Lift Heavy, Protect Your Brain: Strength, Creatine, and Sauna for Women with Dr. Stacy Sims

0:02In part one of my conversation with Dr. Stacy Sims, exercise physiologist, nutrition scientist, and author of Next Level and Roar, we challenged some of the biggest assumptions women have been taught about exercise and nutrition. We talked about why fasted workouts, endless cardio, and eating less often work against us. Not because we're doing something wrong, but because so much of the advice that we've inherited was never designed for female physiology. Today, we're taking that conversation one step further. If we know what doesn't work, what should we be doing instead? We dive into the kind of exercise that actually protects our brains and bodies as we age.

0:46including our muscles, our bones, and our metabolism. We talk about why strength, not endless endurance, is one of the most powerful tools women have and exactly how just 20 minutes in the gym can make a meaningful difference. We also tackle wellness trends dominating social media and separate what the evidence actually says from what marketing wants us to believe. We cover creatine, sauna, cold plunges, GLP-1 medications, and peptides. If you've wondered where to focus your limited time and energy, this episode will give you a plan grounded in science and designed for women's bodies. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner.

1:33I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

1:59The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

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3:29how do you feel about glp1s oh interesting it's a time and a place thing again i love them for what they're doing for the obc epidemic not necessarily excited with the uninformed practitioner who is not pushing lifestyle so we see that loss of lean mass because i can always i think i told you this before the wally movie where they're floating around right and he falls Yeah. And he can't stand up. I'm like, that's where we're going. What I don't like, and I did an Instagram rant on this after the Grammys. And for me, it's not like, okay, maybe you have health reasons for using it. But for me, as the mother of a teenage daughter who's very impressionable, and for so long, we have been really pushing strong, be strong, eat food, skinny is not good.

4:18Now all of a sudden you see all these Hollywood people who are backlashing and now super skinny is in. And the mental health damage that it's doing to all the young people out there is astronomical. Because there's now putting women back in that box to be very small and demure and not take up space. And that's what frustrates me. Because there's no real reason to be microdosing or to get super skinny. We don't know what the long-term outcomes are if you don't need it for health. For normal weight. Right. for healthy people. You're right. And so it's more like the wild, wild west. Okay. And I feel like you can get GLP-1s anywhere.

4:54Anywhere. Well, on that topic, you know, GLP-1 is an FDA approved peptide, but what do you feel about the whole peptide movement right now? We're talking like BP? I'm talking about the gray market. Oh, yeah. Not, not Samorlan and not things that are FDA approved. I mean, for our listeners, insulin is a peptide. Like peptides are just chains of amino acids that bind to receptors and do things in the body. Yeah. And, but I'm talking about the gray market you know yeah and some of them are going to be fast-tracked i think under this administration good or bad but how do you feel is this helping is this hurting do you have an opinion in the are they in new zealand they are in new zealand they're not legal though you have to like i'm gonna say anyway black market circumnavigate to order from australia and say it's for research only you cannot get someone to compound it for you in new zealand and they're very tight on that because they're like, well, there's no real demonstrative evidence to show that they work and it's banned by WADA.

5:48So we're not letting you have it. Some of our professional athletes came back in with it and they got arrested and put on probation because they were bringing a legal substance in. So it's not legal in New Zealand, but very aware of it because I have a lot of injured professional athletes are like, maybe I should get on these. These are going to help. Even when I tore my meniscus and hamstring, I was considering it and I was like, oh, maybe I'll give it a go. So I have tried them and didn't see much. what worries me is now that we are in this mass longevity market and everyone's clamoring to be in there that they're overselling they're overselling results and there's not science to back it up we see stuff in rodent studies that may or may not be promising we don't know yet we don't have any real human trials if you want to experiment on yourself maybe but probably not because we don't have enough evidence.

6:37And that's where I see, like every time you go open up something with longevity and precision medicine is IV therapy, peptide therapy, all this stuff. I went to a longevity conference for women and it was in New York and very excited to go and learn because I'm now treating patients in those last few decades of life. And what is the science saying? What's out there? And it was basically a menopause conference and people trying to sell gray market peptides. Like there was no longevity science, like at least as far as what I was hoping for. And I'm like, is this what women's health in our last three decades has become?

7:17Yeah. You know. And it's not just the peptides either. Now people are pushing rapamycin and methylene blue and mTOR blockers and all these kinds of things. It's like, where's the evidence and why do we need it? Let's first take care of all the basics here. Yeah. And then let's go the traditional route. Maybe we're going more holistic. We're doing acupuncture and dry needling, and we're looking at how are we improving tendon health. Let's listen to Keith Barr where he's talking about how do we improve tendon health if we're doing isometric work from the researcher who's doing the research. But no, this is a case where marketing is louder than science.

