357 | Improve Your Metabolism, Body Composition and Pain during Perimenopauase and Beyond with Dr. Stephanie Estima

[00:00:06] Welcome to The Optimal Body podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical

[00:00:13] therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] and restrictions, and answer your questions. Along with expert guests, our goal of The

[00:00:21] Optimal Body podcast is really to help you discover what optimal means within your own body.

[00:00:27] Let's dive in. I am so excited to announce that we are officially launching the Barefoot mini course

[00:00:34] on sale. This is a huge sale and we're all moving through it together. And because you're a podcast

[00:00:38] listener, and I appreciate you being here so much and continuing to learn, you get an extra special

[00:00:44] discount if you use code optimal at checkout. You get an additional discount on top of what we're

[00:00:49] already discounting this course for. Plus, you get to move through with an incredible community

[00:00:54] to help hold you accountable to actually showing up and doing just 10 minutes a day. It's 10 minutes

[00:00:59] of assessment and exercise on your foot. So you really understand why you might be having pain,

[00:01:05] plantar fasciitis, bunion pain, whatever it may be. There's a reason and a root cause. And I'm

[00:01:10] going to help you discover exactly what your foot needs in this. Just listen to this. Someone said,

[00:01:15] this was the best decision ever. I'm walking without pain first thing in the morning. I'm

[00:01:20] paying attention to my feet, my alignment, my balance, and what my body is saying. I've learned

[00:01:24] so much and I'll continue to go back and make these movements part of my daily and weekly

[00:01:28] activities so my feet can be my best foundation. Oh, it just makes me want to cry reading things

[00:01:34] like this. It is possible within two weeks to learn what your foot needs and start to feel

[00:01:38] something different. So join us in the Barefoot mini course, especially if you haven't learned

[00:01:43] from this one yet. It is on discount use code optimal. We're going to have it linked up below,

[00:01:47] but it's just gen.health backslash barefoot. I cannot wait for this. I'm excited for you to

[00:01:54] to this next guest with Dr. Stephanie Estema, because especially if you are in the paramenopause

[00:01:59] or menopause stage of life, or you probably will be headed there. This one is for you. Now,

[00:02:05] Dr. Stephanie is the founder of Hello Betty, a community centered around female empowerment

[00:02:10] through health and business coaching. She's a doctor of chiropractic with a special interest

[00:02:14] in metabolism, body composition, functional neurology, and female physiology. She's the host

[00:02:19] of the Better podcast with Dr. Stephanie featuring world's leading voices in health and

[00:02:24] wellness. As a creator of her signature female centric ketogenic protocol, the Estina diet,

[00:02:29] Dr. Stephanie has helped over 10,000 women worldwide regulate hormones, reduce adiposity,

[00:02:35] and get off medications in the paramenopause stage and beyond. Following her success of the Estina

[00:02:41] diet, Dr. Stephanie released the bestselling book, The Betty Body, where she shares her proven

[00:02:46] strategies to help women jumpstart and calibrate their metabolism, revive their libidos, rest

[00:02:50] guilt free, and elevate their emotional well being. Dr. Stephanie's mission is to inspire women on a

[00:02:56] global scale to be able to be their best versions of themselves both physically and emotionally

[00:03:01] through the power of easily accessible female education. Because let's face it, women are not

[00:03:06] little men and should be taught about their unique physiology. And when she's not busy teaching inside

[00:03:12] Hello Betty or recording a podcast, she enjoys spending time with her partner Giovanni salsa

[00:03:16] dancing on Tuesdays and her three boys in Toronto, Canada. So let's dive into it. Dr.

[00:03:21] Stephanie, thank you so much for being here and spending time with us. We I mean, your knowledge

[00:03:27] and the way that you educate and what you're educating about I know is so impactful for so

[00:03:32] many here, especially those going whether you're postpartum or you're in paramenopause, post

[00:03:38] menopause. So lots of questions I know we're going to dive into today.

[00:03:42] Well, I'm so excited to be here with the both of you. Thank you for having me.

[00:03:46] And like Jen mentioned, our audience is so into these hormonal changes that are going on

[00:03:54] in the woman's body through all these different stages of their life. And so I kind of just want

[00:03:59] to get a gauge of have you always been interested in health and fitness and optimizing health or

[00:04:07] what kind of led you to this career path of being somebody who likes to educate in hormone health?

[00:04:14] Well, I think I've always been pretty crunchy. Sort of a crunchy person in so far as you know,

[00:04:20] the way that I paid for my schooling was I'm going to totally date myself here,

[00:04:23] but I was a step instructor and I was doing like the Thai bow and the high low and all of that.

[00:04:28] So I've always been into fitness, always been into moving and feeling good. And of course,

[00:04:34] you know, being doctors of physical therapists, you know, as well that,

[00:04:38] you know, movement is life, right? Our bodies are designed to move. So that always really felt

[00:04:43] very natural for me and it informed a lot of my passions in life. I was for a brief moment in

[00:04:49] time, I was also competing in fitness competitions and things like that. So I've always been into

[00:04:57] movement. Quick pause from the interview to talk about an aspect of our health that we could all

[00:05:03] focus on a little bit more. And that is hydration. Raise of hands quick, who thinks that they drink

[00:05:08] enough water or stay hydrated throughout the day? It's something that people just aren't thinking

[00:05:12] about. And that's why Jen and I use element electrolyte drink mixes to make sure that we're

[00:05:17] staying hydrated, not just by getting enough water in, but by making sure we get those

[00:05:21] electrolytes that we are losing naturally throughout the day. Element has the sodium,

[00:05:26] potassium, and magnesium that really help replenish those electrolytes and help keep us

[00:05:31] hydrated on that cellular level. These electrolytes are so important in so many of our

[00:05:36] bodies' cellular processes. It can help with brain fog, fatigue, that crash that you feel in the mid

[00:05:42] afternoon instead of going for an extra cup of coffee or caffeine. I put a little element in my

[00:05:46] water and it's inevitably the pick-me-up that I feel like I need. If you go down to the link in

[00:05:52] the show notes, it's just drinkelement.com backslash optimal. That's element spelled out

[00:05:57] like L-M-N-T dot com backslash optimal. You can get your element and get a free sample pack with

[00:06:04] every single order. I love this because it helps you taste all the flavors and know which one you

[00:06:09] like best for when you inevitably come back to order more. Check out the link down in the show

[00:06:13] notes and get your sample pack. All right, let's get back to the interview.

