Mini Pause #11: Speeding Up & Going Hard: Zone 6 Training Benefits

Note: In the Mini Pause #10 email, some new formatting got the best of us and a few essential links were missed. Here’s the polar heart rate monitor I mentioned. And all [*] reference links are now fully functional in the web edition.

Speed Up Your Cardio: Why Zone 6 Training (Yes, Sprinting!) is Essential to Your Fitness

TL,DR (too long, didn’t read)

In addition to working your base with Zone 2 training, you also want to be training your top end to preserve your power and speed. This type of training biases training of the type 2 fibers. There are three main ways you can train your fast twitch fibers: 1) speed training, 2) plyometrics, and 3) resistance training. We’ll explore each of these in the coming weeks. Today, we explore how to structure speed training into your current cardio regimen.

WHY

In Mini Pause #8, I discussed the importance of Zone 2 training for mitochondrial and cardiovascular health in menopause. We received hundreds (and hundreds!) of questions asking about where sprinting training comes in. So that’s the subject of today’s issue! Ya girl always has your back.

While Zone 2 training should make up the base of your cardiorespiratory work, it’s essential to train the top end of your cardio range, too.

As early as your mid-20s (I know…good grief!), you start to lose your fast twitch muscle fibers (aka the muscle fibers that contract quickly and primarily use glucose as their fuel source) at a rate of 1 percent per year.

As you move through perimenopause, the loss of estradiol contributes to a loss of muscle satellite cells [*]. Satellite cells are muscle stem cells that are responsible for muscle regeneration and adaptation. As you lose these cells, it becomes harder to grow and repair your muscles.

There are several ways to train type 2 fibers. Over the next couple of weeks, we’ll focus on two main ones: speed training and plyometrics.

WHAT

Speed Training / Sprinting

Sprinting is one of my favorite ways to train up type 2 fibers. It’s available to everyone. All you need is a pair of trainers and a road.

True sprint is something you can do ALL OUT for 10 to 30 seconds. No more. There are a few reasons for this.

1: In order to sprint, there are several energy systems involved depending on the length of time you’re doing it. The longer you’re sprinting, you will, by necessity, be gearing down into slower energy production systems. Meaning – also by necessity – that your sprint will be getting slower.

The first 5 to 10 seconds of any sprint is going to be fueled by the phosphocreatine system [*][*].

At that 5-10 second mark, you peter out of this energy system. This is a short-lived system with the energy to power your muscles coming mainly from the stored energy within the muscle itself.

Think about the excitement of a 100-meter dash at the Olympics; they are only tapping into their phosphocreatine system!

After about 10 seconds, you move to an energy system called glycolysis. You’ll notice your sprint markedly slows at this junction point. Glycolysis, when you are still sprinting, peters out around a maximum of 20 seconds after that.

Think about the 200-meter dash at the Olympics; the first half of the sprint is the phosphocreatine system and the second half is glycolysis. When you’re watching the Olympics in Paris this year, you will no doubt be thinking about this little factoid.

2: The second reason for keeping an all-out sprint under 30 seconds is psychological. If you know you’re going to be sprinting for one minute or 45 seconds, you’re going to “manage” your energy output to last that long.

There are several major benefits of sprint training that as a perimenopausal or menopausal woman you do not want to gloss over. They are:

ANABOLIC: When you’re sprinting all-out max power, you’ll build muscle [*]. While steady-state cardio (including Zone 2) can be catabolic, this type of training signals the muscle to develop. This happens even in a fasted state or if you don’t eat for two hours after a grueling sprint. I’m not recommending you do either of these; sprint fasted or don’t eat afterward. You choose what’s right for you.

But let’s say you (or me on a recent Monday) wake up late, haul ass to the gym, and get your sprints in and then oops! You remember you have an important meeting in 30 minutes and don’t have time to eat a proper post-meal workout. Based on the results of this study [*], that doesn’t seem to matter.The point? Sprinting is a strong anabolic (growth) signal to the muscles in the absence of food.

INCREASED TESTOSTERONE & GROWTH HORMONE: The other benefit of course is an improvement in hormonal composition, similar to what we see in resistance training. Post-sprinting, women have a greater rise in testosterone and growth hormone [*]. Both are important for lean muscle preservation, fat management, and mood. I know my Bettys want that trifecta!

HOW

Let’s keep this super simple and say your maximum sprint is going to be 10 to 30 seconds.

  • Recovery should be about the same length as the sprint, so somewhere between 10 to 30 seconds, and then repeat this anywhere from six to 12 times.
  • You can sprint on the road or on a piece of cardio equipment you like. I use my CAROL Bike and I love their “Fat Burn 30” workout. This Tabata-style cycle session features eight seconds on, 12 seconds off for recovery, repeated 30 times. I love this because it’s low impact, and I can track my progress in terms of power output over time.
    • (If you’re curious about this AI-powered bike, click the link provided and use code DRSTEPHANIE to save $100.)

NOW

Choose one day of the week and make it your sprint day. Time of day is irrelevant; just get it in when you can get it in!

  • Start with a 10-second, ALL-OUT sprint. Whatever that looks like for you. Recover for 30 seconds and repeat. Do this eight to 10 times.
  • Over the next several weeks, try to claw back your recovery so that you’re sprinting and recovering at a 1:1 ratio. Meaning, if you’re sprinting for 10 seconds, you’re resting for 10 seconds.
  • Over time, you can increase your sprint and recovery by a few seconds, but max out at 30 seconds on, 30 seconds off.

Question of the Week

Q: How to tell if I’m perimenopausal? I’m 41, had hot flashes for a week and my period came eight days early.

Welcome to perimenopause, friend.

Perimenopause starts for most of us in the mid- to late-30s with a progressive and steady drop in progesterone. We can become symptomatic in our 40s (as you have), with irregular periods, raging PMS, sleep disturbances, and the onset of hot flashes and night sweats.

Many women who’ve dialed in their nutrition, exercise, and stress management can reduce and alleviate many symptoms of perimenopause. You can also consider seeking out hormone replacement therapy options.

Other signs and symptoms of perimenopause may include:

  • Heart palpitations
  • Irritability & moodiness
  • Trouble staying asleep
  • Lower sex drive
  • Vaginal dryness / poor lubrication
  • Lack of focus & poor concentration
  • Short-term memory lapses
  • Itchy skin
  • Achiness through joints and tendons
  • Slower recovery from weight workouts
  • Hair loss and hair thinning
  • Fingernails becoming more brittle
  • Dry skin, dry mouth, dry eyes
  • Sensitive teeth
  • Restless legs
  • More facial hair

While this is not an exhaustive list, you can see perimenopause is an experience of the entire body and brain.

The whole point of this newsletter is to arm my Bettys with tools to better navigate perimenopause!

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.

P.S.

