Women Are Not Small Men | Dr Stacy Sims

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23:00Not really. When we look at aging and looking at the scope of aging, most things are scaled in a linear fashion. And then when you get to the ages 40 to 60, we see a discernible effect of aging in both sexes, but it's more pronounced in women because in that period is a significant ovarian shutdown. So we're seeing this downturn of these ovarian hormones, which again, affects every point in the body. For men, we start to see a little bit of functionality decline, total body functionality decline, and you know, around 50, 55. And then we start to see a decrease in testosterone, which then exacerbates a lot of the functional decline.

23:40Dr. Michael Gervais:And functional means, I don't know, When I'm working out, I don't put on muscle or burn fat as easily as I once did. But maybe I need to adjust my methodologies to be more efficient with like, I know we'll get into it like HIIT training or sprinting or something like lifting heavy weights as opposed to a moderate sledge of zone two, whatever. Yeah, we'll get into that. Okay, so it's different for men and women, Jack. And for women during the perimenopause cycle, there's a hormonal flux. And we're talking about estrogen and progesterone. And somewhat testosterone as well. Right. So testosterone decreases as well.

24:19It's not associated with the ovarian function. But when we're under high states of stress, we see testosterone takes a dive. So we see a lot of natural levels dropping in women who are perimenopausal. And then people are like, but it's not associated with the ovarian shutdown, what's going on. It's because when you are so tired but wired all of the time from that sympathetic drive, your body's under a significant amount of stress. And it interrupts our natural pulses through the day or the 24-hour cycle. So testosterone starts to come blunted and drop off.

24:55Dr. Michael Gervais:Okay. And sleep is compromised. now you've got like a snake eating its tail because we need sleep. You've got a sleep issue that's coming on from the irritation, the agitation, the higher cortisol, the sweat. So there's a compounding effect that takes place when hormones change as well, which of course affects psychological and emotional slash behavioral outputs. Okay. Do you want to get into the hormonal changes and what actually is happening? Is that a value to you? Yeah. To explain? Sure. Yeah, please. Yeah. I always bring people back to puberty because everyone knows the teenage angst of kids growing up.

25:36And we see around age eight or nine, girls start to become a little bit more self-conscious and then boys start to become more aggressive. And this is when we start seeing what we call an epigenetic change from expression of sex hormones. So there isn't a lot of progesterone yet for our girls because they haven't started their menstrual cycle but we start to see these changes and we see the mood changes we see body comp changes we see interactions within society is different we see the efficacy is different at eight and nine yeah and it starts to progress and then when they talk about hitting the teens especially 13 that's a really significant point in time where you really do start to see all these changes is right on the cusp of girls starting the menstrual cycle and boys getting a boost of testosterone.

26:27So you have this really dichotic switch. So if we're talking about, we know all of these things that are happening in puberty, including body composition change, we get to the other end and perimenopause, we have about 10 years of the body winding down all the hormones that have been hitting every system of the body.

26:46Dr. Michael Gervais:Why do we wind those down? That's something no one really knows yet. It's 2026 and no one is really sure why women go through menopause. I heard a really, I heard a, it was a super thoughtful, non-scientific opining from somebody that, an opinion from somebody that I really have high regard for. And it was a conversation that two people were having about, they're both men that were like 55 and they're like, okay, let's talk about peptides. Let's talk about HRT, hormonal replacement therapy. Let's talk about like, and one of the folks in this conversation said, you ever think that we're supposed to not have this, all this testosterone?

27:31Dr. Michael Gervais:And the other two look like, get out of here. Right. It was like a kind of a moment, a banter. And he repeated, he's like, look, I don't know about you guys, but I want to be more sensitive. I want to be more connected. I don't want to be kind of in this rage hormone kind of alpha male thing. Like I want wisdom. I want to be more of who I'm supposed to be as a wise man than like this young kind of lion that's, or this old lion that's trying to be a young lion. I just, I really appreciate that. Again, there's no evidence. There's no real science there that we, that this conversation is pointing to.

28:09Dr. Michael Gervais:If you were philosophically going to think about that for women, what would that be? Well, I always work in the social cultural context of things, right? One of my colleagues is a really good sociologist. And so she's a sociologist in the female athlete space. So we work really closely together. So when I think about it, it's like, why do we have this drive to stay young, right? Why is it that we're now saying men, you need to use testosterone and women, you need to lean into menopause hormone therapy. and everyone should be on the peptide bandwagon and we want to live to be 150. But that is a social construction right there where there's these images that people need to be young to be successful.

28:55And we know that that's not true. We can look at other cultures. We look at like more of the Asian cultures and the wisdom comes with the elders. And there's no press really to stay young because it's not about you're no longer important. You are very important. We can look in the wild too, and we know I like the whale analogy. I'm sure people have heard whale analogy before. So whales also go through menopause. And then when the female whale that has gone through menopause, she becomes the one that chaperones and herds and oversees the entire group of whales. So there is different pockets within biology and within other cultures that don't have this press like western culture to stay young and viral and angry and and productive in the sense that we see it so if we're thinking about borrowing from other cultures it's more of that relaxed of now women are in other cultures like you know what i don't care i am me i have all these experiences and i can share my experiences with you and we can talk about what you're going through because i've already done it, so I can help you.

30:03But I feel like in, especially in the US, there isn't an eye to that, meaning that there isn't the want for women to share their experiences to the younger, but they'll share, like we'll share experiences in our own population group or our own age group, or we'll share what we did with someone who's older, but it doesn't seem to trickle down the other way.

30:23Dr. Michael Gervais:Yeah. I'm nodding my head to everything you're saying. I think that that idea, you're describing a wise woman. You're describing of wisdom. So let's get into like what happens when a woman goes through a perimenopausal cycle or experience. So if we're looking at how long perimenopause is, like I said, it could be up to 10 years. And we start to see early symptoms in our late thirties and how that develops for a lot of women in their late thirties is they might stop sleeping as well. They have changes in their appetite. They're putting on more body fat at a faster rate than what they ever have before.

31:02And there's a change in gut microbiome diversity. So we have a decrease in the gut bugs that allow us to stay thin for the most part and overgrowth of the phyla that really encourages the body to hold on to body fat. Why? Body's super stressed, High stress.

31:20Dr. Michael Gervais:Oh, so because of the stress, not the hormone. But also because of - I mean, cortisol is a hormone, right? Yeah, but also because of our sex hormones, we start to have a decrease in our sex hormones and the gut bugs that would unconjugate them. So what happens is your sex hormones are released in a pulse and they hit some of our target tissues in action. So they go to certain receptors in the body, but then there's still some that's circulating that didn't quite hit those receptors that they needed to. So they get shot to the liver where they're bound by sex hormone binding globulin. And so this little composition of sex hormone binding globulin and our sex hormones gets pushed into our intestines through bile.

31:58And then we have gut bugs that will unconjugate or release the sex hormones from the sex hormone binding globulin and shoot them back out to do a job.

32:06Dr. Michael Gervais:So you want your sex hormone binding globulins to be low in general? Yeah. Let's stay here. I know it's a super narrow thread, but what is a set of best practices to help that happen? I don't know. Neither do I. That's why I asked. I'm like, that's a good question. There isn't like, it's one of those things where you get your bloods tested and you follow over time. We do see that the more diverse your gut microbiome is, the better profile you have across the board. Yeah, to detangle or what did you call it? Deconjugate? Unconjugate. Unconjugate, great. New word for me, I like it. So that would be an interesting bit of research, men and women alike, I think.

32:45Dr. Michael Gervais:but that's a really nice one. Okay. Because we're chasing the increase in estrogen, progesterone, testosterone, but actually the thing that is not allowing it to be effective, we don't know much about. Correct. Right. Okay. Let's go back to the winding down. Some of the more important understanding so we can get to some maybe solutions or steps folks can take. Yeah. So we start seeing this wind down. And we see changes in brain and brain structure. And we see changes in blood lipids. All of a sudden, women who didn't have a problem with cholesterol all of a sudden have high low density lipoprotein or LDL and a high total cholesterol.

33:24And they're like, what's going on? Like, I don't, I haven't changed anything. It's the same. And we start to see changes in muscle mass. We start to see changes in bone density, soft tissue, soft tissue injuries come up all the time. People are like, why do I have plantar fascia? Why am I starting to get these calf niggles? Because our muscles are getting weaker, we lose power first. A lot of the mood and mood changes as well is part of the brain and the way the brain is changing. The decrease in our gut microbiome is also affecting how our body is producing neurotransmitters, especially dopamine and serotonin and melatonin.

34:02Dr. Michael Gervais:The feel good and the sleep good. Right. Right. And then unfortunately, right now, because of the way that most of us grew up who are in this 45 plus age group, is a social construct was you're starting to put on body fat. So you need to eat less and train more. Let's do calories in calories out, which is the opposite of what you should be doing. Because you're already putting on more body fat by the signal your body's highly stressed. And you start restricting calories, it's going to exacerbate it. So we see an increase in the rate of lean mass loss when people start really restricting calories and increasing their training load or their exercise load.

34:43So they get in what we call low energy availability state. It's a really prevalent and people don't realize how prevalent it is.

