Weight Loss, Strength, Hormones and Optimizing Keto with Dr. Stephanie Estima: 2

Hey everyone, welcome! Today I'm here with Dr. Stephanie Estima and we're going to talk all about— she, first of all, she has a new book out which is amazing, and second of all, she's really focused on, uh, making sure that your hormones stay in balance while you're on keto, which can be a particular problem for us ladies. So welcome, Dr. Stephanie Estima! Can you just tell us maybe some of your background, how you, um, found the low-carb diet and how you got into it and your interest in this subject?

Sure, yeah. So I have been, you know, for most of my career very interested in brain health and brain metabolism, and the ketogenic diet was something that I came across maybe 4— well, maybe closer to 5 or 6 years ago now, in terms of some of the benefits that it can have for cognition, for mood, for sleep. And I started implementing it in my practice when I still— when I had a brick-and-mortar practice and was just had profound results in my patients. So it's something that I've always been very, very cognizant towards is this idea of how can we change some of the things in our life, whether that's nutrition or movement or supplementation or stress reduction, as a way to uplevel our brain health in some way. On the ketogenic diet, I'm sure we'll talk about it today, and I'm sure you've talked about this on the podcast before, it's one of those proxies that is very, very, efficient for reducing inflammation in the brain, for helping with clarity of thought, for helping with sleep, and all of the things that are important when we're thinking about long-term brain aging and brain health.

I'm so glad that you brought up this subject because it's also part of my background. I have a little bit of graduate training in clinical neuropsychology, was my focus. And so part of the reason I also came to this space and to this way of eating is because of brain function. Once I read the research and became aware of this, It was kind of like once you see it, you can't unsee it, right? And like you were saying, you put your patients on that. It's probably they came to you maybe for weight loss. A lot of people come to this for that reason, but people realize these other amazing benefits. Like, could you maybe talk a little bit about in your clinical practice some of the effects that you saw on your patients once they started living this kind of lifestyle?

Oh yeah. So I would say you're very right that most people would come for weight loss, but they would stay for all the other benefits, right? Like no one ever comes and is like, "You know what? I would love to improve my mood." Everybody wants that, right? But they don't necessarily think that the ketogenic diet is gonna be the way that that's gonna happen. So weight loss is one of the more profound, particularly early results that we see when you are starting to restrict your carbohydrates. As you know, you start using up your glycogen stores, and as you start to use that, you're also getting rid of some of the water that you have, so for every molecule of glycogen that you store, carbohydrate, you're also pairing it with 3 to 4 molecules of water, so we often see a rapid weight loss in the first couple of weeks doing keto, so that also makes people feel great because now they feel less bloated and they're more motivated to sort of stay the course. Some of the things I've already mentioned, so clarity, sleep, a lot of people say, "I sleep a lot better now, I feel like I have," a sustained amount of energy so that they don't have those highs and lows during the day where they eat and then they have this carb crash and they, you know, they have this carb coma, right? Where then they 45 minutes later are going back for, you know, a bagel or a muffin or whatever it is. And particularly I would see this in my female patients as well. So that 2 to 4, like 2:00 PM to 4:00 PM, you know, time window is typically when we start seeing like an aggregation of more calories. Like we have our lunch, let's say 12 or 1 o'clock. But if the macronutrients are not structured to give you sustainable, long-burning energy, a couple hours later you're already hungry. So we would see people starting to get their little snacks and their little picky type of foods, eating around that time. So women who were going on keto, or at least the ketogenic program that I was structuring for them, would say, "I can have my lunch and then I don't really want to eat again until I get home for dinnertime." So that was also a really huge benefit as well. And yeah, I mean, I think body composition changes. We would see, you know, the waist-to-hip ratio improves. So people slimming down their waist relative to their hips, which is an indicator for longevity. We want to make sure that, you know, if you were to— right now, if you were to take, you know, a measuring tape and measure your navel, like at the level of your navel, and then again measure at the widest part of your hips and you divide those numbers into each other, You want that number to be at least 0.8, like no higher than 0.8, and lower if possible. So we would start to see improvements there, and of course what that's indicating as well, that the visceral fat, you know, if your waist is smaller than your hips, you are starting to create that more hourglass-like figure, which, you know, aesthetic, you know, we don't even have to talk about the aesthetics, like this is the ideal shape for a woman when we're thinking about longevity, because if she's accumulating a lot of weight through her waist relative to her hips, we know that that's likely an accumulation of visceral fat and it's gonna be harder for her organs to actually do the things that they're supposed to do. So, and of course, and of course it looks good, right? We can always talk about vanity, but you know, in terms of like some of the metabolic parameters, you know, that waist to hip ratio, we would see a really great improvement in that as well.

