my workout, there’s at least 35 to 40 grams of protein in a protein shake. I have some carbohydrates, I add creatine, which was a big question. Yeah,

Dr. Mindy
yeah, we gotta go into that. Because a lot of people ask that question to put creating

Dr. Stephanie
an and then usually an hour to two hours later, I have breakfast, and then I have lunch, let’s say at two or one or whatever. And then I have dinner with the kids that you know, whatever it is five o’clock, six o’clock. So over the course of a 24 hour period I’m getting, I’m making sure that I’m getting sufficient calories, which is important. If you’re if you’re trying to build muscle, you can’t really build them in a deficit, it’s harder to do it. And I’m also giving myself the enough sort of the minimum. I’m not just doing the minimum, I’m trying to do a surplus in protein in order to be able to maximize that muscle protein synthesis chemically from my diet as well as the mechanical stimulus that I’m garnering from from the gym. So I think that there you can still like listen, I have trained fasted for decades me, I’ve I’ve built muscle. So it’s not that you can’t do it. It’s just if you have the luxury to choose, it seems like the literature suggests that being in a Fed state is going to be better for your performance better for your joints better for your recovery. But if you’re not able to do that, that doesn’t mean that you shouldn’t work out because that is far worse than working out in a fasted state. And I’ll say that my preference also has an maybe this might be my adaptation, I don’t know. But I don’t like typically working out fed because I feel I just feel full, I feel heavy. So I prefer not worrying about my digestion while I’m lifting. Yeah, so that’s just my own kind of like two cents there. But if you Yeah, the whole thing is work out whenever it works for you. And if you have the option to choose, then I would choose fed over fasted. So

Dr. Mindy
I agree with you on that. And a couple of principles that I’ve been playing with, with different patients of mine and played on myself is the idea that when we’re in a state of a toffee, G, we are in a state of repair and break down, the body’s getting rid of the things that don’t work for it. We know sleep stimulates autophagy, we know HIIT training stimulates autophagy, we know that fasting stimulates autophagy. And when we’ve been in a state of autophagy, and we’re fasting, we also know that there’s going to be higher requirements for exercise from glucose, your those muscles are going to have to dump glucose that might have been stored in there. And if you have carrying a lot of extra weight, it actually might burn more fat around those muscles in order to get access to stored glucose. So a trick that I have seen work over and over and over again, is workout in a fasted state, whether it’s cardio, whether it’s it’s weightlifting, if you can even make sure you’re in a state of autophagy. And that works for you. That’s a whole nother discussion. And really empty out those muscles, break them down, and then come home and power up on protein get back into a state of mTOR. And now we’re back into growth. What I am seeing in Peri menopausal women is that is the key to muscle definition. So you’re not only building muscle, but you’ve really broken down extra glucose that might be preventing and breaking down fat that might be preventing the muscle from revealing itself. So I’m curious what your thoughts are on that. But that is some a little hack that I have seen work really well for women that are like, why can I get my muscles to show? I want more muscle definition? That’s what I’ve seen. Yeah, I

Dr. Stephanie
think that too many women in their 40s are like, I’m just gonna do what I did when I was 25. Yeah, it should work, right. So we do want to be thinking about, and I’ll say this maybe in a slightly different way than you have, but I think we’re saying the same thing is there needs to be build phases and cut phases. So I think that there needs to be you know, there’s a question about can I build muscle and lose fat? And it’s like, yes, you can, but maybe not as efficiently at the same time. As if you were to do them kind of separate, you know, at different times. So I feel like, for women, we’ve been, we’ve been scared, and not just women, I think we’ve been like the the conversation around mTOR the conversation around growth has been like that equals cancer, you know, it’s like you can never be in growth. Because that, you know, we see like the, you know, maybe the some of the Blue Zone research and some of these kind of longevity. Researchers were they’re always talking about this idea of like, how can we how can we lengthen the life? How can we lengthen life? Well, we’re gonna lengthen the life by suppressing mTOR. And the, the the problem that I haven’t and I I’ve said this before, and I want someone to explain this to me, because I can’t seem to reconcile this is that as we age, our protein requirements go up. Yes. So it doesn’t make sense to restrict protein as we age, because we need to be able to overcome the natural insulin resistance that sets in the natural anabolic resistance that sets in in the muscle. So you need to have a greater and greater bolus of more stimulus of protein, let’s say in the in the, in the case of like, stimulating muscular muscles to grow. And so I like I want people to not be scared of mTOR it’s, it’s a, it is a pathway for growth. But when you are doing the right things in your life, right, you are lifting weights, and then you feed your body because you’re trying to build your muscle. This is not a bad thing. In the same way that I want women to kind of get over their fear of carbohydrates, you know, what did you call nature’s? What did you say?