34:49Dr. Michael Gervais:Is there a difference between men and women on this piece? We're starting to see that low energy availability is becoming relatively rampant in men too. Can you talk about time-restricted feeding and eating? like the interval. Can you talk about that a bit and the difference between gender? Yeah. So if we're looking at what we call intermittent fasting versus time-restricted eating. So intermittent fasting is the trend to hold your fast or not eat from like 7 p.m. to noon the next day. So you're getting this really long period of time where your body is supposedly resting from digesting. We see from population research that when you break your fast late like that, you are effectively phase shifting your circadian rhythm, which is a bigger deal for women than men because women's circadian rhythm is a little bit shorter than men's.

35:40So we start to see this change or a shift in the way our body is normally pulsing its hormones.

35:46Dr. Michael Gervais:Wait, you're blowing my mind. This is what I was so excited to say with you. There's a difference between male and female circadian rhythm. Yeah. Yeah. So it's... That's a little bit of a mind bender for me. That's a really cool insight. So it makes sense, right? If you and your wife are watching TV at night and she's like, oh, I'm really tired. It's not o 'clock. You're like, what's going on? I'm not tired. It's because her melatonin is starting to rise and she hits a first wave peak about nine and the second one's at 11. Yours is at 10 and at 12. So there's about an hour difference. I see. So when you're like, oh, my wife gets out of bed really early and gets out, it's because her body is ready to go.

36:28She's a little bit off kilter than what you are because of the circadian rhythm change.

36:33Dr. Michael Gervais:Very cool insight. And so when we're starting to look at the way that we change our circadian rhythm, it's through light and dark exposure and food. So if you're getting up and although you're seeing the light, you're still not eating. Your body's like, whoa, what's going on? and we start to see with women specifically we have a higher cortisol peak in the morning which is our cortisol awakening response we both men and women have that to wake up yeah so you can do some good work with a little bit of cortisol in your system right exactly it's not the evil hormone that everyone puts it out to be yeah for women with that rise we also have an increase in what we call our acylated ghrelin so that's the active form of our hunger hormone at the same time we also have a rise in peptide YY, which is an active form of a satiation hormone.

37:21Dr. Michael Gervais:So the hunger hormone kicks up, ghrelin. Yep. And so you're naturally hungry. Mm-hmm. Okay. But you also have peptide YY that's kind of blunting that hunger, which is why women will say, I don't feel hungry in the morning. Oh, yeah, very cool. Okay. When you have cortisol that's coming up, there's an association with cortisol and the acylated ghrelin. So you have hunger hormone that comes up with cortisol. If you don't eat and cortisol cells elevated, then there's no message to the brain that there's food coming in. So what happens is because you also have the elevation of your peptide YY, you don't feel hungry.

37:56So you kind of keep pushing it out. And this is causing a misstep in the way that your body normally has cortisol responses throughout the day. So your response to a stress is going to be higher from a cortisol perspective. So that's why we see more astute kind of responses to daily stressors. We also see there's a change in our luteinizing hormone pulse or testosterone pulse because hormones aren't released in a linear fashion. They're pulsed throughout the day in response to environment, but also your circadian rhythm. So if women aren't eating within that first half an hour or an hour of waking up, then that cortisol still stays elevated and your appetite hormones become dysregulated.

38:40So we start to see this when women are holding their fast till 12 or after, they actually don't get any metabolic control that they're after from fasting. We don't see a better glucose uptake. We don't see any change in blood lipids. We don't really see a change in body composition.

38:55Dr. Michael Gervais:So if your last morsel, super applied, if your last morsel was at 7 p.m., dinner's done, and you wake up at 6.30, you're suggesting, or the data suggests, to eat before, if you're female, to eat before noon? Definitely, within a half an hour to an hour waking up. If you break your fast early, so maybe it's eight or nine o 'clock and you have food, then you will get a lot of the metabolic control from the fast. Because what we say is time-restricted eating is you have dinner and you don't have anything after dinner, and then you have food when you wake up. So you're getting a 12 to 14 hour overnight fast.

39:32If you're holding that overnight fast longer period of time, That's where you start to have this dysregulation and disruption.

39:39Dr. Michael Gervais:And what happens for folks, women that do that? So it's effectively phase shifting. So what we mean by that is we start to see a change in melatonin production. So instead of that 9 and the 11, it's blunted, so it's not as potent, and it's delayed. So this interrupts sleep. People can't get into proper sleep because they don't have the melatonin to really tell the brain, yep, okay, we're phasing into sleep. So if melatonin normally would be produced around 9 o 'clock for a woman, and you've prolonged the drop of melatonin at 9 p.m. because you've changed your fasting from, let's say, 8 a.m. to, I don't know, 11 a.m., then you're literally pushing back two hours.

40:21Dr. Michael Gervais:The melatonin will help you sleep. You are literally creating an environment where your brain can't get into good sleep because you've blunted how much melatonin is being produced, and you've changed when it is being produced. So if we were to tell women, you're having really a lot of problems sleeping, I always say, let's see where you're eating. Let's back up the food. Let's front load the calories. And then if you really want calorie restriction or to have a fast, we do it from 6 p.m. to when you wake up. So that could be 7 or 6.30 or 7. So you are getting at least that 12-hour fast that's beneficial for health, but you are not phase-shifting your circadian rhythm.

41:02It's like they're in perpetual jet lag. So when you can do that, then you start falling into a normal circadian rhythm and you start feeling sleepy at nine. You can fall asleep by 10 or so. You can catch the next wave of the melatonin as it rises and then starts to come down. Your core temperature follows that same signal so that your core temperature will drop the way it is supposed to to get into a deep sleep. And you don't have all these awakenings throughout the night.

41:28Dr. Michael Gervais:Somebody wakes up, maybe they're not exactly hungry, but they could eat. Maybe the family's eating is your recommendation. And let's say that that woman at this point has the opportunity to go to the gym early in the day. Eat before working out or wait and work out in a fasted state? Having something small before she works out is the ideal. Protein, mostly based like cottage cheese or kefir. It doesn't have to be a lot. A couple of eggs. Yeah. So if we look at Abby Smith Ryan's research from UNC, she's done quite a bit in this area and found that if you're going to do a strength training circuit, then you're looking around 15 grams of protein.

42:11So that's not much at all. And if you're going to do some cardiovascular work with the strength, then you just add 30 grams of carbohydrate, which is not a lot at all. So it's just a very small kind of pre-training snack.

42:23Dr. Michael Gervais:Is the research still that there is a window, an optimal window post, or is that just male? This is the argument, right? So if we look at it, we see that most of the research has been done that way, has been done on young men for the most part and a very small amount of younger reproductive year women. When we're looking at the optimization for adaptation, you want to provide fuel as close to the end of exercise as possible because your body's gone through a breakdown state during exercise. So it needs the building blocks to rebuild. and if we are looking at as you age you become more what we call anabolically resistant to both exercise and protein so that means your body doesn't respond as fast or as well to those but if you provide those building blocks pretty close to the end of exercise then you're going to get more of the feedback signals for adapting so it's not so much the window that's necessary it's an age-related thing.

43:28Like, how old are you and what adaptations do you want? So we know that the older you get, the better it is to fuel close to the end of exercise. When you're younger, you can get away with a little bit of a gap. But I try to tell women, you want to eat breakfast pretty close to the end of exercise if you're doing your first thing in the morning. Because again, we're trying to front load our calories and prevent any kind of energy availability misstep because we want to keep our hormones in this pulse and keep our circadian rhythm pretty sound so that we can sleep because you can't do any kind of body composition change if you have poor sleep.

44:03Dr. Michael Gervais:Full stop. Full stop. And if you are not getting the right benefits from nutrition, hormonal benefits from nutrition, you got a problem. And if you are waiting to eat one meal at 7 p.m., you're probably not going to get enough macros in and now you're in a in a compromised state and throughout the day and your micronutrients we see like very short eating window people are not getting enough of their micronutrients so they become micronutrient deficient so that's low vitamin d low copper low selenium um just a lot of the trace elements which then can affect your entire system okay this is great primes if you're going to work out early in the day prime something a little bit of protein if you're going to do cardio, add a little bit of carbs to it, workout.

44:50Dr. Michael Gervais:If you're in your 40s, 50s, 60s, or later, fuel as soon as you possibly can. And you are not interested then in intermittent fasting. The benefits that I know, let's say from the early research on intermittent fasting, you're saying that's mostly male-researched and or beneficial for men. Yes, and it's primarily clinical. and a lot of it is still done on rats. So what about autophagy? So autophagy is some of the parts of your cells. So you break down and you have cellular debris and your body will pick up that debris and excrete it or use it for the sum of the parts. It's kind of recycling in a good way.

45:33Dr. Michael Gervais:Yeah, you want to get rid of the kind of senescence, the zombie cells, the non-useful cells. Parts, yeah. And that's where the whole idea of fasting and calorie restriction and everything came from. It's like, okay, if we do this, your body is gonna have the drive to use some of the parts because you're not feeding it. But if we look at exercise and one of the massive feedback that happens after exercise is autophagy. Because what's happening during exercise, you're not building during exercise. Yeah, you're tearing, breaking stuff down. You're creating a pretty stressful environment. Exactly.

