Why Women Gain Weight on the Same Diet as Men: Fueling, Fasting, and Biology with Dr. Stacy Sims

24:42Dr. Mary Claire Haver:And the best part? Women in all 50 states can access personalized care, and it's almost always covered by insurance. So yes, I'm glad menopause is finally getting attention. But don't settle for noise. Get care from clinicians who are in this with you for the long haul. Book your virtual visit today at joinmidi.com. That's joinmidi.com.

25:20over social media, we're going to give you actionable guidance to make your financial life clearer, less stressful. We're going to answer your financial questions and take the mystery out of your financial life. Follow and listen to Money Moves with Jill Schlesinger

25:34Dr. Mary Claire Haver:wherever you get your podcasts. I've really been loving the idea of throwing on a cute casual outfit and then pairing it with just the right piece of jewelry to pull it all together. It's funny how that one small detail can completely change the whole vibe of what you're wearing. It makes you feel more put together and a little more confident, even on the simplest days. That's the beauty of Jenny Bird. Everything is designed to mix and match. You don't have to overthink it or plan it out. Just grab a piece or a few and you're instantly elevated. Stack a couple of necklaces, wear a pair of bold earrings, or add some beautiful bangles and it always works.

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26:53Dr. Mary Claire Haver:Talk to me about light. You mentioned it briefly. How important is light? What kind of light? How do you get it? You know, I've heard don't go in a window, go outside, you know. Bright natural light is the best thing if you can get outside. If not, you're looking at really, really bright light inside and it's to stimulate the penal gland to say, hey, wait, I'm awake. It's time to go. For those of us who live in the extremes of the hemisphere, so up Iceland and Scandinavia or down Alaska. Yeah. All those places are down Australia, New Zealand. In the winter when it doesn't get light till 830 or nine, you're not going outside when you first wake up.

27:30So you do have to have a sunlight or something like that to wake up. And it's important so that your body knows, okay, time to wake up. Let's go. Let's do what we need to do in the day. And then when you get dark at night, then that's when your body starts to wind down and have more parasympathetic response, starts to kickstart the melatonin responses so that you can get into a deep repetitive sleep. Talk to me about timing of food too with the circadian rhythm. Yes. So we know that women really do need to eat within an hour of getting up. Why? Why? Yeah. So we have that cortisol awakening response.

28:04That's how we naturally wake up. If we wake up to an alarm, we have a greater peak of cortisol. Now, cortisol is not a bad thing, but it's tightly tied to what we call acylated ghrelin, which is part of an appetite hormone control. When it's elevated, it is a hunger hormone. It's also countered by peptide YY, right? So in order for those to work synergistically and together, we need to eat so that the hypothalamus understands there's nutrition coming in. Yes, we can have ghrelin drop down, peptid-YY comes up so that we feel satiated, and then all of our cortisol levels drop and can pulse at a normal rate throughout the day.

28:43Dr. Mary Claire Haver:Does leptin, which is also a satiety hormone? Part of it, yeah, but it's not as important as the other two. PYY, okay. So what about eating before movement? I was under the impression, probably based on male data, that fasting workouts were fine. Yeah, no, not so much for women. And I mean, those of us who might be in the 5 a.m. club, the idea of getting up and having a full breakfast right before is just like, oh no, let's not do that. How much do you have to eat then? It's just enough to bring your blood sugar levels up and to signal to your brain that yes, there's fuel on board, we can do this exercise.

29:19And I will back it up with when we are exercising, we are creating a breakdown stress on the body. We want that to be a very strong stress that is targeted, meaning that we have a specific plan for each exercise session that we are doing. Then the reparation comes afterwards. if we go into a session fasted we already have an elevation of our breakdown hormones and we can't quite hit intensities that we need to okay because we're not giving our body the fuel that it needs to to hit intensities and for people who get up and say yeah i'm just going to go for an easy walk it's not as easy as you think because your body's already like jumped out it's like whoa it's time to get up let's go cortisol is elevated if you're not eating then it then it feeds forward into the appetite hormone and cortisol distress that we just talked about.

30:11So something small, if you're going to go for a 30 or 40 minute walk, maybe you're just having a half a banana. Okay. Piece of toast. People who can't do that, maybe they're having protein coffee. What is protein coffee? Profi. So this all started like from the social media side from me, because people asked me what I would have first thing in the morning. I love coffee. It's one of My only real vices besides maybe. That was Diet Coke. Yeah. People are going to kill me for that. So it's just a cold double espresso with some almond milk and a scoop of protein. So it gives me some carbohydrate from the sweetened almond milk, a boost of caffeine, and it tastes like a latte.

30:55But you also get a good 20 or 30 gram hit of protein, depending on how much you put in. And so that allows my body to get nutrition. I drink it because I'm like, yeah, great. sits well and away we go. And then I have a real breakfast after training.

