So in this part of the conversation I

want to talk about exercise, nutrition,

fasting, lifestyle, sleep, environmental

factors. And the first question is why

does muscle matter as a woman in

particular?

>> Muscle matters because it helps your

brain produce more neurons and that's

super important for brain health. As far

as protection as we age, it's directly

correlative to the amount of muscle that

we have. And if you have something like

PCOS or endometriosis, it's even more

important for you because building

muscle is going to fight insulin

resistance and inflammation. I've got

two questions to ask. Should women

exercise differently across the

menstrual cycle? And what is the reason

why women hear what you guys say and

they don't do it?

>> I'm so glad we're having this

conversation. We're back with the

leading voices in women's health to

unlock the specific insights, data, and

tools needed to combat the growing

challenges women face throughout their

lives. For women forever, it was all

about aesthetics. I'm healthy. I'm thin.

Because they are under the assumption

through socioultural ideas that a woman

is coming to the gym to lose weight, not

to get strong, not to gain muscle. But

what we've ended up with is an epidemic

of osteoporosis and frailty and really

dementia where 40 to 50% of women will

have low bone density. 70% of all hip

fractures happen in women. And when you

have that, 30% of the time you have a

chance of dying in one year.

>> Because most of it is based on male

data. And I see a large number of women

trying their hardest to be healthy but

what they are choosing to do is actually

having a negative impact on their

hormonal health and it's not your fault

and this is where we have to educate and

it starts now.

>> Which brings me to questions from the

audience like what's the best and

healthiest way to lose weight? Is there

a diet for fertility? Should women ask

is there a link between environmental

toxins and early menopause?

>> We think so. But also, if you were to

design perfect workout regimes for

menopause and permenopause, what would

you Oh, Stacy's clapping. Go ahead.

This is part two of my conversation with

four of the world's leading experts in

women's health. And in this episode, we

go even deeper into actionable,

practical things you can do to improve

your health. And by the way, if you're a

man and you've been sent this episode by

a girlfriend, a wife, a daughter, uh

whoever it might be, I know you might

not think this conversation is for you,

but more than 50% of this planet are

women. You have a tremendous advantage

in your relationships, at work, and just

being a human being going through life.

If you understand the majority of the

population and for so long, women's

health, women's bodies, women's anatomy,

their psychology and physiology has been

a mystery because there hasn't been the

same amount of scientific research done

to understand them. So, in this

conversation, we're going to demystify

all of that so that you can understand

your wife, your partner, your daughter,

your colleague, your mother, your

grandmother even better.

[Music]

So in this part of the conversation, I

want to talk about exercise, nutrition,

fasting, lifestyle, sleep, environmental

factors, and all the things that we kind

of alluded to when we were referencing

hormones and menopause, but in a more

actionable sense. And I guess the first

question is similar to the first

question in part one, which is why does

it matter for us to have a conversation

about women in this context versus

fitness generally or nutrition

generally? Sport and exercise science in

itself is a small subset of like sports

medicine and medical research and most

of the research has been done on men. So

if we look inherently at most of the

recommendations of exercise, recovery,

nutrition, it's based on male data and

we established earlier that's not

generalizable. So when we really want to

get into the nuances of how do we create

an adaptive stress for women, we have to

look at it differently to look through

the female lens. understand the female

physiology and acutely how hormones can

affect adaptations and how women respond

to different environmental cues than

men. Yeah, our hormones distinctly

control a lot of our environment and the

b our other cells that are not what we

think of as our hormone cells work with

our hormones. So, if we think about the

gut, we think about the liver, our

immune system. A lot of this is so

hormonally derived, but it's a two-way

street. Meaning, your hormones influence

what is happening in your gut, but your

gut influences what is happening in your

hormones. And because women have

different hormones than men as far as

what's predominant and when they are, we

have to come at this and approach it a

different way. There's so much to do

with messaging that women receive as far

as their health goes. and this, you

know, be small at any cost, you know,

you know, get to that number on the

scale. And I see it on social media that

the conversation is changing hopefully.

Now, GOP ones is tampering this a little

bit, but strong over skinny, nutrition

over calories. Like we are trying to

build bigger, stronger bodies and take

up more space

is the message that needs to have. I

mean, forever it was all about

aesthetics. You have to look young, feel

young, be young, anti-age, you know, all

those things. And what we've ended up

with now is an epidemic of osteoporosis

and frailty and and really dementia.

>> Should women exercise differently across

the menstrual cycle. So this is the

nuance and this is something if you'd

asked me maybe 5 years ago I would have

said sure from a molecular level we see

that there are certain things that

happen with estrogen

being in isolation for the most part and

then when you have estrogen progesterone

we see their metabolic shifts we see

their temperature shifts but the caveat

is we don't know if a woman ovulates or

not and I'm sure that Natalie can you

know give some stats about the an

ovulatory incidences in most women if If

we were to understand and know when an

woman ovulates in addition to how she

feels across her cycle, then she can

individually tailor her menstrual cycle

to her training. But for general plan,

we can't do that. I think it's important

that you know building muscle, using

muscle, consistency is a huge part of

effectiveness when it comes to exercise

or to building strength. And so one fear

we have when we say do this in one phase

of your cycle and do that in another

phase is that if you know 15% of

patients are not ovulating or they have

no idea when their follicular and ludial

phases are they then doing overall less

because they're waiting on this

directive to tell them what is not

untrue though and how I frame this to

patients is that strength and resistance

training should be the core of what

you're doing regardless of the phase of

the cycle you're in regardless if you're

pregnant regardless if we're doing

fertility treatments, building muscle,

using your muscle. Now, what you do on

other days is where you should allow

yourself to say, "How do I feel this

day? What do I need this day?" And be

okay with giving yourself the grace that

that may look different on your period,

in your follicular phase, in your ludial

phase, and saying something and moving

your body is still ultimately, we're all

going to agree, better than sitting on

the couch. Okay, many women will say

they have more energy in that late

follicular phase. And so if you are

looking at your workout structure, this

is a day I want to try heavier weights

or more reps, it can be smart to put

that in a time where you have a higher

chance of being successful.

>> That's how I explain it. I'm like, if

you have

>> your own data and you know what days you

feel really fantastic, that's where you

want to put your higher intensity, your

heavier lifting because you know that

you're going to hit those training

metrics. What we don't want is for

someone to go in to do a highintensity

session on days they feel flat cuz then

they won't hit the metrics that they

need to get the stimulus we're after.

>> Can you explain this to me like I'm a

10-year-old in terms of where in the

cycle typically women will have more

energy and really be able to push

themselves

>> right here 5 to 7 days before ovulation.

Some women feel really great around

ovulation. Some have a transient where

they'll feel really awful on and around

ovulation and maybe 24 hours later they

feel really fantastic. Most women are

variable through the early ludial phase.

So if we think about day 6 to 14, that's

when we see women feel really robust and

strong and feel like they can take on

the world

>> because estrogen is rising.

>> Yeah. Exactly. And you see the

physiological changes, heart rate

variability, resting heart rate,

>> your immune system is um more prone to

taking on virus and bacteria. It's not

pro-inflammatory. So you have that

working for you. Your core temperature

is lower.

>> You can ask access um carbohydrate a lot

easier. So you have more availability

for fueling to hit high intensities.