7:52Now, let's talk about what works. Creatine. Creatine works. Why? Why? Should all women be taking creatine? Yes, and I read an article. Boy. Are you sure? You said yes so fast. So fast, I know. I'm going to say because I - I take creatine, full disclosure. Me too. Because I read an article this morning that just came across and it was a systematic review that was looking at the benefits of creatine and the people that benefit the most for using creatine are women specifically ages 18 to 65. And this is not for athletic performance, it's for brain and heart health. And I'm like, finally, the research is catching up.

8:29I know Abby's trying. I know. Abby's doing such a great job on that. Yeah. So what is creatine? How does it work? How much should we take? Explain it to the listener. And it's cheap. I mean, it is very inexpensive when you get a really good one, which you have. I have. Yeah. So we look at creatine as we were talking about glycolytics and glycolytic fibers and fast twitch. The very first energetic that happens is the breakdown of ATP to CP. So that's adenosine triphosphate and creatine phosphate. Creatine is part of that. So when you break it down, we need more creatine available to keep doing the ATP-CP and recreating it so that we have that fast energetics.

9:09Most people are not fully saturated. Our liver produces one to three grams a day, not a whole lot for all of our fast energetics. People aren't necessarily eating all of the creatine-containing foods. And we see that women, by the nature of the way they eat and the fact that we don't have as much muscle mass as men typically, then we don't have as much creatine available. So if we are slowly increasing creatine by supplementing, so maybe three to five grams a day, very low dose, over the course of two to three weeks, we fully saturate all of our tissues. So what does that mean? That means that we have increased all the stores of our creatine so our brain works better.

9:48We see that there have been some RTCs that look at creatine. Randomized Control trials. Yes. Thank you. They look at creatine and depression, and it helps people get out of a significant depressive state a lot faster. They're looking at CBT, which is cognitive behavior therapy with creatine versus a serotonin reuptake inhibitor. And the CBT and creatine works better. Wow. So there's lots of efficacy for using creatine, and the research just keeps flowing. And it's really exciting to see the effects of fatigue and jet lag. I am in the jet lag stage, so I'm dosing 20 grams a day. And for those of you who don't know, Dr.

10:26Sims lives in New Zealand and flew here to San Francisco this week. So she is in the jet lag phase. So yeah, we're five hours behind, but a day ahead. But it's okay. So when we look, and I use this in my shift workers too, it's like we want to help the brain eliminate that fatigue and the feeling that it is so fatigued, it goes through a lot of glucose and it alters our carbohydrate metabolism, which is one of the problems that we see with shift work. So if we're looking at dosing creatine, specifically 0.38 grams per kilogram, which... Math. I know. Just tell me a number. So it's about 20 grams.

11:01Oof. Yeah. And we take it over the course of the day. So it's the old bodybuilding idea of... This is for shift workers. Yeah. Five grams, four times a day, but also with jet lag because it increases brain energetics. It's fuel for the brain. so it reduces the fatigue cognition comes up reaction time is better it helps with overall metabolism because now the brain is not being it doesn't have the perception of being overly fatigued so it is really incredible for brain and brain metabolism brain health how much so if you're not a shift worker you're just you know jane in ohio on the couch right now how much should she be taking three to five grams a day when does it matter does not matter we do know that if you mix it in, then it loses its bioavailability within three hours.

11:49So you don't mix in with food or mix in water or whatever liquid it is. Once you mix it in with something liquid, then it loses its bioavailability within three, sometimes five hours, depending on. So you need to drink it within three to five hours is what you're saying. Exactly. Okay. Good to know. So don't mix it in the night before and then drink it the next day. So I walk on a treadmill in my garage. I cannot see the outside because I live in Galveston, Texas, and it's usually 95 degrees or higher with 100 % humidity. So it makes it doable. But what is the difference between walking outside versus walking on a treadmill?

12:24From an energetic standpoint, not much. But from a mental health standpoint, a significant difference. We see so much research now coming about green space in nature and how beneficial it is just to take a walk in nature for mental health. We see it releases more of the dopamine and we have more of a relaxation. We're able to get into more parasympathetic responses, which is great for sleep. And a lot of times when we are out in green space and just being a park and there are other people around, we don't feel isolated. And isolation is another really big killer as we get older. So it's just being out in nature connects you to the environment, to the community, as well as being out in nature really does improve mental health status.

13:10So along the mental health line, we see, in my end, a doubling of mental health, depression, anxiety, rage, new things like misophonia and just a lot of disruption of your normal day-to-day ability to cope with things. Resilience, I call it. From your area of research now, of course, menopause hormone therapy, we're learning leaps and bounds in perimenopause, how beneficial it can be for mental health specifically. But what are you seeing in your research around exercise and nutrition that we're missing? I get this question quite a bit because like one of the newsletters we just put out was about brain health.