Dr. Mindy
I call them nature’s carbs, nature’s carbs. Yeah, villainize the processed carbs. But nature created some amazing carbs for for all of us. Yes,

Dr. Stephanie
they did. And I think that especially and I’m guilty of this because when I was first in the Keto world, I was like, carbs are the devil. That’s why we have at but I’ve modified my position because especially as being a woman, you just can’t always be you can’t always restrict carbs, you know, to art we were talking about refeeds and why that’s really important. And then these women that are like my muscles are not I, you know, full I don’t feel like I can see them Well, part of the way that you’re going to see them you can work out and then you should feed them carbohydrates, you should feed them the nutrients that they have depleted during the workout like protein like creatine likes, like, like carbohydrates that are going to give you that, you know, what are the cool cats saying? Like that swirl look, you know, like, like, the cool cats, and I definitely don’t know that. I’m definitely not a cool cat. I just observe them on Instagram. But you know, like that kind of like, like filled out. Look, right? You see this right a lot, a lot of times before photo shoots, like, you know, female fitness models, let’s say they’ll do push ups or they’ll do squats. So they’ll do like lateral raises, because they’re trying to just bring some flow, some blood flow in there. But you can do that nutritionally as well. Like you can give yourself the carbohydrates and the muscle and pardon me the protein to fill up. Let’s say the muscles Well, yeah,

Dr. Mindy
we really love absolutes is what I think no humans, do.

Dr. Stephanie
They Yeah, we like absolutes. It’s like, well, if I’m going too fast, then everything breaks the fast. You know, like, if I’m going to weight train, I’m going to turn into the Hulk. And, you know, it’s like, that’s not the only two options are not the Hulk or a frail sarcopenic. You know, 90 year old like there’s there’s a happy medium somewhere to be found in the middle. But you’re so right. You’re so right. It’s such a good point, women. I mean, I think humans we love extremes. Absolutely. All the time. Yeah.

Dr. Mindy
So do you do anything post workout? Because that was also a question was supplementation after a workout, do you?

Dr. Stephanie
It’s the creatine question. Yeah. Yeah, I love creating. So I think that women, there’s like a couple of foundational basics, all women should be on, we all should be on a magnesium, we all should be taking an Omega three. And if you don’t have access to sunshine all the time, you should be taking some type of d3 K to blend especially like where I live. I live in a four season. You know, I live in Toronto. So we get lots of summer, we get lots of spring, lots of fall, but we also get a very cold and dark winter. So in those months, I’m making sure that there’s you know, because I don’t have access to beautiful sunshine, as you might, you know, do have access to all the time. Yes. Like, why do I live here? But anyway, d3 and Ketu. In the wintertime? We do have excellent skiing. I will say that yeah. So for creatine, I think that this is so those are the three kind of like basics that for women. And then if you’re a woman who also wants to build muscle, I think that creatine is a very, very exciting supplement. So not only do we see this to be a potent mitochondria, like it will up the efficiency of the mitochondria, but it’s going to replace, it’s going to help you produce more ATP, which is like the energetic currency that we all kind of trade in to increase your workout intensity, which of course is going to have knock on effects to being able to build more muscle. So you know those short, fast explosive movements if you’re like a runner, or if you’re a weightlifter because a lot of weightlifting can be short, fast, explosive movements. And then of course, creatine is also a fuel source, right? So it’s your it’s actually your body’s first choice of energy when you’re doing anaerobic activity. So like the all out sprinting, like when you see like the Usain Bolt, and like the 100 meter, 200 meter, sprints, the first 10 seconds or so, is that phosphocreatine system, so you want to replace the creatine that’s, that’s, that’s been depleted, let’s say in in those in those activities. So people will talk about saturating the muscle cell with creatine and I think that that’s a good idea. So the way that you’ll do that is like, let’s say five, you know, like, usually a scoop of greetings about five grams. So you can do five grams in your protein shake over the course of like a month, and that should saturate the muscle cell. And so and I typically take it after a workout,

Dr. Mindy
you can just gonna say, Yeah, but I mean window like, and you wouldn’t do it in your fasting window.

