Escaping Metabolic Mayhem in Perimenopause with Dr. Stephanie Estima

Hey JJ Here.

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If you are 35 plus and started to notice that things are just going a little wonky, maybe you're starting to gain weight around your midsection, you walk into a room, don't have a clue why, et cetera, you know all the things we talk about as you start to hit into perimenopause or even as you're now in postmenopausal. This show today is for you. I've got Dr. Stephanie Estima back with me today. Hopefully you've listened to her podcast Better, which is an amazing podcast. One of my weekly listen to list. She's got 4 million downloads and counting. She's a world expert on improving lifespan, healthspan and high performance through her understanding of both neuroscience and brain function, metabolism, nutrition and exercise fizz and human optimization. Why I love chatting with her so much and today we are going deep into really what happens as we start to make this transition, but more importantly how we can navigate it successfully. And yes you can navigate it successfully. Dr. Stephanie has helped tens of thousands of patients and clients up level their health and she is all over the place with her best selling book, her speaking her social accounts, her medium, so be sure to check her out. I'm going to put all of this in the show notes along with the lab list that she gave you so you'll know not only which labs you should be looking at, but how to interpret them. What are the ideal ranges that will be@jjvirgin.com Dr. Stephanie and I will be right back with Dr. Stephanie. Stay with me.

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Okay, real talk.

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Dr. Stephanie Estima it's about time you got back on this show.

I am so tickled to be here again. I miss you. I'm so happy that we're doing this.

I know. Thank you for like making the time because we are going to dig into everything perimenopause. Probably talk a little post too. I've got to give a shout out for your podcast Better as well because this is definitely one that you will want to tune into because you first of all geek out on all the science but really get into hormones, Perry post, weightlifting. All the stuff that I think is the most important stuff on the planet and I'm fascinated By it.

Thank you. That is high praise from you. I appreciate it. It's a labor of love. It's my most favorite parts of my work, actually, is preparing for and recording the podcast.

Yeah, it's super fun. And I think the most fun part of podcasts is getting to have amazing conversations, which we're going to do. And so let's dig in to all of this. I think the last time we talked, gosh, I'm trying to think it was probably talking more on keto and all of that. So you've been really diving into peri. I'm sure part of it is because of your own life journey, right?

Yeah. I mean, I'm 45, so I'm in perimenopause by definition. And I think the last time we were here, we were talking about ways for women to optimize their cycle, you know, in their fertile years. And certainly that includes part of perimenopause. But I think one of the big pieces of feedback that I've had in developing sort of more cyclical living as, you know, eat and train and sleep and recover in attune with your cycle, is the perimenopausal. And menopausal women are like, hey, I got an irregular cycle over here, or, hey, I don't have a cycle. And I love what you're saying, but how do I apply that in my own life? So naturally, the work has expanded from just the 28 day or the 29 and a half day cycle to more broadly, including what are some of the changes that happen in perimenopause? There's different, we'll say, portals that we pass through on our way to menopause, and that includes changes in the cycle. And I think for a long time women were just told, oh, it's aging. This is like nothing can be done about it. And there's so much variability and there's not a lot of necessarily support in sort of, we'll call it mainstream ways. A lot of the podcasts, as you mentioned, we focus on talking about some of the different stages of perimenopause and what are some of the things that we can do not to stop it. Because if there's one thing you take away from our conversation today, perimenopause and menopause, they're not diseases. They are a natural function of aging. And I think that we can maybe shift our paradigm to thinking about how we can age well versus not aging at all. Like, we're all aging, it's all happening. But how can we do it in the best way possible because we have women who are 40, 50, 60, 70. We are well lived women. We have something to say, we have experiences to draw on, we have wisdom that we can share either with our daughters or the women that are coming after us and all the men that love them. Right. So I think there's a lot that we can do for the perimenopausal and menopausal population.

Amen to all of that. I've always been bothered by the anti aging term because doesn't that mean you just died?

Yeah. What a privilege to age, right? Like there's so many people that don't have that, so.

Exactly. I look at some of the women I admire and they are in their 70s and 80s and crushing it. And so I've reframed aging to be powerful aging because as you look at the research around muscle loss, everyone's talking about muscle loss, but you lose more strength and you lose the most power. So how do we age powerfully and how do we as women? Because I think for a long time women shied away from being powerful. And it's like all of a sudden they're like, oh, I just turned 40. I just, for me it was 50. At 50, I was like, oh, now I'm going to just do whatever the heck I want. Like a whole bunch of stuff changed. Let's start with the things that start to change. You mentioned the portals. I talk about it like you're out. I can paddleboard outside of my house now that I live in Tampa. And some days it's really calm and then you turn the corner and the wind blows and all of a sudden it's bumpy. And then it goes calm again and then out of nowhere it's bumpy. And that was what it felt like to me. Navigating this perimenopause thing was like bumpy. Not bumpy, not bumpy. And then all of a sudden it's calm on the other side. So what are all the things that start to shift for women?