Then when we see with ovulation, like I

said, some women feel really fantastic

right around the time of ovulation

because of the estrogen surge. Some have

trans transient where they don't feel so

great. They might

>> when that follicle ruptures and the egg

is released the granulosa cells that are

surrounding it which is what actually

makes estrogen get disrupted. And so

some women feel that transient breakage

and their estrogen's dropping before it

reforms to become the corpus ludium and

make again. So you have this high peak

estrogen and then some women are really

sensitive to these hormonal changes and

they feel that drop. So that ovulation

day may not always be your very best

feeling day, which makes women feel like

it should be and like something's wrong

with them.

>> On a side note, we did um survey on

women experiencing pain on ovulation

because it's something that was never

talked about.

>> Middle schmirts.

>> Yes, exactly. Middles.

>> Middles.

>> We had So you can feel the follicle

rupturing and that's called middle. So

it's German for in the middle because it

tends to happen in the middle of your

cycle when you ovulate.

>> And it's a it it's painful.

>> It's a pain. It can't be painful.

It's like a cyst bursting inside your

body.

>> And then some women are down for the

count because of it. So they can't they

don't plan any physical activity around

that because they just can't from a

physical and mental standpoint put

themselves through anything. So that's

why I'm saying like ovulation some women

feel bulletproof. Other women have this

transient feeling of really flatness and

pain. And then afterwards in these early

ludial phase, so day 16 to about day 22,

it's variable. Well, some women will

feel like on top of the world still.

Other women will feel m I can't quite

hit eye intensities. And then in general

these few days about day 24 to 27 before

those hormones actually drop this is

where you have your PMS your

premenstrual syndrome and cramping and

fatigue and a lot of women are like not

so great.

>> That's when your progesterone

>> when both of them drop. I just love how

you guys explain it because what I see

on social media is absolutes. You must

do this doing ficular. You must do this

at ovulation. you must and I'm just like

really you know and so I love how you're

like well some women it may affect them

this way and others this we generally

tend to see xyz so rather than like you

absolutely have to do this at these

different times I think learning to

listen to your body and the signals that

it's giving you I mean across the stages

of your life that's that's really key to

so many of the questions that we're

talking about because you want to

understand your own response and where

many women are falling short is that

they've been suppressing their cycle, so

they don't know about it. And they were

not taught all of these different

changes that are perfectly normal. And

so it's very hard to then hear a social

media post that says only do this in the

follicular phase and don't ever do

cardio in the ludial phase. And you get

a lot of mixed messages when in fact

there's no absolutes.

>> No.

>> And in terms of training, some people

think moderate training is better for

women. Some people think high intensity

training is better throughout the cycle.

and sort of also considering what goals

you might have in fertility. What would

you say there is is should I be doing

highintensity interval training if I'm a

woman or throughout the cycle and

throughout my life?

>> So this is where we have to think about

periodization first lifestyle but also

how a woman is feeling. We don't want

people to do highintensity interval

training every day because that's just

not going to create an adaptive

response. We have to think about the

reason why we're exercising is to create

a a stress that the body's going to

respond to. We don't get fitter during

exercise. We get fitter from the

stimulus of exercise and the recovery

from it. So, if someone's doing

highintensity interval training every

day or 5 days a week, they're not ever

going to get that subsequent recovery to

be able to hit those high intensities

and that stress that we want. We talk

about high intensity during our

reproductive years. you can pretty much

get away with whatever you want to do

during your rep reproductive years

because you have the benefit of our

hormones working for us. We start

getting into pmenopause and we start

getting into menopause. This is where we

have to really carefully look at volume

versus intensity. So that means if we're

doing lots of stuff or are we doing

really purposeful high intensity versus

low intensity because we're trying to

create what we call a polarization of

the training so that when we hit high

intensities we're actually hitting the

intensities we need to create change.

But on the other side of it we want to

hit really low intensity so that we can

have recovery. It gets harder to recover

as we get older regardless if you're

male or female. But in pmenopause, we

don't have the benefit of estrogen

supporting anti-inflammatory responses.

So we have to be very cognate that we

need more recovery. So I'll give you an

example. So my office, my orthopedic

office is in a fabulous performance

center. Outside my windows, I have floor

to ceiling windows. There's a football

field inside. That field is filled seven

days a week with people taking a class I

called Ignite.

Ignite has a lot of midlife women in it

who are never exercising at low enough

intensity to recover

and never exercising at peak intensity

to change their body. So what happens

five or seven days a week they're out

doing moderate mid-range

intensity training but they're not

seeing body changes. They're not seeing

recomposition. They're hurt every three

weeks and in my office wondering why

they're hurt because they're doing a lot

of reps of medium intensity. So, they're

not really recovering and they're not

intense enough to really change their

physiology. But that's really common.

There are whole brands built around

mid-intensity

and

>> and that falls into the whole

socioultural thing where we've grown up

that if you don't have a good sweat sesh

and feel completely smashed when you

leave, it wasn't a good workout. But

that's a misconception,

>> right? So they are smashed. They're

dripping as sweat, but

>> it's not at peak heart rate ranges for

short bursts of time, right? So it's I

know. Look, it's very confusing because

I don't know 20 years people have as

they've switched from only cardio,

they're like now we're going to do high

intensity, which is fine. I'm not

opposed to that word. It's just that how

do you define that? What is high

intensity? And so like you, because I've

read your books, that we're we're

exercising people at pretty low heart

rate where they're about to flip from

burning fat to carbohydrates cuz that's

really metabolically healthy, but not so

intense that people are going to get

hurt. And I also prescribe really peak

sprint interval training. And I did that

myself in midlife, you know, to

recompose my body, sprint interval

training because it's intense and

lifting, right?

>> Is the advice different for different

women at different stages of life here?

So, if I'm if I'm before pmenopause,

>> you get away with most stuff.

>> Assuming you have a regular menstrual

cycle, right? I think there there's

different time periods which we've

mentioned before PCOS, hypothalamic

amenorhea, time periods where you're not

making estrogen or making it reliably,

you can get away with less. And so we

want to protect a little bit of that.

But when it comes to exercise,

variety is the name of the game. You

want to adapt. So you shouldn't be doing

the same thing every day. That doesn't

mean you can't have a plan. There's

seven days in a week. You don't have to

move every single one. But you should

pick these different activities based on

your life, your schedule, what you want

to accomplish. And it it will vary some

in different phases of your life because

your goals are going to be different.

And so when it comes to exercise, we

always have to think about what needs to

happen. Are you somebody who is

overweight and needs to lose weight? Are

you somebody who's underweight and is

trying to gain weight? Are you trying to

get pregnant or going through fertility

treatments or in menopause? So there's

nuance to it which always makes it hard.

But there's not a one do this one

exercise every single day. That's pretty

much not the answer.

>> So the most popular class for females

right now, I just saw the statistic

somewhere is Pilates. And my daughter

loves her lree and gets on that machine.

It's like, you know,

>> where does that fall in all of this?

>> I have a lot of um Pilates.

>> There's a social aspect to it. You know,

there's people hate.

>> Yeah. because um we did this real

talking about how Pilates was not

appropriate as strength training,

especially as a rehab. When we look at

Pilates, it's a complement to true

strength training. What I mean by true

strength training is you're lifting a

load that's heavy in multiple planes.