[00:06:17] In terms of female-specific or female-centric health pursuits, I personally struggled with

[00:06:27] my reproductive cycle. Specifically, I always had issues with my period. It was always the week

[00:06:32] before leading up to my period, the week of. It always really felt like it knocked me off my feet

[00:06:38] and I couldn't understand why that was, why I was always struggling every day. I was always

[00:06:45] always struggling every single month. I sort of felt like it was a curse in some ways.

[00:06:51] The long story short is I started in my private clinic running nutritional programs and really

[00:06:58] looking at the difference between the outcomes in my male patients and my female patients. We would

[00:07:04] run these programs to help our patients eat healthier, to prioritize protein, and prioritize

[00:07:10] fats and all of these different things, which at the time were very contrary to the narrative.

[00:07:15] It was like protein is going to give you kidney disease and fat is going to give you cholesterol,

[00:07:19] that kind of thing. We would see these amazing results in our men and the wives that had signed

[00:07:25] up for the same program were sort of hanging their heads in shame, not understanding why they

[00:07:31] weren't able to elicit the same outcome as their husbands. They're in the same environment, eating

[00:07:38] the same foods, that kind of thing. My practice was really the birth, if you will, of my interest in

[00:07:47] female-centric strategies and protocols. That led to a nutrition program that was designed for women.

[00:07:58] Then through that whole process, I also figured out my own hormonal issues, was able to

[00:08:02] heal my own hormonal issues through diet and exercise and by not overdoing it on the cardio

[00:08:09] and prioritizing lifting weights and recovery. Those things have become even more important to

[00:08:14] me now that I'm in my mid-40s than it ever was, even in my 20s and 30s. I think you can get away

[00:08:20] with a lot when you're younger. Certainly in schooling, I was sitting for 8, 10, 12, 16 hours

[00:08:27] a day studying and not really having the opportunity to move as much as I wanted and

[00:08:33] eat the way that I wanted. Of course, that wrecks havoc on your body. For women, we're exquisitely

[00:08:39] sensitive to our environment. All that to say, that's sort of my back-of-the-envelope story,

[00:08:44] if you will, in terms of my interest in hormones for women, why we are not sort of smaller men with

[00:08:51] the reproductive cycle. We are distinct entities and we have to look at ourselves differently. We

[00:08:57] have to treat ourselves differently in what can be sometimes a more male-dominated society.

[00:09:04] The last thing I'll say is the other thing that I started doing, I'm retired from physical practice

[00:09:09] now, but even just my protocols for women in the clinic, so women who are coming in

[00:09:14] with neck pain or back pain or an ankle injury or shoulder injury, whatever it was,

[00:09:17] I started also modifying the way that they were being cared for based on, if they were cycling

[00:09:22] women, where they were in their cycle because they were able to tolerate, and I'm sure we'll

[00:09:28] get into this, but more aggressive interventions, let's say, in the follicular phase of their

[00:09:33] cycle. They needed a little bit more love and a little bit more hand-holding,

[00:09:37] a little bit more gentle touch, if you will, in the luteal phase. It sort of followed me

[00:09:43] everywhere and yeah, that's my story in a nutshell.

[00:09:46] That's great, and I think you just mirrored every woman's bane of existence when they're like,

[00:09:52] yeah, my husband can stop eating something for a day and loses 15 pounds and I look at

[00:09:57] a cookie and I gain weight.

[00:09:58] You just look at the chocolate and you're like, damn it.

[00:10:00] And I gain fat.

[00:10:03] Let me take that chocolate off your hands, baby.

[00:10:06] Yeah, so it's always this, well, and I think what gets even more confusing is when you're

[00:10:14] looking at social media influencers who are doing what I eat in a day and okay, well,

[00:10:19] I'm gonna try to mirror exactly what they're eating and doing these HIIT workouts and doing

[00:10:25] more and more and restricting and restricting and it becomes really overwhelming to understand

[00:10:32] what you should be doing as a woman, especially as we age.

[00:10:36] And like you said, it even changed for you as you started going into 40.

[00:10:40] So why does it need to change?

[00:10:44] Why do we need to be a little bit more mindful of how we're eating and training

[00:10:49] as a woman and how does that start to change as we age?

[00:10:54] Well, it needs to change because we change.

[00:10:56] I mean, that's the simplest answer I think I can give.

[00:10:59] When we are moving into perimenopause, this is a time period of somewhere between, call it 10

[00:11:06] to 15 years for some women where they will start to see and notice changes in their body composition,

[00:11:11] changes in their mood, changes in their affect, changes in even their carbohydrate tolerance,

[00:11:16] their insulin sensitivity changes.

[00:11:18] So I think we have to change because our bodies are changing.

[00:11:21] And the way that I like to sort of frame this up is when we think about some of the biggest

[00:11:28] changes that are happening in the body as we are in perimenopause.

[00:11:31] So for most women, I'll say a lot of women will start to feel different in their 40s,

[00:11:36] but you can start seeing things as early as sort of mid to late 30s.

[00:11:40] And that might be changes in your cycle, changes in the length of the cycle,

[00:11:45] changes in the quality of the bleed.

[00:11:48] It can also be subtle things like really being more sensitive to noise, not wanting to socialize,

[00:11:55] feeling burning or itchiness in the skin.

[00:11:58] All of these things are indications that we're seeing sort of wilder fluctuations

[00:12:03] in our sex hormones, in particular estrogen or estradiol more appropriately.

[00:12:09] And the overall trend from call it mid to late 30s through to when menopause happens,

[00:12:16] which you know the average age of onset is about 51, is there's an overall decline in estradiol.

[00:12:23] But in that timeframe, your estrogen or your estradiol can be going up and down

[00:12:28] and around and sideways.

[00:12:30] So it can be very difficult for a woman even month to month for her to feel like she's

[00:12:35] like herself, for her to even track her cycle.

[00:12:38] So that's one of the biggest reasons that we have to change the way that we're approaching

[00:12:45] to your question, Jen, around nutrition, around exercise, because we are changing ourselves.

[00:12:49] And I think that a lot of women have, I would say humans, not just women.