Oh yeah, there's quite a few. One of the most obvious changes that a lot of women will talk about are changes in their cycle. Typically what we see initially is the cycle tends to shorten. If you've always been like a 28 day girl, you know, like your period comes every 28 days or every 29 days, or 30, whatever the number is, you'll start to see that you shave off a couple days instead of being 28. Maybe it's coming every 25. You know what have you, or maybe it becomes a little bit irregular. So the first thing that we see is kind of a contraction of the cycle length and then followed by an elongation of it, so around sort of 45, 46, 47, sort of right where I am, we start to see that contraction and then we start to see that expansion. So instead of being like 25, some women who are like bleeding every 21 days, like, I feel like I'm constantly on my period. And then you skip a month, you might bleed for a much longer period of time, which can, you know, instead of the five days, you might skip a month and then bleed for seven, eight, nine days, which can be very scary for some women. If you haven't had anybody tell you, hey, this is what's happening. And this is why I love that we're having this conversation, because any doctor, any coach worth their salt, should be able to predict your future for you so that when you get there, you don't misinterpret your experience as being abnormal. So contraction initially and then an elongation in terms of our cycle, in terms of metabolic, let's say, and general physiological changes. One of the things that happens just as a natural function of aging, if you're not careful, and I know that you talk a lot about on this podcast, muscle building and fitness, is that we start to become more insulin resistant, and that is partially due to a loss of muscle mass. So if you are not strategic about it, you can start losing up to 1% per year of your total muscle mass. You will also start to lose, at a much faster rate, your speed. So this is another area that I'm very interested in, is speed loss. And this is a very scary number. It can be up to 8% per year. So you can be losing 8% of your explosive power or that burst kind of movement through loss of type 2 muscle fibers. So we typically will see a loss of type 2a and type 2b muscle fibers as we age as well. So we are changing. If we're not being strategic, we are becoming more insulin insensitive. So when we have things like carbohydrates, the pancreas has to work a lot harder. So there's a bigger output, let's say, of insulin to try and get the glucose. We know when you eat carbohydrates, we cleave the carbon bonds, we eventually get glucose. Glucose is moved into the cell. This is. I know I'm speaking to the choir here. You know this. But for your listeners who maybe need.

A. I love how you're breaking it down simply. I think it's so critical for people just to kind of hear it in different ways. So I love that you're saying that and especially hammering the insulin piece. And just one quick thing I'd love you address as you're doing this because you hear so often, oh, but your metabolism doesn't change. It's the insulin resistance piece that's gonna create the problem with fat storage at this time, along with estrogen starting to do a weird dive.

The thing that's interesting about the insulin resistance is that to your point, the body has to work harder to get the energy, like the, or the substrate, the precursor to energy in the cell so that you can make energy like. The reason why you and I are talking right now is because our bodies are able to bring in glucose into some of the muscles of our mouth and our brain for us to be able to, for me to be moving my hands a little bit erratically. If you're watching this on video, you know, so there's, there's ATP or energy being created all the time. But when we have high insulin, this is actually why we see on labs for women, we start to see lipids start to change in our 40s and 50s as well, because we are starting to see higher levels of insulin output because the pancreas now is working much harder to bring the glucose into the cell. But now that means systemically, like throughout the body, all of the organs, tissues, glands are being exposed to a higher level of insulin. And when we hone in on the liver, this is actually where this becomes very problematic because when the liver is exposed to high levels of insulin, we are going to now start seeing an increased output of, I don't like to call them bad cholesterol, but just for the layperson, we start to see an increased output of something called VLDLs, which is very low density lipoproteins. LDLs. VLDLs are often called like bad cholesterol. It's not bad cholesterol. It's just the carrier protein is more susceptible to oxidation. So in the presence of oxygen, it can go awry, we'll say it that way. And then you're also going to get more triglycerides spilling out into the blood. A lot of women who've had pristine labs their whole life in 20s and their 30s, cholesterol levels are fine. All of a sudden, their triglyceride number starts creeping up. Their LDLs, VLDLs. If the, if the doc is testing VLDLs we start to see those increasing total cholesterol starts to worsen as well, without actually doing anything different. Right. They're still eating the same and training the same way, let's say that they've been doing in their 20s and 30s. But now we're starting to see this shift because of this insulin resistance. And the one last piece I'll tie into this insulin resistance piece, I know you've talked about this on the show before, is that it actually starts in the muscle. So insulin resistance starts initially in the muscle, and it usually doesn't just start in our 40s. This is a 10, 20 year process where we're seeing women in their 20s and 30s without any symptoms. So not obese, no weight redistribution, nothing like that. Starting to see insulin resistance at the level of the muscle. And no shocker in terms of what the treatment for that would be is resistance training. Right. It's actually working the muscle so that it becomes sensitized to insulin. So that's kind of like a quick and dirty what happens metabolically speaking, and then also functionally as well. So we're losing speed, we're losing strength, we're losing power, we're losing some of those type 2 muscle fibers that are trained. When we're resistance training, we're training up those two A and B fibers. So it becomes orders of magnitude more important for a woman in her 40s, 50s, 60s to be resistance training. Like, if you were like me, you were the cardio bunny. Like, I was the step queen. I did step, I did tai bow, I did all. That's how I taught. You know, I taught my way through school. I was a step instructor, high, low instructor, cardio bunny. For those of you that sort of grew up in that 80s, 90s era of the step. I mean, I still love step. Actually, I still do step. I have a step at home.

But you do step aerobics.

I love, I love it. It's so much fun.

I will tell you something very funny early on because I was pre all of this now. When I was in high school, I worked out with the football team in the gym doing weights. I was the only girl in the gym with the guys.

