Mini Pause #6: Your Metabolism & Body Composition

Is Your Metabolism Slowing Down as You Age? The Surprising Answer

TL;DR

Welcome to this part of the internet where we consider how both lifestyle (nutrition, muscle building) AND hormone changes contribute to body composition changes in women in their 40s and 50s.

The online debates have been spicy lately, and I’ll get in the ring with some data and clinical insights to help you better understand your changing physiology. It is not simply calories in, calories out OR just hormones.

Turns out, like most things, the truth lies somewhere in the forgotten middle.

WHY

For decades now, women have been told to “suck it up buttercup” when it comes to body changes as we age:

“This is just part of aging.”

“This is your new normal.”

“Your metabolism isn’t what it used to be.”

Debates continue on the mechanism for excess and unwanted fat deposition for women in perimenopause and menopause. So many women in the Bettyverse have told me that despite dialing in nutrition and exercise they have continued to gain weight (usually through the midsection) DESPITE these efforts.

When we are told to simply eat fewer calories to compensate for the weight gain, or to increase our physical activity — this advice fails to encompass the totality of what is happening. It is part of it, but not all of it.

So is it metabolism? Is it hormones? What’s driving this persistent change in our body composition?

WHAT

Metabolism — Does it Change With Age?

Conventional thinking tells us that as children, our metabolism is elevated and reaches a peak in our mid-20s. This does not seem to be true.

This study set out to investigate the effects of age, sex, and body composition on total body expenditure and other components of metabolism. It was a nice size (6421 participants, with 64% of them female) with geographically diverse backgrounds from 29 different countries. They looked at men and women from 8 days of age to 95 years old.

A few interesting trends emerge from this study.

  • First: In the cohort of 20- to 60-year-olds, metabolism remains virtually unchanged. This remains true even during pregnancy! It is only around the 63-year-old mark that metabolism begins to decline.
  • Second: The single biggest predictor of your metabolism is directly related to your fat-free mass. For an in-depth look at FFMI, listen to my Better! podcast conversation with Dr. Tommy Wood.

Both of these findings are great news for Bettys navigating perimenopause and menopause! Why? Because it gives us a sense of agency, at least partially, over our bodies in our 40s and 50s.

The biggest predictor of your metabolism is how much muscle tissue you have (and by way of extension your bone density). That IS something you can control. Type A personalities rejoice and say it with me, “WE CAN CONTROL SOMETHING!”

However, metabolism is only a part of body composition. How many calories burned is one thing, but fat distribution, type of fat accumulation, insulin resistance, and the loss of anabolic hormones (estradiol and testosterone) contributing to the loss of lean muscle mass is quite another.

During perimenopause and menopause, your tissues become more insulin resistant as a natural consequence of aging. This makes it harder for your cells, tissues, and organs to get the nutrients they need to produce energy.

We know that insulin resistance shows up in skeletal tissue for decades despite euglycemic levels. Said another way: Your muscles can be insulin resistant for YEARS and yet, you can have normal blood sugar because your pancreas can pump out more insulin to counteract the rising blood sugar levels.

The net effect of insulin resistance is ​​fat production and accumulation in the liver (referred to as de novo lipogenesis) — also known as visceral fat. This is often the reason why women see their cholesterol levels skyrocket in perimenopause and menopause despite “doing everything the same.”

But wait, there’s more!

Declining estrogen levels during perimenopause are also part of the reason you see visceral fat distribution favored over subcutaneous fat deposition in your 40s and 50s.

The phenotype of fat literally changes during menopause where your body will preferentially begin to accumulate fat on your organs versus accumulating fat under your skin.

The fat under your skin is largely harmless despite your general disdain for it.

The fat that accumulates around your organs, however, has terrible consequences for your health including skyrocketing the development of cardiovascular disease, Alzheimer’s disease, type 2 Diabetes, cerebrovascular disease, and stroke.

There also is ample evidence that visceral fat is incredibly inflammatory. This leads to premature aging of your cells, tissues, and organs, and generally makes you feel awful.