46:06So that's how you, I mean, that's the stress. And the response to the stress is, let's go in and clean up. Let's repair, let's rebuild, let's clean up. So autophagy from exercise can be a greater response from an autophagy standpoint than fasting.

46:23Dr. Michael Gervais:Oh, very cool. So this is another reason why fitness is so important. Yeah. Right. Okay. So let's kind of float up a couple levels really quickly. There are hormonal flux happening in the perimenopause phase. and you've already pointed to the power of nutrition from a cadence perspective. You're pointing to the power of sleep. Now, sometimes sleep is compromised if you've got hot flashes or there's some stuff happening there. So I think we should knock that down. And you are pointing to the power of fitness for efficiency of your system running, let alone we haven't gotten to the bone health and muscular strength and mobility and all that stuff.

47:08Dr. Michael Gervais:So what are the big rocks? The way that I scope it is we need sleep first, right? So sleep and then movement and physical or movement nutrition are kind of the next steps depending on personality and motivation. And then the one that is not rated at all, but is important across all of them is your social support being in nature and mindset. Because we see that the research of doing a run or walk outside versus on the treadmill, you have massive differences with regards to how you feel and how your body responds. 100%. That research, just for folks that are unclear, can you walk through the benefits of being in nature?

47:45When we are in nature, we have the natural light, right? And so that allows our body go, oh, okay, I'm outside. What am I doing? The fresh air. And it creates a greater dopamine response. We also see that we have a better ability to take on stress. So we're more stress resilient. There's the whole grounding trend that came from people feet on the ground itself again because the touch of nature to the skin creates a sensation and a feedback response that is more relaxing and parasympathetic driven if you were to bring that inside to a gym or a

48:19Dr. Michael Gervais:treadmill you don't get any of that yeah and the parasympathetic is that rest and digest the recovery mechanism so just being ah there it is and the the the wonder that comes from like being outside with things that are living and breathing. Has the grounding research moved from fringe to mainstream? It's still a bit fringe. It still is. Yeah. It's getting traction, but it's still a bit fringe. Yeah. I grew up surfing and being in this, you did as well, this salt water, there's something, we're calling it grounding because you're walking on grass or something, but there's something about the sand.

48:54Dr. Michael Gervais:There's something about the mother nature's ocean, you know, that is like remarkably, I don't know, grounding. I'll use the word, but you're actually in water. So it sounds like it's a weird thing. Finding Master is brought to you by David Protein. Travel a lot at Finding Mastery. And sometimes travel makes it tricky to eat well. Best intentions, and then you're at the airport. And then suddenly the only options around you are the ones that you'd rarely choose at home. Something I come back to often is that discipline isn't really about willpower in the moment. It's often about choice architecture, setting up your environment ahead of time so that the easy choice and the good choice are the same one.

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51:10Dr. Michael Gervais:One of our teammates here at Finding Mastery picked one up recently. Can't stop talking about it. Says it, they're waking up more rested than they have in years. Right now, they're having a July 4th sale. Go to Lisa.com for 30 % off. Select mattresses. Plus, you get an extra$50 off with the promo code MASTERY. Exclusive for our listeners. That's Lisa, L-E-E-S-A.com. And use the promo code MASTERY for 30 % off. Select mattresses. Plus, an extra$50 off when you use the code MASTERY. i know but one of my things that i love to do the most in the summer is ocean swimming i'm not a big swimmer i hate the pool i'm so slow in the pool and i get so bored but ocean swimming it's the slush slush of the water and you're seeing things and you're going and you're exploring yeah this is a terrifying part for many yeah the seeing of things yeah no that's good or on the board and you're paddling it's the same thing yeah yeah okay so uh there is some research that just seeing mother nature there's a um kind of second tier benefit and then seeing a picture of mother nature there's some benefit there as well but it's obviously weaker yeah yeah so be out outside with yeah with nature and i also just maybe remind myself that i am nature nature is not just the ocean or the pond.

52:31Dr. Michael Gervais:Like we are nature. Yeah. We are organic. Yeah. Completely organic. And people forget that. Yeah. They think they're an algorithm or a linear progression. And so if I do X, then Y will happen. Yeah. And it doesn't work that way. Okay. So sleep. What are some best practices to help people outside of what you just laid out is get your nutrition in early so that you get the melatonin drop appropriately. What are some other things? If somebody is working through hot flashes or they're struggling or they're waking up in the middle of the night, what are some guidance for women? One of the things about awakenings throughout the night that are not related to hot flashes is people aren't eating enough.

53:11We've done some CGM glucose monitoring through the night with looking at awakenings, and there's a really high correlation between hypoglycemic effects and awakenings. So this is one of the first concerns I have when a woman is like, I'm not sleeping, I'm waking up a lot. That's why we look at diet and make sure that she's eating enough. And if she still gets a point where she's not eating enough, then we might have her eat some yogurt half an hour before bed so that she has slow-release proteins that are going to help prevent that hypoglycemia. So you just want to put that in the nutrition box.

53:42When we have things like severe night sweats, hot flashes, inability to sleep well, there are tools in the toolbox for that. You can look at using some pharmaceuticals. You can look at using adaptogens, which are really potent. I mean, we see the use of ashagandha, rhodiola, holy basil. All of these really help. One of the other things -

54:03Dr. Michael Gervais:I love that you bring those. Sorry to interrupt. I love that you bring those up because you and I were introduced by Jeff Byers from Momentus, which you trust Momentus. Yes. I trust Momentus. And they have all three of those. Well, no, they have two of them. They have ashagandha and rhodiola. Yeah. And what was the third one you mentioned? Holy basil. Yeah. I don't think they have that in their stack. Oh, not yet. Nice job. Yeah. So do we need to be careful with the brands that we are choosing for ashwagandha or roteola? Oh, 100%. Yeah. Yeah. Meaning that if you go get something off the shelf, you're not sure what you're getting?

54:38Right. Because supplements aren't regulated for the most part. And unfortunately, people gravitate to the less expensive one. and most of the time those have fillers and flow agents maybe some metals and stuff in it so that's why i mean i'm not plugging momentous but i am plugging momentous because i love them oh yeah because they're super clean and very careful what goes in their stuff so when you're reading the label you know that it's there and they're third-party tested nsf for sport meaning

55:07Dr. Michael Gervais:what's on the label is in inside the bottle yeah yeah and that's really important when you're looking at the supplement industry coming from high performance world we're like you can't buy anything off the shelf. You have to have something that's NSF or certified for sport. I'm like, everybody should have that opportunity. Like you shouldn't just go buy something off the shelf. Full stop. I can't even begin to have a conversation about supplements with anybody without it being NSF because they're mostly elite athletes or whatever. It's the standard. It's the standard. So can you take too much ashwagandha and maybe explain what ashwagandha does and rhodiola yeah can you explain the how they work and why they're important for sleep yeah so if we're looking at adaptogens and that's ashagandha rhodiola for the most part that we're talking about they are plant compounds that come from plants that are stressed so we see they're in high deserts they're in really extreme conditions so they have to adapt to those kinds of stressors so these plant compounds come from these this naturally derived adaptation that the plant has so they come into your body and they read the stress so to speak in your body and it's like oh there's lots of cortisol but that doesn't necessarily need to hit all the receptors so we're going to go blunt some of these receptors so you don't have a strong response so with ashagandha it's really good at helping with that and with rhodiola it can work two ways it can either bring you up and make you focus or if you are just on the cusp of like needing to wind down it'll help you wind down.

56:43Dr. Michael Gervais:It's amazing. I know. Both of those are amazing. Ashwagandha for me like just takes this edge off. Now, can you take too much? You can. So I go to the lowest effective dose. Don't go the pharmaceutical route or the Western route of more is better because it's not. Is it 150? What is the milligram? I can't remember. So for ashwagandha, it's 400 total in a day. 400 total in a day. Yeah. And do you split it? I do. You do? Yeah. Yeah. Okay. Afternoon, you start to get that high stress from everything that's going on and you also start to lose energy i use ashagandha to level me out and you'll take 200 yeah yeah yeah at that point okay and i also use shashandra i don't know this so this one is does the opposite it really brings you focus so it it works on some of your serotonin receptors as well so instead of having kind of a flattening it just makes you focus.

57:36Dr. Michael Gervais:All right. Fantastic. So let's keep going. So what are some ways to work with hot flashes? Yeah. So we see that you do want a cool room, definitely a cool room. And one of the things that we found using environmental stress, this was a study that I did with one of the top complementary alternative medicine researchers from Columbia. she came over she's best friends my mentor at stanford and she was really interested she's the one who told me about adaptogens and we did some research on adaptogens but also she wanted to understand what were hot flashes so we put women in a heat chamber and we were able to kind of mark what what the onset of a hot flash was and be able to quantify it through skin temperature and internal temperature so we quantified it and then we had them do controlled hyperthermia so that means small amounts of time in the sauna to bring their temperature up.

58:34They would have massive hot flashes in the sauna, but then over the course of five or six exposures, it became less and less severe. And when they got out, they didn't have as many or as severe. So if we're talking about the temperature control of the hypothalamus and the way that we start to have a misstep in the way that our estrogen and progesterone are not in the brain anymore, the hypothalamus is like, what's going on? do I need a vasodilate? Do I need to constrict? I don't know. So when you are increasing the blood temperature that goes through the brain, the hypothalamus gets hypersensitized to that heat.