But when I went to my arms, like, that's why we.

And literally I've always lifted weights. So I taught calisthenics in high school because we had jazzercise. That was what was. We had jazzercise. I taught calisthenics. But I wanted to be stronger for everything I was doing. But when I went off to graduate school, we Were taught do not let people lift weights until they lose the weight. Oh my gosh. Could you say a more wrong statement than that? I'm like, but if you lift the weights, you'll lose the fat. Like so you gotta lift the weight. So it was very clear to me as a trainer quickly that if I wanted to get paid and make money, I had to get results. And if I wanted to get results, it wasn't by doing cardio, it was by doing resistance training. But one of the things I used to do, and you'll look at this and go head smack, is I had benches built for clients and I had them doing different types of step up moves, et cetera, on the benches. And then I got surgical tubing from my doctor clients so they could use those. Never dawned on me back then. I was like, oh, you could actually do a class on this? And you could, you can imagine. I was like, oh, damn. But here's the important thing. If you didn't start at 16 lifting weights with the high school football players, it's not too late to start. And I think it's important to distinguish the fast twitch. And you know, they call it fast and slow twitch, but it's really kind of a misnomer. But we do have these two different types of muscle fibers. One's really to let you do all the walking and slow moves all throughout the day. The one we lose is not that, it's the other one. And so if you're doing long slow distance cardio and you're doing like say some pilates and yoga, you're not gonna really, unless you're doing some super hard yoga, you're probably not using those fast twitch. And if you don't lose them, use em, you lose them. So I'm glad that you brought that up. You want to do powerful aging. The fastest thing you could do was resistance training. And I love the post that you do showing what you're doing in the gym. It's fantastic.

Oh, thank you.

So we will link to those. They're great.

Oh, I really appreciate that. I think a lot of people are always like, so yeah, you lift, but what do you do? And it's like, well, it's kind of like same squat, different shirt. Like I kind of do the same thing over and over again. But I do think that it's important to sort of show your work kind of thing. Like, this is the type of back stuff that I do. This is the type of squats that I do. Like, squatting is at least for me, a Very technically difficult move. So I'm constantly trying to tweak my form. And of course, with my background being a chiropractor, like form is everything. Like, I am trying to avoid injury at all costs because you just cannot afford to be injured, I think in your 40s and 50s, because the length of time that it takes you to sort of get back into it, like that rate of loss that we were talking about, you really want to try to avoid.

So what happens with cortisol? During this time we talked about insulin and I just wanna do a shout out. I know you're gonna give everyone your lab list and what labs they should be taking and why, which I'm super excited about. And that will be@jjvirgin.com drstephanie and also in the show notes. You'll wanna grab that. I'd love you to talk about cortisol. But also I would imagine on that list you have fasting insulin. And I think it's such a mistake. Like you look at most lab tests people will bring to you, they don't have fasting insulin. They're checking a hemoglobin A1C and a blood sugar, but those are lagging indicators. So before we get into cortisol, just talk about why people should be looking at fasting insulin. I don't know if you're doing homa, IR or TGHDL ratios, but what you can see to show this early insulin resistance. Because by the time blood sugar's high, like that ship has been out there sailing for a while.