So, you must consider BOTH lifestyle and hormonal interventions.

HOW

Lifestyle Interventions

 

1. 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

2. Lift heavy weights with the intention of putting on muscle mass.

  • “Heavy” means different things to different people, but as a general guideline, the last few repetitions of a set should be very difficult.
  • You should still be able to rep out good form, but the intensity should be an 8 or 9 out of 10. Forget 3 sets of 15.
  • Work until the muscle is done like dinner.

3. Exercise snack your way through the day.

  • I detailed the utility of exercise snacks and their benefits on lipids, body composition, and overall health here.
  • 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: 1.0–1.5 mph is plenty!

Hormone Replacement Therapy

 

  • I’m a big fan of HRT, and think this can and should be started as soon as there is evidence your body is struggling to produce adequate levels of estrogen, progesterone, and testosterone.
  • I always recommend getting blood work every six months to monitor your levels — or sooner if you think something is up.
  • Consider starting HRT in perimenopause when things go awry and plan to be on them for the long haul.
  • Don’t go it alone. Make the HRT decision in tandem with your doctor.

Bonus! Take a listen to my in-depth discussion about the Women’s Health Initiative and why it was a colossal failure for our beautiful menopausal women — check it out here.

NOW

  • Pick up a copy of The Betty Body to learn how to apply the ketogenic diet as a mechanism to reduce body weight, body mass index, waist circumference, fat mass, visceral adipose tissue, body fat percentage, and increase fat–free mass and lean body mass.
  • Book an appointment with your doctor to discuss HRT. At the very least, get some blood work done!
  • Start lifting weights intending to increase muscle mass. Intensity is key here. Work the muscle close to (but not at) muscle failure. For most women, rate your set intensity between 8 or 9 out of 10.

QUESTION OF THE WEEK

Q: Post-workout soreness: How much is considered normal? (If any?)

This is a great question! I’m going to nerd out and break this down into the different components that might be contributing to your soreness. Let’s also look at whether or not they are “common” or “normal.” Much of it has to do with different fatigue types related to recovery.

Muscular Fatigue / Soreness

This is the soreness in the muscle/muscle groups you’ve trained.

There are many reasons for muscle soreness and fatigue. The most common one being a novel stimulus. If you went to the gym on Monday, found your groove, felt like Woman Woman, and decided to either change up some exercises in your routine and/or add weight to the exercises, this can elicit soreness in your muscles.

DOMS (delayed onset of muscle soreness) can occur up to 72 hours after the stimulus as the muscle tissue repairs and remodels itself.

This type of soreness is not required each time you train, but out of the different types I’m going to describe it is the most desirable one. If you trained your glutes on Monday, and on Tuesday your glutes are sore, it’s an indication that the novel stimulus has been directed at the target muscle group. If you’re sore in your biceps after training glutes, that’s a problem.

To develop strength (hypertrophy), you don’t always need to be sore. It is not an indication that you had a successful lifting session.

Said another way: If you’re NOT sore in your glutes on Tuesday when you trained them on Monday, it doesn’t necessarily mean nothing happened.

This is normal to feel or not to feel. I love it when I can feel some muscle soreness, but I don’t hinge the success of my lifting session based on it.

Joint, Tendon, Connective Tissue Fatigue / Soreness

This is soreness originating from the joints, connective tissues, or tendons.

We really want to minimize this type of soreness both during the workout and in the recovery period afterward. Feeling pain or soreness in these elements can indicate that there may be a technique issue with compensatory movement patterns present.

For example,  you really shouldn’t feel pain in your shoulder joint when doing a side lateral raise, or pain in your knee when doing a squat. If you are, it is a possible indication of aberrant mechanics during the move itself. This partially translates the force to the non-contractile tissue. This could be muscle movement patterning, a lack of mobility at the joints themselves, or both. It could also be that for your biomechanics, that particular movement isn’t optimal for YOU. There are many other ways to shred your legs and grow your shoulders.

