Mini Pause #2: How Cold Plunge Benefits Women

Welcome to the The Mini Pause!

This is your weekly roundup of the BEST actionable steps for women 40+ who want to gain control of their hormones during perimenopause and menopause.

Last week we looked at oats and how they can be effectively used as a pre-workout fuel. If you missed it, you can read it here.

Cold Plunge: Is It The Same for Women?

TL,DR (too long, didn’t read)

Cold plunges are a great tool for recovering from muscle soreness post-exercise and there is some evidence it may help with the appearance of cellulite. There are a few considerations for women to keep in mind if you are jumping on this ‘cool’ trend (see what I did there?). Irrespective of the temperature, you want to stay in the water until you start shivering. Interestingly, women may not need to cold plunge at extreme cold temperatures to reap the benefits on metabolism and immune function.

WHY

Cold plunging has myriad benefits and one of the ways it shines is as a recovery tool. When you submerge yourself in cold water, it triggers several physiological responses in your body, such as:

  • constricting blood vessels,
  • reducing inflammation (which helps with muscle recovery), and
  • reducing swelling.

Anyone with an autoimmune condition or an arthritide like osteoarthritis knows how “hot” joints and tissues can get during a flareup and how welcome the cold can be. Women who run hot in the luteal phase of the cycle, or those who suffer from hot flashes, also may find cold plunging a welcome relief and a help with thermoregulation.

Cold plunging aids muscle recovery. This is incredibly important if you lift weights!

  • In the short term, cold plunges help with recovery from high-intensity exercise and endurance activities.
  • In the long term, it helps with muscle strength, muscle power, and even jump performance.

Another benefit of cold plunging is its stimulatory effects on metabolism. While you are in the cold tub and immediately afterward as your body brings your core temperature back to normal, you will burn more calories to heat up. Cold plunging liberates stored triglycerides from your fat depots and uses them for energy as you are trying to warm up.

Now — a word of caution — some online influencers have claimed this is the “single best way to get fat off your body.” This is simply not true. We are all subject to the laws of energy consumption irrespective of whether we cold plunge or not! And frankly, I’d argue that building muscle tissue is the single best way to burn fat.

I’ve estimated using this calculator that I burn about 35 calories while in the cold plunge. Using this estimate, a 35-calorie burn (and then a bit extra to bring your core temperature back up) is going to burn about 3.6 lbs on an annual basis.

In aggregate, this can contribute to fat loss when calories are controlled in your diet.

And finally, cellulite. While harmless, it’s often the reason women don’t wear the short shorts, the short sleeves, or the bikinis. While I think life is too short NOT wear what you love, there’s some emerging evidence that cold plunging can help with the appearance of cellulite.

WHAT

For those of you wanting to better understand the science of cold plunges, the process by which cold plunges impact metabolism is by activating brown fat.

When brown fat is activated, it generates heat by disrupting energy production. The technical term is called “uncoupling” oxidative phosphorylation. This uncoupling is being driven by Uncoupling Protein 1 (UCP1), which is present in the mitochondria of brown fat cells. UCP1 uncouples (or disrupts) the electron transport chain from creating ATP, causing the energy produced through cellular respiration to be dissipated as heat rather than used for ATP generation.

When heat is being created, your brown fat utilizes stored triglycerides as a fuel source. It breaks down triglycerides into fatty acids and glycerol. Then, those are transported to mitochondria to be oxidized for heat production. This process results in the release of energy in the form of heat and the consumption of stored fat.

For cellulite, during a cold plunge the cold temperature is absorbed by the fibrous connective tissue, leading to the collagen being more soluble. This solubilization promotes the removal of the tight, non-elastic network that often contributes to the appearance of cellulite. As a result, the skin’s pitted texture diminishes, creating a smoother and more even complexion. The activation of fibroblasts in response to collagen solubilization stimulates the production of new, more elastic collagen and further enhances the skin’s overall quality.