To your point, often your blood sugar actually might be normal for a long time because of elevated insulin levels. So you could be getting a fasting blood glucose test, let's say, like your doctor might order that and your blood glucose might be totally normal, but it's because your insulin output is so high that it's driving the blood glucose into the cell and it's sort of overcorrecting for what would otherwise be an abnormal level. So, yeah, I always think you should be looking at fasting blood glucose. I do think that's a good fasted in the morning. In the handout, we also talk about times of the day, like best times of the day to sort of get your lab work done. And then for women who are cycling best times of the month, let's say to look at estrogen and progesterone and those kinds of things. But for insulin, you also want to pair your fasting blood glucose. You also want to be getting insulin as well. So there is quite a Bit of bio individuality, like with the clients that I've worked with. I will say that I typically like a bit of a tighter level than what's considered normal. Up to sort of 20 is often considered normal by sort of allopathic, let's say. Holy shit. Yeah, I know. I like five to seven. If you can get between five to seven, I'm happy with that. And the thing with labs that's so annoying is what's considered normal actually changes by the area that you live in. Right. So they're. They're using sort of normal for the population, like how you compare to the population in the geographical area that you live in. So in Tampa, the standard deviation, one or two standard deviations, might be very different than Toronto, which is where I am. So you'll see labs kind of like throughout the country or really geographically change based on the population that's there. So I sort of get rid of all of that in the handout. And it's like this is the number that you really should be aiming for. We want insulin relatively low, especially if it's fasted. Like, you shouldn't necessarily. I mean, there's. There are some outliers. There are some conditions that for every rule, there's always an. There's always an exception, but insulin generally should be low. The cortisol piece that you mentioned, I think is also very interesting for women in their 40s, because we sort of reach this point. You know, you mentioned it, what you said. When I turned 50, I was just like, I'm just gonna do what I want. And there's this interesting, we'll say, environmental pressure that happens for women in their 40s and 50s and 60s, really, where we start to see our parents age. Right. So there's more care often. And women, you know, the primary caregivers often. Right. So if you have a sick father or a sick mother or someone who raised you, let's say, and they're beginning to age, it's very likely that you're going to be taking them to their doctor's appointment and making sure that their medications are, you know, and advocating for them and going to visit them to make sure that they're okay. So we have this sort of pressure from above, let's say, where we start to see this stressor of our age. And then, you know, we're seeing our parents age. You know, we're faced with our own mortality. So there's sort of that pressure from above. And then we also have sort of pressure from below, because in your 40s and 50s, if you've chosen to have children, you're going to have children who are teenagers. And there's a whole host of. I personally think that's when parenting starts, is when the child turns 13, 14. That's when the real parenting, like, you're up at night, are they coming home? You know, they're 16, 17, they're clubbing or whatever. And so there's this pressure from below. And then there's a lot of times you often see women early 40s. We often see a lot of divorces happen at that time. Right. So there's all of these different things that happen at the same time. There's pressure from above. There's changes in maybe family status or relationships, and then there's pressure from below raising these children, which can put us in this hypercortisolemic state. We'll say, like, it's high cortisol output all the time. And that is going to affect all the things that we've talked about up until this point. It's going to affect your menstrual cycle. You're not going to cycle the way that you were, because cortisol is going to affect your ability to produce sex hormones, which are already starting to dwindle in our 40s and 50s. And then it's also going to change your metabolism as well. So if you are always in this state of hypercortisolemia, cortisol's role is to actually pulls the blood glucose in the blood so we can throw it into the muscles for fight or flight. Right. So there's this, like, battle, if you will, between insulin and cortisol, where insulin's trying to get the glucose into the cell. Cortisol's like, hey, wait a minute, we have an emergency here. We need to, like, run away from this bear or whatever, the proverbial tiger. I need to keep blood glucose available for the muscles in case we need to fight or flight. And so you have this sort of battle that's happening, and when you have this, what I see over sort of a prolonged period of time is where the cortisol and the insulin are opponents. Eventually we start to actually see them rise and fall together. Initially, they're sort of pulling at each other, and then as insulin rises, we see cortisol rising, and then we just have. We'll just call it metabolic mayhem. Like, nothing is working the way that it should. Cortisol affects every aspect of our life. And so I love what you said about when I'm 50. You know, when I turned 50, I just said, like, I'm going to really do my own thing. I think that there's this kind of energetic shift for women. You know, I sort of called it a portal. In our 40s and 50s, I almost feel like menopause is this ability to come home. We've been serving our kids, our bosses. You know, we've been serving all these people our whole lives. And there's this point where we're like, I kind of want to do my own thing now. Like, I kind of want to take that pottery class. I want to travel. I want to learn this language. I want to learn squash or whatever. And you start to do the things that actually bring you joy. There's that opportunity to do that anyway, because if you don't, what's the point? What's the point? And let's. No one's going to give you a medal. I just want to tell. If you are miserable for your whole life and you're bitter and resentful, no one's gonna be like, good for you. You served other people, and you're not getting a medal, so you might as well. Yeah, I mean, might sound a bit rude, but you're never gonna get a medal for it, so you might as well do what you want anyway. Life is both too long and too short to not be doing what you love.

Amen to all of that. And so hopefully you don't have to wait till 50. When the light bulb went on for me on that thing, I still look back on what was going on in my 40s and going, how the heck did I even get through that? Holy smokes. So we've talked about the changes going on. Let's talk about how to best navigate the changes, because there are definitely things. And I think that I'm seeing more and more out there now that we are talking about this, which makes me super excited, because it used to just be. I remember sitting in the pool at Palm Desert Country Club listening to these women. I was watching my kids play, listening to these women in a group talk, and they were talking about going through menopause. And one of them said, yeah, my doctor gave me Prozac and put me on the pill. And that was a conversation. And I'm like, holy smokes. I feel so fortunate that I was able to see what was going on because I'd worked with so many clients. And then I had, basically my 50th birthday party was me and Dr. Sarah Gottfried and Dr. Jen Landa and Dr. Ana Kabaya. It was like, me and a Bunch of gynecologists. So I was like, totally dialed in on all my hormones from the get go. But there are definitely ways to navigate this and make this the best time of your life. And that's the message I really would love people to hear, is this does not have to be like this complete, crazy, chaotic hell. It can actually be amazing. And the other side is fantastic. Holy smokes. I would have gotten here faster had I known. But you don't want to do that either. All right, so how do we navigate it?

I think there's a couple ways. We've mentioned one already, which is resistance training. So you can't do in your 20s. Like, what worked in your 20s in the 20s is not going to work in your 40s. So I think it is very important to be training for women, as I was saying, who grew up with me with the Taebo and the Jazzercise and all of that. We'll just start by dispelling the myth that you're not going to get bulky by training. If you think that or someone has told you that, I will quote Lane Norton. It's a really funny saying. He says, you know, lifting weights thinking that you're going to get bulky is equivalent to, like, driving a car and thinking that you're going to be a NASCAR driver.

Right.

He is pretty funny with some of this.

Yeah. I mean, he's. He can be controversial. Yeah, he can be controversial, but he's got some good things to say. I like ladies a good guy. This episode is brought to you by McAfee. I got a message that our flight was canceled, but they can put us on another flight.