HEALTH TOOLKIT: I’ve compiled numerous resources for you on my brand new website. These resources are for my Bettys who are still cycling, experiencing symptoms of perimenopause, or going through the menopause transition. Some items are appropriate across each category, and some are specific for each one. Everything I recommend, I use myself. That’s my rule. I invite you to look around

Mini Pause #10: How to Grow Muscles Without Lifting Heavier

Injury Prevention, Part 2

TL,DR (too long, didn’t read)

In last week’s Mini Pause #9, I talked about ways you can maximize muscle growth and simultaneously prevent injury. Today’s issue continues to explore how to maximize muscle growth without lifting heavier.

Full range of motion—defined as your range of motion that is not restricted and is pain-free—is one of the most effective ways to maximize muscle gains and future-proof your body for injury. Other variables like increasing volume (both in rep and set number), as well as decreasing the time in between sets, are other ways to increase the intensity of the exercise without lifting heavy weights.

WHY

In Mini Pause #9, we discussed the similarities between injury prevention and muscle hypertrophy, and, like most things, it turns out I have more to say about it.

In addition to doing a sport-specific warm-up, working the eccentric and the longest point of the muscle there are a few other variables I’d like to discuss that will help you on your muscle-building journey to becoming comfortable with lifting without injury.

We often hear online that women should lift heavy sh*t. I agree. And, I recognize that many women our age grew up on cardio machines and may not have the neuromechanical integrity or muscle memory to do this well without getting injured.

We must think about improving our strength before we work on power [*].

So, here are a few more ways you can think about growing muscle without adding on weight.

Your goal, eventually, is to progress and lift heavier with time. The key word is eventually. There is no rush, and you can take your sweet time learning. Learn the movement pattern the right way the first time and you will enjoy muscle mommy injury-free status.

WHAT

Full ROM

Building on Mini Pause #9’s idea of working the muscle at its weakest point, your range of motion both for the muscle and the joint is an imperative tool for staying in the gym. You want to get all those muscle gains and prevent injury.

Said another way, if you cannot perform the full range of motion as God and your joints intended, you are missing out on a lot of potential muscle gains [*], as well as future-proofing your body for injury.

This isn’t rehab my Bettys; this is even better. It’s prehab—getting the movement patterning right the first time so that you evade injury and grow the muscle in a safe and controlled way.

If you are dealing with osteoarthritis, rheumatoid arthritis, or any other arthritide [*] for that matter, full range of motion to preserve the joints [*] in question is the absolute name of the game.

In treating my patients with rheumatoid arthritis, the weight on the bar was the least important aspect of working out. It was not important at all. My focus was all about answering the question: What range of motion can this person do without restriction and pain? Then, building on range from there.

Whether you’re a beginner in the gym or someone with 10,000 hours clocked, exploring your range of motion can be how you tweak your routine to stimulate muscle growth AND improve capsular and joint integrity.

Let’s explore this with shoulder training.

Photo 1: Dumbbell lateral raise parallel.

If you’re like me and want glute-sized delts, most of your shoulder work should be focused on the side deltoid muscle, because that is what gives presence to the shoulders when looking at them head-on. (Plus, if you’ve set up your programming correctly, your front and rear delts are going to be hit during chest and back days).

What does full range of motion look like for the lateral deltoid? This is going to, in part, depend on the health of your shoulders.

Let’s assume this is a dumbbell lateral raise. If you are dealing with an injury, you might aim to lift them to about parallel. Something like photo 1.

As you nurse the injury, or if lifting to parallel becomes easier and you feel ready to progress, instead of graduating to a higher weight, keep the same weight, but lift it higher than parallel.

In photo 2, my arms are abducting now to greater than 120 degrees. This is incredibly difficult, and in doing this, you may even need to drop the weights to do the motion properly.

You can continue the movement arc to the top. You want to think about the range of motion for the muscle, and not just simply the movement. You lift until you don’t feel your delts anymore, and it’s all upper traps (this will usually happen north of 120 degrees of abduction with the elevation of the arm shifting from primarily the deltoid to the traps).

Photo 2: Dumbbell lateral raise abduction more than 120 degrees.

Volume

Another way you can accelerate injury recovery and muscle growth without lifting heavy weights is through increasing volume [*]. Meaning, either increasing the repetitions per set or increasing the total number of sets performed.

When intensity is equated [*], we see similar gains in both individuals repping out heavy weights for fewer reps or sets compared with lighter weights with more reps and/or sets.

The signal to the muscle is similar [*] when lifting heavy weights vs. lifting lighter but for many more reps. As long as you get close to failure, you’re going to achieve a similar result.

I often do this in week 4 of my cycle. In my book, The Betty Body [*], I talk about reps in the 15- to 30-rep range with lighter weights to accommodate some of the inflammation many women feel around their cycle.

Truth be told, I will also do this when I haven’t slept well or just am not in the mental space to lift heavy.

Rest Time Between Sets

Another way to manipulate the intensity of your workout without adding weights is to decrease the rest time in between your sets. This works well (read: you will feel the burn!) if you are increasing your volume of the reps in the set.

The burn you feel in the muscle toward the end of a set is an accumulation of metabolic debris and stress. We often rest between sets to allow for this debris to clear and for the muscle to be fresh and ready for its next set.

There’s a lot of discussion about the ideal time to rest between sets, but generally, here are a few good indicators:

  • Your heart rate has returned to baseline or near baseline (I use a polar heart rate monitor for this).
  • Any accessory muscles used in the movement also feel good (e.g., the lower back muscles during a squat, the biceps during a pull-up, or the triceps during a chest press).
  • The target muscles themselves feel ready to work again.

This is probably going to fall in the one- to five-minute range depending on the recovery items above. Decreasing your rest time is another way to elevate the intensity [*] of the workout.

HOW & NOW

  • Keep your training program the same—no need to change anything!
  • Drop the weights (and your ego telling you not to try anything new!) and explore your current range of motion with every movement. Your range is going to be defined as the most movement through an arc that is not restricted or is pain-free.
  • Work your current range of motion with lighter weights while dialing up your volume. Increase your reps from anywhere from 15-30 reps. For example, if your current reps are 15, bump it up to 20. You also can add one more set to your current set split. If you’re currently doing three sets, make it four.
  • One more way to ramp up your intensity is to decrease the rest time between sets. To do this, use your phone as a timer and just see what your current rest time is with your workouts this week. You can start by decreasing this time by 30 seconds next week.

Question of the Week

Q: How can women avoid dyslipidemia during menopause?

If you are starting to see your lipid levels start to climb in menopause, there are a few ways to help improve this. First, we can think about the variables we can control and then perhaps the variables we cannot.

VARIABLES YOU CAN CONTROL

In the Mini Pause #6, I discussed the changes we see in body composition in our 40s through menopause. Some of the suggestions I outlined were:

Consider the composition of your calories.