[00:12:56] We are resistant to change.

[00:12:57] But I think once we lean into the fact that we are changing, we can now adapt the strategies

[00:13:02] to better suit the environment, the hormonal environment, the metabolic environment, the

[00:13:05] metabolic, you know, where you are in your life.

[00:13:08] You can change the constructs around your life to better suit that.

[00:13:13] So the second part of your question was how does it change?

[00:13:17] And I think for women in particular, there's two things that I really like to double down

[00:13:24] on and that is prioritizing muscle mass.

[00:13:27] And the second is injury prevention, which I know that both of you probably love and

[00:13:32] have talked about a lot on the show.

[00:13:35] So as we are seeing our anabolic hormones decline, estradiol, as I mentioned, testosterone

[00:13:41] is another one that we see declining as well.

[00:13:43] And the other sort of thing that's happening at the same time is we're becoming more insulin

[00:13:47] resistant.

[00:13:48] What we know from the research is that we become, the place that insulin resistance starts is

[00:13:53] usually in skeletal tissue.

[00:13:56] It's in skeletal muscle, right?

[00:13:57] So it's the muscles that we see become insulin resistant first before we see sort of that

[00:14:04] systemic problem.

[00:14:06] So there's been a lot of really interesting research.

[00:14:10] Dr. Gerald Shulman, if anybody wants to look him up and nerd out on some of his graphs,

[00:14:15] I find it fascinating.

[00:14:16] But he looked at even like men in, you know, a lot of our literature comes from university

[00:14:22] students because university students will sign up for things because they'll get extra

[00:14:26] credit or money and they're broke and they need stuff.

[00:14:28] And so his work is in university men and he was able to demonstrate in 20 year old otherwise

[00:14:36] healthy men.

[00:14:37] So they're not obese.

[00:14:38] They had normal, you know, BMI is that kind of thing that they could already see insulin

[00:14:43] resistance settling in, in this gletal tissue.

[00:14:46] So we can start whether you are a new mom as you are Jen or you are in, you know, 30s,

[00:14:52] 40s, 50s.

[00:14:53] You know, I always say like the best time to start prioritizing your muscle was 10 years

[00:14:57] ago and the second best time is today, right?

[00:15:00] So it doesn't really matter how old you are.

[00:15:01] You could be 65 listening to the show and you can start your weightlifting or your lean

[00:15:08] muscle or your muscle mass preservation journey today.

[00:15:12] So that is, you know, the big way that you can drive increased muscle mass is going to

[00:15:18] be at the gym with weight training.

[00:15:21] And the other way that you can drive increased muscle tissue is in the kitchen.

[00:15:25] So increasing your protein intake, muscle protein synthesis, which is a just a process

[00:15:33] that, you know, creates more muscle protein is stimulated chemically in the amount and

[00:15:39] it's directly stimulated by the amount of protein that we are consuming in the diet.

[00:15:44] So consuming more protein I think is very important.

[00:15:47] And then of course the mechanical stimulus of getting to the gym and essentially ripping

[00:15:52] apart the muscle fibers, right?

[00:15:53] That's what weightlifting is, is, you know, you're basically breaking down the muscle

[00:15:57] so that you have muscle cell turnover and you're actually creating stronger, better

[00:16:02] muscle tissue over time.

[00:16:04] So that's the first thing.

[00:16:06] And then the second thing, as I mentioned, is injury prevention.

[00:16:09] A lot of women and I'm actually curious to know if you hear this in your community as

[00:16:14] well.

[00:16:14] We see a lot of times in social media, people like lift heavy, lift heavy, lift heavy.

[00:16:18] And like I'm a proponent of lifting heavy as well.

[00:16:21] But I think a lot of women who have grown, who are now in perimenopause have sort of

[00:16:25] grown up in the 80s and 90s as I have where it was high carb, low fat and do all the

[00:16:30] step aerobics that you can and, you know, do all the, you know, be a cardio bunny.

[00:16:34] They don't have the form or the technique and they might be scared of what it means

[00:16:41] to go into the weight area of a gym, right?

[00:16:43] You see all these, you know, what can be really scary looking individuals who are making

[00:16:49] really big grunting noises, who have huge muscles.

[00:16:51] And I think that women are at least what I've heard from my community and I'd love,

[00:16:56] Jen, for you to tell me if you hear this as well, is a lot of women in their 40s or 50s

[00:17:00] I don't want to get injured.

[00:17:01] Like, I don't want to lift heavy stuff because I feel like I'm going to hurt myself.

[00:17:05] So I don't really know where to begin.

[00:17:07] And then a lot of us have that sort of all or nothing mentality where we're like, well,

[00:17:11] if we can't do it, we just might as well not do it.

[00:17:13] Right?

[00:17:13] So injury prevention is another big topic of concern for women.

[00:17:18] So I always like to talk about you can still, you can lift heavy if that's what you want

[00:17:23] and you have good technique and you've been in the gym for a while.

[00:17:26] But if you are someone who has never lifted heavy or you don't feel like you have good

[00:17:30] form, like strip, like leave the ego at the door, strip off the weights and you can actually

[00:17:36] have quite an intense workout with subjectively, you know, with lighter weights.

[00:17:42] Oh yeah.

[00:17:43] Um, but you are really dialing in your form and it's when you have that lighter weight

[00:17:48] is when you can drive that neuro mechanical integrity anyway, because you're not struggling

[00:17:53] to lift something that's really heavy.

[00:17:55] You're just focusing on creating like neural patterning, right?

[00:17:59] Like that motor patterning that you can remember when it is time for you to increase the weight.

[00:18:04] So tempoing your, like a couple of like actionable tips for your audiences, tempoing the movement.

[00:18:11] A lot of people, and the reason why some of those gym bros are so scary is because they

[00:18:16] are throwing the weights around.

[00:18:18] Don't do that.

[00:18:19] Like you move the weights, you know, like the weights don't move you.

[00:18:23] So really focusing on, you know, that concentric or when you're shortening the muscle, that's,

[00:18:28] you know, most people get that well, but where I think a lot of people miss out on is the

[00:18:32] eccentric, right?

[00:18:33] That elongation of the muscle.

[00:18:35] So really focusing on controlling that elongation piece.

[00:18:39] So if you think about a bicep curl, that's like a really easy example.