59:11And then it starts to understand that's what hot means. So when you get out into a natural environment, you don't have as much of that perturbation of the hypothalamus.

59:21Dr. Michael Gervais:So it works. What is the difference between men and women when it comes to saunas? So heat exposure is interesting. In the reproductive years for women who are naturally cycling, they have a change in their core temperature on a monthly basis. When progesterone comes up, it increases the core temperature and the body naturally shifts its onset of sweat the way it feels hot. So you have a new baseline. So when we start looking at heat exposure, there are sex differences, not hormone differences, but actual sex differences that happen. So women will vasodilate first. So that means that the blood comes to the surface and the blood vessels open up and you're trying to offload heat first.

1:00:05Then they will start to sweat. Men sweat first. So they are losing body water pretty quickly in a hot environment. And that is a sex difference that's not driven by hormones per se. So when we're talking about heat exposure, women will get into the hot environment and they'll feel hot. and then they'll start sweating and they'll feel cool again. Where men will start sweating and they'll start building up the heat and their tolerance isn't as great when we're talking about sitting in a sauna itself. When we're out racing, there's a little bit of a disconnect. Women will do better in a humid environment because they vasodilate and then sweat.

1:00:44So there's a little bit of a nuance of being in real life versus in the sauna. So we look at the benefits of heat exposure for both sexes. We see that it increases what we call heat shock protein responses. So that is when you are in a hot environment and you start to have cell breakage, then the heat shock proteins will come in and fix that. It's just kind of like autophagy, but it's a heat-induced response. We see better cardiovascular responses. So that means if you're in a hot environment, your body is going to adapt by increasing the amount of blood that it has, red cells, the water it has, the way your heart is efficient at pumping.

1:01:22We also see that it will prolong training stress. So if you go into a sauna after training, it's a stress that keeps your heart rate up and all the adaptations that come with it. And we see that there are the temperature regulation responses. So if we are having a lot of hot flashes, then it helps with the hypothalamus because your brain gets really hot from the hot blood. And it also helps if you are going to a hot environment, then you're training for something to race in the heat. or say you're living in the Southern hemisphere and it's July, which is the middle of winter, and you go to Texas and you're like, oh my gosh, it's so hot.

1:01:59But if you do some sauna exposure, you get to Texas, you're not that hot.

1:02:02Dr. Michael Gervais:Okay. So what do most people get wrong about being great as a healthy paramenopausal slash menopausal woman? Like what do most people get wrong? Following trends, because there's so much information out there, because it tends to be the new buzzword right now, menopause, perimenopause. Everyone's out to sell you something. And every woman's lived experience is different. So what I've gone through would be different from what my sister went through, even though we're genetically linked, and that's different from what my mom went through. Everything is individual, and I don't think that's being communicated.

1:02:43Dr. Michael Gervais:So how do we have a chance? To communicate, yeah. Yeah, because we don't have the same discernment and scientific acumen that you do. So how do we have a chance to get something right if we need to be completely bespoke, which we are, right? Right. So I always tell women, look, the things that will really budge the needle for you with overall health and increasing health span, because that's where my focus now is because we see sex differences in the last part of the life, right, where women live longer and have poor health across it, and part of it is things like Alzheimer's and autoimmune diseases.

1:03:22One of the biggest ways that we can attenuate or slow the rate of those risk factors that start in perimenopause is through exercise. So if we're looking at exercise, people look at it as, oh, I don't want to do that. But it's embracing the ability to take control, where it's not about going to a gym 90 minutes every day or going out for 10K run or slogging yourself is about being efficient in your movement and being very conscious that you are doing it. If you're going to get up early and do some training, then you are an athlete. And that's what I tell women. I want you to have an athletic mentality because you're doing this for you to benefit your health.

1:04:04So you want to have a plan. A lot of women don't have a plan. They get up and they're like, oh, I should be doing something. So they're going to go out for a walk, but they don't really know why they're doing it. They just know that they're supposed to be doing something. So when we look at exercise, it's a stress to the body and we want to invoke a really strong stress so the body adapts the way it should without hormones. Because if we look at something like strength training and we have all this information right now about how the brain changes because it's estrogen starved and we're starting to see brain fog and changes in the amygdala, we don't have long-term research to show if that's temporary because we see that there is a new baseline post perimenopause so what are we doing if we're looking at some of the inherent changes that happen from muscle in a brain standpoint we know the very first thing that happens in perimenopause is women will lose strength and power so this is is it that order or is it power

1:05:02Dr. Michael Gervais:first as you mentioned we see power first power first and with that comes strength and then we see a drop in lean mass. So part of that is the way that our contractile proteins work. So we see myosin and actin are two major proteins. Myosin grabs onto actin, pulls it towards it, and that's how you have a muscle contraction, which is stimulated by a nerve. We have different things called isoforms. So there are some different forms of that protein of myosin. We see a change in that in the active form of myosin to an isoform that isn't as strong to grab onto actin. And that is part of some of the estrogen or lack of estrogen changes.

1:05:44The way that we can make that step up is nerve conduction. So if we are looking at lifting a heavier load, that's going to create a central nervous system response where the nerve impulse comes down and goes, oh, wait a second, we need all of these muscle fibers to work synergistically to grab each other so that we have a really strong muscle contraction to lift this load. So now we're not relying on estrogen to drive myosin. We are relying on a nerve factor. Not only that, because it is a nerve factor, we see in some new randomized control trials that come out that women who lift heavier loads have a change to the prefrontal cortex.

1:06:27And that's what we need to attenuate cognitive decline. because there's this massive sex difference in cognition and cognitive decline when we're seeing women and men in their 60s, 70s, 80s.

1:06:40Dr. Michael Gervais:Is it a fair kind of ramp to say the way you do your 40s is a good predictor for how your 50s might go? The way you do your 50s is a pretty good predictor how your 60s might go? Yeah. Okay. And when you say put on lifting heavy weights or a load, Are we talking about half your body weight being able to, you know, how much load are we talking about? It's a journey to be able to lift heavy. So if women who are listening to this or their partners are listening to this and trying to encourage their female friends or partners to lift, if you've never done any kind of resistance training, then I want you to have the eye to a year from now you're going to be lifting heavy loads.

1:07:21heavy loads means that you are doing three to five reps at 80 or more of your one rep max which means that you're lifting at an eight on a scale of one to ten you might be able to eke out two more repetitions at really really good form and that is the optimal but the journey to get there is also really important so if you've never done any kind of strength training or resistance training and there's a difference resistance training is just a push pull so that might be your air squats It might be push-ups against the wall. You're using your body weight to create a resistance.

1:07:56Dr. Michael Gervais:Pilates? Pilates is good for isometric control, balance proprioception. Not resistance. It is a little bit of resistance, but it's not strength. Not strength, okay. So when we talk about strength, this is adding more load to the body and it is being very conscious that you're trying to create that neuromuscular response. Okay. The way that I'd like to describe it is if we're looking at being able to do 50 push-ups and working our way to be doing 50 push-ups, are you going to be stronger? You're going to have more muscle endurance. You're going to have a little bit more neural connection. But if you're going to train to do 10 push-ups with a 20 kilo weight on your back, you're going to be strong.

1:08:41You're going to be endurance and you're going to have lots of neuromuscular changes to be able to push the extra 20 kilos in a proper form push-up.

1:08:49Dr. Michael Gervais:Does it matter to you if we're talking about moving kind of the bottom half of your body, squats for the most part, or upper body where you're doing push-ups or pull-ups or it doesn't matter to you? It's the signal to the nervous system and to the brain to say, oh, we need to be strong. We need to recruit and we need to be alive in this experience. Yep. I do find compound lifting, which is your squats, your deadlifts, your binge press, your push-pull overhead, activates more of our stabilizer muscles. So the weaker muscles also get into the playing field of a resistance training. This is a slippery slope here.

1:09:28Dr. Michael Gervais:I'm wondering how you're navigating it because I think you've done it very clearly. You've said, think about a year from now. The reason I'm saying slippery slope maybe isn't the right language. Let me talk out loud here for a minute, because to get somebody to lift safely heavy weights, there is a real sophistication to be able to do that and to be able to repeat it, say, in three to five days, right? Because you and I could go, I don't know, save grandma. We could go lift a car maybe, that idea. And then we're crushed. And we probably couldn't replicate it because all of the stress, you know, that was going into that survival mechanism.

1:10:06Dr. Michael Gervais:but to do it purposely on a daily basis, would you recommend five days a week, three days a week? We see one day is minimum, minimum to maintain. Are we talking about lifting heavy weights or strength training? Just resistance training in general. Resistance in general, okay. And three is to actually make gains. Okay, that's good. So three times a week, and it doesn't have to be a lot. I think that's the other misconception, where people think that they have to go do every body part and they're using all these different machines and supersetting and it becomes really complex. It doesn't have to be like that.