  • In my book, The Betty Body, I detail a female-centric ketogenic diet for women looking to lose weight, and more specifically, lose visceral fat.
  • The ketogenic diet (high fat, moderate protein, and low carbohydrate) has been shown to improve all measures of body composition including body weight, body mass index, waist circumference, fat mass, fat-free mass, lean body mass, visceral adipose tissue, and body fat percentage

Lift weights with the intention of putting on muscle mass.

  • As we have been discussing, you can lift heavy, or you can lift lighter while controlling the eccentric, increasing the volume of reps and sets, and working the weakest part of the muscle to maximize muscle gain.
  • Work until the muscle is done like dinner.

Exercise snack your way through the day.

  • We are designed to have a lot of low-grade activity throughout the day. If you are someone who sits at a desk for several hours a day, consider investing in an under-desk treadmill and a convertible desktop stand to be able to get some consistent walking through the day. It doesn’t need to be fast: 1.0 to 1.5 mph is plenty!

For improving lipids specifically, I have a few more recommendations that have a good amount of robust literature to support them:

  • Consume phytoestrogenic foods [*]. Once demonized, phytoestrogens are a great choice for peri and postmenopausal women alike. Phytoestrogens can potentially reduce atherosclerosis and atherosclerosis-related diseases through multiple mechanisms like regulating lipid metabolism, lowering cytokine levels, and improving the coagulation/fibrinolysis system.
  • Dose up your Omega 3s. It’s well established that Omega-3s are anti-inflammatory, cardioprotective, and sensitize the body to insulin [*]. I like a minimum dose of 2g, and I often take experimental doses much higher than this. (Check out BodyBio, my new favorite Omega 3s. Use code DRSTEPHANIE for a discount.)
  • Take antioxidants like dark berries and green leafy vegetables to combat oxidative stress. The highest antioxidant content is found in almonds, artichokes, blackberries, blueberries, cherries (sour), chocolate (yay!), cloves, coffee (double yay!), cranberries, grape juice, cranberry juice, pomegranate juice, pecans, raspberries, spinach, strawberries, and walnuts.

VARIABLES YOU CANNOT CONTROL

For the things you cannot control, this is most obviously going to be the amount of sex hormones you produce as you age. Specifically, estradiol.

During a woman’s fertile life, the average level of total estrogen is 100–250 pg/mL. Estrogens are produced primarily in the ovaries via a process that uses low-density lipoprotein cholesterol (LDL-C) as a substrate. In menopause circulatory LDL-C can no longer be utilized to synthesize estrogen. This is, in part, why menopause is associated with increased blood LDL-C levels and enhanced cardiovascular risk.

Speaking to your doctor about hormone replacement therapy is a great (dare I say necessary) option for regulating lipids in our postmenopausal life.

I can tell you with certainty that when my hormone levels begin to drop, or I am symptomatic, I will be seeking this out in addition to the lifestyle factors I teach and write about.

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.

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P.S.

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Mini Pause #9: Focus on Muscle Movement Patterns to Avoid Injury

How to Prevent Injury While Lifting Weights

TL,DR (too long, didn’t read)

Injury prevention and muscle hypertrophy science surprisingly have a lot in common. Most of us are leaving the most effective parts of our weightlifting regimen on the table and losing out on potential progress while simultaneously setting ourselves up for injury. Doing sport-specific warm-ups, manipulating the tempo of the exercise, and training the muscle in its most elongated position is a way to maximize muscle growth and prevent injury.

WHY

One of the more contemptuous/common reasons for women shirking away from lifting heavy weights is the fear of injury. Especially women who are new to lifting and are unsure of their form and technique. I agree with this fear insofar as women in perimenopause don’t heal as quickly as they once did. When ligaments and tendons are injured it can take more time than skeletal muscle to heal because of blood flow variations to these tissues.

So, you want to avoid injury AND maximize muscle gains at the same time. And it’s entirely possible.

I want to talk to you today about maximizing muscle hypertrophy and avoiding injury and the commonalities of these two strategies.

WHAT

Before you start lifting any weights at all, think about how you can best direct neural attention to the muscles in question. You want to ask: “What are going to be the best movement patterns to prime the muscles for my weight workout?

Anatomically, nerves and blood vessels travel beside each other through the body, so where (neural) attention goes, energy (blood) flows.

Warm-ups have classically been thought of as five or 10 minutes on the treadmill, which isn’t a bad idea–it just isn’t a great one if you are going to be lifting weights. A good warm-up up is specific to the movement patterns in question.

Muscle-Specific Warm-Up Sets [*]

Let’s say it’s leg day and you’re going to be squatting with weights today. Irrespective of the kind of squat or the machine you might be using, you want to prime the body for the squatting motion.

What better way to prepare your body for squats than… well… with squats?!

Body weight squats, Smith machine squats (with no weight), or back squats with a barbell with no plates on it are EXCELLENT choices for a warm-up if weighted squats are on the menu.

If you’re scheduled for some pull-ups, why not start with assisted pull-ups on a machine?

If you are going to be deadlifting, why not deadlift just the bar?

Make your warm-up sets the same movement you’re planning to do with weights. This is going to reinforce the neuromechanical patterning needed to execute the movement well, and you’re more likely to perform the movement properly with little to no weight.

The other objective of a muscle-specific warm-up set [*] is to get you sweaty and ready to work. So typically I like to perform three or four sets of a warm-up before the weights get serious. I progressively add on a bit of weight each time.

Because these sets are lower in weight, you can execute them with higher repetitions. I like to add a bit of weight to each set to gradually increase the intensity of the exercise. We are not trying to go to failure, simply ramping up the neural stimulus for when you’re ready to lift heavy.

Sample warm-up set for leg day

  • Walking Lunges, bodyweight only: 20 reps per leg
  • Walking Lunges, 10 lbs: 15 reps per leg
  • Walking Lunges, 25 lbs: 12 reps per leg

Sample warm-up set for back day

  • Assisted Pull-Up Machine, 130lbs: 20 reps
  • Assisted Pull-Ups, 70 lbs: 15 reps
  • Assisted Pull-Ups, 45 lbs: 10 reps

(Remember, the assisted pull-up machine is “easier” the heavier the weight, so as the weight gets lighter, the harder it gets.)

The pattern you may already be noticing is to start with little to no weight and rep out as many full range-of-motion reps as you can with excellent form. Each progressive warm-up set gets slightly more difficult. When your warm-up is complete, you should feel warm, slightly dewy (aka you’re sweaty!), and ready to work.

Tempo / Time Under Tension

Another important consideration for injury prevention is that you can replicate the effects of heavier weights by manipulating the tempo of the exercise [*].

Specifically, by elongating the eccentric phase of the movement.