13:46And I didn't want to get into the whole MHT conversation, follow Lisa's work quite closely. And we know there still isn't enough definitive research to say yay or nay, right? Yeah. But when we look at exercise and nutrition, we know there's definitive research that will help change systems. So when I'm talking to people like menopause hormone therapy, we see there's so many benefits, especially in perimenopause. But it's also in addition to the lifestyle. And what is the lifestyle? We see women who are so focused from our generation on volume, volume, volume, volume. I want to be an ultra runner.

14:20I want to do this, this, this, this, this, this, this marathons, Ironman. It's like, why? why are you driving for endurance oh because i have extra time or you really disseminate it down and it comes down to aesthetics and it's like no we want quality like if you want to do iron man great but let's look at your training because the long slow volume of stuff is not going to be beneficial for body brain bone mass any of that talk about the rates of osteoporosis with distance runners. I know. Funny. It's really shocking. I know. I shouldn't say funny as in haha. Funny in the irony. The irony of it.

14:57Yeah. Because people think that running is so protective, but it's not. In many ways. Right. But not for bone. Not for bone. I dug into it a little bit because this happened to a very good friend who wants to do more ultra stuff. And she's got osteoporosis and she's not 50. From what I could find, there's probably chronic underfueling because you just can't keep up with calories when you're moving that much constantly. There's not enough time. Right. Exactly. So maybe that's one of the reasons. Yeah. And the calcium loss that you have with the impact of running. We saw this a lot in our younger runners who were just coming out of Red S, relative energy deficiency in sport, low energy availability, that taking Tums before running helped with the calcium loss because then it was circulating.

15:41So there are things that you But for the most part, people don't realize it because they've been told, oh, you know, running is protective, but it's not. It's not multidirectional. It's not enough to invoke a challenge to the bone that's going to create the signal to make it stronger and more resilient. And again, it's the fueling factor. And so when I'm working with people who are doing long distance, it's like we need to pull you right back. I know that this is your end game here. But if we want to get you there, we have to change up your training. we have to make sure you're fueling we want you to be lifting we want to pepper in high intensity yes volume is important because you're doing endurance i've had so many women who have pb'd in their endurance events have there's a race down in new zealand called god zone so it's a five day multi-day race out in the woods multi-sport all the things and this woman's like i have just been rucking with a heavy backpack i've been lifting i've been doing some intensity i was worried because I didn't have a lot of time on my feet and volume, but we PB'd by day.

16:43And I was like, fantastic. Amazing. So there's so many things that come into play when you start talking to people about what's your end game and how are we going to get there, but we have to look at the signaling that your body is getting across the way in order to maintain your health.

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18:28Are women more fatigue resistant than men? They are. Why? Yeah. So this is really interesting research that comes out from like in utero. We know that when a mother who is pregnant with an XY fetus who's under a lot of stress. That would be a boy. Right. I'm trying to be PC. Versus a woman who is under a lot of environmental and mental and physical stress as pregnant with a girl. That she'll most likely miscarry with an XY. So we see this. And I did not know this. Oh, you didn't? I'm an obstetrician and no one ever told me this. I'm going to send you the research. It's really cool. And we see that there is an epigenetic change that's happening within the XX fetus because of the dosing of the X chromosome that increases the resilience to stress.

19:16So when we take the baby out and the baby is born and we have an XX woman, the resilience to stress is greater than the resilience of XY. So when we start looking at fatigue and fatigue resistance, yes, from a physiological and biological, we can look at things like pain tolerance. We can look at muscle fiber factors, but it really comes down to the epigenetic change that we have with stress that makes women more fatigue resistant and more resilient. So I found that fascinating. That is amazing. What is the difference, you know, you touched on this, but for our listeners between oxidative muscle fibers and glycolic and like how, you know, a lot of women don't understand the difference here.

20:08Right. Right. And I think it's because people just think that the body is more of an algorithm, right? So if we're looking at the way the body fuels itself, we think about glycolytic fibers. And this is our very fast energetics. This is anything that is from zero to 30 seconds, sometimes up to two minutes. and the body hasn't quite gotten up to speed enough to use oxygen so when we're looking at the fuel for it it's primary glucose it's atp which is adenosine triphosphate and you break it and you have adenosine the creme cycle right this is why we need creatine right to boost i'll talk about creatine later yeah and so that's our glycolytic it's not using oxygen it's primarily using glucose and we're looking at breaking down glucose this is also how we produce lactate when we're in high intensity.

20:58Oxidative is when we're at a lower intensity, we've had some time and it might be four minutes onwards and oxygen can come into play. So oxygen is really important when we talk about the Krebs cycle, right? For using fat metabolism and burning free fatty acids to use that as a fuel. So there isn't this automatic switch because they work in conjunction, right? And so when we talk about glycolytic fast switch, women have less of that and we need to work on that. We talk about oxidative women or by the nature of XX have a lot of that and are really good at that. But for men, they have a lot of glycolytic and not a lot of oxidative.