31:08Dr. Mary Claire Haver:Okay. So yeah, it's just something small. Abby Smith, Ryan's lab showed that for women who are just doing strength training in the morning, 10 to 15 grams of protein. That's really cool. Yeah. Get that in based on her research. Yeah. And then if you're doing a cardio aspect to it, add 30 grams of carbohydrate. Okay. So it's not that much at all. Why does getting breakfast help you sleep better at night. So this falls into the whole circadian rhythm, right? So if we're eating breakfast, then our whole body is in its right rhythm throughout the day so that you can hit that parasympathetic, get that initial melatonin peak, and then your body is primed and ready to fall asleep naturally.

31:48I tell people you want to fuel during the day. You don't want to fuel for your afternoon wind down because a lot of people are like, oh, I'm not hungry. I'm going to hold it and then I'll have lunch and then I'll eat throughout the day and then I'll have a big dinner, might have a snack after dinner, and then they try to sleep. You're just fueling for your afternoon wind down. And we don't want that because you've missed the whole part of the day where your body really needs fuel and needs to be fueled well for brain movement, cognitive focus, all of those things. And then we also want good sleep because that's where we make change.

32:20So you can't have any body composition change if you have disrupted and intermittent sleep.

32:25Dr. Mary Claire Haver:That is a frustration a lot of women have. I see on social media, I'm eating the protein, I'm lifting the weights, and I'm not seeing the body composition changes. So how would you address that? Yeah. So I see this so much as well. And I wish I could take each person individually, right? Because that would just be very helpful. So I try to get people to really look at what they're doing throughout the day. When do you first eat? What are you eating? How much? Where are you stacking your calories? because we know that you want to front load your calories to have more of your food in the front part of the day.

33:00You want to have protein fiber at every meal because it's helping gut microbiome. Gut microbiome, when it's healthy and diverse, increases serotonin production, helps with melatonin production, all of those things. It also helps with circadian rhythm and then when we get to sleep. So if we have interrupted sleep, then your body composition isn't going to change even if you're doing all the right things. It's about metabolic control and how your body is understanding glucose, what it's doing with protein. A lot of women, unfortunately, will try to stack protein in the middle of the day, or maybe they'll have a big hit first thing in the morning, and then they kind of forget about it.

33:34But protein is really important for satiation. It's also important for a lot of functions that happen, including hormone production and things like melatonin and serotonin or neurotransmitters. How do we build muscle? How does that work? So this is the complex. So we're looking at muscle. It is a push-pull, right? We want to increase the resistance of all of our push-pull motions. If we are looking at a young person who's in their late teens up to their mid-30s, then they have the availability of push-pull and some protein intake, and that's going to really help what we call turn on the mTOR, include signals for building that lean mass, and it's going to get stronger.

34:19against the resistance. When we start getting older, our body has what we call an anabolic resistance to both protein and exercise. We have to be very specific in how we're building muscle because it's incredibly difficult to build muscle when we get older. I know that every time I travel, I come home like three kilos lighter and I'm always like, oh, it's lean mass, even though I'm going to the gym. It's because I'm highly stressed and I might not be eating enough or eating properly and then it takes a year to put it back on. When we're looking at strength and power and lean mass in older women, we have to have regular consistent doses of that strength training and we want to be on the lower end of reps and weights as we develop the capability of getting there so that we can preserve our fast twitch fiber, we can preserve our proprioception, we can improve our prefrontal cortex connectivity.

35:15And we have... So explain to our listeners. So what is a fast twitch fiber? Fast twitch is all of our really quick energetics. So you go to reach for something and you accidentally hit something that's hot and you jerk your hand away. That's a fast twitch reaction. All of our ability to jump, to skip, all the power-based movements, those are all fast switch. And we lose them rapidly, especially as we age. Women lose them faster than men. And we lose our ability to produce power, which is really important, much faster than men. Men lose lean mass as they age. Women lose power and strength first.

35:55And then they'll start to have cell death or lose lean mass. So when we start to get into our 40s, it's the focus on how are we building that power and strength? Because that's going to not only preserve that end of the spectrum, but also help build lean mass because it's a stronger push-pull.

36:11Dr. Mary Claire Haver:Okay. We'll come back to that. And then you also talked about proprioception. Yeah. And so I know what that is. Yeah. So proprioception is your body and time and space. So it's your balance. Yeah. And so if you step off a curb, you still have the ability to catch yourself and not fall over. And people are amazed at how fast it goes, even in their 40s. They're like, whoa, I can't run down that trail. I'm too afraid. I might roll my ankle or something. It's because they've lost that proprioception. So it's not when we're thinking about when we're in our 60s and 70s, we start to lose it. We start losing it in our 40s.