With Pilates, it's really good for

isometric control, core strength,

balance, propriception, but it isn't a

stress that's going to create adequate

muscle gain and strength of the bone,

which is what we want from strength

training. So, just like yoga, Pilates

has a place. It does definitely fit in

the scheme of things, especially from

the social and the fact that it does

give you control and propriception, but

it isn't the beall end all for strength.

people that do pilateses frequently will

be shouting.

>> But I'm see it's so it hurts so much and

>> I know I hear

>> well I'm sure it's hard the times I've

done it it's not easy but the

>> but it doesn't uh set you up not to be

frail.

>> Mhm.

>> It is not building strength and power.

And I have women who have done so many

Pilates 1500. It's like a badge of they

count their classes.

>> 1,500 at the deficit of anything else.

It's all that goes on

>> and and I think that is another, you

know, you got to mix it up. Number one.

Number two, I say the same thing. So,

I'm not very popular in those crowds,

but it's great for the for the standard

that I ask people do of of flexibility

and joint range of motion so that you

don't become really stiff and hunched

over and shuffling old person, but it

will never give you strength and power

in the way to protect yourself from

falling down

>> because there's not enough weight

>> for the most part. Yes. And we also have

to think about when you're doing

strength training, you are in uh you're

creating a multidirectional force

through the muscle and the tendons and

the bones. With Pilates, especially if

you're looking at the reformer, it's not

multi-directional in the movements. It

each movement is one plane and you can

be

>> yeah, you can be in in different planes,

but each motion isn't multiplaner.

>> So if we think about what are we trying

to get out of out of Pilates, we're

getting neuromuscular control. We're

getting core strength, we're getting

some breath work, and all that is

beneficial. But again, if we're trying

to grow muscle and bone, take up space,

be strong, it doesn't quite hit the

points that we need to in order to

create this new strength to bring us to

that health span that women are looking

for.

>> So do it a couple times a week.

>> Yeah.

>> Not seven days a week. Correct.

>> So if my my partner, she's 33 years old,

so she's not quite at per menopause yet.

If you were to design a perfect workout

regime for her at that phase of her

life, what would you Oh, Stacy's

clapping,

>> you know. Go ahead.

>> So, if she has three days that she can

go to the gym and has, oh, I should say

three 1-hour sessions that she could

have at the gym in a week over seven

days. Each one would start with

mobilization. So using resistance bands

or maybe you're doing a Pilates reformer

warm-up so you're getting through the

range of motion.

>> Why?

>> Just to open up the joint capsules, make

sure you don't have any restriction so

that you can get really good range of

motion for the movements you're going to

do next.

>> The next movements would be

>> does that stuff actually work? I do

wonder this. So many of my friends are

getting injured at this age because that

they're my age and a bit older because

they walk into the gym and they start

picking weights up.

>> Oh yeah. No, I mean I spend more time

mobilizing, I think, than I do actually

training now,

>> just to keep range of motion going and

keep the joint capsules open. And so

that's using the heavy resistance bands

to distend and distract all the joint

capsules to increase range of motion.

>> Stretching doesn't do that. Stretching

will get to an end point of the muscle

to allow you to have more flex in the

muscle, but it's not actually stretching

in the joint capsule to give you range

of motion. So when we talk about

mobility work, we want to get into that

full range of motion. So if you have a

stiffening, so as I was saying earlier

about the guy and my voodoo flossing,

well voodoo floss is a way where you're

creating some blood flow restriction,

then you go in a range of motion and

that blood flow restriction, you take

the voodoo band off and the blood flow

comes back and you go in the range of

motion get deeper in that range of

motion. So, it's all about accessing the

tissues and making the tissues more

viable for increased range of motion so

that when you go do the lifting, when

you go put on a heavier load, you have

better control, better range of motion

and avoid the small little sticky points

that cause injury.

>> Tears. The micro tears.

>> Yeah.

>> Yeah.

>> Uh so it's the micro tears that are

going to lead to in injury and the micro

tears come when I haven't warmed up

>> warmed up properly. Yeah. So, like

shoulder, what would that look like?

>> Or your shoulder. Uh I wish I had a rig.

So, you can take one of those thick um

the big and wrap it around a rig or or

something and you can pull and distend.

So, you're actually pulling the shoulder

out

>> in different ranges. So, you can rotate,

roll, pull, extend, pull, extend.

>> What about this?

>> So, this is more trying to work the

muscle, right? And you have paleo press

as well where you're working rotation,

but that's not getting into the joint.

>> So you want to be

>> So if you're distending, you're pulling

back. You're not bending your elbow.

You're actually pulling through the

shoulder and distracting.

And then the band is going to pull you

forward to give you resistance to pull

your shoulder joint out. And it's not a

painful, but you're just really getting

into that full joint capsule. You can do

that with the hips. You can do a banded

pigeon stretch. just so many different

ways of getting into the joint capsule,

which not only gives you more range of

motion and prevents injury, but it also

gives you more of the flexibility that

people think they get when they're

stretching. The reason this is important

as we age is because ligaments and

tendons and uh the capsule the inside

skin of a joint is made of collagen and

the covealent bonding collagen is like

if you envision strands of rope the

covealent bonding meaning the bonding

between those strands becomes stronger

as you age and you uh become more and

more stiff. Well, when we lose joint

range of motion, we're injured more. Um,

it's why we start shuffling down the

street, hunched over, shuffling instead

of striding because we have full hip

range of motion or full knee range of

motion. And so, one reason to do this is

to maintain full range of motion through

all of our joints. We want full range of

motion not only to avoid injury but for

instance if your knee is stiff whether

it's an injury or because you just

haven't maintained your motion it will

change something called your kinetic

chain meaning we really are from our big

toe to through our spine connected the

big toes connected to the footbone the

footbone because the way each of those

body segments works activates the next

body segment. So, if you've got a glitch

in the system because your knee doesn't

move or let's take this one, this is

easier. Your ankles get stiff because

we've never worked on it. Your calves

are tight, right? You're a jumper.

You've got tight calves. Your your hip

your ankle doesn't flex. Well, then your

shin bone or your tibia is not going to

internally rotate. Well, without that,

your knee is not going to bend as much

and your femur, your thigh bone is not

going to rotate. You must have the

rotation of these bones to activate your

glute.

>> So if you're not activating your glute,

your butt muscle,

people are very hurt or they're not

getting as strong or they start having

lateral thigh pain. So everything works

together and it starts with among other

things

the flexibility and range of motion

exercises. We're talking about it right

now. So that the body works like a

chain.

I see messages all the time in the

comments section that some of you didn't

realize you didn't subscribe. So, if you

could do me a favor and double check if

you're a subscriber to this channel,

that would be tremendously appreciated.

It's the simple, it's the free thing

that anybody that watches this show

frequently can do to help us here to

keep everything going in this show in

the trajectory it's on. So, please do

double check if you've subscribed and uh

thank you so much because in a strange

way, you are you're part of our history

and you're on this journey with us and I

appreciate you for that. So, yeah, thank

you. If I lose my range of motion

because I never did all these things,

can I get it back when I'm 50? So, like,

you know, I'm 33 now and I'm think,

damn, I've not been doing enough of this

stuff.

>> Yeah. Yeah, you can. Unless you're

having bone changes due to arthritis and

it's blocked. Yes, you can.