[00:18:42] You know, you curl the, the, the, you know, you're holding the dumbbell in your hand,

[00:18:45] let's say, and you are flexing at the elbow that you're shortening the bicep muscle.

[00:18:49] And then as you don't just drop the arm back down to starting, like really control that

[00:18:54] down.

[00:18:55] And of course, there's a lot of literature to support the idea that when you are focusing

[00:19:00] on the eccentric portion of the whatever movement you're doing, whether it's a pull up or a

[00:19:05] squat or a bicep curl or bench press or whatever it is, it's the eccentric where all the juice

[00:19:11] is.

[00:19:11] It's the eccentric that's going to drive a lot of that muscle hypertrophy, which is what

[00:19:14] a lot of women should be focusing on in their forties.

[00:19:17] So that was a really long answer.

[00:19:18] So I'll just stop right now because I'm sure you have something.

[00:19:22] I'm sure you want to jump in here.

[00:19:23] I mean, this is, this is perfect.

[00:19:25] This is truly what, you know, we get asked from the community.

[00:19:29] And I think what people are so afraid of in my community of what I hear is, you know,

[00:19:35] maybe they've had a previous injury.

[00:19:37] So they've been told, okay, avoid that, avoid that, avoid that.

[00:19:40] And so there becomes this fear avoidance of ever squatting, of ever deadlifting because

[00:19:44] I've had a previous injury rather than empowerment of how the body is adaptable and resilient.

[00:19:50] And if we start with lighter weights and understanding our body awareness and understanding this

[00:19:55] eccentric control, there's so much more that we can do to build up our body.

[00:19:59] So I love that you're talking about this because this is what I feel like I'm hammering into

[00:20:05] my own head and into a wall sometimes trying to get people to understand this concept.

[00:20:10] So I love so much that you're bringing this around.

[00:20:15] Well, and I think there's so much that we're battling, like you mentioned from

[00:20:19] older styles of workouts where people would do, you know, the step classes,

[00:20:23] like you mentioned, you being an instructor or, you know, just the cardio machines.

[00:20:27] It literally was a cardio machine that all, you know, everyone was getting into where,

[00:20:34] and then even the stigma around pregnancy and childbirth of, oh, don't lift weights.

[00:20:41] And then after, you know, the challenges that we have with people who,

[00:20:46] you know, women who have birthed a child and getting back to movement and how we have,

[00:20:50] you know, desperately underserved that population in their recovery and getting back to exercise.

[00:20:55] I feel like there's many challenges that women have faced over the past decades in

[00:21:01] feeling confident lifting heavy and feeling confident getting back into

[00:21:05] the gym. And just to, you know, speak to Jen's and what Jen's audience says, she does a lot

[00:21:12] of the things that you just mentioned, like, oh, not used to lifting heavy, slow down,

[00:21:16] go tempo, use a very lightweight. I promise you, you will feel it if you're not used to doing these

[00:21:21] movements. And, you know, that's the feedback that we get. It helps people with that motor

[00:21:27] programming, that neural programming that you're saying, and it helps them just feel confident

[00:21:32] going up and down stairs again without having that knee pain or that hip pain.

[00:21:38] And you may have actually answered the next question I was going to ask, because I feel

[00:21:43] like we hear so many people ask about, or just say, comment on, I haven't changed anything.

[00:21:50] I've, you know, eaten this way my whole life, or I've eaten consistently and done these workouts,

[00:21:57] and that might even include strength training, but now I'm having so much trouble losing weight,

[00:22:02] or I'm gaining that extra five to 10 pounds. Particularly in perimenopause.

[00:22:06] Yeah. When it gets closer to perimenopause, and I can't seem to lose it. Like, why is that? And

[00:22:13] I feel like you just answered a bit of that with the, you know, issues with insulin sensitivity

[00:22:19] going down and, you know, reprioritizing protein and strength training. So what would you say to

[00:22:25] the person who says, like, I do some strength training, but now I'm just having trouble getting

[00:22:30] the same results? Yeah. Oh gosh, so much good stuff here. Okay. So first, I will, I want to,

[00:22:37] let's go a little layer deeper with the woman who say, oh, I'm doing everything I was doing when I

[00:22:43] was 25, and now I have this, you know, extra role, you know, I have extra weight through my stomach,

[00:22:48] or I can't seem to lose that last, you know, I keep gaining and losing the same 10, 15 pounds.

[00:22:53] And part of the reason, again, coming back to what we were talking about before,

[00:22:57] is that our bodies are changing, right? What we see very clearly in perimenopause, and particularly

[00:23:04] in menopause, is we see this change in body fat distribution. So for a woman, we know that,

[00:23:11] you know, under the influence of estrogen, again, estradiol being the main one in a cycling woman,

[00:23:17] that's going to be developing her, you know, secondary sex characteristics, right? So we have,

[00:23:21] breast development and hip development, and it also directs where the fat is deposited, right?

[00:23:26] So we will deposit typically fat in the hips, in the bum, the thighs, lower tummy area, that sort of

[00:23:35] region. And that's, you know, the ones that we always want to get rid of, right? That's,

[00:23:38] we're always trying to diet that away. That's what we would call subcutaneous fat, right?

[00:23:43] So it's just underneath the skin. While it jiggles, and we have a general disdain for it,

[00:23:49] it's generally harmless, you know, up to a point, right? As long as you have, you know,

[00:23:53] healthy BMI and your fat-free mass index is good and all of that. When we start our journey in

[00:23:59] perimenopause, and then through to menopause and beyond, because of that declining level,

[00:24:04] those declining levels of estradiol, we now begin to change the way that we deposit fat. So instead

[00:24:12] of depositing fat in sort of the lower half of the body, if you will, a lot of women will say,

[00:24:19] I'm starting, I'm just getting this tummy, like I just have this, you know, and I don't like these

[00:24:24] words, but I'll just use it because I know that it's used a lot. It's like this muffin top kind

[00:24:29] of, you know, the spare tire kind of presentation. And what's happening there is that we are seeing a

[00:24:36] switch from this subcutaneous or under the skin fat to fat that's being deposited in the viscera,

[00:24:43] or on top of our organs. And that's the stuff that's going to kill you. Like that's the stuff

[00:24:47] that we really want to be thinking about. That's the stuff we really want to be avoiding, right?