36:41How do we build that back, specifically proprioception? Proprioception, a lot of balance and one-legged stuff. We can do our one-legged closed eye balance test. We do a lot of functional stuff with our feet, looking at toe grabs and widening our toes and balancing our feet on different platforms. One of the other things that people might forget is that as we're losing power and strength as we get older and lean mass, we're losing it from our feet, from our calf muscles, all our stabilizers. We have to work those well too. And you also said frontal cortex. Yes, our prefrontal cortex. So it's the front part of the brain that's responsible for cognition, reaction.

37:20And we want to have a lot of neurons that are connecting and connecting well in order to preserve our cognitive focus and reduce our risk factor for dementia and Alzheimer's. Okay.

37:32Dr. Mary Claire Haver:You say we need to eat more. Yes. To lose fat and build bustle. That is a paradigm shift. I know. From what I was taught in medical school and now having worked with thousands and thousands of patients this time of life. I completely agree with you. Yeah. But quality is right in there with quantity. Explain to the listener why this works. You know, why she's been fasting and fasting and fasting or just calorically restricting. And she is on the struggle bus. So I'm going to come back to the quality because one of the questions I had in a seminar a few weeks ago was, so I can eat as much as I want whenever I want.

38:09And I was like, no. Valories are important. Not quite. But you cannot build muscle and bone without abundance. And people will go, well, what do you mean by that? And I was like, well, if you're in a calorie deficit or you're stressed under fasting conditions, then your body thinks that there isn't enough food to maintain or build tissue. It's going to conserve fat. It's going to increase visceral fat. And you are not going to be able to build lean mass. If you are in a severe calorie deficit and you are also not having a higher protein intake, then you're going to lose lean mass first and conserve even more fat.

38:50So when we talk about we want you to eat more, we want you to eat that wide variety of colorful fruit and veg, good protein sources, high quality food. And this is where I lean and say I'm not worried about calories per se. I'm worried about the quality of your food because if you're eating appropriately throughout the day, you don't get overly hungry. You don't crave the sugar. And your body has more of a relaxed aspect where it's saying, oh, okay, I can get rid of this extra fat and I have the capability because I have the nutrition to build muscle. And it is a paradigm shift because we all grew up in the calories in, calories out, fat burning workout.

39:29Let's work out for 90 minutes. Let's have that cardio sweat session. Two hours. Yeah, yeah. Yeah. And it's like, that is counterproductive. It doesn't create the exercise stress that we want because it kind of puts you in this moderate intensity, highly cortisol sympathetic driven stress, which is more of a fight or flight scenario, not a let's change body composition scenario.

39:54Dr. Mary Claire Haver:So what should a woman do exercise wise to change that body composition? meaning in a positive way, get rid of visceral fat and gain muscle and bone. Yeah. So all movement is good. And I'll start with that because I have had pushback when I've been absolute because there's, you know. And I 100 % agree with Dr. Sims. You know, if you are sedentary, a 30 minute walk a day will decrease your risk of diabetes by 50%. Like all movement is good. So say you're already walking. What's the next step? Next step is add some intensity to that walking. Because I like to look, if you're already in the consistency habit of doing some aerobic type work, like walking, let's add some intensity to that.

40:35How would you do that? Yeah, exactly. We pick up the pace for a minute or two. We might try to walk upstairs at a faster pace. We might go in onto a hill. So we're just increasing the intensity and we're doing two to three minutes of an increased intensity, right? And then we come back down and we have a couple of sets of higher intensity during our walk. If we are looking at, I'm already walking, I'm already doing hills, then the next step is, okay, well now we really want to add in some super high intensity work. How do we do that? Well, let's look at some kettlebells. Let's do some kettlebell swings.

41:09Or maybe if we don't want to go down the route of kettlebell and into the gym environment yet, let's look at doing some squat jumps. So let's do a body weight circuit within that session. So you walk to warm up, maybe you're going up your hill. And then at the top of the hill, let's do five to six burpees and 15 air squats or squat jumps. Walk down the hill for recovery, run back up or walk back up the hill, do it again. And there we have higher intensity, total body, and we're getting more of what we need. And this is all about the exercise stress. Because we want to look at what kind of external stress can we put on the body that's going to invoke change.

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46:36Dr. Mary Claire Haver:What's the difference between time-restricted eating and intermittent fasting? I love this question. It's pretty much just semantics, I'd say, because intermittent fasting can be time-restricted eating, but time-restricted eating is not necessarily intermittent fasting. So intermittent fasting is when you purposely withhold food and have a very tight eating window. Most people will hold a fast till noon, maybe 11, and then they'll have an eating window from 11 to 5 or maybe 11 to 6. And then they're holding a 12 to 16 hour fast. If we're looking at time-restricted eating, this is where we eat according to our circadian rhythm, where we eat within an hour waking up.