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You to suspicious texts, emails, and deep fake videos. Learn more@mcafee.com online protection. So I think that's something to think about for women, particularly if you're starting weight training. 40s, 50s, 60s, it doesn't matter what age you start weight training. It is very difficult for a woman to put on a lot of weight very easily. For the majority of us, there are going to be outliers. Of course there's going to be women who are maybe, let's say more androgen dominant who have this ability, who've always had, let's say a six pack and have always been very kind of ripped with low levels of body fat, but for like 98% of us, myself included in that cohort. It's very difficult. Like, you have to work, so don't be afraid of lifting heavy. I would say resistance training. If you have the ability to hire a trainer or someone who. If you feel sort of intimidated by the gym or you don't know how to move around it, I would say find a trainer, hire them for a couple of sessions, get them to take you to the machines, get them to take you to the dumbbells, kettlebells, the weight area. It's not just for men. Start there. I often talk about women who are just starting. I get asked this a lot. It's like, should I start my upper body or my lower body? I think both are very important in terms of when we think about aging. Well, I would weight the lower body slightly heavier than the upper body because we want to think about having strong bones and ligaments in the event of a fall. Right. So one of the big things that takes out women primarily, you know, if you are fragile, is fragile, brittle bones. And part of that comes from not having the muscles to support them. So if you, let's say, trip or fall on ice in the wintertime or something, or you just trip on your carpet in your home, let's say you want to be able to withstand that fall. And the way to sort of prevent that is to have dense, strong bones, which comes from training. And that's going to primarily come from training the lower body. So we have lots of big muscles in the leg. We have the glutes, we have the quads, we have the hamstrings. So I would start there, give some.

Examples of a couple lower body moves.

So my favorite is a hip thrust, which is basically, you're sitting on the floor and you're coming up into a bridge, essentially. So you might have your back supported on, like, a soft platform. Or some gyms actually have hip thruster machines now, where you're coming up and you're squeezing the butt at the top. This is one of my favorite exercises for glutes in particular, which are major hip extensors. And I love training the glutes specifically for that reason, because they are hip abductors, meaning that they move the legs out, like, away from the midline, and they extend the leg, which are two movements that we don't actually get a lot of in everyday life. Unless if you're sidestepping, you're walking, you know, you're walking side to side or you're walking backwards, like most of us don't do that. So I would say hip extension, very important. I was asked this question last week. If there was one lower body exercise, if you could only do one, it would probably be a squat. Because the squat, as I mentioned, it works every single muscle. So it works the quads, it works the hamstrings. You know, you have to turn the legs out as you're coming up. So you're getting, like, the calf working. You have ankle mobility. That's really important. And you're getting the glutes.

I think that if we can think about, we go to the gym or we work out to get better at life, not to get better at going to the gym. And in life, a squat is like, one of the most functional things. If you cannot squat, you are not gonna be able to get off the toilet. You know, you are not gonna be able to get off the ground. I totally agree with you on a squat. Plus, you're loading your spine. So you're helping your spine and your hips with bone mineral density. Like, I love that. And I love that you mentioned that, because I think it's really important for women to think you're doing this to avoid the injuries out there in life. Like, yes, you don't want to get injured at the gym, but the reality is that's not where most of us get injured.

It's very difficult. You have to have years of, like, an overuse injury. Are you not lifting properly? Which can totally be avoided by getting someone further along the path, maybe a personal trainer or a friend who is really knowledgeable, let's say, to show you a kind of around the gym, you know, affordability, if it's available to you. Like, a couple of sessions with a trainer, I think would be awesome for most women because then it just gets rid of that mystery around, like, the weight room, there's, like, guys in tank tops, and they're making really. They're grunting, and it can feel like intimidating if you're not used to it. So I think that's money well invested. It's money well spent.

Great. So we talked lower body and specifically, like, let's get your squat on. What about upper body?

Yeah, upper body is also very important. So just before we jump to upper body, I just also want to say you mentioned being able to get up off the floor. If you have ever seen a toddler, they are like a marvel of biomechanics because they can get into a squat and just stay there. And, like, you know, they're. Maybe they're observing an ant or something, or bug or whatever on the floor and they can just stay there for hours. So I think that we can sort of return back to that. We lose it because we sit in school and we sit at our desks and things like that.

What was crazy, I lived in Japan for a while and when I first got there, I witnessed all of these people waiting for the bus. And you know how they were waiting for the bus in a deep squat.

It's amazing.

It was like an 80 year old waiting for the bus in a deep squat. And I just was in Korea. And what was crazy in Korea is that we were staying at these hotels with these amazing gyms that were membership gyms, like the JW Marriott there had greatest gym I've ever seen. It actually had that hip thruster machine. Everyone had gym uniforms on, like PE outfits. And the average age in the gym was about 70. I never saw an overweight person the whole time I was in Korea. Tim saw one. Yeah.

That's incredible.

Quite amazing how they prioritize staying fit. Note to us.

Note to the US and Canada.

Yeah.