[00:24:52] So the protein as we talked about is going to keep you fuller for longer, which is always great. We

[00:24:57] never want to have hungry, you know, people who are hungrier or opening their, you know, their

[00:25:00] faces in the pantry every 45 minutes. But we can, the other thing that we can do is we want to be

[00:25:06] thinking about our calories, but more importantly, the macronutrient composition of the calories.

[00:25:11] So what we know from, you know, the literature on visceral fat accumulation, which is just like fat,

[00:25:18] let's say on top of the liver or on top of, you know, different organs is that we can,

[00:25:23] and I'll say this gently, and I want to double underline and bold the word gently, if I can,

[00:25:30] we want to gently reduce some of our carbohydrate intake. Now that is going to,

[00:25:37] what that means for each individual is going to vary wildly based on their activity,

[00:25:44] how much they're lifting in the gym, how active they are. But if you are seeing, you know,

[00:25:49] you've been doing the same thing that you've been doing when you were 25 or 35, let's say,

[00:25:53] and now you're 45 and you have more weight through the, you know, through the midsection than you

[00:25:58] ever did before, what we can think about is upping your protein. We can think about some of the,

[00:26:04] some of the strategies that we've been talking about in the gym. So you've probably, if you've

[00:26:08] been staying at the same weight, if you're also in the gym and lifting the same way that you have

[00:26:13] been when you were, you know, 10 years ago, it's time for a change. So you can, you know,

[00:26:17] you can either progress with more weight to make it more intense, or if you're not used to that,

[00:26:22] then you can, you can have the tempo manipulation that Jen, you mentioned that you talk about a lot,

[00:26:28] I love. And we can think about even like, how about full range of motion ladies? Like, can we,

[00:26:34] can we think about doing a full range squat or a full range? You know, if you can't do a pull-up,

[00:26:41] maybe you can do a scapular, like dead hangs with some scapular retractions. Like, can we

[00:26:45] fully stretch the muscle? Because again, when you're controlling the eccentric or the elongation

[00:26:51] portion of any movement and you have it, you are training the muscle essentially in the weakest,

[00:26:58] in its weakest position. That is how you are going to gain that lean muscle mass. And of course,

[00:27:04] we know that the more lean muscle mass you have, the more better metabolic, metabolically flexible

[00:27:10] you're going to be. And that's going to also eat up some of that visceral fat. So there has to be

[00:27:14] sort of a combination, there has to be sort of a multi-pronged approach. So it's like in the

[00:27:18] kitchen where we are gently maybe reducing some of our carbohydrates and it can just be like the

[00:27:24] process, it can just be like the sauces, you know, and it could just be like the chips or the,

[00:27:28] you know, the tortillas or whatever that you have in the pantry. Like just reducing some of those

[00:27:32] snacks in your diet, bumping up your protein and then changing the way that you are stimulating

[00:27:39] the muscle, changing that mechanical stimulus again in the gym. And you'd be surprised,

[00:27:43] like sometimes just dropping the dressing, like you can see like incredible, incredible changes

[00:27:49] just by sort of dropping the dressing, having an extra cup of water at, you know, with your meals,

[00:27:54] that kind of thing where we are starting to see that change or we can start to see ourselves

[00:27:59] optimizing or maybe a better word is like maximizing that fat distribution in the way

[00:28:04] that we want to. That's huge. Now, is there, I get this question a lot as well, is there a specific

[00:28:12] time that I'm supposed to be eating prior to a workout and after a workout? And what do the,

[00:28:17] what are those meals really supposed to look like to help maximize the benefits that I'm trying to

[00:28:21] get out of the exercise? Yeah, this is it that I get this question a lot as well. It's a really

[00:28:27] good question too. I think, I think it depends on your level of fitness. So if you are someone who

[00:28:32] has been training for a long time, I think that the, you know, the timing of your meals, let's

[00:28:41] say in the peri-exercise area or peri-exercise time matters less than your total protein

[00:28:50] consumption, let's say, or your total caloric consumption over a 24-hour period. I think if

[00:28:56] you are new to weight training, I think if you are, and when I say new, like maybe less than six months

[00:29:02] of regular training, that peri-exercise window is a bit more important. So we do want to be thinking

[00:29:08] about if you can, fueling before, that's my strong preference. And that's something I've actually

[00:29:15] changed my mind on over, I used to train fasted and all of that when, you know, fasting and not

[00:29:22] eating until 12 was sort of in vogue. I was following that for a little bit and I've changed

[00:29:26] my mind on it. But if you can fuel beforehand, it doesn't actually make any change. It doesn't

[00:29:32] make any difference on your body composition, but it will change your performance in the gym.

[00:29:37] So you'll actually be able to push harder, you'll have more substrate to fuel your workout.

[00:29:43] But if you like to do it fasted, you know, have at it, you can still do that as well. But

[00:29:47] people who are newbies in the gym, if you can eat prior, great. If you're working out at like

[00:29:52] 4am or something and, you know, eating something feels like a brick in your stomach, just make sure

[00:29:57] that you have something after you get home or have a protein shake or something like that after

[00:30:01] the workout. It is more important for someone who is more new to weight training to really be timing

[00:30:06] her protein intake to help with the remodeling and the carbohydrates. I always like to have protein

[00:30:11] and carbs if you can after a training session because you've used up some glycogen, you've used

[00:30:17] up some of that stored glucose. You've, you know, essentially, if you've done the workout properly,

[00:30:22] you've broken down some, you know, muscle cells. So we want to be giving our bodies a substrate,

[00:30:27] the amino acids and the glucose to be able to remodel, to be able to repair and to restore those

[00:30:33] glycogen stores. So the answer is it depends. It's a long way of saying it depends, but it really,

[00:30:40] it depends on your level of fitness. If you're someone who's been doing it like,

[00:30:44] you know, for both of you, you've been working out for years, it doesn't matter as much anymore

[00:30:49] because the rate of turnover, let's say in yourselves is much slower. It's actually,

[00:30:52] you know, the better you get at fitness, you know, the harder it is to make, you know, change,

[00:30:56] right? Like the first six months to a year of somebody weight training, we have this sort of,

[00:31:01] and you've probably heard of the term like newbie gains, right? So like the newbies,

[00:31:04] they get all the gains. They get like 10%, 20%, you know, stronger in a year, which is,

[00:31:09] you know, if I get 4%, 5% stronger in a year, I've made really great, like excellent progress.