So at what temperature do you set your cold plunge and how long do you have to stay in to get these benefits? Like most things, there are sex differences when it comes to cold response.

Generally speaking, women are more intolerant to cold than men:

  • Women get colder faster
  • Women start shivering at higher temperatures
  • The neurotransmitter and immune benefits seem to be slightly lower for women. That doesn’t mean you don’t receive a benefit — it just means your response is smaller than what occurs in men.)

Where you are in your cycle also affects your tolerance to cold temperatures and how long you can be in cold water immersion.

  • Generally, women tend to run warmer in the luteal phase of the cycle — from ovulation through to the first day of your period. Cold plunging may be a welcome relief during this time.
  • In the follicular phase (bleed week through to ovulation), you’re typically more resilient to stressors. This can be a good time to play with longer plunges or colder temperatures.

HOW

Here are a few ways you can incorporate cold plunges as a recovery tool. I’ve outlined strategies at different price points for you to consider:

Cold Shower: This where my cold plunging journey started. I would take my regular shower and then the last minute, I would turn off the heat and stand in the freezing water for a minute. I may or may not have been screaming, crying, or both.

Ice Bag Baths: The next step in my cold plunge evolution was my bathtub. I would fill it up with cold water then top it off with ice from the gas station to get it extra cold. This was a better solution for a while. I could immerse myself in the water completely rather than being limited to the size of my shower nozzle. Over time, I did find the trip to the gas station cumbersome, and it was hard to control the exact temperature this way. If I over did it with the ice, I had to wait for the water to warm up.

Coldture Cold/Hot Tub: I invested in a cold tub when I knew it was a recovery practice I wanted to do several times a week for help with muscle recovery from my training sessions. I know I sound like a broken record, but in perimenopause, it’s all about the recovery!

For those of you wondering, I purchased the Coldture Classic tub with chiller. I decided on this tub because:

  • The tub is portable and I can move it outdoors in the summer if I want.
  • The tub DOUBLES as a hot tub! The temperature range on the chiller goes from 3C- 40C or 37F to 104F.
  • I can turn it on and off from my phone.
  • The chiller gets the exact temperature.
  • The two-step filtration system keeps my water clean.

There are other cold plunge options without a chiller. I went with this because I like to have control over the temperature. (If you decide to check out Coldture, use code DRSTEPHANIE to get a discount.)

I have the temperature set at 13C / 55F and I’m in there for 11 minutes, or until I start shivering. Depending on where I am in my cycle, this can be anywhere from 8 to 12 minutes. As I continue to build out cold tolerance, these numbers will change.

The main point is this: irrespective of your method or duration of cold water immersion — you want to stay in the water until you evoke a shivering response.

NOW

Choose your cold adventure (cold shower, ice bath in your bathtub, or cold plunge) and ignore the voice in your head telling you to avoid discomfort. That’s where all the growth, grit, and resilience happens!

Research on women and cold plunging is almost non-existent (surprise, surprise), but here are a few general guidelines for you to follow. Also, let your intuition guide you.

  • Aim for 10-12 minutes per week to start. If you are plunging 3x/week, that will be anywhere from 3 minutes to 4 minutes per session. Stay in until you elicit a shiver response.
  • Aim for the temperature to be 10C-16C / 50F-60F to start.
  • Towel off when you get out, and if time allows, don’t get dressed right away. Let your natural shivering response warm you back up. Truthfully, I’m only able to do this on weekends when I have a bit more time. I usually find my shiver response to last anywhere from about 15-30 minutes after the cold.
  • Note where you are in your cycle (if you’re still regular). You might find cold plunging a welcome relief in your luteal phase. That’s when you tend to run hotter and your tolerance for longer sessions is lower. During follicular phase plunges, the water may feel relatively colder, and you may be able to tolerate longer sessions.

Question of the Week

Q: I’m in menopause and my cholesterol and blood sugar have both gotten worse. Why?

 

Excellent question!  Let’s tuck into it.