47:22We eat periodically throughout the day to fuel our body well. Then we have dinner and then we don't have anything after dinner. So then you still end up with a 12 to 13 hour overnight fast, but you're not interrupting your circadian rhythm and you're not phase shifting any of the important hormone pulses and appetite control and sleep metrics that happen with intermittent fasting.

47:44Dr. Mary Claire Haver:Okay. And this just seems to get way more important across the menopause transition. Absolutely. Because our hormones are in chaos and disrupting our sleep and like just adding on to all of this. You kind of get away with it in your 30s. And then all of a sudden when the hormones start swinging, you know, it becomes a critical mass. Exactly. Because I'm pretty sure that someone who's in perimenopause isn't going to go out to the pub, come home at 2 o 'clock in the morning, have a big feed, go to bed, wake up and say, I feel fantastic. I feel great. Okay. In one study, people ate the same meals and the same calories.

48:18Dr. Mary Claire Haver:But those eating bulk before 3 p.m. had better metabolic outcomes and lost more weight with no calorie restriction. So just timing. Just timing. Amazing. Yeah. Yeah. And there's more and more of the public health research coming out who's talking about early fast versus late fast. And breaking fast early, which means eight to about three, you get all of the metabolic controls that you find with full day fasting and super calorie restriction in rats. But in humans, we don't get that when we're having extreme fasting. And again, it's because we're working with our circadian rhythm and then we are allowing our body to have that rest and digest process and get into that reparative sleep.

49:02And we're not exactly sure why we need to sleep. We just know so many functions happen while we are sleeping that is important for total body health. So if you eat so close to bedtime, why is this disrupting so many women's sleep? Your body's spending all this energy trying to digest and it's actively working instead of resting. If you are trying to digest, then you're having lots of metabolic processes that are happening and your body thinks it should be awake. And your brain is like, I should be awake, but yet I'm sleeping. How do you talk to shift workers? Because I was a shift worker.

49:38Dr. Mary Claire Haver:Yeah, it's hard. It's really hard. So looking at how their shift plays out and looking at when they get off work and what they need to do. can we exercise when we get up before we go to our job or do we have to do it afterwards, preferably before so we're not doing it? And working a little bit with some chronobiologists looking at microdosing melatonin and knowing that with shift workers, you don't want to take it right before you go to sleep because it's too late. It's the same as women with ADHD. We see that if you are using melatonin three or four hours before you should go to sleep, it helps reset the brain to be able to get into the sleep that it needs to.

50:21So when we look at ADHD, it's effectively a phase shift of the circadian rhythm as well. So if we look at microdosing our shift workers. With melatonin. With melatonin.

50:33Dr. Mary Claire Haver:Everyone hears microdose now and they think GLP-1. And we'll talk about that in a little bit. Melatonin. microdosing melatonin because what you buy over the counter is way too much right so what so what is microdosing melatonin so we're looking at 0.5 milligram not five milligrams so you can get a one milligram tablet and crush it if you really need to but you can also get a prescription for 0.5 milligram and that's your microdose and you take that three to four hours before you need to be asleep and then it kicks in and allows your melatonin to work properly while you're sleeping and allows your body to reset.

51:09Dr. Mary Claire Haver:And what is the mistake people are making? I know when I first tried it, I heard about it, didn't read anything, and went to the drugstore and bought a 10 milligram tablet thinking more is better, right? Like it's a sleeping pill. I had no idea how it worked. I thought it would put me to sleep. And like a sedative. And had crazy dreams and completely drugged the next day. Yes. Yeah. And part of it also is because you're a woman, right? And the doses are primarily for men, which is why we've had issues with Ambien. But it overstimulates the brain to be in its kind of sleepy, fatigued state. So you wake up feeling hungover and drugged.

51:45Dr. Mary Claire Haver:Yeah. If you're using very, very small doses, then it actually works with our GABA system in the brain. It helps parasympathetic activity. So it does the things that melatonin is supposed to do. But a big whack, which is how all Western ideas are, the more the better, is way too much. And your brain is like, I can't handle this. Okay. What is your eating window? Do you mind sharing? This is not prescriptive. No, it's not prescriptive. This is not the... So full disclosure, when I'm highly stressed, I forget to eat. So my husband's always tapping on my shoulder. But I get up and I have some food, maybe half an hour-ish after waking up.

52:21Then I'll do some training. I'll come home. I'll have real breakfast, which might be 8, 8.30 in the morning. Then because I live in a Commonwealth country, we have morning and afternoon tea. So about 11 o 'clock, have some more protein fiber. Then I have lunch about one. And then we have afternoon tea, which is more protein fiber stuff about three. When my daughter gets home from school, her afternoon snack is also how we have our afternoon tea. And then dinner is between 6.30 and 7.30. And then I go to bed about 10.