One of the biggest mistakes I see in the gym–whether it’s squats, bicep curls, or shoulder exercises–is the focus on the concentric phase of the movement.

People often just focus on when the muscle is shortening (and even count the rep on the concentric) and short-change themselves on the eccentric phase of the motion [*].

An easy example here is biceps. The concentric is the first part of the movement when the muscles are shortening; the eccentric is when you’re lengthening the muscle back to the starting position.

Now be honest, how many people have you seen only focus on the first part of the curl, only to drop the weight back down and completely ignore the eccentric lowering?

Now be even more honest–does this sound like your form?!

In the spirit of truth and transparency, I always used to do this too!

I made it all about how much weight I could curl or squat or deadlift and who gave a flying fish about lowering it slowly!! I’d slam it on the weight rack to let everyone know I was there, thank you very much. This is known as the ego running the show.

Let’s come back to squats because I know my Bettys like to work on their juicy peaches. The eccentric is the first part of the squat: the descent. The concentric is getting back up. So many of us shortchange ourselves and don’t think about lengthening the time of the eccentric as a way to build muscle [*].

But you can absolutely (and often by necessity have to) use lighter weights when slowing down the weights so you can focus on the eccentric part of the movement. It’s the harder part of the movement because you’re elongating the muscle and at the same time increasing the force production to get the muscle back up again.

For those of you who like to load plate after plate on a bar, or derive a lot of satisfaction from lifting heavy, take note that slowing down the tempo and focusing on the eccentric is going to humble you in some surprising ways.

I actually would cry when I started training this way because I thought “I was not working hard enough.” This was my ego dying a hard and brutal death, friends. To save yourself some gym heartache, lighten up the weight, master the eccentric, and watch your gains go through the roof!

Work the Weakest Point of The Movement

One of the best ways to prevent injury is by training up the weakest point of the movement [*] [*] [*]. It also happens to be the best position to drive muscle growth, which is why full range of motion is so important for both injury prevention and technical skill to grow muscles.

In all cases, this is when the muscle is stretched and at its longest. NO exceptions.

  • Squats: It’s at the bottom of the movement.
  • Lunges: It’s at the bottom of the movement.
  • Pull-Ups: It’s at the bottom of the movement.
  • Chest Press: It’s at the bottom of the movement.
  • Push-ups: It’s at the bottom of the movement.
  • Bicep Curls: It’s at the bottom of the movement.

I hope you are seeing a pattern here! When the muscle is stretched the most, it tends to be the weakest. It’s where the movement sucks the most.

This is why the full range of motion matters. If you’re squatting to 90 degrees of knee flexion, it is ok, but not great at tensioning out the glute as much as if you were dipping below 90 degrees.

And if full range is an issue (maybe there is a foot or ankle mobility issue, or an arthritic condition), then keep the weights light and work on restoring full range of motion. Go see your chiropractor or physio, and for the love of Cleopatra do the mobility exercises they are giving you!

It’s here, in the last few degrees of motion, where you leave so much of your goals on the table. If you could set your ego aside, tempo your workout to focus on the eccentric, and get into the longest position possible–all while using lighter weights–I’m confident in saying that you will make extraordinary progress in your muscle pursuit AND prevent injury.

HOW & NOW

  • Whatever your current program is, keep it. You’re just going to modify the tempo and depth of movement a bit.
  • Add in a warm-up set before you start adding any weights.
  • Shift your attention to the eccentric (lengthening) part of the movements in all your exercises. Slow it down by counting in your head. Start with a four-count descent.
  • Try to execute all your exercises with full range of motion: go all the way down, and then (and only then!) shorten the muscle again to come back up.
  • Compare and contrast the fatigue and pump you generate by simply priming the nervous system, changing the tempo, and working the weakest point of the muscle.

Question of the Week

Q. What is your approach now to IF (intermittent fasting)?

I’ve modified my stance on fasting somewhat over the past few years. I still think it’s a good tool for caloric restriction, weight loss, and overall health.

I typically fast for about 10 to 12 hours a day, with the bulk of that being sleep (I sleep for nine hours of that).

WHAT DO WE KNOW FOR SURE?

What I take issue with is how it has been perversely distorted as the ONLY tool that can help women, and how women are punishing themselves with this tool. It seems to be masquerading as a socially acceptable eating disorder.

Online influencers like to talk about autophagy as a hallmark of fasting, with autophagy of course being just the equivalent of your roomba vacuuming up cellular junk in the body. The problem with this is we have no real way of measuring autophagy.

Does 16 hours of fasting raise autophagy levels more than a 12-hour fast? If so, by how much? We have no idea, and anyone who tells you 16 hours is better than 12 is straight-up lying.

They have no idea of how to quantify “better” because we cannot measure it. And let’s pretend we could measure autophagy–is more always better? When do we move from beneficial to harmful? And how does this apply to women?

WHAT’S THE END GOAL?

What I know with certainty is that women feel like they must do more, more, more. Which coincidentally and ironically comes from a place of less. Does fasting for 24 hours make sense for most women?

I think a lot about the pressures on women and it’s always: Get thinner! Be Younger! Do More with Less!

I wonder if fasting culture is just a version of that. A wolf, disguised as a health influencer, hiding in sheep’s clothing. Telling you IF is the tincture to solve your problems, and in the end, you do lose: your period, your hair, and the joy that comes from eating food with others.

Women don’t eat enough as it is. I have seen way too many women fast for 16 hours only to complain about belly weight that won’t budge, weight loss that won’t happen, losing their hair, and yet still terrified of calories.

My current approach includes eating when I wake up. I front load the majority of my calories so that I’m finished eating by about 5 pm. The only “rule” I try to follow is I try to stop eating 3 hours before bedtime so it doesn’t affect my sleep.

If I am paying attention, this usually means I’m eating for about 12 hours. When I’m in my luteal phase, I eat for more like 14 hours, fasting for 10. But I’ve stopped paying attention to it. I just kind of naturally fall into this rhythm of eating.

IS IT THE BEST TOOL?

Fasting is one of many tools, and like many tools, it can be taken to the extreme and become a distress. So I like it, but put an asterisk on it. Not everyone should be fasting, especially if it feels overly restrictive and you hate it.

Patients with obesity and other chronic diseases can tolerate longer fasts with good results but most women with a normal BMI should not be engaging in any kind of 24-hour+ fasting practices. Especially if you want to build muscle.

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.

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Read: This week’s bonus article on drstephanieestima.com looks at the links between air quality, sleep, and hormonal balance.
For You: Visit Jaspr and use code ESTIMA to get an exclusive discount.

P.S.

FREE WORLD SLEEP DAY WEBINAR-LIVE!