You want this type of fatigue and soreness to be as close to zero as possible. It is certainly not normal to be feeling this kind of soreness all the time.

Axial Fatigue / Soreness

This is the fatigue and soreness through the spine and back from spinal loading.

It’s anything that loads weight on your spine top to bottom (e.g., putting a barbell on your back) or from hinge movements like a deadlift where a lot of the lower, mid, and upper back muscles, as well as the deep muscles of the back, are involved in stabilizing and executing the movement.

While not inherently good or bad, we want to be mindful of excessive axial loading being the limiting factor in lower limb progression.

For example, when I’m training my legs, I have to be mindful in between sets that both legs are sufficiently recovered AS WELL AS my lower back before I start again. My glutes can be ready, but if my lower back still needs a minute I wait until any secondary mover (in this example my lower back) is ready again. Otherwise, it’s going to be my back that limits my execution, energy, and form on the next set.

Your back is designed to carry heavy loads and with training, you will necessarily experience some axial loading. Fatigue is normal.

Ensure you’re 1) giving yourself sufficient rest in between sets, and 2) giving yourself adequate time between leg days.

Overall or Systemic Fatigue

This is the fatigue that occurs after too many days of poor recovery. It can be many weeks or months before you feel the effects.

You might notice that you begin to experience brain fog after workouts, or you’re generally less excited about training in general.

Other markers like poor sleep, excess or prolonged soreness, or any other types of fatigue above are beyond what you would consider normal.

This lack of desire when you have been able to demonstrate a consistent training schedule in the past is usually a gentle reminder to take a break.

A lot of women dealing with autoimmune conditions might experience systemic fatigue when they have pushed it too far in the gym. Learning how to stimulate — not annihilate — your muscles when dealing with an autoimmune condition might be tricky, but it’s fundamental to train at 40–50% less capacity so you don’t overwhelm an already overwhelmed immune system.

When you experience overall fatigue like this, it might be time for a deload week (another topic I will be exploring), or taking a few days off altogether.

What I Recommend: LMNT

Because you lose water and sodium when you sweat, you have to replace it. The water? Pretty easy. The sodium? It’s got to be the right kind of electrolyte mix. LMNT combines sodium, potassium, and magnesium. This trio helps prevent muscle cramps, headaches, and energy dips.

For my Bettys in a cold climate, your hydration needs go up in winter. And while I’m truly a fan of LMNT’s limited-edition Chocolate Medley for hot drinks, the Chocolate Mint was a surprise. (I actually don’t like chocolate mint anything.) I wanted give it a fair shot, though, and ended up loving the taste. I mixed it with hot water. Super simple and the perfect complement to a snowy day at home this past week.

For my Bettys in a hotter climate, you’ll want to try the Watermelon for some refreshingly fruity, zero-sugar hydration.

When you go to drinklmnt.com/drestima, you’ll get a free LMNT Sample Pack of flavors with your order. I know you all love recipes, so be sure to visit LMNT’s “Recipes” section for some salty inspo.

P.S.

HEALTH TOOLKIT: I’ve put together a toolkit for you on my brand new website. I designed these resources for my Bettys who are menstruating, experiencing perimenopause or have gone through menopause. There are commonalities between the categories and also specifics for each one. Everything I recommend, I use myself. That’s my rule. I invite you to take a look!

Mini Pause #5: What’s Better: Fasted or Fed Workouts?

Fasted or Fed Exercise?

TL,DR (too long, didn’t read)

Most evidence suggests that fuelling before a workout is better for performance in the gym, and has the same outcome on body composition as fasted workouts. That is not to say that working out fasted is pointless and ineffective. As long as you are fuelling appropriately in the peri-exercise time around your lifts — your body is a genius and knows what to do with the stimulus.

WHY

There are so many of you who struggle with not only what to do in the gym, but what to do in the window that surrounds your workouts.

Fasted or fed training?
Fasted or fed cardio?
What to eat?
When to eat it?
How much to eat?

With conflicting evidence abounding, it can get overwhelming really fast. And based on the comments from a recent Instagram post, you’re also trying to figure out what works, too.