52:51Dr. Mary Claire Haver:All right. Let me walk you through mine and tell me if I'm making any mistakes. Okay. So I wake up and I have coffee, black. and I have a view of a beautiful view of the water from my bedroom, which I'm super fortunate. So I sit with my laptop and I get, I answer a few emails, I drink my coffee, I do my meditation, my journaling, my like, you know. And then I get up and I make my shake, usually when I'm at home. And so that is a ginormous, God bless myself, but I have, I've seen it. My protein, a little bit of collagen. I have my Greek yogurt, usually frozen berries. and I have my Zoe 30 seed mix in there so I can get my 30 plants.

53:31Dr. Mary Claire Haver:Yeah. And a little extra scoop of fiber. It's like eight more grams of fiber in there. And so I sip on that. I try to get like a quarter of it down before I head down to the gym. So I have a gym in my home. Yep. And so I go down there and I do usually my lifting and sprints or whatever, my high interval stuff. And then I get on the treadmill and take all my calls. And so I have a walking desk. Okay. And it's not super intensive, but it's better than sitting. Yeah. And so I do that while I'm sipping on my shake for the rest of the morning. Okay. So are you sipping on your shake while you're on your treadmill?

54:03Dr. Mary Claire Haver:While I'm walking and working. Yeah. Perfect. So, and then I finish that up by like 11 noon-ish and then I'll go have lunch. Okay. So, and that's my biggest meal is lunch. Yep. And then what do you do in the afternoon? So I'll probably like have apple and cheese or some kind of snacky thing or some fiber crackers, you know, mid-afternoon I'll get hungry. And then my husband and I eat really, we're empty nested now, which is super fun. And we'll have some kind of a lean protein, some veggies, a salad, whatever, for dinner. And we go to bed. I stop eating by six usually. Yeah. Great. What's the macronutrient profile of your massive shit?

54:38Dr. Mary Claire Haver:So typically when I look at it, I usually don't pay that close of attention. But I'm trying to get like 100 to 120 grams of protein a day. I get 50 in that shake. So that kind of helps space that out, you know, get that kick in there. And I'll note that the 50 is not just protein powder. It's from your nuts and your seeds. Yeah, all of it. Like I count it all in there. Because people think that when you say 50 grams of protein, you're just scooping in the protein. No, no, no. It's not two scoops of protein. Yeah. No, no, no. I get it from multiple sources. And then I really only count really protein and fiber and try to get 30 plants in a day.

55:08Dr. Mary Claire Haver:And I get at least 35 grams of fiber a day. Yeah. Perfect. From multiple sources. Exactly. That's how I think about it too. I'm like... Completely different than what I was doing 10 years ago. Right. Which was eat as little as possible and work out as much as possible. Drink lots of coffee. Yeah. All day. When I was working as a doctor, like full-time and taking call, the only liquids in my body were coffee, Diet Dr. Pepper, and an occasional sip of water. That was it. Yeah. Sounds. Yeah. And then when you're really down for the count, Mountain Dew. Okay. So I'm doing okay. And again, this is not prescriptive to our listeners.

55:41Dr. Mary Claire Haver:This is just what Marie Claire does and literally completely different than what I did 10 years ago. Yeah. Because I'm thinking about me at 80. Yeah. Instead of me in a bikini. Right. Exactly. But you'll still be rocking hot at 80 in a bikini. I think I'll look great at 80 no matter what, you know, and I will wear a bikini and hopefully be chasing my grandchildren if they ever appear. All right. You said something that was a revelation. All those diets, keto, carnivore, plant-based, intermittent fasting are designed to create health outcomes through eating. But if you just exercise, you get all those outcomes.

56:17Yeah, I know. Funny, huh? Yeah. We chased this whole diet culture, right? We're bombarded by diet culture, right?

56:25Dr. Mary Claire Haver:I was part of the problem and I followed that hook, line, and sinker for years. Yeah. I think we all did. And it was either personally or when we're working with clients, we're telling them something. I remember looking back at some of my old files from maybe 15, 20 years ago, and I had some female triathletes doing some fasted workouts because that was the research that we had at the time. And now I'm like, oh my gosh, I'm so sorry. But when we're looking at things like keto and the goal of keto is to lose body fat, right? Well, you talk to any lipidemiologist and then like the outcomes for a healthy person using keto is just dire on lipids.

57:00It's really specific for people with traumatic brain injury, epilepsy. It's good for brain health. The problem with a lot of these diets is they've come from a clinical scope and then pulled over into the health and fitness world and got traction. So everyone's after the aesthetics when they're looking at it. None of these are really promoted for health span. If we look at exercise, exercise in itself is a really strong stress that your body is like, yep, okay, physical activity, we have to do something about it. So it has so many different feedback mechanisms that allow your body to look at that stress, encounter that stress, overcome it and repair itself better.