1:10:41You can have a really effective resistance training session in 20 minutes where you do some mobilization, you focus on one really good compound movement. It could be squats, it could be lunges, so you're doing a knee hinge. So you're just focusing, this is what I mean, when people need to have a plan, where what is your focus, how much time do you have, and what is the goal of this session to also match the goal of the month.

1:11:04Dr. Michael Gervais:What does that mean, the goal of the month? When we're talking about resistance training, we have to be very consistent, and we also have to look at adding load, which is periodization. And I like people to think, what am I doing now so that at the end of the month I can do X, Y, Z? And the end of two months I can do this, this, this, this. So we start by saying, okay, resistance training, for women who've never done it before, I've been saying a lot of this, or this a lot this year, I want you to have three 10-minute wellness meetings with yourself first thing in the morning. So we know that we can't cancel meetings.

1:11:35We're just indoctrinated not to cancel meetings. So something on your calendar you cannot cancel. For the first week, I want you just to get up and use that time just for you. So you might have a cup of coffee looking out the window and you're going, okay, I see that tree and it's waving. It's saying hello, good morning, whatever it is. So you take one really positive thing from that first 10 minutes and you take that with you all day. So if you get to a stress point, then you can bring yourself back to it. The second week, I want you to add some air squats or maybe some wall push-ups or something else that's a little bit of movement that's going to start becoming that habit three times a week.

1:12:11And that's how you start your journey.

1:12:13Dr. Michael Gervais:Great. And then you might have a friend who wants to join. You can get an app and work together. You can meet to go do a circuit outside. or maybe you go together to a smaller, more boutique gym that's more focused on helping women develop in the whole strength training journey. There's lots of different options. How do you adjust the narrative, which is like, oh, but I don't want to look bulky. If you're asking me to lift heavy weights, that's what weightlifters do. And I want to fit in my jeans. I want to, you know, like, I don't want to have all of the muscularity that, and there's some, I don't know, wild image of like, I don't know, Hulk Hogan, you know, type of thing, right?

1:12:57Dr. Michael Gervais:So how do you address that or address that? Women have to work incredibly hard to get bulky. You might have a genetic predisposition for putting on muscle, but it doesn't mean that you can do it easily. And if you want to get super bulky, then you have to really work at it. You have to be consistent in the gym four or five times a week, doing hardly any cardiovascular work, eating a lot, a lot of protein, timed it, making sure that you're getting meals all the time. Because if we look at some of the top CrossFit athletes that are relatively bulky, they work really hard to get that muscle. Just across, when we think about that physique in CrossFit or take the name out, I don't, it doesn't matter if it's CrossFit, but that type of training at the competitive level, are they measured, are they tested?

1:13:47Yep. They are now. Yeah.

1:13:48Dr. Michael Gervais:So this is a natural competition, right? So you can look like that and be that athletic naturally. Yes. Yeah. So there's a real sophistication to be able to have that type of transformation. Right. And what you're suggesting is like, look, start a journey wherever you are in your path, non-negotiable is like three times, non-negotiables one ideal is three um and then we slot in cardio at the off days so cardio is interesting because we see that the mindset of like zone two and long slow stuff it's not appropriate for women so a long walk where zone two is like when you can you can have a conversation while you're walking you got a little bit of a uptick and heart yeah yeah but you know zone three is like, you're going a little bit faster than normally.

1:14:38Dr. Michael Gervais:Like, you know, it's not a race pace by any means, but like, it's a little harder to walk, to talk and walk. Right. So you're saying zone two and you're saying that's not good for women. So there's, there's two ways to explain this. First, when we look at the zones, the zones are based on certain tests that have been done in the lab to differentiate what a low impact or a low stress on the body is versus a super high stress. When we're testing women and men in the lab, we know that women can work at a greater percentage of their VO2 max or their maximum and still maintain aerobic steady state.

1:15:17What I mean by that is they might work at 88 % of their VO2 max and still be able to be pretty good in tempo. Men can't do that. They fatigue a lot faster than higher. So they have to actually work. because when we look at the sex differences, we have differences in the muscle morphology. So that means that women have more endurance-type fibers, so less fast-twitch fibers. And with that comes more mitochondria density. So that means we have more mitochondria in there. We also have more proteins within the mitochondria which allow women to use free fatty acids better. And there's a switch across the menstrual cycle because of estrogen progesterone's effect on fueling.

1:15:58So across the menstrual cycle, women are very metabolically flexible. So when we talk about zone two, one, it's arbitrary. There's no real hard and fast research behind zone two because it's not a really strong stimulus to invoke mitochondrial change. So when we start talking about zone two, it's great for recovery and it's great for like getting out there, but for actually inducing metabolic change and mitochondrial change for women, it just doesn't hold up to the research.

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1:19:16Dr. Michael Gervais:It's like, why? Why is that beneficial? Yeah. so again i'm talking about optimal right so any movement is good so if you're like i i just have the capacity of going for a walk great but in your walk i want you to pick up the pace a couple of times maybe do the old school fartlek training where you're going light post to light post and then cruising just to be able to implement a little bit more intensity is that like a jog a sprint or just like a walk a faster walk okay and if you feel like jogging go for it it's whatever brings up that intensity because optimally we want to see women doing true high intensity interval training a couple of times a week.

1:19:52And that is also what we call sprint interval training. So we talk about sprint interval training. That's 30 seconds or less as hard as you possibly can go with two to three minutes recovery between our 20 to 30 seconds, which is different than

1:20:07Dr. Michael Gervais:Tabata training, right? So you're having equal time on to equal time off. No, 20 to 30 seconds full gas, two to three minutes. Two to three minutes. Okay. So high sprint, long recovery. Yes. Two to three minutes. And this is so that your whole body can recover to be able to hit that intensity again. Yeah. And that full gas, this is like 85 % to full max or 110 % go all the way, all the way, let it rip. And most people like, Oh, I can do four or five of those after to the, oh my God. That's right. Yeah. You also need to be thoughtful about when you are ready to sprint. Yeah. It doesn't necessarily mean running sprints.

1:20:50Dr. Michael Gervais:You could be on a bike. You could be on a bike. You could be on a rower. You could use kettlebells. You could use battle ropes. Okay. You could do sled push. It's the intent of the intensity that we're talking about with that long recovery. And this is beneficial for women, also beneficial for men, but you're saying specifically this is better women yeah it works for men too but for women because we have this incredible increase in visceral fat and that's what causes what they say the minnow pot is so that accumulation of belly fat because there's a disconnect between because estrogen is anti-inflammatory so when we start have losing estrogen we have more inflammatory responses and the liver is perceiving that as oh these free fatty acids they need to be stored somewhere else So instead of having free fatty acids, there's feedback from the liver to change the form of it to esterified fatty acids and store it as visceral fat.

1:21:45If we have that really high, high intensity, it creates what we call myokines, which are feedback responses from the muscle, which also feed to the liver and say, no, no, we don't need you to change those free fatty acids because we need those free fatty acids at rest. So it causes an epigenetic response over time to stop storing visceral fat and to help degrade or downplay the amount of visceral fat that you have.

1:22:12Dr. Michael Gervais:Love this. And so this is one day a week, three days a week? One day. Five days is too much. Way too much. Yeah. So no more than three? Twice? So when we talk about the sprint interval, that super high intensity, you could do one of those a week. And then you also have a little bit less intense called high intensity interval training. So this is like at 85 % max. But you had to be specific with those intervals too. It's not like going to an F45 class or because we've all been so conditioned to get out of one of those classes feeling super smashed and sweaty, but it actually puts you in that zone three, which doesn't do anything.

1:22:52Dr. Michael Gervais:For men and women or just women? For men and women. Zone three. Yeah. Yeah. Which is zone three is like, it's hard. It's not overwhelming. It's hard, but for an extended period of time. Right. And so it's too hard to be easy to create adaptations to unit at an easier level, but it's too easy to be hard to cause the adaptations that we're trying to get from exercise. We call that the junk zone. It is the junk zone. It's a junk mile. Are you familiar with TBS? Toilet bowl syndrome? No. Yeah. It's a funny phrase. I don't know if it's local here or whatever, but if you haven't been training for a while and you're deconditioned and you go hit it hard and then you get TBS, toilet bowl syndrome, like you're so full of brain deconazin, lactic acid that you can't sit down and get back up.

1:23:38Dr. Michael Gervais:Like way too sore, you blew it. So you want to avoid that. You want to avoid that. Yeah. So you're really being super thoughtful about start where you are and intentionally increase the intensity in a way that's reasonable. Correct. Yeah. And what is a good resource that you found other than a local coach? What's a good resource that you point to for folks to be coached? So there's some really good apps out there for women who are just starting their journey and trying to understand exercise and movement. Betty Rocker is really good because it's all at home. Might use a kettlebell or two, a lot of body weight stuff getting you into the habit.

1:24:16She's some great programs. Then when you're ready to step it up and you want to work with a friend or a partner, or you want to go to a gym and you want to know what to do, but you don't have the funds or want to hire a personal trainer, then you can look at Haley Babcock's Haley Happens Fitness. She does some collabs with Vonda Wright, which is a learn to lift. You can do that at home or at a gym. She also has a series of power programs that starts very beginner into very advanced, and it has the lifting and the specific sprint and hit stuff in there.