Yeah, I'm really glad that you mentioned the visceral fat thing because it also, You can probably speak to this more clearly, but you mentioned, you know, it doesn't allow your organs to work as well, that sort of thing. And it's also, you know, linked to all of these sort of diseases of aging like heart disease and probably everything, diabetes, all of these things. I think that when your waist-to-hip ratio gets out of balance, you're more at risk for basically every kind of particularly metabolically related disease. Any further thoughts on the heart disease? Part of that with visceral fat, because you probably know way more about that than I do at this point.

Well, I mean, I think when we, when we think about cardiovascular health, um, both across the board, men and women, it is the number one killer, right? We often are, as women, I think we're very scared of, you know, the C word. We're very scared of cancer, uh, particularly breast cancer. I think there's a lot of focus put on that. Um, and I'm not to say, I'm not saying that that's not important. Of course it is. And there's also some schools of thought that are actually proposing now that cancer does have some of its roots in metabolic dysregulation. But cardiovascular disease is still the number 1 killer for women. And my focus is really on female physiology. I don't know if I mentioned that in the beginning, but I have a really big interest in some of these proxies like the ketogenic diet, like fasting, supplementation, working out as it applies to women. For men and women, I know this is true for men and women, you know, CVD, cardiovascular disease, is the number one killer, and we wanna be, especially when we're thinking about how can we live a longer life, we also wanna be paying attention to, so that would be called lifespan, like the span of years that you live, but we also wanna be thinking about healthspan, so of those years, how many of those are spent healthy? So when we think about ways that we can augment that, ways that we can make that, to extend that healthspan, one of the ways, one of the easier ways to do that is through manipulation in our diet. And I love the ketogenic diet for women for a pure ketosis, so trying to get a woman into pure ketosis for a short period of time. So I love a therapeutic intervention of the ketogenic diet. And then I actually sort of differ from a lot of people, I think, in the ketogenic community in that I don't think that women should be in ketosis forever. I do think that over the long term, it is very, when we are thinking about honoring our female physiology, honoring our hormones, honoring the different hormonal milieus that we will go through, not only as a reproductive woman, you know, a woman who has a menstrual cycle, but then as we, when we are menopausal as well, there's a certain cadence that we adhere to. So I love the idea of keto cycling, and I talk about that in my book, "The Betty Body." If you're watching, this is my beautiful book baby. And we spend a lot of time in the book talking about this sort of phase 1, which is that therapeutic intervention of ketosis, and then moving into, for women, keto cycling. So a week on, a week off, a week on, a week off. And then there's other things that we talk about like protein cycling and carbohydrate cycling in order to support our hormones, to support our cardiovascular health as we've been talking about, and to support healthspan, which is kind of that like— it's not— there's no point in living a long life if you're diseased and sickly, right? We want to be living a long life that's healthy and robust. And, you know, I'm already training, you know, I sort of say this jokingly, but I'm training to be the best, the favorite grandmother. Like, I want to be, I want to be the, the grandma that can get down on the floor, play with my grandkids, pick them up, be able to get up off the floor unassisted. You know, if I'm traveling, I want to be able to, you know, carry my own luggage. I want to be able to put it into the overhead bin I want to be able to do push-ups, and I'll say, if you'll allow me to get on my soapbox, a push-up is a push-up on your toes, not on your knees. We call them ladies' push-ups, and I get a little nervous tick when I hear that because there's no such thing as a ladies' push-up. Women, push-ups on your toes, it's the equivalent of squats for your booty. We want to be thinking about the ability to push our own body weight and to be able to pull our own body weight, to be able to do pull-ups. These are things that I think about when I'm, when I'm thinking about how I'm going to be the favorite grandma in, you know, 20 or 30 years from now.