Your overweight cousins to the north. The ability and like part of mastering a squat is actually ankle mobility. And ankle mobility is one of the biggest in that squat you were mentioning when they were waiting for the bus. And then that deep squat, that's what's being worked. I mean, there's other things, but ankle mobility, knee mobility, hip mobility, all those things are kind of being tested. You know, you're stretching out the calves and all those different things are happening when you're in that deep squat. So that's what I would say for. I just wanted to bring that up. You mentioned upper body. This is like the top of the hourglass. So the squats and the hip thrusts and the deadlifts and all that, that's like the lower half of the hourgl. I think I'm like Team Shoulder Boulder. Like, I'm looking at your arms, I'm like, I bow down to you, jj. I bow down to that mature, gorgeous muscle that you have there. But yeah, I think there's a couple things I like. So I used to do this in the clinic all the time. So I would test patients on how many pushups they could do. So on their toes, not on their knees, how many they could do. Most women could do maybe one, but with very bad form. And the other thing I like to look at and train is like pull ups. If you're not able to do a pull up, one of your goals should be to be able to lift your own body. Weight with your hands and then dead hangs. So how long you can actually hang off of a bar, which is testing your grip strength. So those are things I like to look at. And then back, like I'm a chiropractor. You need to have a nice strong back. You know, like a lot of the reason why we see those grannies that are sort of, you know, hunched over is so many years of sitting in a flexed position and the muscles are not actually able to hold the spine upright. So of course what happens is we have these forces that are now going through the front of the spine rather than the back, and then that denigrates and deteriorates the bone. So then we just naturally sort of start crunching forward. So I say like back workouts. Like, I typically like to work back twice as often as I work chest. Because in life I'm typically more contracted and flexed like I am right now sitting in a shortened position. So I like to counteract that with like, more back work. And then, of course, pull ups. I think every woman should be able to pull up their body weight at least once, but ideally more than that.

I'm so glad you mentioned pull ups. I am just fascinated with all the research that's now coming out. Everything from gait speed to grip strength. I remember reading something about grip strength and the people with the lowest grip strength have the highest all cause mortality, dying from diabetes. But then people were like, what should we do? Should we use those little hand grippers? I'm like, no, not the point.

You know, it's not strong hands. It's like, no, it's not. What comes with the strong hands? What comes with the strong hands are strong shoulders, backs, biceps, triceps, right? Yeah.

So pull ups are a huge one. And I think women naturally think, oh, no, I could never do a pull up. It's like, so if all you did was start with a hang and then start with a bent arm hang, and then you'll get the pull up and then you'll get more pull ups. That is so key. And the other one that I really love are bent over rows. Because I think about in the days when we used to get the groceries out of the car, which of course never happens really anymore. But like, think of the things you have to pick up off the floor. And ever since I heard Dr. Peter Attia talk about the centenarian decathlon, I've been like, okay, what do I want to be able to do at a hundred? I want to be able to pick a grandkid up off the floor. God willing, I have one. Someone needs to get into action here. Or a great grandkid memo to my children. I know. I was like, gosh, someone here. You know, my son Bryce is getting his PhD in math and he's like, math is my girlfriend. I'm like, oh, come on. But you think about those things you want to be able to do. And it's like, I certainly don't want to have to call someone to get off the toilet or get out of a low car. And you certainly want to be able to pick things off the floor. So you better be training for all of it now. So I love that you brought up all this. And again, I'm going to put in the show notes like, you can watch Dr. Stephanie do this. She really is doing this. And next time you're in Tampa, I literally just built out a gym to be able to do all this so that I can do videos with people. Cause I think how fun would that be? Battle ropes, the whole thing. Like, oh my gosh, self propelled treadmill.

Yeah.

Et cetera. So what about the food side of things?

Oh, this is a good one. Buckle up. All right. What I would say is the biggest change for women in their 40s, 50s, and 60s again and beyond is changing the way that we think about protein consumption. So there's three things I like to think about with protein consumption. The first is we want to think about thinking about our protein for perimenopausal menopausal women as an absolute number and not a percentage of total calories. So often we think about, oh, I'm doing like, if it's keto, I'll do 70% fat and 20% protein and 10. No, we're not going to do that. In perimenopause and menopause, we're going to say my target is going to be this amount. I'm going to have one gram of protein per ideal body weight. So let's say you wanna be, I don't know, I'm just gonna make a number up like 130 pounds. Your target then is gonna be 130 grams of protein. So you're gonna take that number and then you're gonna back everything else into it. So the protein target comes first and it's not a percentage of your total calories. It's an absolute number. And then everything else is built around it. That's the first thing. So let me give you an example of simple math that I can do on the fly. So I typically take in about 150 grams of protein, which is more than my ideal body weight. But I'm also lifting five times a week and I need more protein just as I'm aging. So 150 grams, you multiply that by four. Sorry, I'm going to scare people with math very quickly. Not your son who's doing the Ph.D. in math. So 150 by 4 gives you 600. Right. So I'm going to take 600 away from my total calories. And then whatever the fill is, I can do either higher fat if I like that or higher carb if I like that. It actually doesn't matter as long as the protein target is met. So that's the first thing. The second thing is timing of protein. So If I'm having 150 grams of protein, I'm not just gonna have that at breakfast.

I'd love to see you do that.

That's like, I'm gonna get like the meat sweats and be like, oh yeah, I know.

That's the funniest thing with protein. It's like you just go, try to eat that like 40 ounces of steak over there. Good luck.