1:24:49Dr. Michael Gervais:Same with nutrition. What's a resource that you trust that's important? For nutrition, that's a hard one because there's so many things out there. I probably would lean into a lot of the lifestyle medicine groups that are at the universities because they're really, really understanding what Mediterranean diet is, how to improve gut microbiome. I really do love the Zoe project and the Zoe podcast out of the UK. Okay. So, uh, Tim Spector. Oh, yeah. Yeah. Yeah. Yeah. Yeah. Great resource. Yeah. He was phenomenal. He was on the podcast. He was great. Yeah. Yeah. Zoe Z O E. Yeah. Yeah. And it's his, um, gut biome product as well.

1:25:29Dr. Michael Gervais:So yeah. Yeah. Okay. Fantastic. And even, I mean, just going to the website to read everything that they have, it's really good. Yeah. Okay. Yeah. Is there a difference between gut biome between men and women? That's up for debate, actually. We see there is a little bit of a sex difference, but it's very influenced by environment. And then when you start having the sex hormone changes in perimenopausal women, that's when you really start to see a sex difference in the gut microbiome, even if you're living in the same place. Let's talk about hormones for just a moment. Replacement therapy. You've done a nice, that you introduced me to the idea of from hormone replacement therapy to menopause hormone therapy.

1:26:12Dr. Michael Gervais:And so I think somewhere early, I swallowed the idea. This was like, I don't know, 20 years ago, 30 years ago when I learned it. And unfortunately, my wife thought that it was best practice to avoid or not use hormones because of the risk for cancer. And so can you speak to the best, the most current, the most sound research around hormones and therapy? Yeah. I want to give some context to the Women's Health Initiative, which is the big study that came out in the States that scared everyone off. I worked on that data set at Stanford. My mentor was one of the PIs. So I understand that study and how it was misrepresented.

1:26:56So that study was initially designed to see if women who are well past menopause would benefit from using hormones. And they did not.

1:27:05Dr. Michael Gervais:And that's what, we missed that slight nuance. That nuance was not played up in the press. Although at the very same time, there was a study going on in the UK called the Million Women Study. And they were looking specifically at perimenopausal women and gave them exogenous hormones and they benefited. So now you have this discrepancy in the conversations where people Commonwealth, So that's New Zealand, Canada, UK, other places in Europe. They're very pro-menopause hormone therapy. Everyone should be on it for all these benefits. And then you have people in the States who are like, oh, Women's Health Initiative causes cancer, all sorts of scary things.

1:27:43But then there's new research coming out. So if we can tease out those two groups and say, let's look at the research as it is now, we know for sure that the new formulations are relatively safe. There are nuances where you have to talk to your physician about your own risk factors for it. But we have transdermal, which is your gels and your patches. We have vaginal cream for estrogen. We have progesterone that is micronized, and it's an oral or a transdermal. So we want to look for micronized because this is more what they call body identical or bioidentical. But the caveat there is because you are bringing in externally, either through the skin or you're ingesting it, it doesn't hit the receptors the same as your endogenous or natural production.

1:28:31And that's the part that also is not in the conversation. We talk about target tissue. So we see that when we are using exogenous hormones, so those are our external hormones, that the receptors don't get activated the same as the pulse from our ovarian hormones. Because when you whack a whole bunch on at once, it is a flurry and then it drops off.

1:28:55Dr. Michael Gervais:This is a little bit like, let's say, cocaine and serotonin. Yes. Right? Like you just flood it. So there's a great feeling, but then this is not how it's supposed to work. I got too much in the system and there's problems from that. Right. Yeah. And it's kind of the same thing. Yeah. So we see from when we're tracking hormone and bioavailability, like with a patch where people are told they have to change it every two to two and a half days. It's because you have this massive uptick and then it starts to drop off. And if you don't change the patch, then you get to this significant lull and you have side effects and issues.

1:29:30So this is the conversation that isn't being had. We do see from Lisa Moscone's work that she has a massive grant to look at the brain during perimenopause. And initially she saw that when women are doing fMRIs, so functional MRI for the brain, the estrogen receptors lit up, like, I need estrogen, I need estrogen. That was perceived in the media as the brain needs estrogen all the time, so everyone should be on menopause hormone therapy. Not as this is a natural thing, the body is using what estrogen it has, and there's going to be a time where these estrogen receptors kind of wind down. We don't have the longitudinal research yet.

1:30:11We also don't have lots of randomized controlled trials to show is it beneficial for dementia or not. So we don't have those studies. Cardiovascular stuff, we don't have all the longitudinal data. So right now when we're looking at the robust data, we know that it's very effective for helping with bone health. If you have a risk factor or low bone density, yes, menopause hormone therapy is one of the ways to go to prevent osteoporosis. If you are looking for mood and anxiety, yes, it is definitely a fantastic tool in the toolbox. Hot flashes, not so much. We see that it can be beneficial, but also using something like a serotonin reuptake inhibitor with cognitive behavior therapy is really effective because it's a serotonin response in the brain that is triggering the hypothalamus.

1:30:58So if we're dampening the serotonin receptors or using the mechanism of a reuptake inhibitor, it helps with hot flashes.

1:31:07Dr. Michael Gervais:With traditional therapy. Yes, with traditional therapy. And I get backlash all the time because people think, oh, you're anti-hormone therapy. I'm like, I'm not anti-hormone therapy. What I'm anti is everyone needing to be on it because it's a tool in a toolbox. It's very, very effective, but not everyone can be on it. Not everyone needs to be on it. But the rhetoric is that everyone should be on it. I'm waiting for the longitudinal research to show definitively that you need to be on it for brain health. Because if we think that this whole population before us, like my mom, she didn't have access to it.

1:31:43And she doesn't have dementia. She's fine. Like you see this whole population of women that didn't have access to hormones. And it's not just this previous population, but all the way back. So that begs the question of the story that you brought up earlier about testosterone is, do we really need to put women on a dose of hormones that they stay on for life? Or do we use it just to help with the symptomology as their body finds its new state?

1:32:14Dr. Michael Gervais:Is there benefit to starting earlier? There is some benefit. Yeah, there is. Can you talk about that? Yeah, so we see women with the APOE4 gene, which is a risk factor for Alzheimer's. The earlier they start, the greater their risk reduction is. So that's the only research we have with regards to dementia and Alzheimer's is because it's a genetic factor. And that is supplementing with estradiol? Estradiol, yeah. Estradiol? Yeah. And so E2, as it would be called? Yeah. And you can get that test done. It's relatively easy. My wife and I have been testing that for years. Like it's on a lot of basic panels.

1:32:55Dr. Michael Gervais:Yeah, yeah, yeah. Okay, that's good to know. And bone density too. Say it again, for bone density as well. But what it's not useful for, and there have been studies that come out and have shown this, is for weight management. So people think, oh, I'm not going to get the body composition change if I'm on menopause hormone therapy. So, and the opposite of that is I'm paramenopausal or I'm in menopause. I put on some weight. I should take hormone replacement therapy. and you're saying that's not the reason to do it. Correct. You need to put in the lifestyle interventions to... Lift heavy weights, do some sprinting.

1:33:29Dr. Michael Gervais:Eat well. Eat properly, sleep like you are a world-class lion that sleeps around most of the day if you possibly can. Yeah, yeah, yeah. Yeah, okay. Is the research accurate that there's like this 10-year window for hormones? And then what do we do when we're 62 years old? Yeah, so we don't want to start it 10 years after menopause because we have all the data that shows that your body's gone through this wind down process and the receptor is not very open to using exogenous hormones. It is an individual thing. So if you are eight years, you could still have a conversation. Why do you need it? What are some of the symptoms?

1:34:05Some women have hot flashes for the rest of their life, so they would benefit using it.

1:34:09Dr. Michael Gervais:Oh, so there is not a 10 year window. That's been disproven. That is disproven. So if you started, let's say for whatever reasons you start at 50 years old and you're, you are taking a patch of estrogen with some progesterone is usually how it goes, I think. And you get to be 60 and things are good. Like you're like, okay, look, I've got my lifestyles in place, nutrition, sleep, fitness. I like the way I'm thinking about aging. I'm interested in X, Y, and Z in life. I feel generally healthy. Do you stop or do like, how do you know when that window, the benefits of that window have closed? Right now we're just going on anecdotal research because we don't have the long-term studies.

1:34:55Dr. Michael Gervais:That's why you say long-term studies. You want and part of the long-term studies is knowing when does the efficacy start to fade away? Okay. Because you'll have a lot of women right now are like, they're going to pry hormones out of my cold dead hands. It's like, because it's been working because it's been working yeah but this is even people who are uh physicians in that space it's like that's a little bit irresponsible because we don't have the research to show on these existing formulations what are some of the long-term effects or how long should we be on it so now it's an individual choice so if you're that 60 year old woman you're feeling great you could start going should i be on it should i not do a chance to get off it what should i do so you could have that conversation you could look to taper down you could taper down the dose and see how that makes you feel or you just completely go off it.