I love— when I first— so how I came in contact with Dr. Stephanie is we spoke at the Keto Diet Summit, and I knew like from the beginning of just hearing you talk and seeing you that I just was so in line with what you were saying. Um, I was just literally talking on a live on Instagram before we got on here, and I was kind of talking about, oh, I'm getting ready to record with Dr. Stephanie, and this weekend We were, we were snowboarding and we were in Utah where they got like about 4 feet of snow in, I don't know, a few hours. Now this is a little extreme, I realize, but I do have a point here that's coming. So I'll be 48 here in about just about a month. And I think about this a lot too. I'm like, I want to be able to be healthy enough and strong enough to do the activities that I love. And also, we, you know, we have 2 boys. I'm hoping we'll have some grandbabies at some point. And all of that, I think if people can wrap their mind around making that their purpose rather than always making it about weight loss, that is what makes this lifestyle so sustainable to me. Because I know that every day that I make choices, it's because I want to be able to go get on my snowboard in 4 feet of powder and like survive that experience, basically. So, um, I just think as a mindset thing for weight loss, if people start to think about those longer-term goals or core values, that that really helps them stay on the diet or stay on all the things that we need to do, as you mentioned, like doing our push-ups, doing our workouts, and that sort of thing.

Yeah, and I love what you're saying because I think that when we only think about it in the context of weight loss, we tend to take a short-term lens to that. So we tend to say, well, in 5, you know, in 2 months I want to be 5 pounds or 10 pounds lighter or whatever it is, or 3, or You know, for the high school reunion that's happening in 4 months, I wanna be able to get into such and such dress, which is fine. Those are great goals to have, but you also wanna layer that on with a long-term view because what is the point? I mean, I'm also, you know, I also wanna honor my inner sloth here. Like there's no point in doing all this work if it's just gonna come back again, right? So I want, if you are thinking about fat loss, if this is something that's important to you, it would behoove you to think about the short-term goal, but also to be thinking about how can I sustain this over a year, 2 years, 10 years, 2 decades? Because that is actually the hardest part. We've all seen The Biggest Loser and like weight loss shows where they can lose an extraordinary, all of us can lose an extraordinary amount of weight in a short amount of time. But of course, we also know that the success of those people on Biggest Loser, you know, 90% of the participants gain the weight back because they haven't actually learned how to have these lifestyle modifications, how to be able to bring in some of these small little habits into the everyday. They go back to their life, they go back to the same stress, the same coping mechanisms, and then, you know, we see the weight gain come back again, and sometimes, and many times more so. So they may have started off at a, you know, an obese weight, they lose the weight on the show, they go back, and then they're heavier than they ever were. So I'm really interested in how we can take small little habits that are not hard to implement every single day and be able to consistently apply them and to have that commitment to that consistency over the long period of time, over that long delta T. And that's how we really get some of those, um, you know, some of the great results that we're talking about, right?

The brain stuff and all that. Yeah. The longer you do it, the better it gets. I mean, I have noticed, and my husband the same, he keeps saying that he really thinks, and he's 54, um, that his brain function— he feels just so much more clear and easier to remember things. Everything that, you know, we have to worry about is normally aging brains, not just later on neurodegenerative disease where, you know, they're kind of calling it type 3 diabetes now, but also just normal brain function that kind of starts to decline as we get older, unfortunately.

Mhm. Yeah.

Um, so that's probably a pretty good lead-in to your book about how, um, people can implement things on a daily basis talking about the carb cycling. And since you're focused on women in particular, I'd love it if you kind of talk about the diet in relation to people maybe like 20s, 30s, 40s as we age and any slight differences there that you found really help people.