Dr. Stephanie
You could, I don’t, you could, it’s just I don’t remember to do, I just remember that I’m about to eat some like, oh, just put some in my smoothie, I’ll just put some, it’s right beside my protein powder. So it just I put it in there. And I think that it’s actually, you know, the muscles right after a workout are actually primed to take that you know, to say to take substrate up. So I like the idea of creatine post workout even though I know a lot of people talk about you know, pre workout creatine and you can certainly do that as well. I just find that the post workout it works for me in terms of remembering it, which is also when we’re thinking about habits over the long term. It’s like what’s the thing that you can remember to do the most consistently will I remember to do before my workout? No. Will I remember because it’s right beside my protein powder. And that’s exactly where I go to right after my workout. Yes, yeah. So

Dr. Mindy
yeah, I love that. I love that I’m gonna I’m gonna have to add that in. I haven’t been adding I’ve been really obsessed on aminos lately and adding in more aminos and looking at where that could shows up for performance and moods for me.

Unknown Speaker
So have you noticed anything? Well, I’ve noticed

Dr. Mindy
a lot. So here’s what’s really interesting about aminos. When you dive in to understanding amino acids, you see that they are a precursor for two key neuro chemicals in our body, they are a precursor for neurotransmitters, and they’re a precursor for hormones. And as women go through menopause, we’re just getting more depleted on every front. So when we add these aminos, back in, you start to see changes in mood, you start to see changes in energy, and I’m also seeing changes in muscle performance. Here’s the trick, when you take an amino, you should feel like a mood lift within 20 to 30 minutes of taking that amino acid. So for example, a great combo, my new favorite combo to tie in what you said about exogenous ketones, is all do a scoop of exogenous ketones and a scoop of perfect aminos. And I am buzzing and happy. And that is a great pre workout drink doesn’t elevate my blood sugar, and then I can go in and rock a workout and then come out of that workout and lean into a higher protein. I do do animal protein, I don’t feel like you can get the complete amino acid profile with a vegetarian diet. So I’ll do an animal protein at that point. So now the second part about aminos that is really interesting is it takes about four to six months of continual amino acid supplementation in order to build your reserves back up. So you it’s like you go in and you pulse it to help with the neurotransmitter and hormone production. But then you got to stay with it at some point throughout your day for four to six months, so that you can bring it back up really depends on how depleted you are. It has been a game changer for mental health and and for for building muscle that I’ve seen in the menopausal women and Peri menopausal women.

Dr. Stephanie
That’s really interesting. I have never I have never used the BCAAs. You’re talking about branched chain? Yeah, I’ve never used them in my training regimen. I don’t know why. I think I’ll play with it and see ya

Dr. Mindy
play with it. Yeah, the trick is, if you and now we’re gonna get really geeky. The trick is if you think about what stimulates a toffee G is a toffee G is not just stimulated by a decrease in blood sugar. It’s also stimulated by a decrease in nutrients. So one of the conversations I’ve been having with a lot of functional medicine doctors is well what if you come in with amino acids in your fasting window? Are you pulling yourself out of a toffee G? And I think these are questions we just don’t know. And you just have to play with it and see how it works best for you. But But I do have that question in my mind.

Dr. Stephanie
Yeah, it’s an interesting one. Because I we know that as you mentioned before, there’s a lot of things that stimulated topology, including training, right? You have this like cellular turnover of muscle cells, as they’re getting stronger, you kind of replace the old weak ones with the new strong ones. So it’s, it would be interesting. Yeah, I have to I have to I’m gonna play with it.

Dr. Mindy
I’ve never even with it and see, I feel it, you know, do you know the cellular danger response, where the cells get so overloaded with physical, emotional chemical stressors that they get stuck in this feedback loop that has the mitochondria, not making ATP, it actually makes a signaling molecule that tells all the other cells, Hey, shut down energy production, shut down hormone production, because we’re in a crisis. When you break that response down, what you see is that what will happen is mineral and amino acid and some some overall vitamins will be depleted. But the biggie is amino acids. So we have so many people, but especially specifically women that are in the cellular danger response. So when I come in and I backfill in with amino acids, I’m watching them come out of the response. So now they’re handling stress better, their moods are better, they’re having more energy because those mitochondria are not making the signaling molecule they’re actually making ATP for what then that’s what we need. Right? So it’s my new game changer. I love aminos

Dr. Stephanie
I learned something new today.