57:38So if it has that stress again, it can have less of an impact on the whole system. So when we look at autophagy and everyone's like, oh, what is autophagy for our listeners?

57:49Dr. Mary Claire Haver:It's very misunderstood. And you might say autophagy in your head because I did that until I heard someone pronounce it. Yeah, I did the same. Yeah. So we look at cells and recycling dead cells in some of the parts. And we want to have the body recycle some of the parts of the cells. Otherwise, we have a whole bunch of different cell parts and free radicals and things that aren't so great for the body. So autophagy is your body's way of cleaning up garbage and recycling it, not just throwing it away. And we see people want to do long fasts because it triggers autophagy and it also helps with telomere length.

58:24So this is increasing the health of our DNA. If we look at exercise, exercise in itself is an autophagy event because it's breaking down fuel. It's breaking down muscle tissue with every contraction. Impact will load the bone. it also breaks down the bone. And after exercise, it has to clean it all up. And that's part of the reparation process. So if we're looking at a strong stimulus for cell repair and cell regeneration and cell recycling, it's exercise. Because the post-exercise response of that stress is to clean everything up. If we're looking at increasing our fat metabolism, which people want with the ketogenic diet to lose abdominal fat and overall body fat and distal fat, this is where we look at the intensity of exercise and strength training, right?

59:11Because those in conjunction are going to create a metabolic shift to reduce body fat. In the actual moment of exercise stress, if we're doing high intensity, no, we're not burning fat. We're using our fast glucose because we need it for fast energy. So if we're using a lot of glucose, then at rest, our body's relying on fat because it wants to conserve glucose for that exercise stress. So when I see all these diets that are purporting better body composition and aesthetics, it's let's exercise and let's fuel for the exercise because we know we cannot out-exercise a bad diet and we cannot get all the changes we want from crazy diets.

59:53So when we're looking at the research world, there's physical activity researchers and there are nutrition researchers and rarely do they come together. When you find those people who come together, you're like, it makes sense. We have exercise that's distress. All of these feedback and signalings happen for the reparation. And then we need nutrition for the signaling and feedback to actually make a difference. So that's why I said, you know, all of these diets will do something. But if we are specific in the exercise and what we do, we get better outcomes because we are controlling that stress and actually putting a proper stress on the body to get the outcomes that we want.

1:00:31Dr. Mary Claire Haver:Welcome back to another MidiPause. I'm Dr. Mary Claire Haver, host of Unpaused. Today, let's talk about something that often flies under the radar until it becomes a serious problem, bone health during menopause and why DEXA scans matter more than you think. Osteoporosis isn't just a bone issue. It's a major women's health crisis hiding in plain sight. It's the most common bone disorder, yet many women don't think about it until a fracture happens. And the statistics are hard to ignore. Half of all women will break a bone due to osteoporosis. A hip fracture, in particular, isn't just an injury.

1:01:11Dr. Mary Claire Haver:It can be life-altering. One in five people will die within a year of surgically repaired hip fracture. And that number rises to 70 % when surgery isn't an option. So why does this happen? As estrogen levels drop during perimenopause and menopause, bone turnover increases. We begin losing more bone than we build, and the process is silent. You won't feel it happening, which is why osteoporosis is often called silent disease. For many women, the first sign is a fracture. In fact, women can lose up to 20 % of their bone density in the first few years after menopause without even realizing it. That's why this stage of life is such a critical window to start paying attention.

1:01:57Dr. Mary Claire Haver:This is where DEXA scans come in. A DEXA scan is a simple, non-invasive test that measures your bone mineral density, typically in the hips and spine, the areas most vulnerable to fractures. Think of it as your baseline. It tells you where your bone health stands now so you can make informed decisions moving forward. And while many women are told to think about bone health later in life, the reality is that earlier awareness leads to better outcomes. Don't wait until there's a problem to get your first scan. The good news is that there are clear, evidence-based steps you can take starting as early as your 30s and 40s to protect your bones.

1:02:37Dr. Mary Claire Haver:But it starts with having the right information. That's where platforms like MidiHealth can make a real difference. Midi takes a more comprehensive approach to midlife care, including bone health. Their clinicians can help you determine if and when a DEXA scan makes sense based on your personal risk factors, walk you through your results, and help you build a plan that is tailored for you. Just as importantly, their virtual model gives you access to care that understands menopause without feeling rushed, dismissed, or left to figure it out on your own. Because the truth is, you deserve more than a quick dismissal.

1:03:15Dr. Mary Claire Haver:You deserve data, context, and a plan. Bone health isn't something to think about after a fracture. It's something to be proactive about now. So ask about the scan, know your baseline, and make sure you have the right support to protect your long-term health. Go to joinmidi.com, join M-I-D-I.com, and connect with one of their clinicians today.