>> So, I can start I could theoretically

start at 40

>> cuz if you think about your muscle and

how it responds to picking up a weight

and right, you're going to build the

muscle. So if you're creating a force

within the tendon and the ligament and

the collagen and it's a repetitive

force, a positive force, you're going to

invoke change.

>> Tissues are malleable.

>> So people that think they're stiff and

they say, you know, I can't touch my

toes and

>> they can work on

>> they can get it back.

>> Here's another reason. So what happens

in midlife men and women actually they

remember what they used to do

>> and then they're like I'm going to start

working out and I'm going to start

>> their success.

>> This is when I get people who just show

up on the basketball court after not

having been there for quite some time

and they return to their memories of

success but because they haven't

lengthened their tendons, their joints

aren't moving quite so well. They

rupture tendons because the load

outstrips the ability of the tissue to

be compliant.

>> That makes sense.

>> Friends have been getting injured and I

think that's in part why because they're

trying to work out like they used to

work out.

>> Yeah. And listen, they can return to

really high level, but you can't stop.

You can't start where you left off 20

years ago or 10 years ago. It takes a

minute.

>> Few weeks for me.

>> It takes a minute. Yeah. So Mel's 33.

You

>> mobility work when she gets to the gym

first and foremost.

>> Y

>> on day one

>> or every day?

>> Every day.

>> Every day. So I'm assuming, and I could

be wrong, that she already has a

strength training history.

>> Yeah, she does. Yeah.

>> Okay. So we do the mo mobility work for

about 10 minutes. Really warm up. Well,

then we pick one compound movement we're

going to work on. So could be squats on

the Monday. So we're going to work on

loading in a squat pattern. So that's

your knee forward, you know, quad

dominant type squat motion.

>> Back squat, does it matter?

>> Back squat, front squat. You could do

Bulgarian split squats. So we're adding

load and we have a periodized program.

So this is just a snippet of one day in

a periodized program.

>> What if you didn't have that strength

training history?

>> Well, then we work on adding load

through our I want to see how she moves

first and we want to make sure that

you're moving well before you add load.

So this is where we would work with

lighter loads and more reps.

>> What if she's doesn't have you there?

>> Yeah, that was my question. Like what if

you're not there on her own?

>> Yeah. So this is still like how do you

squat? Where are your sticking points?

So you can assess, self assess. If

you've done your mobility, then you'll

know like, oh, my hips really tight, so

I need to work on that. So let me do

some air squats to see how I move. Then

the next time you go in to do squats,

maybe you're picking up um two 10 pound

dumbbells and you're holding them and

doing air squats with your dumbbells.

And eventually you're gonna move to the

barbell. So it's all about small

progression under load to get to a point

where you feel more confident to use a

barbell back squat to get into more of

those compound movements.

>> Why don't people exercise? Specifically,

if we just focus here on women, what is

the reason why people hear what you guys

say when you're talking about exercise

and they don't do it? They don't start.

>> It's hard.

>> For what what set of reasons make it

hard?

>> Well, for women, it's set up in a

gendered environment. Like I always use

the example of a woman who has an

interest in strength training. if they

go to a typical like 24-hour fitness or

another brand gym that's out there,

they'll walk in and they'll say, "Yep, I

want to join." And the membership person

most often will say, "Great. Here's the

class schedule. This is where we have

our spin classes. This is where we do

our our

classes."

>> They never direct them to the lifting

platforms. They never look and say,

"Hey, here are are the way to get

strong." Because they are under the

assumption through socioultural ideas

that a woman is coming to the gym to

lose weight, not to get strong, not to

gain muscle,

>> not to recomposition. Yeah.

>> Right. But if a man walks in, then it's

always the great, here's the lifting

platforms, we have x amount of barbells,

we have x amount of bumper plates. How

much weight do you want to gain? Do you

do you want to work with someone to, you

know, help you build that mass?

>> Vonda, why does it matter?

You know, cuz there's a big social

pressure on women to look a certain way

>> and it doesn't typically involve muscles

in the especially in the upper body.

>> Yeah.

>> So, you know, we're still living under

the times of be as small as you can,

>> but small doesn't mean lean. There's a

concept of skinny fat which you know

it's you can be as tiny as tiny but you

can be 50 you can have a body fat of 50%

which means you're neither strong you're

not metabolically healthy you're just

little right

>> so it's there is also a misconception

that lifting heavy is going to

automatically turn you into a physique

model or a bodybuilder shape

if that's your goal that's probably

going to take you five years or a

decade. It's a lot of hard work for a

long period of time with proper

nutrition. So for a woman who's

wants to feel better, the goal is to

build muscle to be lean, to recompose,

not lose weight, right? I'm not really

interested in somebody's weight. I'm

interested in their body fat percentage

and their lean muscle mass.

>> Um

because it's what you're made of that

matters, right? Not the size of the

shell.

>> And why does muscle matter as I age? As

a woman in particular,

>> it matters for everyone, but for uh

muscle matters because it's not just

part of locomotion. It's not just part

of moving you around. It is a metabolic

organ. It is critical for glucose

metabolism. It's critical for uh insulin

sensitivity. It uh talks to the bone.

Bone and bone and muscle are endocrine

organs which cross communicate all the

time. So both bone and muscle have

access to the brain. Right? Uh muscle

will produce a hormone called irri which

has multiple functions in the body.

The the axis between muscle and brain

helps your brain produce more neurons.

Right? bones access to the brain has a

role in satiety. Isn't that amazing?

Which means not hungry anymore. Why

would you think these locomotive

structures, if that's what you limit

them to, would would even have those

functions? It's because we put organs in

a box. So to answer your question,

muscle in men and women, but women in

particular for this conversation, we

need as much muscle as possible to fight

the insulin resistance that we get when

estrogen walks out the door. We need uh

muscle for glucose metabolism. We need

muscle for the pure strength of it

because

we do not want to become frail and be

one of the twothirds of nursing home

residents who are women because we can't

do something as simple as get up out of

a chair.

>> But I could just get muscle when I'm 70.

>> You can actually harder.

>> So why does it matter for Mel to be

thinking about it when she's 33?

>> Well, here's the great part for Mel is

she still has all her estrogen. Mhm.

>> Estrogen has a profound effect on muscle

protein synthesis. Um it is a

significant anti-inflammatory.

So high inflammation, chronic

inflammation, we've talked about

decreases muscle synthesis. It decreases

bone synthesis because inflammation with

its high cytoine level I've mentioned

them before IL6 tumor crosis factor

those are all detrimental to these

normal metabolic pathways. So the

wonderful thing for Mel who is entering

what I call the critical decade which is

35 to 45 estimated. It's the prime time

to set your physical activity standards

and to build as much as you can while

you still got all your estrogen.