Personally, I used to train fasted (both my lift sessions and cardio) for years, and have since changed my approach.

At the beginning of my fasting journey (when I was completely discounting the fact that I was female) I would work out in the morning and then continue my fast until noon. Needless to say, I was starving, and angry, and as soon as noon came around, I had a very large meal. Larger than what was necessary. The same continued at each subsequent feeding. It was hard for me to admit, but fasting until noon was not working the way I had hoped and the way it seemed to be for many others (mainly men) I admired and respected.

Over time, begrudgingly admitting this was not working well for me, I shifted my fasting window to eat immediately after my workout. I was still fasting for long lengths of time, but the phasic shift to earlier in the day was helpful. This worked well for me for years.

It was only until one of my kid’s soccer practices was moved early in the morning on the weekend that I changed things up again. Since I wasn’t able to get to the gym before his practice, I had the opportunity to experience fed training sessions.

I had breakfast, took him to practice, had another snack, and worked out afterward.

I was shocked at how well I performed. Was it the food? That I had more time to limber up my joints? My core body temperature? I wanted to figure this all out.

WHAT

So in examining this topic, let’s review the literature on the effectiveness of fasted versus fed workouts. Is there a difference?

Fasted Workouts

This meta analysis looked at several studies where the intervention was either:

  • fasted exercise with a standardized post-exercise meal
  • fasted exercise without a standardized post-exercise meal
  • fed exercise with a standardized post-exercise meal
  • fed exercise without a standardized post-exercise meal

What they found was the second intervention (fasted exercise and no post meal) appeared to be the most effective strategy to produce a short-term decrease in energy intake. But there was a catch: it also resulted in increased hunger and lowered energy expenditure afterward.

This is known as metabolic adaptation. If you have a higher energetic expenditure but are not fuelling properly either pre -or post-workout, you might be able to temporarily decrease caloric intake. But, the body will compensate over time by increasing hunger and/or lowering your total energy expenditure. This is the “calories out” part of “calories in, calories out.”

Said another way, aerobic exercise performed in the fasted state with no post-workout fuel induces higher fat burning WHILE DOING THE EXERCISE, but will then correct for energy output after the exercise is finished. This means, there is nothing inherently superior to fasted workouts.

Another study looked at 20 healthy young females and looked at the difference between fasted exercise on body composition. They kept calories constant between the two groups and either gave them a meal before exercise or had them work out fasted and fed them after the exercise was completed. Again, no significant difference was noted between the two groups in terms of body composition. They both demonstrated equivalent weight and fat loss.

Fed State

So here is where it gets interesting! Even though body composition seems to be agnostic to whether you are in a fed or fasted state, there’s a significant difference in performance and repair of muscles when you are fed before exercising.

Specifically, when you consume carbohydrates and protein before a workout, this positively affects muscle glycogen stores. This is going to give you the oomph you need to maintain energy and execution during your lifts. It’s also going to improve the repair of muscles and help to improve the short-term and long-term adaptations to training.

Said another way — being fed before a training session helps with the performance during that session and the repair afterward. I would argue that this speeds up changes in body composition over the long term because it is going to favor muscle tissue performance and repair. The faster you can put on muscles, the better your body composition is going to be.

For those of you wanting to go even deeper, check out this article on nutrient timing, and listen to one of the authors of the paper, Alan Aragon, on my Better! podcast.

HOW

If you want to try fueling before a workout and have been training fasted for years, start small!

Here is a short list of pre-training meals you can experiment with:

  • Add protein to your coffee. I often add a Core Power to my coffee, or I will blend Equip Foods or Schinoussa protein powder into my coffee.
  • Have a banana. It is light enough to avoid that “brick in the stomach” feeling.
  • Have a Protein Shake. (½ banana, scoop of whey protein powder and water)
  • My overnight oats recipe (check it out here)
  • Greek yogurt with some honey and walnuts
  • A few rice cakes with peanut butter and jelly

Personally, I am a creature of habit so it’s either my overnight oats or I add one scoop of whey protein to oats and mix. I eat either one of these options before every lift. When it’s leg day, I will also add a banana into the mix.