EVALUATING

Menopause, from a strictly hormonal perspective, can and should be viewed as an estrogen deficiency. Estrogen has a direct effect on our lipids by directly acting on the liver to reduce total cholesterol, to reduce LDL cholesterol, and to increase HDL cholesterol.

In menopause and in perimenopause you have marked changes in estrogen levels. This means that in an environment of reduced estrogens, total cholesterol and LDL cholesterol will rise, and HDL cholesterol will lower. And the jump is significant — most women will see a 10-15% rise in their lipid levels in their post-menopausal years.

In my podcast with Ben Bikman, he called women “metabolic superheroes” prior to menopause because of of this lipid-balancing effect estrogen has. Once you’re menopausal and not taking hormonal replacement therapy, you can absolutely see a rise in total cholesterol and thereby increase your risk for cardiovascular and cerebrovascular disease. In fact, the female risk of cardiovascular disease in women who are 10 years into menopause tends to square off with the risk in men!

Our blood glucose similarly has a similar fate through a different path — your muscle. Skeletal muscle is the largest organ in the body by weight and is one of the primary regulators of glucose balance and homeostasis. Skeletal muscle is responsible for 80% (not a typo) of the glucose that circulates post meal.

As you age, the muscle desensitizes to the insulin signal from the pancreas, which has a net result of increased circulating blood glucose. Now, pair this with menopause, where you have a lower concentration of anabolic hormones like estrogen and testosterone, and this insulin insensitivity is amplified.

NEXT STEPS

The good news here is that you can always do something about it.

Women with a healthy weight and normal to high muscle mass are much less likely to experience the glucose dysregulation and dyslipidemia I described above. Maintaining or building your lean muscle tissue can be achieved through dietary or mechanical means.

Consuming protein (at a minimum of 1g/lb of body weight) is ideal for stimulating muscle growth. (There’s a lot more to say about what kind of protein, dosing of protein, and % of protein targets in the diet. Look for that in a future newsletter.)

Mechanical stimulation is what you might have guessed — regular resistance training! You have to give the muscle a reason to grow! Lift weight as heavy as you can with as close to perfect form as you can.

I will be diving into far more detail on form and type of exercises in coming newsletters and podcast episodes. I have spent the better part of 30 years mastering this and, as you might imagine, have a lot to say about it!

Nutrition plays a role here too — specifically your fibre consumption. Women who consume 25-35g per day will positively impact cholesterol levels, and can offset excessive weight gain.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: LMNT

Healthy hydration isn’t just about drinking water. It’s about water AND electrolytes. You lose both water and sodium when you sweat. Both need to be replaced to prevent muscle cramps, headaches, and energy dips. This is especially true in winter, when your hydration needs actually rise.

I’m loving the new LMNT limited-edition Chocolate Medley for hot drinks. All three flavors, Chocolate Mint, Chocolate Chai, and Chocolate Raspberry taste great on their own or swirled into my favorite recipes. And the Chocolate Caramel rounds out the hot-drink flavors.

Visit drinklmnt.com/drestima to receive a free LMNT Sample Pack with any order.

Mini Pause #1: You Can Eat Oats. Yes, Really.

Welcome to the The Mini Pause!

This is your weekly roundup of the BEST actionable steps for women 40+ who want to gain control of their hormones during perimenopause and menopause.

I am going to get back to what I love — teaching. I get to research, write, and then share evidence-based strategies for you to apply however you see fit! 

How you can get the most out of this newsletter:

  • You can either luxuriate in the details, or just skip to the good stuff.  
  • At the top of each newsletter you will find the summary, lovingly entitled TL,DR  (short for “too long, didn’t read”). Skim that for the general topics covered in the newsletter.
  • Just want to know how you can make use of the info? Go to the HOW and NOW sections below to get the specific tools or action steps to try.
  • Want the know everything? Read it top to bottom, click the links and resources, and reply to this email with your feedback.

Whatever you have time for, and whatever your inclination, I’m here for all of it.

Let’s begin.