Sure. Yeah. So the book was, you know, divided. We divided women into two main cohorts, right? So one is women who are in their reproductive age. So that includes loosely up to about age 50. So you should be ovulating every month. If you are a woman or female-bodied. And in menopause, that's sort of the second cohort, so around roughly 50, 52 for most of us, where we are no longer cycling, we no longer have a menstrual or a reproductive cycle anymore. So when we think about this in the context of women, one of the things that I, when I used to run, when I first started running a ketogenic diet in the clinic, I was totally running it like a guy. Like I was totally, you know, with the, you know, all true, like being totally truthful and transparent here, it was like bacon butter burgers and repeat, right? It was sort of very, you know, it's been very commonly called like dirty keto, right? It was like anything but avoid all the carbs at all costs. And very quickly I recognized that there was a difference in the results that we were getting between our men and our women. So, you know, and this is especially true in the husband-wife duos, you know, so we'd have like a husband and wife that would sign up and they would come in after a week and the guy would say, wow, doc, like, This is the best program. Like, I've lost like 25 pounds. Like, I feel great, you know. And then the woman would sort of be like sulky, you know, behind him being like, I don't know what the hell, but I've lost 2 pounds and I feel like shit, you know. Like, I feel like terrible. So, um, so I started really digging into how we can nuance the application of this to our female population. And there's a couple of tenets that really, um, were birthed from that. So the first thing is we started changing for most of our women, and this is true for the Betty Body— like, we talk about this in the Betty Body, and this is outlined in the Betty Body book in detail— but we want to be making sure that we have lots of green leafy vegetables in. So a vegetable, just in case anybody's not aware, is a carbohydrate, right? And I think people forget that. Like, they know, you know, meat is protein, they know olive oil is fat. Carbohydrate— like, vegetables are carbohydrates. And vegetables, in my opinion, are important for women because of the phytonutrients that we get, you know, especially when we talk about green leafy vegetables, in particular the Brassica family. So the cauliflowers, the broccolis, the bok choys, the Swiss chard, the arugula, all of these things. These also have a component in them called sulforaphanes. And without sort of getting too nerdy, so I lose all of your audience, you know, like the sulforaphanes are—

I like it, but we don't know about everybody else.

Yeah, so sulforaphanes, essentially, they amplify liver detoxification. So they are going to help augment, they're gonna help improve your liver's ability to take toxins, to take hormones, to change them into intermediates, and then to excrete them. Now, why this is important for women is if you are a woman who is 35 or older, you know, 35, let's say, to 50 years of age, what you may find in that time period is your, as your progesterone starts to lower, 'cause at about mid to late 30s, we start to see progesterone lowering, and if you do not have sufficient clearance of your estrogen through liver detoxification and your gut, 'cause this is how we actually get rid of estrogen, there leaves this inherent weakness for estrogen to hang around too long, let's say in the bowel, and it can be reabsorbed and reactivated. So now you have extra estrogen that you do not do not need. And the golden rule for estrogen is use it and then lose it, right? You want to use it, you want to use it for its trophic and anabolic properties, and then you want to get rid of it. Because if you are always under this anabolic, always under this growth, the influence of this growth hormone, then we have things that grow that shouldn't, like cysts in our breasts, right? So, um, so it's important for us to consider green leafy vegetables as women as a way to amp up our liver's ability to detoxify. So that's sort of one thing, is like this idea of consuming vegetables that have insoluble fiber in them. That's also going to help with your bowel movements. So the other thing, you know, I should mention is when you're eating foods that have a lot of insoluble fiber content, your body cannot actually break down the fiber. The carbon chain is too long, the starchy chain is too long, so it actually passes through undigested. And what happens is The fiber will attract water to it, so you're now creating, as the bowel itself, as the excrement is sort of being accumulated in the gut, it's making it softer so you can actually pass that bowel movement. And you're also, through the roughage, is also kind of cleaning things up, and you're having regular bowel movements, right, which is again one of the ways that we excrete our estrogen is through having regular BMs, regular bowel movements. And a regular bowel movement for most people should be a minimum of once a day, minimum, right? So you can have, you know, and there's an upper limit, like you shouldn't be going every time you go to the bathroom, right? But 1 to 3 times a day is a sufficient amount of clearance through the gut. So that's one hallmark. The other hallmark that's really important for women is this idea of resistant starches, and a lot of people, I've written articles on this on Medium, you know, I talk about it like a super nerd in the book, but resistant starches are also super important because they are going to, they're going to help deepen your state of ketosis. So again, resistant starch, it resists digestion, very similar to the insoluble fiber, and it is going to serve as a food source for your large— so the microbiome in the large intestine, it's going to serve as a food source for them, which is going to quell your cravings. This is one another thing that I I don't know if you've come across this or not, Cheryl, but I find that women, like 3 or 4 weeks into doing keto for the first time, they're like, "I don't know what the hell's going on, but all I want is a pizza. All I want is a burger. I want bread, I want rice, I want pasta." So giving yourself these resistant starches is going to help quell those cravings because those cravings are actually a distress signal from your microbiome. So we quell the cravings, we help with sleep, right? So the microbiome is going to, chow down on the resistant starch, release something called butyrate, which is a short-chain fatty acid. So now it's deepening your state of ketosis, which is like, yay, we want that. It's also gonna help with your sleep. It's also gonna help repair the digestive, the lining of the gut if you are someone who has digestive issues. And it's gonna get rid of your cravings. So it's sort of like this triple threat. It's like this win-win-win situation. You always win when you have these two elements in a ketogenic diet for women. I mean, there are other things, but those are sort of the two main goalposts that I like to set for females on a ketogenic diet for it to be sustainable. Like, you can do dirty keto for a month, right? And you'll lose a ton of weight, but it's not really in your best interest to consume bacon with a side of bacon on top of bacon with some bacon, right? Like, we want to be thinking about the phytonutrients and some of the broad variety of food that is available to us.