1:35:42But you do have to be careful when you completely go off it because then it's just like no hormones at all. So there's a, you would want to titrate

1:35:50Dr. Michael Gervais:down. Yes. You would want to like ease into that transition. Exactly. Okay. Just like if you're using a serotonin reuptake inhibitor, you don't stop immediately. 100%. Where are you on peptides? GLP-1 peptides or the BC-157s? All of them. All of them. I am like, I'm trying to understand them because it feels like this new world is emerging. It is. And there's complexities. There's like these really wild benefits that seem to be happening. That's right. We don't know long term. And it's uncontrolled. It's unregulated. And so like, where are you? You're cautiously observant or you are actively engaging in research?

1:36:34So if we look at the peptides that are being promoted for longevity and health, so you're seeing the TB500s, the BPC157s, all those named, like letter-named ones, I'm waiting for the research. But the caveat is I did try it because I had a really significant knee injury. And everyone's like, you've got to get on the peptides. You've got to get on the peptides. I'm like, well, I can't get them in New Zealand. So I was on a trip and I tried it and I didn't feel like it did anything. And then retrospective of this, like, what were you doing? You don't know what you were injecting in yourself. There's no research behind it.

1:37:09But in the moment, I was so devastated by a torn hamstring and a messed up meniscus and not being able to walk. I was, like, desperate. So I can see how it's gotten such, like, I'm a scientist and I normally am very pragmatic about things. I want to see the research. I want to know where it's coming from. But in the moment of that, oh my gosh, what is going on? I'm completely injured. Everyone's telling me these things work. I tried it. But when I start really looking at it, I can see how it's gotten such gravitas in the media where you have small claims where the N might be super small, five men, a lot of rodent studies, and there's some efficacy.

1:37:45Maybe not. We look on a molecular structure. Why would a gastric juice help? Like why would a gastric peptide help? because in the body, if gastric juice escapes, it's an acid that can cause a lot of harm. So the body has a protective mechanism, which is the BPC-157. But we don't actually know if it works outside of that specific environment. So that's the research that needs to be done. So in the whole realm of things right now, it's marketing is stronger than science, except for the GLP-1s.

1:38:18Dr. Michael Gervais:Yeah, there's a lot of research. They're coming on their third third class. Yeah. And those are looking really promising and interesting. Yeah. Okay. Use for the right reason. Yes. Use for the right reason. Yes. Not Grammy microdosing and that's right. Yeah. Okay. What are the things that are absolutely still baffling you that you, you just wish that you could communicate with all sincerity and, you know, great potency that you just wish people would get this thing, right? What, what are the things that are most important to maintaining independence for everyone men and women and how do we do that by being able to be functional in our bodies so we now are in an environment where we don't move i had someone ask me once or just a few weeks ago why is it that you're saying that we need to do the strength training and this high intensity work and do all this stuff when people 50 years ago didn't and they're fine i was like well 50 years ago life was completely different we didn't have garage door openers.

1:39:20We didn't have Netflix. We didn't have jobs in front of a computer that made us sit. We had jobs where we had to get up and move around and we had to go like press the fax button or something like that, you know? So there were things that allowed us to move incidentally more throughout the day. But now we see people are sitting all day. There's this massive episode of young kids not getting their peak bone density because they are not moving. And if you don't to your peak bone density, then as you age, you're going to have more of a risk factor for osteoporosis. We see a decrease in muscle mass as well because they're not moving.

1:39:59So there's a higher incidence of sarcopenia. So it's like, how are we going to maintain independence and not be a drain on healthcare, which in itself is a nightmare to navigate, to be able to be autonomous and be able to live our lives in a productive way through movement. And so all this idea about exercise being a chore. I look at it as it's independence and we want people to be muscle focused and muscle centric because what do you have to gain when you're focusing on maintaining muscle? You have the opportunity to gain confidence, to gain autonomy, to gain independence, to gain health, to gain cognition.

1:40:39What do you stand to gain if you're focused on weight loss? Aesthetics, maybe, maybe not.

1:40:45Dr. Michael Gervais:Maybe, maybe not. Yeah. Maybe you get better cardio metabolic factors, but exercise does that. We know that exercise helps with cardiovascular and metabolic risk factors. We know that muscle is a massive glucose sink. So people are having issues with blood glucose control. We have them go for a walk after dinner to use their muscle to be able to pull glucose in without insulin. Is that a good zone two movement? Yeah, but it doesn't even have to be long. It could be 10 minutes. Yeah. It's a best practice in our family. Like after we eat, we'll just get up and kind of go for a quick little walk.

1:41:23Dr. Michael Gervais:Walk the dog or whatever. But it's like it just feels like it keeps the whole system advanced if you are advancing. Yeah. Okay, so. I was going to say, and the other bee in my bonnet is AI. It's a bee in your bonnet. Why is that? Because if you look at the existing AI that's out there, it's an echo chamber of male data. So if we think about the way that the parameters are set and the human touch, it's still viewed through that male lens. And when we think about the outliers, as we talked about at the start, there's not a lot of research and robust research in women's health in general. And so those become the nuances and the outliers.

1:41:59So what's being read is this echo chamber, right? So the outcomes that are coming out for women, still not appropriate. We see an incident with Open Evidence a few months ago where it was telling women that no one should be on menopause hormone therapy because it causes cancer. It's been disproven. They're just pulling on old research. We see things like our wearables, right? And we see heart rate variability. For men, it's fine. It's actually following that physiology. But for women, we have a beat-to-beat difference. It's a sex difference. We also see there's a change in heart rate variability over the menstrual cycle.

1:42:33As soon as you have progesterone that comes up, your heart rate variability goes down. And wearables will read that as you're getting sick, you're highly stressed, you're not recovered.

1:42:42Dr. Michael Gervais:How ought women be able to use some of the monitoring data, the wearables, for heart rate variability? Finding Mastery is brought to you by AG1. Summer is here, at least for those of us in the Northern Hemisphere. You can just feel it, though. Days are longer, pace picks up, and there's this sense of momentum that comes with the season. For me, that also means more travel. It's more early mornings, more late nights, and it's just really a schedule that isn't consistent as I'd like it to be. That's exactly when having a simple, reliable, daily foundation, it matters. AG1 has been that foundation for me for over a decade now.

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1:44:41Dr. Michael Gervais:The best part? It only takes about 90 seconds to do. So just head over to findingmastery.com slash morning to download the audio guide for free. Again, head to findingmastery.com slash morning to get your morning mindset routine. Trends over time. What does that mean? So you have to look at across the month what's happening. And so you can compare month to month so that you can see, oh, well, if you're regularly cycling, you can see where you're in your follicular phase, where you might have ovulated, where your progesterone came up. You're going to see that it's normal to have disrupted sleep.

1:45:18sleep it's normal to have an elevation near core temperature how does that affect you though is the question and we know that if you are having poor sleep it's because progesterone has increased your core temperature so maybe we look at doing some cooling mechanisms before sleep so that you can

1:45:33Dr. Michael Gervais:get into a deep restful sleep if we knew what you knew how would we be better partners to women let's call it spouses yeah um so i've talked to my husband about that because he's behind the scene. So he's heard everything and has learned a lot. And he said that one of the biggest things is listening and not trying to fix. Because whenever you try to fix, that's when things go wrong. Because it's a different lived experience for a man versus a woman. And I even find that with my 13-year-old daughter. I used to be like, let's fix this. And then I'm like, wait a second. No, because now I'm trying to be her lived experience.

1:46:09Where if she vents, then I'd listen. and then later she'll circle around and say, can you help me with this? That's the same with partners and spouses. It's like, don't try to fix in the moment. Just listen, be supportive, know that you are there for her. Or if you're a woman with your male partner, you're there for him. And then later it'll circle around to be a fix. Because I think we have this, we need to immediately do something right away instead of going, this is what's happening. This is a lived experience. It's a little bit different than how you were a couple of months ago. Let's figure out why.

1:46:41Dr. Michael Gervais:If we knew what you knew, how would we be a better coach to, and I'm thinking athletics or sport, to a young athlete, to a college-aged maybe pro athlete, and then the advanced, you know, like 30, 40-year-old that's really also on the world stage? Like how would we coach differently? And I don't know if you'd bifurcate those three in any way. I would. You would. I would, especially when we're looking at our young teenage athletes. Unfortunately, the default, again, is the little boy or the coaching like we coach boys. But puberty is a massive differentiator. We see biomechanical changes in girls.

1:47:26Our hips are widening. Our center of gravity drops. Our shoulder girdle widens to accommodate for the wider hips. Body composition changes. we have poor core strength and elongation of our peripherals our arms and our legs and you see that with girls who used to be very confident in the sport and running around and all of a sudden they feel very ungangly and they don't want to participate in sport so if they are in a sport and they're being coached the same way that boys are one they turn off because the way that we coach girls isn't to pit them one against each other like we do with boys for example soccer and corner kicks.

1:48:05Go, go, go, go. Girls are like, uh-uh. But if you have three girls and no one's singled out, it works. We talk about warm-up. We want to warm up the posterior chain and really work on cutting motions in girls to prevent ACL injury.

1:48:18Dr. Michael Gervais:It's an overwhelming ACL issue for young girls. 12-year-olds having surgery. And we know that it's because it's poor posterior chain strength, so that's your glutes and your hamstrings. Girls tend to be more quad dominant. They haven't been taught how to run again with the new mechanics, how to land, how to do cutting motions. So we have to look at the functionality. How are we coaching our girls for their sport with regards to function? So we do function and functional drills. Then we're adding in the speed and everything. We have to bring it right back to make sure that their bodies are resilient enough to withstand the training.