This clocks in somewhere between 350-400 calories, which is about right for the length and intensity of my workouts. I would say the bare minimum calories should be around 200, especially if you just starting to experiment with food intake early in the morning.

Many of you work out early, and I do as well. I eat my oats and protein of choice almost immediately after waking and then I get dressed and get to the gym. This buffer gives me about 30-45 minutes from the time I eat to the time I am in the weight room. Precisely about the time those glorious amino acids and glucose are spilling into the blood so I can drive them into my muscles to werk. Not work. WERK.

NOW

Decide on what small meal you are going to try. Tomorrow (or your next planned lift session), wake up and march into your kitchen to eat. Naked if need be — we’re talking about better muscle performance and recovery here! Then go about your regular morning schedule and head to the gym.

Be patient with yourself. It may take a few weeks to adapt to eating on a new schedule. I would choose one food and just have that before your workout for two to four weeks to see if you notice a difference in your performance at the gym.

It may or may not work for you. Either outcome is fine. That you are willing to try different things is what makes you the champion you are.

In this article, I mentioned my two favorite protein powders. Take a look and choose the one that’s right for you: Equip (use code DRSTEPHANIE to save 15%) or Schinoussa.

Question of the Week

Q: What does it mean when I’m spotting before my period?

Spotting outside your bleed week can be unsettling and there are a few explanations for it.

Before we dive in, consider your age, where you are in your cycle, and if you could be pregnant. And a word to the wise: I’ve had several friends in their late 40s get pregnant, so this is something to always rule out!

EVALUATING

Menstrual Cycle:  

  • Ovulation: Not all, but some women will notice some light pink blood mid-cycle around the time of ovulation. The pink color most likely is a mixing of the blood and cervical fluid. It should not be heavy enough to warrant a tampon, a cup or a pad, and this is considered uncommon, but normal.
  • Luteal Phase: This is most common in perimenopause when we see falling levels of total progesterone and estrogen. Lowered progesterone is unable to maintain the endometrial lining and premature shedding of the tissue can occur as it becomes ischemic and dies. Discussing hormone replacement with your provider might be in order here.
  • The spotting prior to bleeding might also be due to an estrogen deficiency or luteal phase defect where the luteal phase is shorter than the follicular phase. Typical diagnostic criteria consider 10 days as a luteal phase defect coupled with elevated FSH and LH. This can be confirmed on a blood test.

Hormonal Birth Control: If you have recently started on any kind of hormonal birth control like pills, patches, injections, or intrauterine devices, you may find you are spotting for the first few month as your body adjusts to its new hormonal environment.

Implantation Bleeding (Pregnancy): If you are pregnant, implantation bleeding often happens in the six- to eight-week mark of your pregnancy. This is right around the time you “should” be getting your period. The fertilized egg is burrowing itself into the womb and can cause noticeable spotting. This is normal, although you might mistake this for your period!

Sex: Penetrative sex can cause some spotting afterward, especially if you are experiencing vaginal dryness. This happens most commonly in perimenopause with declining levels of estrogen leading to reduced lubrication. The friction from sex can cause microtearing in the walls of the vagina. So, either ramp up the foreplay, grab some lubrication, or both.

You can also see some post-coital bleeding from cervical polyps. These are benign growths on the muscular wall of the cervix.

In all of these cases, keep a log of what is happening so you can discuss the specifics with your doctor. You’ll want to note where you are your cycle, how much, how consistent, what colour, and duration of the spotting.

TESTING & NEXT STEPS

I love to run lab tests on myself and patients every six months. This is ESPECIALLY true in perimenopause when your sex hormones can drastically change from visit to visit.

YOUR TURN!

‘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: Living Libations

As your hormones fluctuate in mid-life and your skin begins to change, you want products that deeply nourish.

Best Skin Ever-Rose is crafted to bring all skin types into balance and uses Rose Otto to replenish your skin. Use it as a cleanser, a gentle exfoliator, or a luscious face and body moisturizer.