Right. People that may not be familiar with the term resistant starch yet until today, can you give some examples of, you know, whole food sources that— because I know you can get it, obviously you can actually get some of these resistant— because this is such a popular topic now, you can get it in a can. But can you give some people examples of real food sources where they would get resistant starch?

Sure. Yeah. So if you were to go to the grocer and buy green bananas, if you were to— just as an example, if you were to take some green bananas and just let them sit on your counter, A couple days later, they're a little less green, a bit more yellow, and then a couple days later still, they're yellow. And if you leave them too long, they turn brown, and that's when you have to make banana bread, right? So the green— the reason why we don't eat them when they're green is because they're not really sweet, right? They're sort of— they're hard, and, you know, they don't have a lot of sweetness to them. That's a resistant starch. So green bananas, their cousin plantains— so you can have green plantains as well. I actually like both of those in a powder form. So I will, and you can get this at any grocer at this point, as you said, like they're in tins now. So like green banana flour, green plantain flour. Another whole food example is a raw potato. So again, if you were to look at a raw potato, you know, not super appetizing to bite it, right? It's not really, it doesn't have the softness to it. And that's because the primary makeup of the starches in the potato is a resistant starch. And of course, as you cook it, you break down, like the heat is going to help cleave some of those starch bonds, and then it becomes more consumable. So, you know, when you eat hot potatoes, you know, that is a digestible starch. When you, you know, cold potatoes, even the ones that have been cooked and then cooled in the fridge, we actually know that there's this crystallization effect that happens if you take a cooked potato. Same thing with rice. If you cook rice and then you cool it in the fridge overnight, and then have it cold, there's that gel— the resistant starch has crystallized, and so it also acts as a resistant starch for you as well. So those would be whole food examples of it. I always like to take it— so you can get raw potato starch. If you're a baker, you know that you can easily find that. It's like you can help thicken stews with it. And then the green banana and the green plantain flour, as I mentioned as well. Awesome.

And thanks for that. So since you kind of talked about, you know, women through their various stages always being focused on gut health, that sort of applies to everybody. As a person myself that's getting older, and I know that some of— a lot of my audience is kind of the same age group that hitting that perimenopausal to menopausal stage. And you said that that was kind of your two cohorts. Could you maybe talk about how you found keto to work differently or not in, you know, us older ladies, and any tips, uh, or practical things that we should be aware of as we get older. Definitely having, you know, resistant starch and the liver support of the veggies, but anything else beyond that?