Topic: Women & Sleep: How Hormones Affect Your Rest and Recovery

Join Us! Friday, March 15, 9:30-10:30 a.m. Pacific Time

What: Join me and Dr. Dave Rabin, M.D., Ph.D., co-founder and Chief Medical Officer of Apollo as we discuss one of the most-requested topics from our communities: how women’s hormones affect their sleep and how women can best support their health through life’s transitions. We’ll talk about cycles, infradian and circadian rhythms, how to improve your sleep at every life stage, and much more.

Bonus! Get YOUR personal questions answered.

Can’t Make It? Be sure to register even if you’re unable to join live to receive the recording in your inbox.

Register Here! World Sleep Day Webinar

Win! One webinar registrant will win a free Apollo wearable!

2024 HORMONE SUPER CONFERENCE

When: March 18 to 24, 2024

What: In this online event, you’ll learn how to identify and heal hormone disruptions and imbalances so you can improve your physical, mental, and emotional health

  • Day 1: Women’s and Men’s Hormones
  • Day 2: Thyroid and Adrenals
  • Day 3: Nutrition and Weight
  • Day 4: Nervous System Dysfunction
  • Day 5: Mental Health
  • Day 6: Functional Medicine
  • Day 7: Self Empowerment

Who: I’m thrilled to be one of the featured presenters among 40+ interviews with doctors, psychiatrists, psychologists, researchers, scientists, functional medicine experts, acupuncturists, and bestselling authors. They’ll be presenting effective, science-backed ways for you to foster hormone health.

Register Here! 2024 Hormone Super Conference

Air Quality: The Silent Guardian of Your Sleep and Hormonal Health

As women, particularly those of us over 40, we’re often vigilant about our diet, exercise, and mental well-being. Yet, there’s a silent factor significantly impacting our health that deserves our attention: the quality of the air we breathe, especially at night.

The Links Between Air Quality, Sleep, and Hormonal Balance

Air Quality and Sleep

  • The Hidden Disruptor: Poor indoor air quality can be a hidden disruptor of sleep. Pollutants like dust, allergens, and chemical vapors can irritate the respiratory system, leading to disrupted sleep patterns.
  • Deep Sleep and Clean Air: Studies suggest that cleaner air can enhance the quality of sleep by reducing the risk of airway irritation and facilitating easier breathing.

Impact on Hormonal Health

  • Cortisol Levels: Poor air quality can stress the body, leading to elevated cortisol levels, which can disrupt other hormonal balances.
  • Estrogen and Air Quality: Research indicates a link between air pollution and estrogen levels. Pollutants can mimic or disrupt hormonal activities, potentially affecting menstrual cycles and menopausal experiences.

Specific Concerns for Women Over 40

  • As we age, our bodies become more sensitive to environmental factors. Women over 40 may experience more pronounced effects of poor air quality on their sleep quality and hormonal health.

Strategies for Improving Indoor Air Quality

  • Regular Ventilation: Ensure your living spaces are well-ventilated. Open windows, when possible, to allow fresh air circulation.
  • Air-Purifying Plants: Incorporate plants like spider plants and peace lilies, which can naturally filter out common pollutants.
  • Mindful of Household Products: Be cautious about the use of harsh chemical cleaners and air fresheners that can degrade air quality.
  • Invest in a Quality Air Purification System: A reliable air purification system can be a game-changer, especially in bedrooms where you spend a significant part of your night.

My Home Experience

As a health-conscious woman and a professional dedicated to women’s health, wellness, and performance, I explored various solutions to clean the air in my family’s home. When I discovered the Jaspr Pro, I knew it checked all my “have to have” boxes.

It’s more than just an air purifier; it’s a complete home air purification system that intelligently adapts to my indoor environment, significantly improving the air quality in my home.

I learned so much about how air quality affects my overall health in my conversation on the Better! podcast with Mike Feldstein, founder of Jaspr. Take a listen to episode 349: Air Quality for Sleep, Recovery, and Brain Health.

Embracing clean air in our homes is not just about comfort; it’s a crucial step toward better sleep and hormonal health, especially for women over 40. As we focus on nourishing ourselves, let’s not forget the air we breathe is just as vital.

Learn more about how to improve air quality in your home with Jaspr. Use code ESTIMA to get an exclusive discount.

Warmly,

Dr. Stephanie

Mini Pause #8: Make the Change to Zone 2 Cardio Training

Zone 2 Training for Energy Heart Health & Metabolic Flexibility

TL,DR (too long, didn’t read)

Much ado has been made about the ideal zones for training. But, as usual, there’s often a gap in evidence to demonstrably show that these sweeping recommendations are also appropriate for women in perimenopause and menopause.

Estrogen, our metabolic superheroine, keeps us insulin-sensitive when we are younger, but as this dwindles in perimenopause and menopause, we should be thinking about Zone 2 as a protective activity for heart health and a way to keep us metabolically flexible.

WHY

The big question I want to answer here is “Why should perimenopausal and menopausal women care about Zone 2 in the first place?”

Simply, as a woman over 40, you want to double down on cardiorespiratory fitness, and Zone 2 trains up mitochondrial function, health, and density. This is going to maximize your capacity to produce energy.

You know the days where you are absolutely bagged and your teenager comes home with drama, the laundry room has clothes piling up on top of the washer, there are seven glasses of water on the counter despite only having two children, the dishwasher needs to be emptied and you still need to find time for your skincare routine, a social life, save money for retirement, and deep condition your hair?

Zone 2 won’t solve these problems, but it will certainly increase your capacity for energy production to help you navigate your to-do list.

Zone 2 also helps to sensitize our muscles to both insulin-dependent and insulin-independent glucose uptake. Said another way, it makes you more carbohydrate sensitive which is something we tend to lose as we age.

It helps to combat inflammation and reactive oxygen species (ROS) and generally slows the aging process.

WHAT

Most exercises are defined into zones based on muscle fiber recruitment and whether the energetic demand is aerobic or anaerobic.

As the energetic demand for activity increases, we will move from burning fat to burning some fat and some carbs to exclusively burning carbohydrates. As the demand increases, your body will turn to glucose for its fuel.

When we think about fiber type distribution, there are differences between men and women. Women typically have a greater distribution and area percentage of Type 1 fibers (“slow twitch”). Men typically have bigger cross-sectional diameters of all fiber types and have more Type 2 fiber types (“fast twitch”).

This is not to say men have MORE Type 2 fibers than women, but that the diameter of our Type 2 fibers is smaller so that the whole body percentage tips towards Type 1. This can certainly be one (of many) reasons why men can exhibit greater muscle strength and power compared to women, and women typically demonstrate greater muscular endurance.

Some have looked at this data and suggested that this means women need less Zone 2 training than our male counterparts. While I think this is true for women in their fertile cycling years, I do think perimenopausal and menopausal women are a cohort unto themselves. Women in their cycling years may need less Zone 2, but as you creep into perimenopause and menopause, your needs change.