Yeah, good luck too. Yeah. So you wanna think about separating, you wanna think about sort of dividing the timing of your protein over the course of the day. So 150, really easy example, that's probably why I follow it is like 50 grams per meal, right? So it's like 50 grams at breakfast, 50 grams at lunch, and then 50 grams at dinner, let's say. So you wanna think about timing the protein. So evenly spacing the protein over the course of the day and then the last piece around protein, which at the risk of being controversial, I will say not all protein is the same. Okay. So protein quality, protein sourcing matters. Animal proteins, whey proteins, even soy protein, which I'm actually a fan of for perimenopausal and menopausal women, has about a 95% absorption rate, meaning that what you're eating is what your body's able to extract. When we start looking at more plant based proteins, so like the rice and the pea and all these other sort of like non animal or soy based protein products, we start to see that the absorption rate there is much lower, like 60 to 70% absorption. So if you think you're getting let's say 20 grams of, let's say pea protein, your body's able to assimilate about 60 to 70% of that. So thinking about the quality of your protein source I think is really important. That doesn't mean that you can't do this, like if you're vegan or you're vegetarian. Although I strongly. I have thoughts about veganism, but I think if you are vegan or vegetarian, you can certainly get there with plant proteins. You just have to understand that the bioavailability of these protein sources are not the same. They're not the same as animal protein.

So now that was not controversial. That's just stating facts. And I think what's important here is.

You should see some of my posts on Instagram. The hate that I get when I mention that.

Yeah, here's the thing. This is just science. We're not reporting. This is not a religious debate. This is. Here's the reality when you look at protein in terms of absorption, digestibility and the balance of essential amino acids.

Yeah.

And here's the reality in these different pieces. I was doing a talk the other day and someone said, I'm a vegan and I want to be able to get the protein I need, which I'm right up there with protein requirements with you. And I don't want to use any supplements at all. Can I do it and how do I do it? And I go, I can't guide you on that because you're going to be so far over the mark in carbs.

It's like, I don't know, total calories or just total calories. Yeah, you're just going to be like.

Yeah, I don't know how to help you there. You know, it's like not to where you need to be. Maybe in your 20s, like when you don't need as much, but not now, can't help you. So I just think it's important for people to know that. And I think I heard Dr. Donald Lehman say this. He goes, if you want to do that, you just have to be a very good nutritional biochemist.

You really do. You really do need to be able to know about protein combining and all of that, which is.

Yeah, it's a lot of work.

It's a lot of work. The vegans that I've cared for, vegetarians, we often run into nutrient deficiencies. Like more often than not, it's that we have B vitamin depletion. We have like all these minerals and vitamins, taurine, carnitine.

It's hard enough to not have nutrient deficiencies as an omnivore. Then you.

With our soil and our agriculture already. Yeah, yeah, the soil's depleted and all of that is already so hard. And then you add this layer of veganism on it. Which I don't know if you ever had a conversation to chat with Rob Wolfe, but his book Sacred Cow and his co author, Diane, her last name is escaping me now. Anyway, they make a really good case for some of the ethical, economic and environmental sort of we'll say arguments that vegans often make and why some of them don't always hold up.

Yeah. So beyond eating protein, what are your other dietary recommendations?

I think that's the major one. I typically find that initially if you are someone who's looking to, let's say, lose weight, like a lot of women talk about weight redistribution. So whereas they may have had, let's say, more fat through their lower body all their life, now we start to see that weight redistribution kind of come through the belly area. I would say for a woman like that, I would probably put her transiently on a lower, like a slightly lower carbohydrate diet. But it doesn't need to be that way. And this is sort of where I've softened my view on carbs because I do think that carbs are important for mood, I think they're important for sleep. So we can restrict carbs initially to sort of get the ball rolling. But then as we're integrating, as you said, we're integrating the weight training early in her program, we're getting kind of low level activity, hopefully through the day, like she's going for walks with her dog or maybe she's gardening or whatever. Then we can start to add in sort of complex carbohydrates back. You know, last night it was my husband's birthday, we went out with the family, just went to the keg with the boys and you know, we had some cake. And it's like, I don't have cake often, but I had a bite of the cheesecake or whatever with a little candle on it. But I know that I had had a great workout this morning. Some of that extra carb fueled my workout. So I think initially kind of as a kickstart, I'll typically restrict carbs a little bit, but then we can kind of put them back in. And hopefully the mainstay of carbohydrates are going to be some of these complex carbohydrates, like, you know, plant forward. So I do like plants, I do like starchy, like potatoes, I like rice, like all those things on the plate for a woman, for sure.

Yeah. And I liked what you said about the fact that it's like protein is an absolute. I think this is very important for people to get. And then you manipulate carbs and fat based on what feels good. Those are your fuel. See how you do diets or tools and holy smokes. If we live in a world where we can't go out and have a bite of birthday cake or two, then we're doing something wrong.

The other nutritional piece, I'll say this is where I do draw a hard line. And I remember talking to Sarah about this on the show and she's like, you know, I'm like, I'm a bit of a softer line. And I'm like, I'm gonna be a hard ass here and say almost no alcohol. And a lot of women are like, okay, you lost me there. But I do like to restrict alcohol. The more I learn about alcohol's effect, not that I didn't know about it before, but I think as a 40 year old, I'm 45, I find that I have alcohol maybe once or twice a year. So I usually have it at Christmas. We didn't have any last night. We had water in our. We just, we had water with our steak.

Wild night at the keg.