[00:31:16] Yeah. I feel like all the most, all the best, but most frustrating answers when it comes to

[00:31:21] general health questions is it depends, but I feel like you gave enough specific examples to give

[00:31:28] people an idea of what they might want to try or at least start experimenting with a little bit.

[00:31:35] You briefly brought up fasting and how this is something that you have kind of

[00:31:39] changed your mind. And I know that intermittent fasting is something talked about a lot just

[00:31:44] in the nutrition space in general. And there's a lot more conversation now circling around

[00:31:49] is intermittent fasting something that is healthy, good, beneficial for women to do?

[00:31:56] So what have you changed your mind about? And is intermittent fasting good at certain times,

[00:32:03] bad at certain times, or depending on where you're at in perimenopause, menopausal or

[00:32:09] premenopausal? Yeah, I think this is a great question. And I still get asked this a lot,

[00:32:15] because I've said to my community, I've changed my opinion on fasting. Like,

[00:32:19] do you mean that you don't fast anymore, doc? And that's not what I mean. When I first started

[00:32:24] fasting, when we look at sort of time restricted feeding, and you look at some of the work of,

[00:32:31] let's say, Dr. Sachin Panda, out of the Salk Institute, he looks a lot at circadian biology.

[00:32:39] He would talk about this idea of restricting your window of eating. And somehow that was translated

[00:32:46] to the public as don't eat until noon. That was sort of the takeaway. So you can still,

[00:32:55] and that sort of goes against our circadian, our natural circadian rhythm. We are much more

[00:33:00] insulin sensitive in the morning, and much more insulin insensitive as the day goes on.

[00:33:08] So the same, you know, if you equate for calories and macro composition, the same meal that you eat,

[00:33:16] let's say at eight in the morning, is going to be tolerated different and have a different,

[00:33:21] we'll say metabolic consequence than the meal that you eat at 8pm, right? So when you eat is

[00:33:29] very important. So where I've changed my mind, I used to be the, you know, I'm just gonna not,

[00:33:35] I would work out in the morning as I often do. And then I would not eat until noon, like come hell

[00:33:42] or high water. Oh, actually, I'm sorry if I'm sorry if I swore. I don't know if we're allowed

[00:33:45] to do that. Like it didn't matter. It didn't matter. I was, I could be starving, I could be

[00:33:53] hangry and I was not going to eat until 12. And for women, I would say that this is a terrible idea.

[00:34:02] And I did this for years. So I'm calling myself out here. It's a terrible idea because we are

[00:34:07] always in terms of our reproductive cycle, we are always scanning the environment for safety. I mean,

[00:34:13] we do this at every level. We do this in our psychology, right? We want to feel safe with

[00:34:17] our partners. We also want to feel like there's an abundant supply of food so that we can go

[00:34:22] through the normal reproductive function of creating an endometrial lining that can,

[00:34:28] that is getting ready to receive a fertilized egg, right? So irrespective of whether you want

[00:34:34] a child or not, that's what your body's going to do every month. Your body is going to prepare

[00:34:38] this five-star hotel, you know, this endometrial lining to receive a fertilized egg. And if you are

[00:34:45] restricting excessively where you are not eating in the most insulin sensitive time of your day,

[00:34:54] your ovaries, I mean, if we just want to talk about concentration of mitochondria,

[00:35:01] just as an example, your listeners may, this is like just for the nerds that are listening,

[00:35:06] you know, in the ovaries we have something called the oocyte, which is just like,

[00:35:11] you know, the cells of the ovaries, which is a fancy word for that. There's a hundred thousand

[00:35:15] mitochondria per oocyte. If you contrast that with something like a hepatocyte, which is a cell

[00:35:22] of the liver, it's like 2000 mitochondria per hepatocyte, right? So your ovaries are all,

[00:35:29] they are the eyes without an optic nerve, you know, in the female body. So they are always scanning

[00:35:34] the environment. If there's scarcity, they might say, you know what? There's not enough food here

[00:35:39] for her. This will be a terrible month for her to get pregnant because her baby is not going to have,

[00:35:43] you know, the baby's not going to have enough nutrients. And so what we see is with women who

[00:35:48] aggressively fast, you can become amenorrheic. Like you can go a month or two or more without

[00:35:56] having your period. We actually see this a lot in the fitness community, right? We see these fit,

[00:36:00] you know, you mentioned social media at the top of our conversation and some of these women who

[00:36:04] are excessively lean are not menstruating every month. They, you know, I think it's around half

[00:36:10] of the women that are sort of competing or they're, you know, considered, let's say,

[00:36:14] fitness influencers don't have a regular period. And so for women, I think it's a terrible idea to

[00:36:21] be restricting until 12 or one o'clock. I think if you're going to do something,

[00:36:26] you know, have this sort of phasic shift, like front load your food, eat in the morning,

[00:36:30] eat around the time that you're exercising. And maybe, you know, you do what I do, which is,

[00:36:35] you know, I finish eating somewhere around four o'clock, five o'clock. And then I go to the,

[00:36:40] you know, whenever we go, my husband and I, whenever we go for, you know, dinner, we go

[00:36:44] like seniors, but we get the senior special, right? Because we're eating at like 4.30 in the

[00:36:50] afternoon, which is what, you know, we have lunch with like all the grandmas and all the grandpas

[00:36:53] and the nonnas and the nonnies, whatever. So I think if you're going to fast, you can move that

[00:37:00] food consumption up in the day. And then the other thing I'll say is don't be so restrictive

[00:37:06] on the window. So I used to do like the 16-8 all the time, like 16 hours of fasting and eight hours

[00:37:11] of eating. And I don't do that now. So I'm usually, you know, I don't even know what I do.

[00:37:17] I don't even track it, but it's something like 10 to 12 hours of eating time and then whatever the,

[00:37:23] you know, 10 to 12 hours of fasting time. Yeah. Well, and I think that helps to reduce

[00:37:28] the stress on it as well for our bodies and not being so obsessed of what is the time that I have

[00:37:35] to do this and I have to eat by. And I kind of used to be the same of not really eating until

[00:37:40] the afternoon or, oh, quote unquote, I wasn't hungry. But once I got pregnant, oh, how quickly

[00:37:46] that shifted. And I was like, I don't care anymore. I need food right now or else I might murder

[00:37:52] someone. And since then, it's just kind of been like, now I just listen to my body. If I'm hungry,

[00:37:58] I eat. And if I'm not, I, you know, I mean, I don't think that I ever skip a morning anymore.