As we navigate perimenopause and menopause, we absolutely need to be training up our capacity for Zone 2 AND because our Type 2 fibers are smaller in diameter, we need to also prioritize resistance training and sprinting (in Zones 5 or 6), both of which are anabolic to Type 2 fibers. Sprinting and resistance training will most certainly be topics for future Mini Pause newsletters!

The primary argument that women are better at fat oxidation than men is largely due to estrogen levels. Estrogen has major implications on our metabolism because it helps to sensitize the whole body to insulin. This fundamentally changes in menopause where we see estrogen levels fall off a cliff to one percent of their previous levels. This means that metabolic derangements like insulin insensitivity, Type 2 Diabetes, visceral fat accumulation, dyslipidemia, and weight gain around the abdomen are rampant in menopausal women, despite no changes in their lifestyle habits.

If you want a deeper dive into body composition changes during menopause, read issue 6 of the Mini Pause.

In essence, we lose our metabolic superpowers and now, in menopause, have to work to stay metabolically flexible.

Zone 2 training can serve as a foundational tool to help improve insulin sensitivity. As you get stronger, your power and work output will also continue to increase. You’ll be able to do more work and sustain a higher heart rate in zone 2 as you get better at it.

HOW

Ideally, you can do a Functional Threshold Power test on a bike and multiply this by 80% to get your Zone 2 number. You can read more about FTP here if you’re a nerd or have a champion attention span for details.

I have used my Carol Bike’s 20-minute FTP test to determine my Zone 2 levels and now retest this once a quarter. I like the bike because it is AI-based and calculates my resistance and watts for me–I don’t have to think about it!

If you don’t have an FTP test available to you, you can also crudely measure heart rate by using Phil Maffetone’s MAF equation: 180 minus your age. Then, multiply that number by 80% and that is your baseline HR to aim for.

In full transparency, I do find this equation slightly underestimates my heart rate. Remember, as you get fitter through Zone 2 training, you can work at a higher heart rate and workload. Nonetheless, it’s a good metric to start with.

You can do Zone 2 on any cardio machine as long as you have your target heart rate and stay there. Rucking (walking with a weighted vest or backpack), salsa dancing, or twerking all can get you in that Zone 2 sweet spot. And who doesn’t want to be twerking on the regular?

For my Type A Bettys who don’t think they’ve worked out unless they go max all out, take note: that isn’t Zone 2! I often joke that my toxic trait is being unable to stay in Zone 2 because it barely feels like a workout.

I’m sweating…sort of.
I’m breathing heavier….sort of.

If you can still have a conversation or nasal breath through the workout–but you’re working hard enough that you would prefer not to do either–you’re doing it correctly.

The next question is how often should you be doing Zone 2 work? This is going to depend on how conditioned you are. A beginner to Zone 2 might start at 30 minutes, three times a week, and each week, aim to ramp up the time by a few minutes per session.

Ideally, I would love to get everyone up to a baseline of about 45 minutes, three times weekly. The 45-minute mark is where the mitochondrial magic happens.

There are a few ways I get my Zone 2 training:

  • Most of it is on my Carol Bike, and I aim to get in two longer sessions of about 75 minutes during the week. (If you check out the bike, use code DRSTEPHANIE for a discount.)
  • I recently started yoga and have been doing a few Vinyasa classes per week. I wore my heart rate monitor a few times and, as I suspected, my heart rate was in that sweet spot for Zone 2.

NOW

  • Look at your calendar and see where you might be able to fit in three, 30-minute Zone 2 workouts this week:

-Could you tack it onto a time you are already at the gym?

-Do you like to watch TV at the end of the day? Could you do that with a treadmill and a weighted vest or a stationary bike?

  • Start this week with one 30-minute session. Put it on your calendar right now.
  • Next week, add in two minutes until you are comfortable and able to do 45 minutes at your Zone 2 heart rate.
  • As you monitor your heart rate, you should see, over an eight- to 12-week period, where the intensity of your workout becomes “easier.” You may even notice your heart rate doesn’t get up as high. This is a great sign! It means going ahead and making the workload a little harder. Up your speed, watts (if on a bike), or incline on a treadmill to challenge yourself.
  • Now high-five yourself and your heart for adaptation!

Question of the Week

Q: How do you cope with feeling like you’re losing your youthfulness?

To Kristen in the Bettyverse, thank you for asking what many of us have felt at one time or another.

MORTALITY

I think aging and the feeling of losing your youthfulness force you to contend with your mortality. I think about death probably more than the average person, and I try to contrast it with the life I currently have.

Most of us never thought about the totality of our lives when we were in our 20s and 30s. And yet, in our 40s this thought that we might not be here forever begins to stir and frequent our thoughts more often.

A part of life is death.

And despite the speed at which science is progressing, I think most of us are going to have somewhere around 80 or 90 great years in us. Maybe slightly more, maybe less, but this is a reasonable estimate.

EXPLORE YOUR THOUGHTS

So if you’re 40-something and starting to feel like your better years are behind you, what does that mean?

First, consider why you so heavily place weight on youth:

  • Is it your youthful beauty you are mourning?
  • Your lack of responsibilities like mortgage payments?
  • Your ability to travel without kids?
  • Or does the brain select only the positive aspects of your youth and forget the rest in the name of nostalgia?

Maybe your skin was plumper 20 years ago, but with age, a different kind of beauty emerges.

The beauty of being comfortable in your skin, the unhitching of who you THOUGHT you should be with just being who you ACTUALLY are.

The wisdom and experience of your life can now work harmoniously with the intuition you likely ignored when you were younger. Decision-making gets easier. You fight for yourself rather than sacrifice yourself at the altar of others’ desires. You spend time with people you truly enjoy being around.

As for the aesthetics… sure, our melanocytes are not producing pigment in our hair anymore, and the elasticity of our eyelids is not what it once was. But that is the privilege and gift of aging.

I’ll repeat it for emphasis: That is the privilege and gift of aging.

It is a privilege to watch your children grow up.
It is a privilege to become a grandmother.
And it is even a great privilege to die with people around you who love and revere you.

A life well lived is one where your time is spent without the shackles of what you think you should do and how you think you should act. Forget what society tells you should be. Age brings the ultimate gift of “you do you, boo.”

SHINE YOUR LIGHT

For me, the prospect of aging is more about the time and impact I want to make.

  • I have a gift and I want to share it with as many of you as I can.
  • I’m not going to spend any more time hiding because I fear judgment or criticism from others. I have no time for that!
  • In my 40s, I know what I am capable of, who I am, who I am not, and how to remember who I am when I have temporarily forgotten.

And if we’re just talking about loss of youthfulness: grays can be covered, and skin creams and cosmetic procedures can be applied to make you look younger.