Wild night. It was a wild night at the keg. Yeah. The cheesecake was the most interesting part of our meal. It was like side of cauliflower mash and my steak. Anyway, I feel like the alcohol can really. For women who are more susceptible coming back to that liver if we see sort of a derangement in our lipid profiles, et cetera. If a woman is consuming alcohol, let's say even if it's like a glass in the evening, like a nightcap with her husband, the problem with that is that one your liver is going to prioritize metabolizing the alcohol over everything else. And you know, when we typically drink, alcohol is usually in the evening, right very close to bed. And alcohol is basically just sugar water, right? With, you know, there's some ferments and whatever in there, but like it's basically sugar, liquid sugar you're messing up. Like when you're putting in a dense amount of nutrients into the body very late in the day, your body has to say, oh, okay, well, there's like all this energy coming in. We have to kind of rev up the system to be able to like process the alcohol piece, but also the calories that are coming in as well. So often the quality of sleep that a woman will have the night after. And if I'm being honest, it's like, I know at Christmas, like I don't sleep really well for two or three, three nights afterwards. And I'm a lightweight. So, like, a glass or two of wine really does affect quality of sleep. And sleep does become very important for recovery, rest. You know, we're thinking about building muscle. That's actually when our muscles are built, is like when we're not in the gym, when we're recovering at home. I do like to put strong holds around alcohol and restrict that as much as possible.

Yeah, you're definitely. If you're looking to burn fat, alcohol's definitely not gonna be your friend.

And I'm interesting enough without it. I don't. I don't need the alcohol to sort of be the, you know, to. To have fun with people. So I. I think maybe that's also a shift in mindset, too. Some people feel like it takes the edge off and they relax a little bit. It's like, you're perfect as you are. You don't need a drink of alcohol.

So I want to just remind everyone again about the lab list that you're giving everybody. Just let everyone know what's on it. It will be. Of course, you can check out the show notes, but it's also@jjburton.com drstephanie and all your other cool stuff will be there, too. Your podcast, insta, et cetera. But what will they get in the lab list?

So the labs are just, you know, one of the ways that I think you can be an active member in your own health and taking charge of your own health is actually having some data so that what you measure you can manage. So the lab download that I've created goes through. There's so many to list, I can't remember how many pages. It's like five or six pages of labs. So it's like full lipids. Thyroid, which is, you know, I know we didn't have a chance to talk about this, but thyroid is also another big, like, endocrine organ that we see a lot of women running into trouble with if they haven't already run into trouble. 20s, 30s, we tend to see the thyroid. Tend to see issues in our 40s and 50s. So full thyroid, sex hormones, when to take them, if you're still cycling, what time of the month, if you happen to know. Then we also look at things like fasting glucose and fasting insulin that we've talked about. Cortisol levels, basically everything we talked about insulin. But there's also IGF one there. So insulin, like growth factor, growth hormone as well. So there's all of these different parameters and sort of the ideal ranges, irrespective of geography. That you should be trying to fit into. And so what I want you to think about with labs is it's just if you've never done labs or you, you've sort of just relied on your doctor to sort of like, is it, yes, it's okay or not, not actually understanding the numbers to have a baseline, have a conversation with your primary healthcare provider and say, hey, these are some of the labs I'd like to look at. I know maybe we haven't done these in the past, but I'm in my 40s and I would like to sort of have a full compliment, like, I'd like to have a full visibility in terms of some of these different areas. If you get some resistance from your pcp, which sometimes can happen, particularly around the thyroid, I'm sure you, you've run into this before. People will refuse to test certain aspects of the thyroid. There's companies that you can order the test directly, they come to your home or they send you kits and you can send it off. And so you, you don't necessarily need to be beholden to the gatekeeper, let's say, in your local town, because they don't know anything about thyroid interpretation. This is just a guideline for you to create a baseline if you haven't been in the habit of taking your labs. I often recommend, at the very minimum, once a year, ideally once every six months, we're taking a look at our labs again to see how they're changing. And yeah, it's all in there with explanations and optimized values too.

Fabulous. Thank you so much for that and thank you so much for all of your time today. You are amazing. And we're not gonna wait like two or three years to get you back on again because just like you said, we have thyroid week still Unpack. We didn't even talk about supplements. So many more things. Come back soon.

I will absolutely come back soon. And you're going to be on my show soon as well. I can't wait for that conversation. Keep the conversation going.

Yay. All righty. Thank you, hun.

Thank you.

Be sure to join me next time for more tools, tips and techniques you can incorporate into everyday life to ensure you look and feel great and more importantly, that you're built to last.

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Hello, listeners, this is Anne Bogle, author, blogger and creator of the podcast what Should I Read next? Since 2016, I've been helping readers bring more joy and delight into their reading lives. Every week, I take all things books and reading with a guest and guide them in discovering their next read. They share three books they love, one book they don't, and what they've been reading lately, and I recommend three titles they may enjoy reading next. Guests have said our conversations are like therapy, troubleshooting issues that have plagued their reading lives for years and possibly the rest of their lives as well. And of course, recommending books that meet the moments. Whether they are looking for deep introspection to spur or encourage a life change or a frothy page turner to help them escape the stresses of work, school, everything, you'll learn something about yourself as a reader and you'll definitely walk away confident to choose your next read, with a whole list of new books and authors to try. So join us each Tuesday for what Should I Read Next? Subscribe now wherever you're listening to this podcast and visit our website what Should I read next podcast.com to find out more.