[00:38:03] It's just, I'm hungry. I need a fuel. I want to eat in the morning. So it's completely shifted

[00:38:09] just naturally, I guess, based on getting pregnant and nursing. But another thing I want to talk

[00:38:17] about, you know, for shifts that happen, especially in the fitness industry, you know, seeing that

[00:38:22] shift happen with intermittent fasting and the strictness of it, there's also the shift of,

[00:38:30] you know, going from that cardio and doing all the HIIT training to now it's strength training. So

[00:38:36] can HIIT and cardio still play a role as we continue to age? And how does, and how can it

[00:38:43] be successful when we're also trying to really focus on strength training?

[00:38:49] This is an excellent question. Yes, I think that cardio absolutely plays a role. I think for women

[00:38:56] who are still in their cycling years, you can get away with not doing as much cardio.

[00:39:02] I think one of the things that we do see in perimenopause and of course in menopause,

[00:39:08] and this is again, this estrogen deficient state, estrogen in many ways makes us metabolic

[00:39:14] superheroes. And I'm using that quote from Dr. Ben Bickman because he said that when he was on my

[00:39:19] podcast and I love that so much. So I'll continue to repeat it and give credit where credit's due,

[00:39:24] but we are really metabolic superheroes when we are in our fertile and in those cycling years.

[00:39:29] When we are in perimenopause and menopause, we have to work at our cardiovascular health.

[00:39:34] So obviously without getting into like type one fibers and type two fibers and all of that,

[00:39:40] strength training is very important. It typically will train more fast twitch,

[00:39:44] like more of the type two fibers, type two A. And then if you're doing like explosive movements,

[00:39:48] like sprinting, you'll also in more anaerobic conditions, you'll get into type two B.

[00:39:53] But cardiovascular work is very important. I think that zone two training, which has gotten a lot of

[00:40:00] sort of hype around the benefits, it's very beneficial for men. And partially because

[00:40:06] they're not the metabolic superheroes that women are. We typically have our type two fibers are

[00:40:11] much smaller. We have more of a percentage of our type one fibers females do than our

[00:40:15] male counterparts. So type two is really important for guys. And as we lose our estrogen for women,

[00:40:22] type two becomes very important. Zone two, I should say. Zone two training becomes very important

[00:40:27] for women as well. So we do want to be thinking about cardiovascular disease in our forties and

[00:40:32] fifties. It is the number one killer of women. A lot of us will ascribe like cancer, breast cancer,

[00:40:38] and there's a lot of fear around cancers for women. And I'm not downplaying that, of course,

[00:40:43] that's a very scary disease. And cardiovascular disease is the number one killer for women. So

[00:40:50] making sure that you have the strength training regime dialed in that is by like, if you were to

[00:40:55] make a Maslow's hierarchy of importance in terms of fitness, for me, strength training is at the

[00:41:03] bottom. It is the foundation of your health. And then you would be adding on to that cardiovascular,

[00:41:08] like if you were to go up one tier, let's say cardiovascular, cardiopulmonary fitness is going

[00:41:13] to be there. Recovery is also very important. I think that a lot of type A's such as myself,

[00:41:21] we, I for many years would just like throw recovery out the, I didn't want, I didn't want to rest. I

[00:41:26] never, I never wanted to do any of that was, that was for weak people. But of course, recovery is

[00:41:32] where all the gains happen, right? It's like, that's where your muscles grow. They grow when

[00:41:35] you're on, when you're not in the gym, you break them down in the gym, when you're recovering,

[00:41:38] that's actually when they grow. So can you give them the right environment with which to, with

[00:41:43] which to flourish? So I think that cardio and strength training to answer your question, I know

[00:41:48] I'm going off on a bit of a tangent here, Jen, but cardio and strength training absolutely are

[00:41:53] so important for women. I think all through the lifespan, but particularly it's, you know, we

[00:41:58] want to, we want to strike a nice balance in perimenopause and menopause and you can like

[00:42:02] zone two, you know, I can get into zone two by doing a yoga class. Like I've, I've, I've brought

[00:42:07] my heart rate monitor a couple of times to my there's this vinyasa class that I love. And I'm,

[00:42:13] I'm there, like I'm in my zone two, you know, in that heart rate zone for that. Or you can,

[00:42:19] you know, things like salsa dancing or, you know, gardening or, you know, rearranging,

[00:42:24] you know, I like to rearrange my house like every spring I'm like where, you know, the time

[00:42:28] that we're recording this is around, you know, the beginning of spring, I'm getting the itch to

[00:42:32] like rearrange things, right? So all of that can also be, you know, cardiovascular work, let's say.

[00:42:37] Can you just define quick, I'm forgetting the exact percentages, but zone two cardio

[00:42:43] Yeah, it's, it's going to vary for everyone. But the way that I calculated it is based off of my

[00:42:49] FTP or my functional threshold power. This is getting a little technical here. But if you have

[00:42:53] a bike, you can probably do, you can either do a ramp test or like a 20 minute test, which is like

[00:43:00] how long, how fast and how hard can you bike for 20 minutes? It's a terrible test by the way, just

[00:43:06] pre-framing. It's awful. And then, and then your zone two is going to be 80% of that. So let's say

[00:43:12] you're able to, gosh, I don't know, like let's say you're able to, you know, have a, on the bike

[00:43:17] is easier because it has watts. So let's say you have, I don't know, 130 watts, let's say you can

[00:43:23] punch out 130 watts and you can do that for 20 minutes, your FTP is going to be 80% of that.