21:34So when we talk about the bro data and the male data, it's really why it's so hard to apply to women. Exactly. Exactly. What is power-based training? Power-based training, there's two aspects. When we're thinking about in the gym, power-based training, this is lifting under speed and working tempo. So you might go in your squat, really one, two, three, four, pause, and then explode out. So that's power-based. Plyometrics, jump training, anything that's fast explosive type stuff. Why is that important? That's all fast twitch. And it's also really good for maintaining proprioception, neural connections, good metabolism.

22:11We think med ball slams, all that kind of stuff is just really accelerate and really fast, powerful. And we need that because not only are we seeing that having power and strength is a good indicator of how you're going to live your later years, but it's also really beneficial for our brain metabolism, for signaling to get rid of visceral fat, to allow us to not fall, to improve our balance and proprioception. So I go down to the gym and I have 20 minutes. Yep. What should I do? Well, I know that you have a history of strength training. Yeah, I do. Right? And high-intensity work. So if I were to take you for 20 minutes and you're in your home gym, I would warm up five minutes with mobilization because this is part of the conversation.

22:59I'm so bad at that, Stacey. I just want to get right to it. I know, but it's so bad. It's important. We have to be able to move well. And if we neglect mobilization, then we don't move so well. So what is mobilization? So this isn't stretching. this is like using resistance bands to what we call voodoo floss the hamstring so you have it attached to the rig so you can bend over and pull and distract the hip capsule get into the hamstring so it's not stretching but it's opening up everything for a full range of motion you start to have a little bit of shoulder impingement you can use the resistance band pull back it in and pull the shoulder back it helps prevent shoulder impingement all sorts of things so then if we say, okay, now we have 15 minutes left.

23:40I want you to do one compound movement. So are we working on our squats today? Then our mobilization is going to get in that full range of motion, opening up our hips or knees or ankles. And then we're going to build up our squats. And then maybe I'm going to have you do some pause squats. So you're going to tempo down two, three, four, pause at the bottom, explode out. And we might, depending on where you are in your program, maybe you're doing four sets of that. Maybe you're doing five sets of that on a heavier lobe, but we're trying to move with intent and some explosiveness. And then I'm going to have you finish with a little bit more mobilization because you've done some really hard explosive work in your squat.

24:19If we're not doing the explosive work and we're just doing our typical squats, then I'd have you finish with some battle rope work or maybe some sprints on your treadmill just for a little bit more high intensity. Done and dusted in 20 minutes. Wow. Okay. Most women, when I looked at the research, have never lifted a weight. I've there's been a really fun memes going around about women being the first in their generation to ever work on strength training and I'm I'm very certain it's my mother jogged and jogged so much she's had three bladder lifts and eight children so that was definitely a part of it but like she swam a little bit and but they had one of those machines that had the band that went around her waist oh yeah and would shake and then my dad would get on it and And my sister and I would sit there and watch them shake their bellies.

25:09And that was their gym. Yeah. The vibration. The vibration. Similar. My parents both jogged. My dad was push-up stuff because of the army. I had to do calisthenics. We ended up with the Nordic Trek. And I think we had one of the Chuck Norris rope pulley systems at some point. And then when I was a teenager, I found the firm Aerobic Workouts with Weights. Oh, yeah. Remember the firm? Yep. so I think I was the first one and then I got into going to the gym with my friend at 16 because her brother was a bodybuilder and we had to go meet him at the gym so instead of hanging out we're like okay we're gonna lift and then I introduced my mom to the firm aerobic workout with weights amazing she started doing small weights and she's been doing small handheld weights but trying to get her to build that weight stuff up is hard because it's not in yeah because it's not in the culture how do you know you know for an absolute beginner if she's like listening to this podcast.

26:04Where does she start? Where does she start? I tell people, if you're just starting your journey, that you want to have a wellness meeting with yourself 10 minutes, three times a week. We don't break wellness meetings. Well, we don't break meetings and we definitely don't break wellness meetings with ourselves. If at first it's just the consistency of those 10 minutes, three times a week, and you're going outside with your cup of coffee and having time in nature to improve mental health. Fantastic. But over the course of maybe two weeks, then I want you to start adding in some body weight stuff.

26:35That could be doing some air squats, could be doing some single leg lunges. Maybe you're doing balance on one leg, tree pose, pushups against the wall. Anything that's going to be resistance push-pull for you as you start your journey. And you're going to find what you really like. And if you're like, oh, I really enjoy working out at home and I want to be outside, then maybe you get a nap. Maybe you get into something like PeeVolf. Maybe you get into like Haley Happens stuff. Like there are lots of different really good programs that you can do at home. But ideally you get a friend and you meet your friend and you have 20 minutes together where you can catch up, but you're also working out.