>> In addition to the fact that for proper

hormonal health, you think about

inflammation coming in, it's like static

on a walkie-talkie. The brain's trying

to interpret your hormones and when

inflammation's coming in, it's making

the signals really hard to hear. So, we

need to make sure that we're actively

fighting that. And building muscle is

one great way because it's going to use

up glucose and fight insulin resistance,

which means makes your cells more

sensitive to when it sees glucose and

able to use it better. If you have

another thing that is pro-inflammatory

such as PCOS or endometriosis,

it's even more important for you because

your inflammatory burden by default of

what's happening at a cellular level is

higher. We now need to not just say, I

need to not make it worse by being

exposed to things. We have to say, I

need a plan to fight this because my

world is pro-inflammatory on a daily

basis. What is my game plan to fight

this? And building muscle. It's not just

exercise is better than no exercise but

specifically building muscle because as

everybody's saying it's has a metabolic

function in your body is going to help

you the most. There's a term called

geroprotective geroproction. So gerero

is is the term we use for aging. So

gerontology is the you know the part of

medicine that focuses on the elderly

patients. And so when we look on in

females and the organs that are, you

know, are the most ger protective, it is

the muscle and the ovary and the ovaries

go away. We have a shelf life in our

ovaries. So then we're just really left

with our muscle as far as protecting us

in those elderly years as we age. And

it's directly correlative to the amount

of muscle that we have because if you

have a lot of muscle, you're going to

have stronger bones.

And this this is where the intensity

part where um Dr. I was talking about

seeing the ignite class and everyone's

in that moderate intensity all the time.

With moderate intensity, you don't have

the post exercise anti-inflammatory

response. So, if we're trying to build

muscle and we're trying to dampen

inflammation if we're always doing this

moderate intensity cardio, then we're

not one going to be building the muscle

we want and two we're going to have this

baseline elevation of total body

inflammation. So we need to mix it up

and have that precedence on being muscle

centric and building that muscle

>> one to help with aesthetics. I mean

that's the byproduct of lifting weights.

You tend to look better but it's more

than that. We see it improves brain

health because of the neuro connections

and the neuroplasticity of the brain and

I told

>> sleep all of those things you get an

incredible parasympathetic response when

you've done a significant heavy lifting

session or a sprint interval session

which you don't get with that moderate

intensity cardiovascular work.

>> Two questions to add to what you you're

about to say here is um am I right in

thinking that

>> at the end of that golden decade that

you referenced 45 years old

Because you have changes in estrogen,

one will expect to see a a natural

decline in muscle.

>> Yes.

>> Um and an increased chance of

osteoporosis, osteopenia, bone issues

later in life? Do women, this is several

questions, I apologize, but do women

then also tend to have more frail bones

in later life and is that linked to the

muscle loss?

>> So this is how it works. So both men and

women build bone and peak about up to 25

some sometimes 30 and then bone loss

plateaus for a little while. Men

continue to lose about 1% a year. So men

do not arrive with hip fractures or

devastating fractures

until their 70s or 80s or older. Women

also decline slowly until we lose our

estrogen. And then the rate of decline,

and I'll tell you why it happens, for

bone doubles or triples such that you

will lose 15 to 20% of your bone density

during your pmenopausal period just from

loss of estrogen alone because estrogen

plays many roles. I've already talked

about estrogen being a huge

anti-inflammatory. Bones are very

sensitive to inflammatory chemicals in

your body.

Estrogen also directly affects the

balance of the two main cells that

subtract minerals from bone, the

osteoclast

and the cell that builds the bone, the

osteoblast. And in well hormoned times,

there is a balance. The body loves

balance. We take what we need, we build

it back. But because estrogen has such a

profound effect on the osteoclast, the

Pac-Man bone eating cell,

there's a dis there's an imbalance and

we take more bone than we're capable of

building. We're still building bone, but

the rate cannot keep up with this. So

with the inflammation,

with the direct effects on the

osteoclass,

women will lose bone density if they do

nothing. Well, number one, they're going

to lose bone density, but they must do

something about it. The reason it's so

critical

for a 33y old is because you still have

your estrogen. So, let's learn how to

lift heavy. Let's take advantage of the

estrogen circulating. Let's learn to

have a jumping practice and impact our

bones. Right? So the the way our body

tells our bones to build more is um

there's another little cell called the

osteocy. It sits encased in bone but

it's connected to these other uh cells

by little tunnels that contain fluid.

When you jump, the biomechanical impulse

of that fluid shifting in the little

tunnels is translated into a biochemical

stimulation that tells the bone, "Oh my

god, she's jumping around. I need to

build more bone." So, we need that

impact to stimulate the laying down of

more bone.

>> I was looking at this graph, which is

what you were describing.

>> Yeah. um men and women aren't that far

away in terms of

bone mass.

>> So this is showing the fact that because

of the way testosterone interacts with a

man's bones, he will peak at a higher

bone mass than a woman will.

>> Yeah.

>> So he's starting at a higher level.

>> Yeah.

>> So I would want young women to do

everything humanly possible to start at

the highest possible level. But I see

lots of 20 year olds, 30 year olds,

really young women with poor bone

density for a lot of reasons. And so I'm

a big proponent for having bones

measured early. Don't wait until you're

old so you know where you're starting,

>> but that's not the standard

recommendation.

>> No, the standard recommendation is 65,

which

>> long way

>> for that. But because I do do either a

DEXA scan or a REM's ultrasound to look

at bone quality on everybody, um, we can

catch it earlier. And that's really

important to get in front of it because

it's estimated, uh, research says that

in order to affect bone density, if

you're going to use estrogen for

instance, you need to have do it for 10

years.

>> And why should people care about bone

density? Everyone cares about muscles,

but very few people talk about bones.

>> Fracture. can't carry your muscle around

if you have weak bones.

>> So without bone, muscle is just a

heaping pile of steaming metabolic

tissue sitting there, right? There would

be no bicep to complement, right?

Because it has to be connected to a

bone. So they're important for

locomotion and giving support to the

muscle. But bone is an endocrine organ

that secretes hormones that go to your

brain to help build neurons to your

pancreas to be active in insulin uh

release to the muscle for glucose

metabolism. In men to the testes to

build testosterone and that's only one

of the many hormones that the bone

produces. The bone is not not only

structural, not only hormonal. I've

already talked about it being a

storehouse, but it's an incubator in our

pelvis is where we build all of our

blood cells.

>> Mhm.

>> And so it has these multifunctions.

But to Mary Claire's point, for women,

40 to 50% of women will have low bone

density. And when you have that, 50% of

the time you'll break a bone. So if

we're looking around at this table, if

we all have osteoporosis, which we

don't, uh, one in two of us will

fracture. When that fracture is a hip

fracture, which is very common, 70% of

all hip fractures happen in women.

30% of the time when you hit the floor

and something breaks, you have a chance

of dying in one year. This quick, your

life changes. 50% of the time, even if

you survive, you will never return to

prefall function, meaning you can't go

home. And that puts your family in this

situation of having to figure out

24-hour care

>> or you move in with your eldest daughter

or you go into a facility where you use

your life savings until you have no more

and then you have to apply for Medicaid

and the government will pay for it.

These are terrible situations

to get at something that we could have

prevented had we started early enough.

>> So, you want to start early. So, I'll

have Mel. So, Mel's going to be doing

strength training, not just for the

muscle benefits, but also because it's

going to help her build strong, healthy

bones in that critical decade.

>> Yep. And then we finish it with some

jump training.

>> Jump training.

>> Yeah. So plyometric type work or if

we're looking at not having the

robustness of doing straight pio then

you can do banded assisted pogos. You

can do low depth jumps so you're getting

some impact the bone because as um Dr.

Roy is talking about it's a

multidirectional stress not people think

oh I run I'm going to have strong bones

but running doesn't do it. You need

multidirectional stress. So if you think

about it when you land your body has to

move the ground doesn't. So it's called

the ground reaction force that comes up

through the bone to create that

strength.