Oats: Toxic Peasant Grub or Muscle Food?

TL,DR (too long, didn’t read)

Oatmeal is not as bad a food as some influencers online would have you believe. It’s a surprisingly good source of protein, fibre, minerals, and a great option for pre-workout fuel. Oats with protein before a lift session also will improve your performance. There’s a reason many bikini competitors and bodybuilders have oatmeal as a staple in their diet.

WHY

There’s also a lot of discussion online about oats and the merits of its consumption. Some have called it peasant food, others call it a toxic soup that “steals” your nutrients, with the basic premise being that it should never be consumed.

Or…should it?

If you want to improve your performance at the gym-leading to all those muscle gains), it’s worth considering oats as a staple in your pre-workout arsenal.

WHAT

In the grain family, oats are the heavyweight champ for fibre. Whole oats clock in at about 11% fibre. If the name of the game is a long, healthy life, you want fibre in your diet and lots of it. Aim for 25g daily.

Fibre has a multitude of benefits; it:

  • regulates appetite by making you feel fuller, longer. That, in turn, regulates your calorie intake.
  • reduces total peaks and valleys of blood glucose levels, which improves your insulin sensitivity, mood, and energy swings.
  • lowers the risk of cardiovascular disease (the No. 1 killer of women).
  • improves lipid profiles (like total cholesterol numbers, LDL(c), and Triglycerides)
  • reduces blood pressure.

Oats contain many minerals that can help you with energy, mood, and sleep. They’re high in iron, magnesium, and potassium — all crucial minerals every woman needs.

In a 50g packet of oats, you get 34% of your daily magnesium requirement (clocking in at about 135 mg per serving), 15% of your daily iron requirement, and 5% of your daily potassium requirement.

Finally, while oats are not usually considered “high protein,” they actually DO have a pretty decent amount of protein compared to other grains. A 50g serving has 8g of protein! While oats are mainly carbohydrates (that same serving size has 28g of carbohydrates, with 6g of fiber) — it’s still a decent amount of protein for a grain.

HOW

To maximize the benefits of oats, eat them with some protein 45 minutes to an hour before your workout. The easiest way I do this (especially for my morning lifts), is to combine 1 scoop of protein powder with some instant oats. Simple. Easy. No mess or prep.

If you’re feeling like a Domestic Goddess, here’s my tried and tested Overnight Oats recipe:

  • ½ cup oats
  • 1 scoop chocolate protein powder (like EquipFoods or Schinoussa)
  • ½ cup Greek yoghurt
  • ½ cup milk (of your choice)
  • Sprinkle of chocolate chips

This makes 1 serving. (I usually quadruple this recipe to have pre-workout fuel over four days.)

This will render about 309 calories, 46g of protein, 20g net carbs, and 4g of fat. For pre-workout fuel, this is the perfect carbs and protein combo to feed those working muscles! If you want to bulk up the fat, you can add 1 Tbsp of nut butter, too.

NOW

Try some protein and carbs before your next few lift sessions and see if you notice a difference in your performance. Prep the Overnight Oats recipe above, or just pour water over some instant oats and add in your favorite protein.

I lifted fasted for years but I have abandoned it as of late as there is a distinct difference in performance when I’m fed vs. when I’m fasted.  

Question of the Week

Q: How do I measure my hormone levels and at what point do we start taking hormones?

 

I love this question! It’s a great one to kick off this newsletter.

EVALUATING

Ideally you would start measuring hormone levels in your 20s so you can take baseline levels of your estrogen (the main one being estradiol), testosterone, and progesterone. This is easily done through blood work. There are urine tests like the DUTCH (the DUTCH complete or the Sex Hormone test) that also can evaluate these hormones and their metabolites.

Irrespective of the way you measure, you want to be evaluating the relationship between estradiol and progesterone in the second half, or luteal phase, of your menstrual cycle. 

In other words, you want to evaluate: “What does my progesterone look like relative to my estradiol after I ovulate?”  