1:03:44Dr. Mary Claire Haver:It's so exciting. So when I'm in the gym, I stopped thinking about aesthetics for the first time. I look at aesthetics like that now, not like, oh, the bikini vision I used to have in my 30s. But I'm also thinking about what's happening on a cellular basis and how it's lowering my risk of depression and my risk of dementia. And I literally am like, one day less in the nursing home. Yeah. You know, that's my thought process when I'm down there. And it just motivates me so much more than me trying to look like a 14-year-old. Yeah. My mind shift changed when, well, I had a hard pregnancy and all the things that I planned after pregnancy didn't happen.

1:04:23So I had to like find ways around of going from rehab, from surgery to surgery to rehab, to putting weight on, a whole bunch of things. And keeping a human alive. And keeping a human alive, yeah. And in the back of my head, I was like, I have an extreme risk factor for dementia in my family. So I just really started going down that route going, what are these things that we can do to prevent dementia and Alzheimer's? And you're reading the research, you're like, there isn't anything, especially for women. Why is this? We see that women are the ones that are getting all this cognitive decline. So then because of my education and ability to be in a human performance and looking at neuromuscular changes that we see with athletes and motor patterns and going, okay, if we're looking at increasing motor patterns and getting faster athletes when they're in their 20s, what's going on neuroplasticity?

1:05:16So then we come down to research coming out now within the past four or five years and looking at motor patterns is a driver for neuroplasticity, which means that we're increasing connections of our neurons. We're not developing towel plaques, like all of these things, as well as lactate production. So this is where the high intensity work comes in and we're looking at why that is important.

1:05:39Dr. Mary Claire Haver:Yeah, so there's a lot of drama online with the gym bros about who should be doing HIIT training or not. I know. I hear this. Don't worry. When we're looking at the gym bros and they're relying on the male data, right? They're like, oh yeah, we don't necessarily want women to do high intensity work. It's bad for their metabolism and increases cortisol. It's like, no, no. Inherently, there is a sex difference between women and men and muscle fibers. We know that women have more endurance fibers than men, which also means we have more of the proteins in our mitochondria, which are a powerhouse of our cells, to be able to use free fatty acids or fat than men do.

1:06:18So when we're talking about the zone two work and all the low intensity work, that's all for male data because men need to do that to become more like women. They need to do that in order to have more endurance, right? But women, we can go long and slow forever.

1:06:33Dr. Mary Claire Haver:My daughter can run a full marathon. Without too much training. No? No. Good mechanics, but also metabolically, women can go long and slow. This is why we're seeing ultra runners and ultra cyclists, they're all women, dominating the ultra fields because our bodies are designed for that. We look at what's happening in perimenopause across into postmenopause. We have a significant change in brain metabolism, meaning that our brains become less capable of using glucose. And this is where we start to see a misstep in our body's metabolic rates across the board. we also see this is where we have an increase in cognitive decline.

1:07:14Some of it's brain fog.

1:07:14Dr. Mary Claire Haver:Moskoni talks about that specifically and like how we consolidate memory. Yeah. But also when she looked at glucose uptake across the transition and how much it changes based on estradiol levels. Right. So lactate is preferred fuel by the brain and the heart. It's not a byproduct. For our listeners, how do we make lactate? So lactate is when we do higher intensity work. and this could be one to four minutes where we're just at a threshold where it's really uncomfortable and people used to say it was the burn because it is an acid that's produced as a byproduct of glucose metabolism. It's not a waste product that people used to think, oh, you know, got to flush out the lactate.

1:07:54While you're producing lactate, your brain and your heart are like, great, yay, better fuel. So if we produce lactate on a regular basis, one, we are able to keep fast switch fibers because those are the ones that generate the power that then produces the lactate. We also increase our body's ability to use lactate, both in the muscle and the heart, but also in the brain. So if we're able to increase the lactate levels that get pulled into the brain to be used as a fuel, we're improving our brain metabolism. If we're improving our brain metabolism, again, that reduces dementia risk. We see it reduces the tau plaque and the amyloid development.

1:08:33So lactate is super important. And this is why I get so frustrated with people like, you shouldn't do high-intensity work if you're a perimenopausal woman. Because they are not looking at the full picture. They're looking at male data. And if we're looking at strength and conditioning, they're very much in the, what are we doing for muscle? What are we doing for muscle? They're not looking at bone. They're not looking at brain health. They're not looking at metabolism as we get older. Again, because men age differently than women. even in that 40 to 60 range where I get a lot of pushback because I keep telling women you need to lift heavy and the boroset's like no you don't you just need to do resistance training I'm like to optimize women for health span we look at the changes that are because let me be clear what

1:09:13Dr. Mary Claire Haver:we're doing right now is not working we have an epidemic of osteoporosis and frailty and dementia in this country in our in our older women over 65 right exactly and I'm I'm right here and right now, I'm not okay with it. I am not either. And I mean, my grandmother lived to be 106. So I know that there's longevity. I'm facing, I'm only halfway through my life. And she was independently living and she did all the things, right? And so I'm like, I want to be like her. Whereas my grandmother on my dad's side was the one with dementia in a wheelchair, and I don't want to be like her. So I see these two in my future.