[00:43:30] If you don't have a bike or you don't have like an exercise, you know, science lab around the

[00:43:34] corner from you, Phil Maffetone has come up with a, you know, 180 minus your age is going to be

[00:43:41] around your zone two. Although I find that at least for me, my, it underestimates my heart

[00:43:47] rate a little bit, but that's a really great place to start. Like whatever your age is, just

[00:43:51] take it off of 180 and then you multiply that number by 80% and that's going to give you your

[00:43:56] zone two heart rate target. Gotcha. No, I think that, yeah, quick method that probably won't fit

[00:44:03] for everybody depending on, especially depending on what, what age you're at. It's probably more

[00:44:08] accurate for some than others, but last quick question that I know in no way is a quick

[00:44:13] question, but when we're talking about hormones and people having difficulties and frustration with

[00:44:20] getting hormones balanced, hormone replacement therapy often comes up as a potential solution or

[00:44:27] part of a treatment plan. What are your thoughts on when this might be appropriate, when it might

[00:44:33] be appropriate for people to start seeking out those types of options? Yeah, this is, as you said,

[00:44:40] not an easy question. I would say, I'll start by saying that I'll state my bias in that I'm a fan

[00:44:48] of it. I think that HRT can be life-saving for many women and unfortunately there is still a

[00:44:59] persisting myth, we'll say that HRT, it's hard to talk about it without getting into the weeds,

[00:45:04] but it will say this, like there was this study, it's called the Women's Health Initiative

[00:45:10] published in 2001 and they stopped the study early because, you know, they were running the stats and

[00:45:16] they found that there was an increase in heart attacks, an increase in cancers, an increase in

[00:45:20] all these, you know, increase in death from taking essentially from taking HRT. And of course we know

[00:45:26] now that, without getting into the details of the study, like the participants were well past

[00:45:31] menopause, they were usually like six, they were, I think the average age was like 65. They were

[00:45:35] smokers, they were obese, it's like if there was ever any condition for cardiovascular disease,

[00:45:40] it would be a smoker who was overweight, right? So these are the participants and the way that

[00:45:45] they were sort of slicing the data unfortunately was, I'll just say unethical. So they stopped it,

[00:45:51] they sensationalized this, you know, the headlines like HRT causes heart attacks and then

[00:45:58] every single, people who were on, women who are on HRT went off HRT, doctors were told not to

[00:46:03] prescribe this and this still persists today, you know, 23 years later. So you'll find a lot of

[00:46:13] women who are listening will probably nod their heads and say, yeah, I've spoken to my doctor about

[00:46:17] HRT and they said it's dangerous or it carries risk of breast cancer, it carries risk of a sudden

[00:46:23] cardiac death, SCDs. So I think that we have to evaluate every individual, we have to evaluate

[00:46:32] the individual on their risks, so you have to look at their history. Is there histories of things

[00:46:36] like CVD and heart attacks and breast cancers and all of that? Does the person have a uterus still?

[00:46:42] All of these different things we have to sort of take into consideration, but I do think that on

[00:46:48] balance it is a net positive for women. But you do have to have a conversation with your PCP, you do

[00:46:53] have to have a conversation with your primary health care provider and make the best decision

[00:46:56] that's for you. And if your doctor is telling you that this is just, you know, you're aging and this

[00:47:01] is, you know, part of life, like find a new doctor. That's an unacceptable answer because if someone,

[00:47:06] you know, if you were to go, you know, if any guy were to go in to their medical doctor and be like,

[00:47:10] you know, my libido is not what it was and I'm feeling anxious and I'm feeling depressed and I've

[00:47:15] never felt this way before. And he said to you, you know what? It's just because you're getting

[00:47:19] older and like maybe you should just take up woodworking. Like you'd punch him, right? That's

[00:47:25] not an acceptable answer. So if anyone is telling you like it's part of aging or take up a hobby or

[00:47:32] here's some SSRIs, you know, I mean maybe the SSRI piece, like maybe that is justified, I can't say

[00:47:37] either way, but you deserve to have a, you deserve to be spoken to about the possibility of taking

[00:47:43] hormone replacement therapy. I couldn't agree more. Education and understanding about your body is so

[00:47:50] key and that's everything we try to provide and I know you are too. So Dr. Stephanie Estema, I just

[00:47:56] really appreciate all of the knowledge that you just brought for us today and I know there's so

[00:48:01] much more that we could dive into. I had a lot of questions written down for you. So for people who

[00:48:06] are, you know, wanting to understand this information a lot more, where could they go

[00:48:12] to find your information and learn from you? Oh, thank you so much. Yeah, so if you want to,

[00:48:18] I talk about this a lot on my podcast. So my podcast is called Better with Dr. Stephanie

[00:48:22] because that's my philosophy for life. It's not about being the best, it's about being better. So

[00:48:25] Better with Dr. Stephanie was just a free resource, another free resource I try to post regularly on

[00:48:31] Instagram. I'm probably there a couple times, at least a couple times a week posting something on

[00:48:36] building muscle, healthy, you know, meals, mindset, all things menopause. So those are two

[00:48:44] free resources if you are someone who's still cycling and you want to figure out how to eat

[00:48:48] and train in accordance with your cycle. I wrote a book about that, it's called The Betty Body

[00:48:53] and we named it Betty after our better listeners. So they started calling themselves Bettys which I

[00:49:00] loved and spoke to my vintage heart so we named the book after them. So The Betty Body,

[00:49:04] you can find that, you know, Barnes and Noble, Amazon, anywhere where books are sold.

[00:49:09] That's amazing. Well, if you're listening and interested, go check out Better and Dr. Estima

[00:49:15] on the socials. And Stephanie, thank you so much for spending some time and dropping your wisdom

[00:49:20] with us. Oh, it's been a delight spending time with you both. Thank you for having me.

[00:49:26] Thanks for sticking around for that interview. Such great information from Stephanie and we hope

[00:49:30] that you took a few things away from this podcast. If you heard anything that you feel like could

[00:49:34] benefit a friend, a family member, please consider passing this episode along because that can help

[00:49:39] this information get out to the people that really need it. If you haven't yet,

[00:49:43] please consider leaving a rating and review on your favorite podcasting platform. And remember,

[00:49:47] we have a massive discount going on right now on our Barefoot mini course. So if you're somebody

[00:49:51] out there who has had plantar fasciitis or bunions, or just feel like you want to optimize

[00:49:56] your foot health that little bit extra, go check out the link in the show notes and get the discount

[00:50:01] on that Barefoot mini course while it is still live. We'll have a significant discount for this

[00:50:06] week only. So make sure you check that out. And of course, we'll see you next time on the Optimal

[00:50:10] Body Podcast. Transcribed by https://otter.ai