If you have MORE estradiol than progesterone in the luteal phase, this can set you up for a greater risk for fibrocystic breasts, uterine fibroids, endometriosis, breast pain, and horrible PMS. This is precisely what I wrote about in my book, The Betty Body.

It will also tend to make perimenopause symptoms worse, as early stages of perimenopause you have naturally declining levels of progesterone. This natural decline can make an already imbalanced estradiol-progesterone relationship worse.

TESTING & NEXT STEPS

So to answer the “how” part of your question — blood testing is great for most as it is the most accessible and you can take several blood draws over a month if need be.

If you are financially able, a DUTCH test can provide further information about how you process the estrogens in your body (there are certain pathways that are more troublesome than others). You can also evaluate DHEAs and the androgen pathways there, as well.

If you are in your 20s or 30s with a regular cycle, I typically recommend making your appointment on Day 21-22 of your cycle to try and capture peak progesterone. If your cycle is longer than 28 days, you want to be capturing progesterone about a week before your bleed week.

For women who are more irregular in their cycle, this becomes harder to figure out when “peak progesterone” occurs because the cycle tends to be shorter. Let’s say your cycle is 25 days in length, you would take the test about six days before the onset of your period (25 days/4 = 6.25).

If you have not been diligent since your 20s, start getting yearly blood work now. Aim to do a complete blood workup every six months so  you can detect any patterns of change. For most of women, progesterone levels decline first — so that’s an easy “tell” that things are changing.

Taking hormones should be evaluated for the individual, so there is no hard timeline for you to start. Depending on your history, your current symptoms, your quality of life, and your blood/urine data, this should be a conversation you have with your primary health care provider.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: AG1

This drink covers my bases when I don’t have time to chop all my veggies. I scoop, mix with water, and my daily nutrients are done! I am a supplement minimalist and AG1 tics all the boxes for me: comprehensive, convenient, and easy.

One daily serving of AG1 delivers a potent blend of nine health products—a multivitamin, minerals, probiotics, adaptogens, and more. It’s the comprehensive, foundational nutrition you need with the convenience your life demands.

Use this link to order and receive a FREE One Year Supply of Vitamin D3+K2 and 5 Travel Packs!

Dr. Stephanie

Why You Need More Protein During Perimenopause and Menopause

(4-minute read)

As women transition into the perimenopause and menopause phases of life, they encounter numerous physiological changes that can impact their overall health and nutritional needs. Among these, the role of protein becomes increasingly significant. It’s essential to understand why protein is vital during these stages and how it can support your health as your body undergoes these changes.

Stomach Acid Reduction Affects Protein Digestion and Absorption

One of the less discussed but critical changes during perimenopause and menopause is the reduction in stomach acid production.

Stomach acid, primarily hydrochloric acid, plays a fundamental role in digesting proteins. It does this by activating enzymes that break down protein molecules into amino acids. As stomach acid levels decrease, the efficiency of protein digestion can decline, leading to inadequate absorption of these essential nutrients.

Proteins are the building blocks of life, vital for repairing tissues, supporting immune function, and maintaining muscle mass. During perimenopause and menopause, maintaining muscle mass becomes crucial. It helps regulate metabolism and ensures physical strength.

With reduced stomach acid, women may experience symptoms of inadequate digestion, such as bloating, gas, and cravings in the short term.

Over the long term, women may experience symptoms of protein malabsorption, such as hair loss, thin nails, impaired immune function, weakness, fatigue, and others.

To counteract this, you can focus on including high-quality protein sources in your diet that are easier to digest. These can include lean meats, fish, eggs, and dairy products (if you tolerate dairy).

Additionally, a grass-fed and grass-finished beef protein powder like this one can provide an easy-to-digest source of protein in a blend-and-go form.

Keep in mind that animal-based proteins are more readily absorbed than plant-based proteins, but plant-based proteins will confer some benefit if you do not consume animal products.

Be sure to talk to your doctor about digestive aids, like supplemental digestive enzymes or betaine HCl. Seek medical guidance, as some digestive supplements can be extremely strong.