Dr. Mindy
I love it and then you’re gonna have to come back and tell me what yeah, we’ll have to

Dr. Stephanie
do another one. And I’ll be like, I’ve been doing these aminos and let me tell you what I noticed. Yeah,

Dr. Mindy
yeah, it’s amazing. Okay, other questions? So we went off the the question, although we kind of included them we’ve included a lot

Dr. Stephanie
of them. There was a lot of questions around fasting there was there was one that I wanted to there was one around like is constant low blood glucose optimal. So I want to just address that and then I want to get into some of the fastest because there was you know I know that you just being you know the author, future author of fast like a while you are the author it’s just not out yet fast like a girl You must get I mean, I also I get a lot of fasting questions, and I wanted to maybe spend some time on all the fasting stuff that came in. So there was just one question that came in, it was like, is constant low blood glucose levels optimal? And this kind of goes back to what you were saying before about, like, we love to live in the extremes, right? It’s like, we love to be like, Well, my blood glucose, yours is 70. Well, mine zero, you know, mine’s better than yours. Yeah, I can one up you by getting it even lower. And I think that the better way to think about optimizing glucose regulation is, do you what is the response of the body to an external or internal stimulus? Right? So what is the response of the body to glucose as an exogenous substrate? So you have a carbohydrate meal, you have a protein meal, you just have a meal. Okay? What does your body do? So if you have a 70, you know, in her question she’s like, is like 70 to 89 milligrams per deciliter good, or should it be even lower? And it’s like, okay, so there’s a lot of reasons why even just looking at that number is incomplete. So you could go to, like, you could, you could have a CGM, or you could go to a lab, and you could get your blood drawn, let’s say it’s fasted. And you might have rebound hypoglycemia, which you’re gonna have super low glucose, right? Oh, you’re gonna be in that range or lower. And they’re gonna say, Hey, good job, you got like that really low blood glucose. But of course, we know that there’s a, there’s a process behind that that’s sort of artificially creating this low blood glucose. On the opposite side of that you could have, you know, we talked about this on the last show the dawn effect, right, you can have this art like this glycogenolysis and gluconeogenesis. That sort of spills blood, a blood glucose, rather, or glucose into the blood is what I’m trying to say. And that’s going to artificially raise your blood glucose. So does that mean that that individual now has deranged blood glucose regulation? Yeah, he maybe not. Right. So we want to look at things in context. And then just one other thing I wanted to talk about. And I’m talking specifically to this woman and every single woman who always wants to a plus, okay? You want to look at your response. So if you have food, and let’s say, within two hours, you know, maybe you started off at 70 milligrams per deciliter, as she gave it her example. And then I don’t know, you go up to like 130. And then within two hours, you’re kind of back down to like 100, or 90 or 80, or whatever. I think that that’s a good blood glucose. Right? We’re looking at it in context. Yeah. If however, you start off at 70, you have a meal, and then your blood glucose is goes to like, 141 5160. And then it stays there. That’s the bigger problem. Yes. Right. Yeah. Yeah. Right. So I just want her and everybody who’s listening. It’s like, we don’t we’re not always striving for one number. And I just interviewed Dr. Brett shore, Bret share, sorry, of the from the diet doctor. And he was saying, I have a patient, I can’t get his insulin under 15. But he’s so healthy. He’s like, the healthiest he’s ever been. And that’s where we’re going to stay with him. Right. But if we said arbitrarily, because I was like, Oh, well, you know, I, you know, in my you know, and I do this too. So like to this woman who asked this question, like, I’m with you, because even in that interview, when you hear it, I’m calling myself out here publicly, I was like, well, ideal. Insulin should be between five and seven. And he was like, okay, also, let me school you for a minute. And I have a patient who is an outlier to that example. But they’re also experiencing the absolute best health they ever have. And their insulin is hovering around 15. Now we’ve gotten it down from you know, whatever number it was 40 or 30, or whatever it was before. So there’s been a market improvement in their insulin output, but it’s still not kind of fitting in that little box that I have created where I’m like, optimal five to seven, you know, so we want to be thinking about like relaxing our thinking a little bit and I have to do this and I have to work on this as well as a practitioner because there’s like, optimal ranges that I have, like, you know, become my mantra that I’m always trying to push my patients towards right but sometimes that’s not possible.