Yeah, I think one of the things we want to be considering for women who are close to menopause, uh, you know, in that sort of late 40s, early 50s, uh, age range And even if you're menopausal, one of the things that we know that happens physiologically is that you become more insulin resistant as you age. And that's not because you've done something wrong, that's just sort of what happens over time. The same is true for our muscles. They become more, there's more of this anabolic resistance that develops in the muscle. And what that means is that your muscles are more resistant to growing. So when we are thinking about how we can support our ladies who are sort of late 40s, early 50s, or 60s and 70s and beyond, we want to be considering that she tends to be more insulin resistant and more— her muscles have more anabolic resistance. I'll say that the more that I sort of dive into the literature and learn about insulin resistance, the more I realize I know nothing about— we learned in school, it was like this lock and key thing and the insulin was like something was gumming up the receptor Of course, that's far more, that is such a simplistic, almost pedestrian understanding of it. It's far more complex than that. However, what we wanna be thinking about for these ladies is we wanna be thinking about metabolically, how can we dispose of more glucose? Because when we have, what happens with insulin resistance essentially, and the most basic way that I can explain it, is that we have glucose in the bloodstream, so whether that was sourced from, like you had carbohydrate bolus or protein bolus or whatever, you have insulin that's elevated and your insulin is not able to get the glucose into the cell, 'cause that's her role. Insulin's role is, this is the fed state hormone, her role is to take the glucose, take the substrate, take the fatty acid, the amino acids, and put it into your cells so that your cells can create energy. Now, if your insulin at the same sort of titrate, at the same sort of level of secretion, is not getting that glucose in, what your pancreas does is she releases more insulin, right? Because we are going to try and like continue to increase the insulin levels until we can get that blood glucose at a normal level, because we know that blood glucose hanging around there without doing nothing, it can be fatal. So What we want to think about, uh, for our ladies that are a little older is how can we efficiently get rid of that glucose? And one of the answers lies in our muscles. So when we think about our liver, when we think about our, like, the biggest sort of gobblers, if you will, of glucose is your brain, you know, liver, and your muscles. But by weight, you know, by sheer volume, your muscles are the biggest sort of gobblers of glucose, if you will, because there's just more of them. So if you can continue to either, like, maintain your muscle mass or to ideally improve it as you age, you are going to be a much more efficient glucose disposal, disposal agent because there's just more muscle, right? There's more muscle around and you're gonna require more energy to maintain it. One of the things I talk about in the book, there's several chapters that are dedicated to this idea, is the idea of resistance training and when and how to resistance train in accordance with your menstrual cycle and if you're menopausal, how this changes. We want to be thinking about lifting heavy weights and I pinky promise you do not bulk, you do not turn into the Hulk. I was a figure competitor for a few years and I wanted to bulk. That was the goal. I was trying to bulk. Very, very difficult. And I was a natural athlete, so not like not taking any exogenous testosterone or any of those sort of anabolic steroids. And it's hard to do, like as a woman it's hard to do. So even if you want it like I did, you know, you got to work. You got to like work with an E, you got to work for it, you know what I mean? So my counsel to women is to lift weights and lift weights until your muscle is fatigued.

And there's a lot of different ways that we can bring the muscle to fatigue.

It can be with heavy heavy weights, low reps. It can be with lighter weights, higher reps. There's a lot, and I sort of outline all of that in the book. But that is one of the best strategies that I think perimenopausal and menopausal women can take in their, you know, in terms of the things that they do every day is lifting heavy stuff. Because we want to, as we age, the other thing that that confers is bone density, right? So as our muscles are supple and big and strong, so goes our bones. Our bones and our muscles are sisters, so what happens to one happens to the other. So if you have a lot of lean muscle, strong muscle that's flexible and pliable, you will also have dense bones that are flexible and pliable, versus if you are someone who is under-muscled and you are starting to move into like what I would— not just what I call, what others call sarcopenic obesity, where you have this fatty infiltration of the muscle, Now you are also going to have bones that are brittle and weak. And if you look at them, if you image them on X-ray, you'll see sort of this pockmark. It almost looks like teenage acne, you know, on the bone where we're seeing these like gaping holes through the bone, which makes it very brittle and very susceptible to fracture. And as a woman, we know that, well, this is true for men and women truly, but if you were to slip and fall, I can't tell you how many patients I've had over the 10 years that I was in practice ladies that slip and fell and the cognitive dementia that follows that. So it's often like if you fracture your hip, the rate of cognitive decline is also very— it's also very— they're related to each other.

Very interesting. I've never heard that one before. I'll have to delve into that a little bit more. But while I've got you on that particular subject, one of the things I've been delving into lately, again, as a person that's moving into that part of my life, and I do I'm not as good at resistance training as I should be, but I know that it's necessary. But, um, one of the things that I've been delving into recently is it appears that, number one, a lot of women have always been diet-focused, right? And a lot of the things they give up tend to be protein because they'll start eating a bunch of salads and stuff as they, you know, to try to lose weight or in an attempt to maintain. So one of the things that I have been looking at, um, to actually build muscle mass is to really make sure that you get the proper— not only the proper amount of protein, but maybe even a slightly higher level of protein as we get older to maintain. And also that you can just build muscle mass by your diet, possibly with protein. Um, any further thoughts on that or things that you've seen about that sort of idea?