>> So that ideal situation in a workout for

her would be some mobility, some heavy

lifting. If we're doing plyio, that's

also strength or a sprint type training.

So you're getting a metabolic stress. So

you're hitting all the major factors in

one 1-hour workout. I read that um that

there was a study done with some

Australian elderly ladies on bone growth

>> on lifting and bone growth.

>> Yes.

>> Yeah. Lift more lift more study by Dr.

Beck.

>> Yes.

>> She was trying to dispel the myth which

I hear every day that you've got

osteoporosis, you can't lift weights.

>> Yes.

>> And so her study because we're big

proponents of teaching people to

progressively lift heavier and heavier

and that scares people. but especially

if you think you're going to break. So

she did a study where the load was five

reps, five sets under a supervised

situation. So five reps means that it

was heavy enough that at five reps they

were near failure.

>> Right? So these women all osteoporotic

not only were capable of lifting heavy

under supervision, none of them broke

and uh they built bone.

>> Yep.

So that answers the question, right? Can

you lift? Yes.

>> Yes, you can. And the other thing that

isn't really brought up into these

conversations is when you hit

pmenopause, not only is estrogen sort of

the stimulus for sat satellite cell

where we're building muscle cell, but it

has a distinct um I guess influence on

measin. So meosin and actin are are two

contractile proteins. So if you think

about a sliding filament or coming

together, you have meosin and actin that

bond together to then pull and move and

pull and move and that's how you have a

muscle contraction. Estrogen is

responsible for how tightly meosin bonds

to actin. When we start to lose estrogen

or we start to have variability in our

estrogen, we get myosin dysfunction. So

that means we're not going to get a very

strong contraction.

>> So we get weaker.

>> We get weaker. And this is one of the

very first things that people complain

about to me. I don't have power. I don't

have strength. I can't I my grip

strength's gone. I don't know. But their

body composition hasn't changed yet. So

if we think about lifting heavier loads,

it's a neuromuscular response. And that

direct stimulus creates the adaptive

change in measin that now estrogen isn't

responsible for. It's a different

external stress that creates that change

in measin to go, yep, I have to grab

onto actin and have a very strong

contraction. So we see that this

dysfunction happens first before we

start seeing a change in our lean mass

development. So if we are already in the

habit of lifting heavier loads, then we

can offshoot some of that measin

dysfunction that occurs with the

estrogen change. So when my patients

come in and they are looking to prevent

osteoporosis or they've gotten a

diagnosis of low bone density, you know,

what can they do? I've discussed the

Lyftmore trial. The new study just came

out May of this year of 2025 and they

looked at very similar to the protocol

used in Lyftmore. So there was a control

group where they just did nothing. Then

a group that did the they did three days

a week and they did resistance training

and jump training. And then the third

group did all the same exercises and

added HRT. And depending if they had a

uterus, they got estrogen or estrogen

plus a progesterrogen. And so, of

course, as expected, the do nothing

group lost bone. You gained bone as

expected in the resistance group, but it

seemed to be synergistic. When we added

hormone therapy and the resistance

training together, they grew even more

bone. They had even better results. So,

when my patients are like, I want to

hedge my bets. My mother fell and

fractured. she's broken her hip in a

nursing home, whatever. And I'm trying

to avoid this. I'm we're hitting all the

points and the only medication of it.

Now, we have other medicines that will

help slow down resorption of bone, the

bisphosphinates and stuff, but they, you

know, there they can be hard to take and

they have a lot of side effects. So, to

me, prevention is always better than

cure,

>> right? So, I'm trying to get them and

get them early. I just ignore the

guidelines that say you have to wait

till 65 unless you have some chronic

medical condition to get a bone density.

I'm telling patients you can find it for

about $99 around I work in Houston and

that is worth the investment for you to

go get your baseline bone density. I

don't know a single orthopedic surgeon

you know a singer exercise physiologist

or anybody who deals with with

osteoporosis who thinks 65 is a good

idea. So if your listeners are like oh

well you know my insurance won't pay for

it. I'm like, there are centers popping

up now where you can go and get a DEXA

scan

>> and just pay out of pocket and get a

great, you know, and figure out where

your starting base is.

>> A DEXA scan is

>> a bone scan to see your bone density is

the easiest way to describe it

>> and your muscle mass.

>> Yeah,

>> they can do that as well. This

conversation is really important though

to extend besides just menopause or

permenopause that there are women of

reproductive age years who have profound

periods of low estrogen who are also at

risk for serious problems with their

bone density both now and down the road.

And so if you come to me and you say,

"Oh, I haven't had a period for 7 years.

No big deal." Well, that is a big deal.

And depending on the reason why, many of

the causes will result that you had low

estrogen and you were not ovulating and

you have hit that graph you showed of

while you're building your bone, that

person's on a different trajectory. And

those women do need bone scans much

earlier so that we can see where they

are and see what treatment we need. But

it's one of the biggest reasons. Bone

health is one of the most acceptable

medical reasons for why we should put

younger women who are have low estrogen

time periods onto estrogen treatment

because it can so profoundly change

their bone health long term. So in my uh

niche of active women, we see there's a

very very high incidence of recreational

active women and low energy

availability, meaning they're not eating

enough to support daily life as well as

their training. So the subclinical

aspect of not eating enough creates a

myriad of of issues that does create

lower bone density, menstrual cycle

dysfunction, greater inflammatory

responses. So you know the end result

would be hypothalamic amenora. So their

periods have stopped which is a low

estrogen standpoint. So, you know,

keeping track of of your period, make

sure you're eating enough is one of the

first stop gaps that we have in the

athletic realm. It's like we want you to

eat enough. And if you're looking at

bookending our calories on either end of

the day, that's not appropriate. We have

to look at how your circadian rhythm

works because the circadian rhythm, like

we talked about in the first um half,

was about the pulses of our hormones. So

if we're holding our calories on either

end of the day, then there's this big

space in the middle of the day where

your body thinks it's under a starvation

threat. So you start to have this down

downturn of all of our metabolic

functions. We see after 4 days of low

energy availability, there's a direct

impact on thyroid function. So we have

to be very cognate that women who are

saying, "I haven't had a period in seven

years or my periods are really

irregular." We have to bring it back to

the energy function as well. So, I know

unfortunately we're still in this

environment of aesthetics and I'm always

like, we need to eat. And if you eat in

and around your training and fueling

appropriately for what you're doing, it

has a positive impact on body

composition.

>> You're not going to gain body fat,

you're going to gain lean mass, you're

going to gain bone, and you're going to

see a decrease in body fat. But it's a

trusting the process that out in general

socioultural concepts is just not

acceptable for so many women right now.

>> And with that exercise regime I asked

you to make for a woman that's pre

premenopause.

>> Was there anything left off there? We

had day one which is mobility works

strength training.

>> So if you were to do three days a week

in the gym that would be pretty similar

except for the compound movement. What

are we doing for each of those compound

movements? A different muscle. So it

would be the knee forward squat motion

one day, push pull upper body next, and

then uh posterior, so your hip thrust,

your deadlifts, that kind of stuff.

Because women are quad dominant to

prevent injury, we really need to build

the posterior chain. And this is your

glutes, your hamstrings,

>> your deadlifts,

>> your Yeah. So you're getting really uh

strong around the knee joints, the hip

joints because again that feeds forward

to better movement, movement economy and

prevention of a misstep for a hip

fracture later down.