If you don’t become MORE of who you already are, the loss of youthfulness doesn’t matter as much because you’re still warring with yourself internally.

Maybe a soliloquy on mortality wasn’t what you were expecting with this question, but I hope this helped redirect what it means to age, and how lucky you are to do it.

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: BEAM Minerals

It’s almost impossible to get all your minerals from food alone. And many of us are experiencing that deficiency in the form of chronic health issues like fatigue, muscle cramping, anxiety, hair loss and imbalances with adrenals, hormones and blood sugar. In my case, it was hair loss and chapped lips.

It was only when I started supplementing with minerals and electrolytes that I noticed a substantial slow down in hair loss and my lips are not peeling anymore.

I use BEAM Minerals daily. It’s so easy to just pour a capful and throw it back. It tastes like water and is a powerful system detoxifier, removing mold toxins, heavy metals, and pesticides.

Head over to beamminerals.com/BETTER and use BETTER at checkout for 20% off sitewide.

P.S. FREE! Hormone Super Conference

Menopause and the years leading up to it could actually be some of the best, most stable, enjoyable, and healthful years of life. I believe this so much I’m going to be a speaker at the online 2024 Hormone Super Conference, March 18-24.

At this event, you’ll learn how to manage hormones (and so much more!) during these periods of your life. 40+ of the world’s foremost experts on hormone health will present breaking science, unmatched wisdom, and proven remedies for stabilizing hormones before, during, and after menopause as a means of experiencing optimal health and joy on every level.

This seven-day online event is 100% FREE of charge. Save your seat right here. And when you sign up now you’ll be given instant access to six BONUS GIFTS!

Mini Pause #7: Great Skin Health Inside & Out

How to Make Your Skin Health a Priority–One Habit at a Time

TL,DR (too long, didn’t read)

We lose collagen and elastin at a rate of one percent per year, and over time, we often see more wrinkles, poor elasticity, and decreased hydration of the skin. Supplementation and a proper skincare routine can help to reverse the skin aging process.

I’ve outlined best practices in food, lifestyle, supplements, and skin routines in today’s newsletter. The links throughout take you right to the science behind this information.

WHY

As we age, many of us notice changes in skin quality. Dull skin, fine lines, and a loss of elasticity are among the most common grievances in women during perimenopause and menopause.

While fillers and injectables are certainly options, I would put them second in line after a few items well within your control–your nutrition (or your internal health), your exercise habits, and your skin routine (external topicals). All of these can address wrinkles, elasticity, and hydration both from the inside out and outside in.

While you likely won’t see immediate results, when done consistently, you may see a noticeable difference in your skin in about three months.

I’ve made a personal goal to have my best skin ever this year, and it has become such an interesting rabbit hole to go down!

WHAT

Fine Lines & Wrinkles
The facial muscles are a group of about 20 flat skeletal muscles lying underneath the skin of the face and scalp. Most of them originate from the bones or fibrous structures of the skull and radiate to insert on the skin. This is a unique feature of facial muscles–a direct insertion point to the skin.

Other skeletal muscles typically originate from and insert into bone. The insertion directly into the skin is what allows for the face to move.

Years of facial expression start to show up at perpendicular angles to the muscle fibres. For example, the infamous “11” lines in between the eyebrows are exactly perpendicular to the muscle fibres of the procerus muscle. This muscle originates off the nasal bone and then flares upwards and inserts into the skin of the forehead. It is involved in furrowing or depressing the medial part (inside part) of the eyebrow.

This is in part due to wear and tear, but also an accumulation of oxidative stress, and a decrease in collagen and elastin production. As we age, this can look like a one- to two-percent loss per year.

Elasticity
It’s well known that collagen hydrolysate has several positive biological actions in the body, such as acting as an antioxidant, an antihypertensive, and being involved in lipid-lowering activities, and reparative actions in damaged skin.

Collagen is super interesting because it has a dual action in the skin where it first provides the building block components for collagen and elastin to be synthesized in the body. It then binds to dermal receptors to stimulate the synthesis of collagen and elastin as well as hyaluronic acid.

I think collagen is the heavyweight champ of skin supplements.

Hydration
Drink more water–YES! We all have to do this.

I typically aim to drink 3-4 litres daily. Most days, I settle on 2.5 to 3 litres. One thing that helps me is flavoring the water. I often add cucumbers and blueberries to a big jug. This little action makes the water feel more special.

Another component of hydration is your ability to hold onto that hydration. This is where you might find an electrolyte helpful.

Electrolytes, including sodium, potassium, and chloride, are minerals that carry an electric charge when they dissolve in water. Sodium is a cation with a positive charge (Na2+), while chloride is an anion with a negative charge (Cl2-). Other common electrolytes include phosphorus, calcium, and magnesium.

Electrolytes are involved in:

  • transporting nutrients to cells,
  • transporting waste out of cells,
  • proper function of nerves, heart, brain, and muscles,
  • pH balance, and
  • fluid balance.

Hormones
While hot flashes are often ascribed to “typical” menopausal symptoms, declining levels of estrogen can have devastating effects on our skin and hair.

Decreased estrogen levels in perimenopause and menopause can look like:

  • skin dryness and itchiness (pruritus),
  • skin thinning and atrophy,
  • wrinkles and sagging,
  • poor wound healing, and
  • reduced vascularity of the skin.

Many women find that using topical estradiol on the face and décolletage area improves the appearance of the skin. This topical application does not act systemically when applied only to the face. However, you must discuss this use with your primary healthcare provider and consider your individual risk factors.

HOW

LIFESTYLE INPUTS
Generally, consuming darker-colored foods like blueberries, blackberries, pomegranates, cherries, raspberries, etc., are great for skin health as they contain polyphenols that love your skin. Salmon, avocados, nuts, and seeds are good foods to be consuming often for their healthy fats.

Resistance Training: In researching for this newsletter, I was delighted to discover that resistance training also positively contributes to healthy skin by reducing circulating inflammation, increasing skin turnover rates, and by thickening the dermal matrix.

  • This is great for women in their 40s and beyond! Why? Because the tendency is for our skin to get thinner with declining collagen and estrogen levels.

Cardio: Tomato-faced cardio bunnies rejoice! Regular cardio is going to be wonderful for improving circulation to the face, which allows the blood to deliver nutrients to the skin.

  • Cardio also helps to increase mitochondrial function of the skin cells and reduce circulatory inflammation factors.

Red Light Therapy: This has been one of the interventions (above resistance training and regular cardio) with which I have noticed the biggest difference.

  • Research shows that red light therapy, or photobiomodulation, improves the enhancement of mitochondrial adenosine triphosphate (ATP) production, cell signaling and growth factor synthesis, and the reduction of oxidative stress.
  • I invested in the BON CHARGE Red Light Face Mask and the Red Light Neck & Chest Mask and I use them daily in the morning when I check my emails. This is a simple habit stack! I always check my emails at my desk, so it’s an ideal time for me to pop these on while I organize my inbox.