Dr. Mindy
Yeah. Yeah. There’s so much in that it was that I think we can educate on and here’s the what I look at it blood sugar from a very simplistic metabolically flexible place, which is we got we go back to were either a sugar burner and a sugar burner state or a fat burner state. So when your blood sugar is lower, so when you’re at like 80, and you’re now maybe 10 hours into a fast, your ability to switch over into the fat burner fits place is going to be much more effortless because your blood sugar doesn’t have as far to come down to signal to the body at needs to switch over into fat burning to make ketones. Now I have watched a lot of women who will tell me my blood sugar 70 I’ve been fasting 20 hours, I can’t get a single ketone to come out of my out of my body. Yeah. And in that scenario, we got to start looking at toxins because toxins are causing the really effective we can go sugar burner, fat burner and how metabolically flexible we are. So if I’m the woman who answered the ask the question, if I’m always just trying to keep my blood sugar between 70 and 90, that’s only one part of the story. The next part of the story is, are you making ketones? How can you make ketones, so make sure you can do that as well. The last thing that I want to say on this, that’s really important. Well, two other things I would say, is what you talked about, which is the post meal blood sugar. I think we don’t give that measurement enough credit. So if you want to know if you’re insulin sensitive, here’s a really good question. Does your blood sugar come back to a pre meal level what it was, before you put that food in your mouth? Does it come back within an hour to two hours after that meal? I think clinically, we they say two hours. I personally like to see somewhere between an hour to two hours. And if that you’re coming back into a pre glucose meal, a number that was similar, then your body’s pretty insulin sensitive, which is what we’re looking for. And then the last thing I recently I had a really cool conversation with Dr. Baz. Do if you haven’t brought her on your podcast?

Dr. Stephanie
You need to bring her on? Oh, you gotta make an introduction? I don’t know. I don’t know what that is.

Dr. Mindy
Yeah, she’s another YouTuber that has been talking she’s internist that has been talking specifically about hemoglobin a one C, and then she has something called the Baz ratio, where where you can measure a toffee G. But here’s what she told me recently is that if your hemoglobin a one C is is above five, then your red red blood cells are going to be gunked up with glucose, and you’re not going to drive oxygen into your tissues. So I say that to say blood sugar is one number. And I really want to compliment the woman who asked this that she knows it. She knows 70 to 90. Now the next question is, what can you get into ketosis? What is your blood sugar do after you eat? And what are you? What’s your hemoglobin a one C yet? I think those are that’s the next elevation of that conversation.

Dr. Stephanie
Beautiful. All right. So Mindy, do you? This is a question Do you fast every day,

Dr. Mindy
I would say 95% of the days, I really try to make myself eat breakfast one day a week. I don’t crave it. But I’m really trying to mimic more in and out of feast famine cycling, that I think a better question would be do I fast the same way every day? And the answer is no, I you know, sometimes I may, maybe it’s 10 hours, 12 hours and other days. It’s like I’m just gonna go all day and I’ll have one meal. You know, recently I decided I got really into doing three day water fasts. So I’ve been trying that out and seeing where that sits with my hormones. So I’m always very knit the hardest thing is to like an eight hour window would be really hard for me to eat. Eat within an eight hours.

Dr. Stephanie
You mean fat so fast for 16 and eat for eight hours? Yeah, just one.

Dr. Mindy
No, no, like, I’m sorry, fast window of eight hours. So. Yeah, like I wouldn’t

Dr. Stephanie
for 16 Yes. Wow. That’s hard. Yeah. Like, but that’s

Dr. Mindy
what most people are doing. Right? Yeah. Yeah. So you would never see me like, eat finished dinner at eight and then wake up in the morning and eat again at eight. Like it would just wouldn’t happen. So I guess I’m doing some form of intermittent fasting almost every day.