>> What about cardio? And

>> so that's where like if we're looking at

those three days a week and we're

finishing with pio or some sprint work,

then the other days just walking, lowle

intensity walking or maybe you have soul

food, you want to go for a bike ride,

you want to go for a run. If you're not

training specifically for something,

then those three strength training days

are your key workouts and then you can

pepper in all the other things that you

like to do.

>> I hear a lot about V2 maxes, so I

thought but we should all be driving our

cardiovascular performance up to get a

high V2 max.

>> Well, that's where the intensity is.

Yeah,

>> I think it's only I mean, and correct me

if I'm wrong, but my understanding after

reading and watching everything is

doesn't take that much to build V2 max.

doesn't it's that high intensity that's

a little bit uncomfortable where you're

pushing at that max for uh you know

about four minutes to build that V2

in the sports science world it's always

been the 4x4 the Norwegian 4x4

>> 4 minutes on four minutes off four

minutes on four minutes

>> but that's not three days a week no

>> protocol is once a week

>> once a week at the most right

>> and the other sprints just to give you I

tend to give my examples because it

makes it more real but When I'm doing

sprint intervals,

um, I do it the 30 seconds on and then

complete recovery, meaning I'm for 30

seconds I'm taking my heart rate as high

as I can get it

>> and then I'll completely recover, which

takes me two to three minutes.

I just happen to do it on a treadmill,

but the reality is you can do it on

anything. It's a heart rate function,

not an apparatus function. So, for me,

on a treadmill, after I'm done warming

up, you can't do it cold or you'll hurt

something.

>> Exactly.

>> After I'm done warming up, cuz I'm a

really short person, I punch the

treadmill up to 11 and I am just working

so hard I don't fly off the back. But

that gets my heart rate up really high,

about 186. Everybody's top heart rate is

different.

>> And then I completely recover. And I do

that four times.

>> And that's all you need.

>> It doesn't take that long. And you feel

so good when you're done.

>> Yeah. So I can't run at the moments.

This morning I did explosive kettle bell

swings.

>> Why can't you run at the moment?

>> Uh torn hamstring and miniscus. So I

can't run at the moment.

>> Running is in.

>> Run clubs have come

>> in strong. It's back in.

>> It's not happening.

Are you at all concerned with the fact

that people are running all the time and

doing resistance training less? Because

running is cool like cool now. It's how

people date. It's it's they're not going

to nightclubs.

>> It's a sacrifice of other things. It's

like we said about Pilates, you know, if

all you do is running, then that is

definitely not the best way to be. It's

not the healthiest for your whole body.

It's not that you're unhealthy, but

we're really talking about how are we

optimizing your body and your hormonal

health for a variety of different goals.

But also, if we look very micro at

running, 58% of runners have a ludal

phase defect. That means that the second

half of their menstrual cycle is not

going to be able to last as long as we

want it to. Likely due to what Stacy was

talking about earlier, this relative

energy deficiency coming back to the

brain. the brain signals not as strong

to keep that corpus ludium what happens

after the follicle alive and a lot of

women say I still have my period so I'm

okay but if we're using our cycle as a

vital sign we can actually say the ratio

of energy balance is not great and it's

often because we're doing it at

sacrifice of other things. So, if you're

doing the strength training three times

a week and you're running, however,

you're spacing out your other days,

that's such a healthy balance. It's hard

that you're going to be in a bad

position with that and you'll actually

improve your running more so than if you

were to run every day or every other

day. Cuz if you're getting strong

through full range of motion, then that

feeds forward to better running economy.

Then you can vary your pace without

getting injured. But for people who are

running every day and they're shuffling

and they're getting stronger in their

strong muscles and weaker in their weak

muscles, then it perpetuates this.

>> And they're in my clinic.

>> Yeah.

>> People are very keen on doing marathons

and half marathons at the moment and got

a couple of friends that are doing a lot

of marathons at the moment and they're

very very very skinny.

>> Oh, welcome to my world of Texas.

>> Yeah. Is that healthy? I'm not even sure

if that's that's the right question or

one can judge from just looking but

being extremely skinny in that regard

being that sort of marathon runner

physique

>> there are some that are naturally

predisposed to that

>> right so naturally predisposed having

really good running economy running

biomechanics having a leaner body and

this is what we were talking about the

Olympics earlier where we can see the

ideal body type for that particular

sport and then there are those like me

who build muscle naturally it's pretty

easy so I'd never be a skinny little

runner and my running economy is a

little bit off because of where I build

muscle versus not. So, not everyone is

meant to be a long-distance runner and

there are some that are meant to be

long-distance runners. So, if we're

talking about your friends who are like

super skinny, are they e economically

viable for being a long-distance runner?

Possibly. But we also have to look are

they male or female? What is their

injury rate? What is their fueling? And

then for me, I'd want to see the dexas

of the women that are just training long

distance and super skinny because most

of the time we see a higher visceral fat

in um in and around the organs as we're

talking about. Even though on the

outside look super lean, but they have a

really high percentage of visceral fat

because of the inflammation, the low

energy intake and most likely estradile

suppression.

>> And that's the skinny fat thing you you

talked earlier. Is is there an

evolutionary lens on this? I always

think about this when we're having these

conversations like what what used to

happen thousands of years ago.

>> If we talk about the evolutionary

biological theories and there are a lot

of sociologists that will counter what

I'm getting ready to say, so I'll

apologize in advance. We look at

original huntergatherer type

communities. The male body was designed

to go out to find the calories. The

women body was designed to stay and take

care of the offspring and make sure that

home was set. If it was low calorie,

menstrual cycle would stop because you

didn't want to reproduce in a time of

low calories. Body fat would come on

because there weren't a lot of calories.

>> And so the equival now is that I'm not

eating enough or I'm burning more than

I'm consuming.

>> Exactly.

>> So I'm in a calorie deficit in some way.

>> Exactly. In an energy deficit. So with

the male body and we see this their

brain and hypothalamus is not as

sensitive to those nutrient deficits as

much as a woman's body because we have

menstrual cycle and menstrual cycle

function. A man will lean up and get

more cognitively focused in times of low

calorie intake. So this is what we see

with fasting data and we see with

restrictive diets

>> and that was we need to bring it back to

that biological lens. low calorie, I

have to go find the calories. I have to

be fit to go find the calories. Low

calories, I need to not have to eat as

much. So, I need to store fat and I

can't have a baby because we don't have

enough calories.

>> And then stress,

>> when we add modern stress onto that,

that's a comprehensive addition of

cortisol and addition of inflammation

and that also perpetuates body fat.

>> I mean, like stress 10,000 years ago

would have been like a lion.

>> Oh, yeah. It's a lionic, right? We had

stress and that this is a natural stress

response. We have to have them to

survive. But these were episodic,

>> right,

>> stresses. Well, and your hormones would

change for a very specific purpose that

you would then go do. Your body would

free up glucose from your liver. You're

getting it ready in your bloodstream so

you can go run from the lion and then

things would shift back to normal. And

what's happening with chronic stress is

you're getting all the hormone shifts

because your body's really getting ready

for the lion except it's just that bad

meeting you had and then you're just

sitting there longer and you're not

using that glucose up. Exactly. Exactly.

>> Are women increasingly overtraining?