It’s been a favorite face oil of mine for YEARS and for good reason. It is pure luxury. This is my “special” night oil when I want to up the glow and dewiness of my skin.

I also love the lightweight Rose Glow Serum that’s rich with ingredients like jojoba, seabuckthorn, and geranium. It makes my skin feel silky soft while soothing and protecting.

Visit Living Libations link and save 15% off. (The discount is automatically applied at checkout.)

P.S.

MISSING LINK: In last week’s Mini Pause, I included a link to a hand-held vacuum I like to use on my mattresses, but the link wasn’t functional. Here it is!

HEALTH TOOLKIT: I’ve put together a toolkit for you on my brand new website. I designed these resources for my Bettys who are menstruating, experiencing perimenopause or have gone through menopause. There are commonalities between the categories and also specifics for each one. Everything I recommend, I use myself. That’s my rule. I invite you to take a look!

Mini Pause #4: How Dust Mites Disrupt Your Sleep

Dust Mites & Making Your Bed: Are You Making Your Sleep Worse?

TL,DR (too long, didn’t read)

Dust mites thrive in a warm and moist environment, which is precisely what making your bed in the morning facilitates. Dust mites worsen allergies, disrupt REM and deep sleep, cause systemic inflammation, and can drive skin irritation like eczema and dermatitis. In fact, a dust mite is probably chowing down on something yummy in your eyebrow right now. Yep, it is going to be that kind of newsletter today, my friend.

WHY

In my podcast conversation with Mike Feldstein about air quality, he mentioned something that made me have an unexpected, audible gasp while we were recording. The gasp was more of a visceral noise of disgust and was totally involuntary as the idea was so incredibly repulsive.

Mike explained that our homes are designed to be sealed tight — to filter out the cold, rain, snow, and bugs, etc. So, once something gets in, it’s hard to get out. Things like dead insect parts, dust mites, pollen, bacteria, and viruses — even our dead skin cells. All of this gets trapped in our bedding, our curtains, our carpets, and our clothing. And, if you’re not actively doing something about it, it never leaves!

I’ll pause while you, too, digest this (dead insect parts?!). Blech.

It’s nearly impossible to rid ourselves of this unless we are willing to live in homes that are penetrable to the cold, wind, moisture, and not use bedding or clothing. Which I’m pretty sure none of us are willing to do.

WHAT

Dust mites burrow themselves into any and all porous materials — carpets, mats, curtains, our hair, eyebrows, our clothing, bedding, comforters, pillows, and rugs. You name it and a dust mite has called it home. They survive by breaking down our dead skin cells into something they can eat.

They are also terrible for our health.

Dust mites worsen allergies, disrupt REM and deep sleep, cause systemic inflammation, and can drive skin irritation like eczema and dermatitis. Many people often confuse allergies with an allergic reaction to dust mites. And since this idea was so repulsive to me, I went down a bit of a rabbit hole and discovered two truly unnerving pieces of data:

  • We are not allergic to dust mites, per se. We develop an allergy to the fecal matter dust mites produce. We also develop an allergy to the dead corpses of dust mites that still reside in our mattresses.
  • Over the eight- to 10-week lifespan of one dust mite, it will produce 1,700 to 2,000 fecal particles.

I’m sorry. I know. More blech.

And even if you don’t have an allergy to them, just the visuals of the above facts are just… well, gross.

If you are someone who deals with allergies, I don’t need to tell you that they can impact your quality of life, and your sleep in particular.

For women in our perimenopausal and menopausal years, we’re typically struggling with sleep. Allergens like dust mites only hinder sleep quality and quantity even more.

Overnight, while tucked in your sheets, you naturally generate heat and sweat. If you’re suffering from night sweats or hot flashes, this further increases the heat and vapor produced overnight. Ovulation and the onset of your period are also natural times in your cycle where core body temperature rises and increase the heat and moisture you produce.