Dr. Stephanie
Yeah, I am. Yeah, yeah, I am, too. For me, you know, I’m still cycling. So I typically find in my follicular phase, I can do a little longer, you know, so I will, I will push it a little more. So I like you know, a 10. Like, I’ll fast for 14 hours, maybe 16. And then, you know, my window is, you know, whatever the other 10 or eight hours. Yep, eating window. In my luteal phase. I don’t feel like doing that. So I’m just generally hungrier. And I would also so I’ll do like maybe a 1212. You know, 1014 also works well there for me as well. And I think that it also depends for me on my my output. So my physical activity if I have had like a monster leg day, I’m just generally hungry or so no matter kind of where I am, in my cycle, I will probably be a bit more lenient in the hours that I’m fasting. So I also kind of take into account my own. We’ll call it autoregulation. Like how how how hungry I am, you know, because usually legs like my legs are hungry, because I really wish I really, really pushed legs. So I like it. Usually a little bit more lacks on legs like days for my for my fasting window.

Dr. Mindy
And I would say I do that on in an opposite way when I know that like I have a bunch of podcast interviews or when I was writing the book like, what I know it’s a performance day, as far as my mind goes, I will actually fast longer. Yes, I know with ketones, I can just get to that to your point to those, those neurons can fire up and give me some words a little bit better if I’m in a state of ketosis. So what about

Dr. Stephanie
hair loss and fasting? This was a question that came in do you see this with your women with fasting if they’re doing it a certain way, a certain type of fast a certain length? Is that something common that you see?

Dr. Mindy
Yeah, 1,000%. And it’s means two things, it means you’re fasting too much so or you’re not fasting with your cycle. You’re not You’re not stepping out of a fasted state that week before you’re not doing enough variation. And then the third thing I would actually throw in there is minerals a lot. We’re just so depleted of minerals. I feel like fasting is like a mirror. So if you look at something like my hair’s falling out, the next question would be, you know, am I using the tool, right, which is why variations are really important. But then the next one would be what am I deficient in? What am I depleted in? And we all are so depleted in minerals right now because of the way our soils are?

Dr. Stephanie
Yeah, well said. And then I think, what was the what was my other question here? Time restricted eating. What do I do in perimenopause? It’s so confusing.

Dr. Mindy
Okay, I just want to say perimenopause is the hardest one to track all of this too. And then try writing a book teaching women how to track like, so here’s what I would say you get to know your symptoms, I really feel like we should understand when the body needs more progesterone. So every woman in perimenopause should be tracking her cycle, every woman should be tracking her cycle. But just because your cycle may come every two weeks, or it may come every 60 to 90 days, you want to start by tracking it. And the first day that you see blood, you’ve got to use feminine care products. That’s day one. So get really familiar with tracking. The second thing I would say is that you really want to get to know your symptoms. So spotting spotting is progesterone is way of saying hey, up the carbs, I need more carbs, I need to come in a little bit stronger here. So spotting anxiety, those body anxiety that can be a sign that estrogen is is or I’m sorry, progesterone is needing you to not fast, whereas estrogen is going to kind of knock on your door when you’re a Peri menopausal woman when your brain is really foggy. When mental clarity is down, maybe your energy’s down a little bit, that’s when I think, Okay, throw some longer fasten there. And let’s see if we can help support estrogen a little bit and get you bring inflammation down. So to answer the question, yes, we need to be fasting, when estrogen goes down in your Peri menopausal years, you are going to hold on to wait a little bit more. So you’re more insulin resistant. So it’s a great tool. But this is why there’s an art to it, you have to learn how to kind of use the tools depending on what your hormones are needing.