Supplements: Collagen Supplementation: A daily scoop of hydrolyzed collagen has been shown to augment the effects of aging including poor elasticity, fine lines and wrinkles, and skin hydration. I add a heaping scoop of Equip Foods collagen or mindbodygreen collagen to my morning water as I’m heading to the gym.

Vitamin D: Vitamin D is well known for improving many hallmarks of skin aging. Here are a few good things that it does:

  • prevents DNA damage,
  • stimulates DNA repair mechanisms,
  • regulates keratinocyte proliferation (keratinocytes produce keratin and make up 90 percent of your epidermal cells), and
  • regulates mighty antioxidative responses.

I love the mindbodygreen Vitamin D3/K2 supplements. I take 4000 IU in the spring and summertime, and pump it up to 6000 IU in the wintertime.

Electrolytes: I use LMNT, a salt-based electrolyte, daily with hot water. My current favorite is Chocolate Caramel. My regular rotation includes Watermelon, Grapefruit, and Raspberry.

OUTSIDE INPUTS
I have incorporated these steps into my skincare routine following a conversation with my friend Dr. Tony Youn on the Better! podcast at the start of this year. This cadence included Dr. Youn’s routine essentials for better skin through topicals:

Morning Skin Routine: 1. Cleanser, 2. Vitamin C or antioxidant serum, 3. Sunscreen

Evening Skin Routine: 1. Cleanser, 2. Retinoid, 3. Moisturizer

I am also becoming interested in peptides and stem cells and their ability to help rejuvenate the skin. Coming up:

  • Dr. Adeel Khan will be a guest on the podcast to discuss regenerative medicine through stem cells and peptides (not just for skin, but aging in general).
  • I’m visiting his clinic to have some peptide treatments done on my skin and can’t wait to share the results with you!
  • And, I’m already knee-deep in stem cell and peptide research and will have a special Mini Pause newsletter on this topic.

NOW

You may have some of these foundations already in place like eating good fats, or resistance training.

I want you to pick only one item from the HOW section that you want to incorporate into your existing skin routine. One of the best ways to make it “stick” is to pair it with something you are already doing. For example:

  • I put collagen into water I am already taking to the gym.
  • I use my red light face mask when I am seated and already checking my emails in the morning.

Habit stacking is an efficient way to make a small–and significant change–to your routine that won’t be overwhelming. This way the new habit is not an extra step, it is blending into an existing one.

YOUR TURN!

What are your skincare questions? Which one of these steps are you going to try? Let me know at support@drstephanieestima.com.

Discover Beauty That Fits Your Style

When I find something awesome that makes a difference in my health, I want to share it with my Bettys. So, if you vist the items I’ve shared in today’s newsletter, here are discount codes for you to use. I hope you love these products as much as I do!

  • Equip Foods collagen; use code DRSTEPHANIE
  • mindbodygreen collagen; use code DRSTEPHANIE
  • mindbodygreen vitamin D3/K2; use code DRSTEPHANIE
  • LMNT electrolytes; direct link to free sample pack with purchase
  • OneSkin peptide skincare (cleanser, sunscreen, moisturizer); use code DRSTEPHANIE
  • Timeline Skin Health serum; use code ESTIMASKIN
  • BON CHARGE red light masks; use code DRSTEPHANIE
  • Bonus! In a previous Mini Pause issue, I mentioned my love affair with Rose Best Skin Ever and Rose Glow Serum by Living Libations. They are both divine in a bottle! The link auto-applies a discount at checkout.

Question of the Week

Q: What about fibre?

From the Bettyverse: Thank you, Gabi, for asking for more about this topic!

I have a question related to the comment about fibre. There seems to be so much conflicting information about whether we need fibre at all. For instance, I hear of the carnivore diet being good for autoimmune issues and as long as you have enough dietary fat (not too much, not too little) you will have normal bowel movements. But I’ve also heard that women benefit from fibre to rid the body of excess estrogen.

My personal issue is inflammation of my joints. (For context, I’m 45, perimenopause (regular cycles, low progesterone/ estrogen dominant), and have been healthy keto for five years. I manage everything through diet and appropriate supplements. )

Could you say more about whether we “need” fibre and why? And the place of plant-free/fibre-free diets like carnivore?

WHAT THE SCIENCE SAYS

This is a multilayered question and I will try to address all of it succinctly.

I guess the short answer here is, you–need fibre. Full stop. I don’t care if the carnivore community says it isn’t important. That is inconsistent with the robust amount of literature and clinical outcomes that say otherwise.

A staggering amount of evidence demonstrates that fibre consumption reduces heart disease and cancer. (Another meta-analysis review here.) fibre has an unwavering and amazing ability to reduce LDL cholesterol. Many studies have demonstrably shown a 20-25% reduction in LDL cholesterol levels with adequate fibre intake.

In cancer risk, more fibre consumption has best shown a reduction in colorectal cancer by about 20%, as well as other cancers we care about like ovarian and breast cancers. Fibre plays a role in the estrobolome (the area of the gut dedicated to processing estrogen) and does help to bind to and get rid of estrogens.

KEY POINT

If you are going to eat a lot of meat, it is probably a good idea to pair it with a lot of fruit and veg.

Typically, individuals who eat high amounts of meat often miss out on the opportunity to consume foods with fibre. That does drive up the risk for heart disease and cancer over the long term.Vegan ideology might be tempted to conclude that it is meat consumption that drives heart disease and cancer. Hear me on this: it’s the lack of fibre consumption in individuals who consume meat that drives up cancer risk.

Clinically, this is where we need to think with a little bit of nuance.

SHORT-TERM VS. LONG-TERM BEHAVIOR

Going carnivore for a year, in the grand scheme of your 85+ year life doesn’t affect health outcomes. Just like if you have elevated LDL cholesterol levels for one year in the context of 85 years of healthy LDL cholesterol levels also doesn’t marginally affect outcomes. What is far more important is the chronic elevation of LDL over many decades that drives up the risk for these multifactorial diseases.

Imagine it another way. Remember when you were a silly, naive teenager and did dumb stuff with your friends because you thought you were invincible? While the activities you engaged in (and compounds you ingested) were probably really bad for you at the time, they aren’t going to be predictive of health for your entire life. It was a year, or two (or five) of doing dumb stuff. And then you came to your senses and corrected your behavior.

Now, before you send me a message about why I am hating on carnivore and how great the carnivore diet was for you–I get it! I, too, have used carnivore interventions in autoimmune patients with great success. The big idea I am trying to convey is that the intervention, while it worked in the short term, is designed to be transient. It doesn’t last forever.

Because the diet you need when you are sick is not the same one you need when you are well.

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.