Your bedding, pillows, and mattress absorb this excess heat and moisture, essentially serving up a gourmet feast to dust mites.

HOW

While we can’t get rid of dust mites entirely, there are some ways we can reduce their impact on us.

  • Washing your linens weekly on a allergen cycle

This cycle typically has a higher temperature and the wash cycle is longer, with the intention of killing allergens embedded the sheets (the dust mites and their poop). I typically add a ¼ cup of vinegar to the load, too.

  • Unmake your bed!

I know many a guru has touted the benefits of making your bed in the morning, and you love the hit of dopamine that occurs when you can check off a to-do box first thing in the day. But, given that women have more times in our life where we run hot, we know this contributes to the dust mite population in our home.

Instead of pulling the covers up when I’m making my bed, I started layering them at the bottom of the bed. It’s still “making” the bed, just in a different way. I’m letting the bulk of the mattress air out and get cold.

  • Crack open a bedroom window in the morning (especially if it is near your bed)

In the morning when I wake up, I pull all the covers off the bed and I open the window right next to my bed while I head downstairs to have a coffee and cold plunge. This way I give my bed around 30 minutes of a fresh blast of air from outside and allows for any heat and moisture to evaporate.

This is when air pollution and pollen counts are generally low, so it’s a great time to air out the bedroom with fresh air.

  • Buy a mattress vacuum

I have this one from Amazon and while the sheets are in the laundry, I will vacuum the mattresses.  It is actually shocking the amount of dust and debris it captures.

  • Invest in an air purifier like Jaspr

This is a medical grade device used in dentist offices and commercial buildings that’s now available to purchase for family homes. I have one running in my bedroom at all times and on vacuum days because I know things are getting disrupted and thrown up into the air, I use the “turbo” setting which is a deep clean of the air that runs for about 15 minutes.

I started noticing a difference in my sleep after about three days of having the unit in my bedroom. My Oura ring was telling me I was getting more deep sleep and my chronically low HRV, while still not the greatest, jumped by about 10 points after just three days of use.

Using the Jaspr has been the easiest (laziest?) way I have ever contributed positively to my health. (If you’re interested in a unit for your own home, use my code ESTIMA to get a discount.)

NOW

Push the image of the dust mites and all their disgusting glory out of your mind and choose any of the above options in the “HOW” section.

You can start small, and work your way up from the no-cost options (unmaking your bed, opening a bedroom window in the morning) up through the cost options that are right for you.

Which dust mite intervention are you going to start with? Reply to this email and let me know!

Question of the Week

Q: How many calories are ideal pre-workout?

One of our Bettys asked about pre-workout calorie intake. She’d heard Dr. Molly Malloof, who I also admire, recommend just 150 calories. She then asked if I agreed with that recommendation or would suggest a larger meal?

CALORIE DECISION MATRIX

A few things can inform this decision: What time are you working out? What kind of workout is it? How long will your workout be? What is the intensity of the workout?

Most of my workouts are early in the morning. While I used to almost exclusively work out fasted, I have changed my mind on this because of the noticeable difference being fed has on my performance in the gym.

For a weight lifting workout I always like to have more carbohydrates and protein 45 minutes to an hour before I get to the gym.

So my pre-workout will include either my overnight oats recipe (which you can find here), or simply steel cut oats with a scoop of protein powder, a banana, and a coffee. This clocks in at around 350-400 calories.

I find 150 calories a little on the light side as a means to enhance my performance at the gym. Although this might work well for her and her schedule and workout format. My weight workouts are on the longer side, about 75 minutes. When I do legs, it’s closer to two hours.

LISTEN TO YOUR BODY

Some of you have mentioned that you do not like to eat first thing in the morning and the literature seems to support that with respect to cardio. There’s not much difference on body composition whether you are fasted or fed. So, you do you, boo.

However, for lifts, eating before you work out can augment your energy and performance during said lifts. Does that mean you are doing it “wrong” if you do not eat? No. We gotta do what we gotta do based on the constraints of our lives. A fasted workout is better than no workout at all.