1:09:49I'm like, I'm going towards to the 106-year-old who is living by herself. So when we look at aging between 40 and 60, there's a definitive change in both men and women. We see that there's a definitive aging aspect. How do we tease out perimenopause, menopause from aging? Well, I'm not so concerned about the hormonal profile. I'm concerned about what's happening on a cellular level of the muscle and also how that affects bone. If we look specifically at women, and this is not hormone driven we look at specifically at women from an aging factor we lose our ability to produce power why because we have two contractile proteins in the muscle one is myosin and one is actin myosin is tightly tied to neuromuscular like the the way that our body contracts the muscle and how fast it contracts the muscle there's a dysfunction in that in women when we start to age when we have estrogen that fluctuates it's even worse it exacerbates it so a lot of people like oh, it's just estrogen.

1:10:47If we use MHT, you'll get better. But it doesn't work that way. Target tissues and all the things that happen with an exogenous hormone versus it. So that's a whole another podcast. But for women, when we're looking at the basic molecular changes that are happening for muscle protein, we have to be down on the heavier end of strength training so that we keep that neuromuscular connection, so that we keep targeting myosin to do its job, so that we change what we call the ISO form into one that actually works and not a dysfunctional one. For men, they don't have that same problem. Men over the course of 40 to 60 want to focus on building mass because they lose lean mass.

1:11:29We lose that power and strength end, and then we start to see cell death or the loss of lean mass. But if we're preserving that end of power and strength, we're also preserving lean mass.

1:11:40Dr. Mary Claire Haver:What percent of the population do we think is actually doing these things in the gym? I don't know. I think it's very little. I'm sure it is. You know, I think it's getting better. Yeah. The message is getting out, but there's still so much misunderstanding, misinformation. So I'm Gen X and the generation right above me are the boomers. I think the boomers are still concerned with being slim. Absolutely. You know, slim, slim, slim. I need to be slim. I get DMs from the, you know, the 60 to 70s and they're just concerned about their waistline. Exactly. What would you say to them? Yeah. I mean, I see this with my mom's friend group and they're out walking and they think that's enough.

1:12:20And I'm watching frailty increase. And one of my mom's good friends has early onset dementia. And I'm like, you just need to do strength training. I don't like the gym. I don't like the gym. I don't want to go to the gym. I don't need to lift weights. I want to be thin. I don't want to be bulky. Michael, one, you're not going to because you are at an age now where it's incredibly difficult to put any kind of lean mass on so you actually have to work on it. But their response is, I only gave weight my middle. I don't want to necessarily want to eat more and try to put weight on. And I'm like, okay, you're here at this point right now.

1:12:53And we see over the past year how frail you have gotten. Next year, how do you want to be? Walking is not going to do it. We have to put in some resistance training. And I'm not saying go to the gym. I'm saying let's do a circuit of air squats and some push-ups against the wall. Let's do stuff that's a push-pull to increase the neuromuscular connection. The question is, what's neuromuscular connection? Brain health. You don't want to have your early-onset dementia accelerate, and you other women do not want to get that. So if we are doing more to increase that neuromuscular connection, you are maintaining your brain, but you are also maintaining your health.

1:13:34So if you are out on a walk and there's black ice because you live on the East Coast and you slip, you won't necessarily fall and break your hip. Because if you fall and break your hip, we know that's one of the leading factors of why women end up in hospice and a very fast demise. Yeah. So I bring it all back to what are the main things that is going on right now? It's not about being slim. It's about let's protect your brain. How do we protect your brain? We have to get those neurons firing with motor patterns.

1:14:06Dr. Mary Claire Haver:So Lisa Moscone talked about not everyone with plaques and neurofibrillary tangles will have the symptoms of dementia. Right. Some of them will never, you know, they'll have the biological process, but they'll still be cognitively intact. And I wonder, listening to you, is it the neuromuscular connection where they're just working around, you know, their genetics? Yeah, most likely. And they're never going to lose their cognitive abilities, even though they've got blacks and tangles. Let's hope. Yeah, I really hope so. You can connect with Dr. Sims through her website and her newsletter at drstacysems.com.

1:14:44Dr. Mary Claire Haver:You can find her on Instagram, Facebook, and YouTube at DrStacy Sims. She's also on LinkedIn at Stacy T. Sims PhD. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawselife.com. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. This podcast is sponsored by Midi Health, the first virtual clinic created for women by women for the treatment of menopause.

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