>> I think the problem in this country is

not

maybe in the women who are really

intentional maybe there are some that

are overex exercising but if we look at

a population

nobody is exercising enough. Exactly.

>> I mean, I would take People ask me all

the time, "Tell me the first thing

people need to do." I'm like, "I'll take

anything."

>> I mean, I'll take getting off the couch

with any method, whatever makes you

happy.

>> I'll say, get off the couch and do 10

air squats. Thank you.

>> That's enough. Yeah, that's enough.

>> Resistance train.

>> So, so in the crowd that's like, I'm

going to invest in my health every day.

>> That is not the majority of people.

>> Yeah,

>> that's my bubble. Yeah, but who the

people who listen to your show might be

a different demographic we have to

acknowledge, right, than population of

America. I mean like a lot of people who

listen to your show, Stephen, are

interested in health and their body and

achieving certain goals. And so

certainly, you know, I have practiced

fertility in North Carolina and in

Austin and I see a completely different

patient population, you know, in Austin,

Texas, which is a very fit area. PE

women are constantly overtraining. But

to Stacy's point earlier about this

maybe evolutionary what happens

women go into this hypothalamic

dysfunction even before it's what we

call like amenora. Hypothamic amenorhea

is essentially where the brain where the

hypothalamus is shuts off says can't

reproduce right now. XYZ reason no FSH

and LH are coming out. You're not

ovulating. You're not making estrogen.

You're not going to get pregnant.

>> So you're more likely to survive.

>> Yeah. It's a survival mechanism.

>> Pregnancy is dangerous as in hunter

gatherers,

>> but there's state modern medicine acts

like you're perfect or it's turned off.

And the reality is there's all these

shades of gray in between where these

different chronic stressors and your

insulin resistance and your inflammation

and you're overex exercising and you're

under fueling come in and make it so the

hypothalamus is not responding

correctly. And that's what we're trying

to get people to intervene there before

it gets too bad. And I see a large

number of women who do fall into that

zone where they are trying their hardest

to be healthy, but what they are

choosing to do is actually having a

negative impact on their hormonal health

and how their brain is interpreting

their hormones. And you it's very rare

to see that in a man. Meaning the number

one reason why I will see low

testosterone is purely because many men

are taking testosterone or because of

other exogenous factors like marijuana

use. It is very rarely my brain is not

sending out the signals to cause my

testicles to make testosterone. I like

to frame it where women are under

recovering not overtraining.

>> So if we're under recovery then it makes

it more acceptable to fuel and I always

want to bring it back to it doesn't

matter like because I come from high

performance I'm going to use those words

where it's like you're not recovering

enough. We want to focus on recovery on

these days. We want to make sure that

you're eating and fueling around. So,

it's never overtraining. It's always

under the balance is wrong. They're not.

>> So, what do you say to all the voices on

social media that are just yelling at

mostly women and telling them it's just

a matter of willpower

>> and you don't have the body composition

you deserve.

>> Well, you swipe left and don't talk to

those people.

>> But that's me, right? But I mean, I'm

talking to the woman in Ohio who's

feeling defeated and stumbles across

someone screaming at her on the internet

that her body composition that she's not

happy with

>> is her fault. I hate that because it's a

construct of society, right? Especially

western society. This is where we have

to educate. It's not your fault. These

are the things that have come into play

and lined up to create this situation.

But now we have tools to offer you to

take one step out of that situation and

let's see how many more steps we can get

you away from the situation to improve

your health.

>> Yeah.

>> And are the rules of exercise slightly

different once you've entered

permenopause?

So, this is where we really need to look

at how we can use exercise and some

environmental stress to create a really

strong adaptive stress and a really

strong recovery stress.

>> Stacey, can you explain adaptive stress?

Because I'm thinking of the 10,000

people who follow me who will be like,

>> "You have no idea what adaptive stress

is." So, if I go and I uh do some

resistance training, some heavy lifting,

I want to create a stress on my body

that's going to then have a signaling

cascade to repair the muscle in a

stronger way than when I first

>> lifting the muscle damages the muscle.

>> Yes. And it creates a series of feedback

mechanisms that make it repair stronger

than when you first went in. So, that's

an adaptive stress. And we're looking at

what levels of stress we can put. So

it's a training stress or what levels of

stress we can use through exercise to

really really create an environment that

improves our health. Okay.

>> So if we talk about sprint interval

training, the 30 seconds on and the two

to three minute recovery, the reason why

we want that super high-end stress of

our heart rate is it then creates a

eventual epigenetic change. So, it's

that environment that's going to create

a change within the muscle that's going

to allow that glute 4 protein that I

mentioned earlier to open up and have

glucose come in, reducing insulin

resistance. Also, with that really high

high heart rate, we're having a lot of

stress on the muscle that's going to

release some myioines, which are little

hormone signals that then will go to the

liver and say, "Wait a second, we don't

need to store visceral fat. we need to

create non-estrified fatty acids which

can then go into our skeletal muscle to

be used in the mitochondria as fuel. So

we want to have the stress that's strong

enough to create these cascades of

feedback mechanisms to improve our

overall health.

>> If we stay in that moderate intensity

zone, we aren't creating a strong enough

stress

>> to create that signaling.

>> What are we doing?

>> We are exacerbating

inflammation. we're exacerbating

cortisol. Now, cortisol isn't the demon,

but when we have an elevation of it, and

especially in pmenopause, when we're

sympathetically driven and we already

have a higher level of baseline

cortisol, if we are continuously in this

moderate intensity zone, we never get a

signal to allow that to drop. So if

we're looking at polarizing which is top

top end and low recovery end then with

the top end we get the signal cascade

of improving body comproving uh insulin

sensitivity as well as getting growth

hormone and testosterone responses which

then feed back to drop cortisol.

>> So am I right in thinking the solution

if I'm permenopausal is to do

highintensity interval training for

short periods of time. So, we look at

the quality of the training, not the

volume of the training. So, if we're in

our reproductive years, then yes, you

can do the moderate intensity stuff

because you have estrogen and some of

our other hormone feedback signals that

are going to drop cortisol. It's going

to allow your body to recover and

repair.

>> And when you what makes quality

training? What is quality training?

>> So, this is your polar. So, you have a

very specific session that you're going

to do.

>> So, for Vonda, it's your 30 seconds on

as hard as possible, 2 to 3 minutes

recovery. You do that four times. That's

your session.

>> Okay. I'm going to try and summarize

this.

>> See if this is a test. See if I

understood all of this stuff. So, if I

do a lot of volume, but I I play in that

sort of medium intensity range, I'm

basically just like stressing out my

body in all the worst ways.

>> Exactly.

>> Like the inflammation, it's just not

good for my body necessarily. If I don't

do vigorous enough exercise, then that's

also bad because nothing's going to

break and therefore build. it's

nothing's going to adapt, nothing's

going to grow.

>> If I do it for long periods of time,

really anything for long periods of

time, that's also stress. But the key

thing to do is to do

shorter, higher intensity

exercise that will cause my body to

adapt, but won't put it into that

inflamed stressful state.

>> And you also have to pepper in some

lower intensity work. So this is your

>> flexibility.

>> Mhm. so that you have recovery, you're

getting u blood flow circulating, you're

tapping into some mitochondrial work so

that you are still getting benefit of

exercise but it's not in that modern