Metabolic Slowdown and Macronutrient Adaptation

The metabolic shift that often accompanies perimenopause and menopause is a well-documented phenomenon. Women tend to gain weight in their 40s and 50s, and the diet and exercise regimens that worked in the past may not be effective during this new phase.

As metabolism changes the body may not use carbohydrates as efficiently as it once did. This can lead to potential weight gain and decreased energy levels. This metabolic shift makes it important for women to adapt their macronutrient intake, which includes carbohydrates, fats, and proteins.

Increasing protein intake can be particularly beneficial during this time. A diet higher in protein helps maintain muscle mass, which is metabolically active tissue. This means it burns calories even at rest, helping to offset the metabolic slowdown.

Protein also has a higher thermic effect than carbohydrates or fats, meaning that the body uses more energy to digest and metabolize protein. This further supports metabolic health. The focus should not just be on the quantity of protein, but also on the quality and timing.

Consuming protein with each meal can help ensure a steady supply of amino acids for muscle maintenance and repair while keeping metabolism active throughout the day.

Protein’s Role in Balancing Blood Sugar

Many women in perimenopause and menopause develop insulin resistance, which can lead to elevated blood sugar levels and potentially increase the risk of developing type 2 diabetes.

When insulin resistance is present, the body’s cells do not respond effectively to insulin, which is responsible for transporting glucose into the cells. As a result, glucose remains in the bloodstream, leading to high blood sugar levels.

Protein consumption moderates this response because it stimulates the release of glucagon. Glucagon is a hormone that works to regulate blood glucose levels by promoting the release of stored glucose from the liver when needed.

Protein could play a role in balancing blood sugar levels. Unlike carbohydrates, which can cause a rapid increase in blood sugar, protein provides a more sustained source of energy without the same spike in insulin.

By incorporating protein into every meal, you can help ensure a slower, more controlled release of glucose into the bloodstream. This steady energy source reduces the demand on the body to produce insulin. This can be especially beneficial for women who are already experiencing signs of insulin resistance.

Practical Tips for Incorporating Protein

Here are a few ways to ensure you are getting enough protein during perimenopause and menopause:

  • Start the day with protein. Beginning the day with a protein-rich breakfast can help keep you steady for the day.
  • Include protein at every meal. Aim to include a source of protein with each meal to help maintain muscle mass and keep blood sugar levels stable.
  • Choose high-quality protein sources. Opt for organic meats, fish, and eggs when possible for maximum absorption. If you have difficulty hitting your targets, high-quality protein supplements, like Equip Foods Prime Protein, can boost your overall protein count for the day. These sources provide essential amino acids and are generally easier to digest.
  • Stay hydrated. Adequate water intake is crucial when increasing protein intake to help the kidneys process the protein and to aid in digestion.
  • Combine protein with fiber. Consuming protein alongside fiber-rich foods can further aid in blood sugar regulation and support a healthy digestive system.

The importance of protein in the diet cannot be overstated. As your hormones change, your nutritional requirements do, too, and protein can help address some of the challenges that arise during these transitions.

Protein supports muscle maintenance, aids in metabolism, and helps regulate blood sugar levels, which is especially crucial for those dealing with insulin resistance.

By understanding the changes that occur during perimenopause and menopause and adapting dietary habits to meet these new demands, you can maintain your health and well-being through these significant phases of life.

With a balanced approach to nutrition and the inclusion of high-quality protein sources, the effects of metabolic changes can be mitigated, promoting a more vibrant and energetic lifestyle.

I use Prime Protein from Equip Foods to help meet my daily protein goals. I’m happy to pass along savings to my Bettys with this link so you, too, can prioritize protein. It’s just that important.

If you’re reading this before the holidays, use my code ESTIMAGIFTS to get 20% off through Dec. 31, 2023.

After Jan. 1, 2024, use code DRSTEPHANIE to get 15% off your order.

Dr. Stephanie