Dr. Stephanie
I think that’s such an important point. I think I honestly it’s the through line for our entire conversation is that what we’re talking about our what has worked, let’s say in the patterns in our clinical practice what we’ve seen with our women, and there’s going to be some nuance for how it’s going to work for the individual listener, right? So the listener that saying, Gosh, man, perimenopause, it’s so confusing. You might find it works really well. Like for example, in the aseema diet, we have two phases. There’s one that’s more ketogenic and one that’s higher protein. What I’m noticing is that a lot of women perimenopause, like that second phase better. They like the higher protein, they like the higher carbs, slightly lower fat content. I mean, we’re not going crazy with the carbs, but it’s still it’s about 20% of the total calories that we’re taking. And it’s like and some women in perimenopause really like to cycle they’re like, No, I really feel good when I do keto, one week, higher protein, the next keto one week, higher protein the next. So you have to really play and the only way that you’re going to figure out what works for you is by allowing yourself that child like permission to play, you know, to experiment and to and to say, this was wrong for me, or this really felt good or what if I just do a little bit like what if I just tweak it a little bit like this? And I think that you know, the information that you put out the information that I put out, I think you’ll be able to find some combination of something that works for you, but you have to be willing to experiment and not necessarily look for a cookie cutter Better recommendation on in terms of like fasting for perimenopause because you know we were talking about it before like perimenopause has a lot of different kinds of stages to it. contraction of the cycle, then elongation of the cycle and then we see estrogen up and then we see estrogen down and then it’s like, then you’re like, I haven’t had my period for six months. Is this it? You know, like, Am I in menopause, you know. So there’s all these kind of different. We’ll say waves to ride in perimenopause. So it’s hard to say, you know, what do you do in perimenopause, like, we got to figure out what works for you for your age, for your metabolic flexibility, your fitness, your, you know, your stressors, all of the things. So yeah, I just wanted to highlight and I

Dr. Mindy
love, the word I like to use is Be curious, like, just be curious about what your body’s doing and why it’s doing and and get to know your hormones. I feel like once we go into those Peri menopausal years, the bitching goes up, and we start complaining, and then you get a couple of Peri menopausal women together, now you got a lot of bit chain. And what I would encourage us to do is to be curious, and to understand what it feels like when progesterone is trying to come in to give you actually help you bleed. And when estrogen is trying to come in to actually push an egg out. Like what does that feel like? And it’s you know, in fast like a girl, I go through this because we definitely wanted that book to map from the 17 year old up to the 78 year old, you know, we really wanted to go across to all all hormonal profiles. So understanding that will hopefully be helpful. But I’m also I don’t know about you. I’m a huge fan of hormonal testing. I think every woman should I like the Dutch test. I think every woman should get a Dutch test and every year, and then you’ll know your hormones like you’ve never known them before.

Dr. Stephanie
Well, I think this is a perfect carrot to dangle. Because I know that you’re coming back on the show for your next book fast like a girl where just as you said, we are going to be talking about fasting from, you know, seven, what, maybe not 717 to 1717. Yeah, well, it’s

Dr. Mindy
really tough to pick a teen but I will say 17 How about

Dr. Stephanie
17 to 77 or whatever. And I think that we can really go into a lot of the weeds of the book and some of these principles on our on our next with our next time together.

Dr. Mindy
Yeah, I love it. I love it. i It’s this is always like, Oh, is this work? Because this is really fun. What we’re doing right now,

Dr. Stephanie
I know you’ve been talking for like 90 plus minutes. Yeah.

Dr. Mindy
I love it. I love it. So you all if you love this, please, you know, leave reviews for us. Let us know because this started because like you said of an Instagram follower. I feel like we should know who she was. I bet if we want to

Dr. Stephanie
go back and find her and we’re gonna shout her out next time because it’s so fun. Yeah, I’ll go back in my I’d send my I’ll have it. I’ll find it in my Instagram somewhere.

Dr. Mindy
Awesome. I lost. Awesome. But thank you. And again, like I learned stuff from you. And, you know, I’ll end on this thought. I really feel like as women, it’s time for us to collaborate. And it’s time for us to stop being in competition with each other just and women in general. And what I love about coming together in a situation like this, is that not there’s no one person that’s going to know everything. Yeah. And when we bring together the questions of our communities, we bring our minds together. Everybody wins in that. And so this was a joy. So thank you, Stephanie. Appreciate it.

Dr. Stephanie
So well said thank you. And I agree with you. I think that we want to be thinking about collaboration over competition. I think that’s just that’s just the way and that’s how we, we’ve been taught that we have to compete with other women and we don’t there’s no reason for that. There’s more than enough to go around for everyone. So, on that note, we will have you back on the better podcast for your date your next book fast like a girl. I hope you all enjoyed this. So as Mindy said, Please leave, like tag us in Instagram, leave a review on the read on the resetter podcast on the better podcast on iTunes or wherever you listen to on YouTube as well. We would love to hear from you there too. Yeah, great.