1:48:55Where boys don't have that biomechanical change, so you can keep loading and loading and loading. The functionality can also be in the weight room. I'm not saying girls shouldn't go in the weight room. Of course they should.

1:49:04Dr. Michael Gervais:At what age? Any age, really. It's about adding load effectively and not, it used to be, oh, you don't want to weight lift because you'll damage the epithelial plates and stop growth. That's not true. No, it's not. It's clear. And that's for men and women. For men and women. Boys and girls. Yeah, exactly. It's creating a very positive environment that's not gender because gender is very real when you're talking about a gym space, right? So you have to make it a non-toxic environment. And you can do that through the coaching mechanisms. Like how are you fostering a positive environment and leaning into the way a girl interacts in her environment versus the way a boy interacts in her environment.

1:49:43So I think if the coaching practices at that base level were different, then the rest of it would be easier too.

1:49:50Dr. Michael Gervais:There you go. And would you coach an elite male athlete and an elite female athlete fundamentally differently? Or are they at the elite level? 0.05, like the true kind of tip of the spear, are they more similar in your mind? Yeah, they are. The reason I asked you that is I answered the question just like that at a ESPNW conference. I was like, well, what did I just step into? So the question, I was on the panel, the question was the elite level, how do you train differently? And I said, actually, they're more similar than disillusionment. They're more alike, male, female, than the other 99%. And I said, there's some obvious differences, but they are more similar than just, and it was like, maybe I shouldn't have said it, I don't know.

1:50:40Target on your back now.

1:50:41Dr. Michael Gervais:No, it was like, this was like, I don't know, 12 years ago. And I'm having, I still from the, like, I have a hard time understanding how I'm off there. So hearing you say it, I go, okay, that's interesting. Like, what does that mean to you? So it means that you're not looking at the gender, you're looking at the individual. Yeah. Right? So if we're looking at the top of the top, like you have the women's Tour de France rider and the man Tour de France rider, and they're both on the same team, just women's team, men's team, would you train them differently? A little bit. A little bit. You have to look at recovery.

1:51:15You have to look at training stress score. You have to look at intensities. And you dial that in knowing that women can work at a higher threshold of their VO2 for a longer period of time. So you would change the thresholds for them, but the actual threshold workout, how much time you're spending, wouldn't necessarily be different. It's just looking at the individual. Menstrual cycle coming to play? Yeah, absolutely. Are you changing the training according to menstrual cycle? Maybe not. Because at that elite level, they're dialed into how they feel. So they can say, you know what? On this day, I feel awful, but I'm going to have to race on that day.

1:51:50So let's look at some interventions to help level the playing field. They're more in tune to their body. So when you get to the lower tiers, they've lost that or they haven't learned it yet.

1:52:00Dr. Michael Gervais:They haven't figured that piece out. Yeah. Yeah. Yeah. And then, so how would you coach the NCAA or pro that's in their 20s, you know, in that age? Yeah. So this would be taking account hormone profile. Are they on oral contraceptive or not? Are they naturally cycling PCOS endometriosis? All of that has an effect. Yeah. There's a, there's a difference there for sure. Yeah. So you're looking at mood, you're looking at injury rate, you're looking at attrition. Like, are they showing up? What kind of training status are they putting in? There was a study that I found really fascinating where they blinded menstrual cycle status to the coaches.

1:52:39And they, athletes knew, of course, but they didn't tell anyone. And the coaches were asked to rate the performance in that training session for three months, and then they matched it up. and when the rowers had an RPE of lower than 5, the coaches didn't know that, and rated themselves as not doing very well because of menstrual cycle-related symptoms, it matched up with what the coaches saw. So there is something there about following menstrual cycle and listening and understanding that it does have an effect. From a molecular level, yeah, we know, but when we're talking about the whole body, there's so many other factors, but actually listening and knowing your pattern is so important.

1:53:23So being able to explain that to someone who's in their 20s, why it's important to track your hormone profile, not so that we can keep tabs on you, but so we know when we can push you and when to pull back. But also if you have to be on on the day that you don't feel so great, we have all these tools in the toolbox.

1:53:42Dr. Michael Gervais:That we have practiced well in advance. That we have practiced well in advance to level that playing field. Yeah, very cool. Yeah. Yeah. How do you think male coaches can become better? Where do they go to study and learn? So if they happen to be coaching a female athlete, like where's a good resource to invest in that? Obviously read your books, take your courses and first point to, please point to the best resource for that. Yeah. So what I'm finding is that the younger the coach, the more these conversations are happening. So menstrual cycle isn't taboo so much. And they're able to talk to their athletes, even like high school coaches and stuff, because it becomes a conversation amongst the girls.

1:54:25So the very first resource is in yourself, not being afraid, because it's out there. If we start looking at other coaching resources, we're seeing more and more coming in through the IOC, they have different diplomas for sport and sport coaching for the female athlete, the Australian um used to be the Australian sports and institute of sport which has kind of been filtered and but you can still go to the website and they have some really good stuff about coaching the female athlete as well uh and then just listening to your athletes that's going to guide

1:54:57Dr. Michael Gervais:you too it was a cool I don't know if the trend is still vibrant but when I first learned about it was a handful of years ago the red dot have you like I was like oh that is so good yeah just and the red dot or the red sticker i'm not sure exactly what it's called but it was with some athletes i was working and i said what is that and they said oh i'm just i'm in my menstruation cycle and so like i was like oh cool like like it's it was almost a very cool flip badge of honor like that's right yeah you know and i'm and i'm absolutely you know killing it like i'm great so it was very cool yeah first is that still happening on a regular basis i don't know we're seeing more people use it as like whenever you show up to practice your coach is like how's everyone doing today anyone injured anyone highly stressed you're trying to do the wellness check and some of the questions are anyone on their period anyone having menstrual cycle symptoms it's becoming part of the health check there you go which is really cool that's great yeah good all right listen you are a wealth of knowledge i i am super grateful to have your science and your your astute explanation of complicated science in simple ways in the world.

1:56:09Dr. Michael Gervais:It's helped me a lot. And this is a real gift to be able to have you here. So thank you for being here. And thank you for helping me be just a little bit better in my approach. Thanks for having me. I appreciate it. It's been great. And what's the best resource for folks, for you? If you go to our website, thedrstacysims.com, you can sign up for our newsletter. And we send it out every two weeks has a little snippets of science that's been translated also you can see all the stuff i'm doing yeah and um when's the next book uh manuscript is due in september yes you are writing oh fantastic you're writing two right now selena and i are writing one that is longevity for active women because exercise creates epigenetic changes right great and one for the puberty set.

1:56:57Dr. Michael Gervais:Oh, exactly what we were just talking about. Yeah, that's great. I was really, so this is kind of a set, not a set, a side tangent, but, um, working with a group in Australia that's equivalent to Sephora in the States, it's called Mecca and they have a, a nonprofit called empower. It's about empowering girls and women throughout everything. We partnered to get all of the next gen curricula about coaching girls through puberty into all of the Australian and New Zealand curricula. So that launched on the 1st of April. Well done. I'm very excited. Well done. When do we get it in the States? I know.

1:57:34It's not a nationalized program here is the problem.

1:57:37Dr. Michael Gervais:That's right. You can go state to state, have to rally to get state to state. Oh, geez. Or if there's an organization, a corporation that wants to fund it. Yeah. And I guess you'd have to take it through this, you still have to go through the state though, through the school system or yeah yeah listen awesome thank you for making a dent it's it's great to meet you and thank you for the research that you're you're bringing to the table you're welcome thanks next time on finding mastery we're joined by ross sabo one of the leading voices in youth mental health education wellness director at geffen academy at ucla founder of the human Power Project, an author of Behind Happy Faces and a kid's book about anxiety.

1:58:21How many young people look like they're doing just fine while quietly struggling beneath the surface? Ross shares why parents often miss the signs, why schools need to teach mental health the same way they teach physical health, and how we can give kids the skills to navigate life before they reach a crisis point. Join us for this crucial conversation on Wednesday, July 22nd at 9am Pacific, only on Finding Mastery. All right.

1:58:47Dr. Michael Gervais:Thank you so much for diving into another episode of Finding Mastery with us. Our team loves creating this podcast and sharing these conversations with you. We really appreciate you being part of this community. And if you're enjoying the show, the easiest no cost way to support is to hit the subscribe or follow button wherever you're listening. Also, if you haven't already, please consider dropping us a review on Apple or Spotify. We are incredibly grateful for the support and feedback. If you're looking for even more insights, we have a newsletter we send out every Wednesday. Punch over to findingmastery.com slash newsletter to sign up.

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1:59:59Dr. Michael Gervais:Lastly, as a quick reminder, information in this podcast and from any material on the Finding Mastery website and social channels is for information purposes only. If you're looking for meaningful support, which we all need, one of the best things you can do is to talk to a licensed professional. So seek assistance from your health care providers. Again, a sincere thank you for listening. Until next episode, be well, think well, keep exploring.