Yeah, so I think that there's two places you can build muscle. One is in the gym and the other is in the kitchen. So you can be building muscle by prioritizing protein, and that's actually part of the the keto cycling plan. So we sort of have one week off where we're doing like keto, and then the other week is like protein and carb cycling. And what that does, of course, is you are gonna be driving something called muscle protein synthesis, which is just kind of what it sounds like. It's making new muscle protein. And you do that by a certain amino acid that starts this. It's called leucine. So leucine is very abundant in You'll find it across protein sources. It tends to be, there tends to be a better bang for your buck in whey and animal-derived proteins. You can get it with plant proteins, you just, you know, you gotta eat more. So there's also a caloric consideration there. So you can, if you're vegetarian or vegan, I get this question a lot, can I do keto if I'm vegetarian? The answer is yes, but you do have to be mindful for your calories. And you also have to be a bit of a chemist as well because I think you have to really be making sure that you are combining your proteins in such a way that you are getting all of your essential amino acids. Where, as I am a meat eater, I can kind of just eat a piece of steak and know that, like, it's kind of lazy. Like, it's like, I know I'm getting my full spectrum here and I'm good with that. But a vegetarian or a vegan really does have to make sure that she's getting the full spectrum of amino acids. So that's something else to consider as well. But you need typically 2 to 2.5 grams of leucine to start the process. So for a whey protein or an animal-derived protein, that might be like some, if it's a chicken breast or something, it might be like 20 to 25 grams of whey protein powder. For plant protein, I've done a little bit of research on this because I've had women come to me and say, "I'm vegetarian, I wanna do it this way, I don't wanna have animal products." You can get it done with soy protein, pea protein, but you just, you end up having more. So instead of having 20, like a scoop of 25 grams to get that, you know, 2.5 grams of leucine to start the process, you might need 40 grams or 45 grams depending on the source. So, you know, you want to be thinking about how much calories you're taking in. If weight loss is a concern, if something, if that's a goal for you, it may require that you that you restrict— you either restrict calories elsewhere or that you do have some animal proteins, right?

And I would say, just for myself, trying to, you know, focus on that optimal amount of protein to do, you know, to start that process, muscle protein synthesis, is that it can be difficult to eat that much protein in a day and still have it be really palatable because, you know, you kind of lose your appetite for it a little bit when you're eating a lot of protein. And so then it's kind of more difficult in the other direction, like are you consuming enough calories for the day? Which if you're trying to lose weight, that might not be as worrisome, um, which is probably why a lot of people are attracted to carnivore now, um, just because it kind of limits intake almost very naturally, much as does keto, just because you're very satiated.

Absolutely.

So for the book, I think you said you had— and I, I got these when I purchased the book— but you had some special little, um, things for people that support support the book and purchase it, can you talk a little bit more about what people get when they buy the Betty Body?

Yeah, so you can buy— first of all, you can buy the Betty Body anywhere in any online retailer, Barnes Noble, Amazon, like anywhere that you would buy books. And once you do, I would love for you to go to bettybodybook.com. So that's B-E-T-T-Y B-O-D-Y B-O-O-K dot com. And there I've put together a program for you. So we put together So you don't really have to think. Like, it's one thing to write a book and have all the science and all the stuff, but it's another thing to do it, right? So what's the how-to? So the how-to, we've done that for you. So we have done 4 weeks of a pure ketogenic diet. We've given you 4 weeks of keto cycling, so up and down with the protein. And we've also given you rehabilitation. We've also given you beginner workouts, intermediate, and advanced workouts because another thing that I hear is like, well, I want to start weightlifting, but my gym is closed right now and I don't know what to do. So these are all designed for home use with minimal equipment. Most of the time it's your own body weight. And if you are someone who is invested in a home gym, of course, we give you the options for weights and all of that. And then there's also rehab, which is something that I spent 16 years really diving deep into. So that's a big— a lot of people will say, I want to, you know, I want to resistance train, but I have this like niggling injury that doesn't— that, you know, sort of prevents me from doing it. So we've also included that in, in the, in the bonuses for the book as well.

Awesome. I'm so excited to try some of that stuff out. Um, the last thing I want to kind of go to is, as we talked about before, the point of this podcast is making things sustainable for people, right? So that we don't lose them. Because, you know, I'll hear a lot of people like, well, I tried it for a few weeks and it just didn't work for me. Not just women, just men too. They get tired of it or they don't. I think having somewhat of an understanding about why it's healthier for you. Again, going back to that, how knowing your why, um, can help people stay on it. But some of it is too, like, they don't know what to eat, or they just really have those cravings, or, um, you know, they want to have a pizza. And, and I try to tell them, like, hey, you know, you can still do that at some point. Um, but, you know, there is some benefit, I think, in becoming keto adapted at the beginning, um, being a little strict for a while, and then moving into the cycling So as you said before, you started out with a very traditional approach to keto when you were in clinic and then you kind of moved into this more cycling. Did you find that for people that, that sort of cycling aspect of it made it more sustainable over time? And just any other further tips for people about, you know, how to stay with it long term that you've discussed?

Absolutely. Yeah. It's hard to stay in ketosis all the time. You really do have to watch your carbohydrates very closely. And for some people, depending on their muscle mass and their genetics and their processing, it is easier for them to have more carbohydrates. But for other people, they get kicked out of ketosis with like 15 grams of carbohydrates. So the cycling definitely makes it a lot easier. It makes it a lot more sustainable. And it's also, it's hard to eat the same thing all the time. We just tire of it. So that's why the cycling where you're having a ketogenic week and then a week where you're increasing your protein and then another week where you go keto, it gives you that opportunity to have flexibility. And this is one of the things that I'm hoping to achieve with the book is that we don't have to— it's not only just one way. You know, there's many roads that lead to Rome. Like, if you want to lose weight, there are many ways to do that. This is one of those options. And what I have found with, you know, implementing this with thousands of women at this point is that it is a very easy thing for most women to do over the long term. So The tips I would offer is, I would encourage anyone if they are looking to try it, like you can even just, if you don't wanna invest in the book, if that seems like too big of an investment at this point, just check out my podcast and think about some of the things that I've talked about there. I talk a lot about keto cycling on that podcast. And then, I mean, I would just, the tip I have is just try it. One of the things that we have to, learn to be a little bit easier with on ourselves is this flexibility. It's not always like, I have to do it, and if it doesn't work, like, I've wasted my time. Like, you've actually— if something doesn't work for you, what you've actually gained is a lot of information, right? You've gained a lot of information. Why it didn't work. Maybe there's a particular— maybe that at that particular time in your life, there was a lot of stress that you weren't able to, you know, commit to it. Or maybe the diet didn't adapt enough to you. So I think that I would love for people to get comfortable with the idea of, um, not— I mean, failure has a negative connotation to it, but I think that the more we try things and the more we allow ourselves to play, the more that we discover, uh, who it is that we are and what it is that we need. I think that so often we're just so stiff and we don't want to be beginners and we just want to be the expert. We want to know everything. And is it going to work? I need the guarantee. You know, and that, you know, I wish life would work like that, but you know, you just got to try. So, you know, you know, pinky promise, hopefully, uh, you'll, you'll try this book, you'll try my protocol, and it'll work for you. And I would love to hear, uh, love to hear your success stories.

Yeah, I love it too. And I hope that we get many people trying this because I think this approach, it just makes, it makes logical sense. But makes logical sense to me because I've been doing this now for 5 years at this point. And you know, I couldn't have done it that long if I didn't have times where I played with different things or change things up or allowed myself to, you know, get kicked out of ketosis. Like, who cares? And to be fair, I don't have diabetes. I have a very, really robust metabolism, so I don't have the same issues as other people do. But you only need to know that by experimenting for yourself, right? Um, so I think that's wonderful advice, Stephanie. So to end up here, I would just like for you to share all of the places that people can find you. You mentioned the book is pretty much available everywhere at point, but where do people find you online? Where can they hear more from you? You mentioned your podcast. Tell us all of the things.

Sure. Yeah, so my podcast is called Better with Dr. Stephanie. So every week we have interviews with thought leaders. I have a sort of a mini show on there called Geeky Magic where I'm just like talking about something that's really, you know, important, whether it's metabolism, body composition, you know, fat loss, whatever it is. So Better with Dr. Stephanie is a pod. You can find— I'm pretty active on Instagram, so you can find me at Dr. Stephanie Estima. That's, um, D-R-S-T-E-P-H-A-N-I-E-E-S-T-I-M-A. And then the book, bettybodybook.com, would be where you can find all of my programming and more information about the book.

Fantastic. Well, thank you again so much for your time and sharing all of your knowledge with us today, and I appreciate it so much.

Thank you so much. It's been a pleasure.