If you are someone who wants to play with a pre-workout and you exercise in the morning, start small first and see how you feel.

Here’s a small sampling of options to try when you don’t want to feel like there is a brick in your stomach in the morning:

  • One banana & 1 Tbsp nut butter
  • One or two rice cakes with peanut butter & jelly
  • Overnight oats
  • Protein shake with milk and berries
  • Add a CorePower drink to your coffee
  • Greek yoghurt with berries
  • Sourdough bread with lox and cream cheese (this is my son’s favorite!)

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: PELUVA

You build all your weightlifting workouts on the foundation of good foot mechanics. This allows full articulation and range of motion in your feet and leads to better ankle mobility, knee tracking and hip mechanics. Since our feet comprise about 25% of the bones in our body, having a shoe with minimal correction during a lift session is super important.

My choice for a minimal shoe is Peluva. They’re functional and good looking. Use code DRSTEPHANIE to get 10% off your purchase.

Mini Pause #3: Add ‘Exercise Snacks’ To Your Movement Menu

Exercise Snacks: An Easier (Better?) Way to Stick to Your Goals


TL; DR (too long, didn’t read)

Exercise Snacks (exercising in small 5- to 10-minute increments through the day) yield the same, if not slightly better, results than one big session at the gym.   

And we are not just talking about waistline — exercise snacking demonstrates improvement across fasting insulin, fasting glucose, lipids, and cardiorespiraory fitness. They also show a slightly better outcome in body weight and LDL cholesterol!  

WHY

January is a busy month for gyms. If you’ve just joined a gym, or even if you’re a seasoned muscle mommy like me, you may be feeling some of your original New Year’s goals already falling by the wayside. But have no fear — if you’ve set a goal and are having a hard time keeping up with an aggressive gym schedule you’ve set for yourself — I have a solution for you!

Simple exercise snacks.

Since the pandemic, more and more people work from home either permanently or have a hybrid model working from home and being in an office. What has emerged are new work norms that allow you more freedom to find opportunities in your day for movement.  

I’ve always said moving consistently through the day trumps one big workout followed by sitting for 12 hours. And there’s robust scientific evidence to back this up.

WHAT

This meta-analysis looked at 19 studies with a total of 1080 participants. They were looking for studies that evaluated whether one bout (continuous) of exercise was better, worse, or equal to the same exercise broken into smaller pieces through the day (cumulative or what I am referring to as “exercise snacking”).

They controlled for intensity of the exercise, duration, and type of exercise. Said another way: they were looking for the exact same workout either 1) completed in a single session, or 2) broken up into smaller chunks over the course of the day.

Results showed that the exercise snack group and the single bout group both reduced their total body mass, but the exercise snack group fared slightly better. The exercise snack group and the continuous exercise group both improved their LDL cholesterol, with the snackers faring slightly better here as well.

Both groups improved their total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, and fasting insulin.

Bottom line: both a continuous session at the gym AND exercise snacks can yield comparable results.

There’s mounting evidence that exercise snacks have incredibly positive benefits on your health:

  • like this study looking at exercise snacks on blood glucose levels after a meal
  • or this one on how exercise snacks lower blood lipids after a meal
  • This study showed that 1 minute of all-out sprints (broken down into 3 x 20-second sprints, bookended by 2-minute warmup and cool down) improved cardiometabolic and mitochondrial health AS MUCH AS individuals doing cardio for 45-50 minutes. That’s five times less time and volume!

Pretty compelling, right?

Exercise snacks also alleviate the pressure to get in a big exercise session every day. If you’re able to replicate a 1-hour workout in smaller pieces through the day, the results seem to be equivalent at worst, and superior in terms of body mass and cholesterol levels at best.

HOW

You’ve got two options on how to implement exercise snacks. You can use either option or a combination of both.

  • Option 1: Replace your Gym Session with Exercise Snacks


In order for this to work, you have to think about the intensity and duration of your regular workouts. You’ll want to match your regular, continuous workout by breaking it down into smaller bits.  

So, if you are working out for 60 minutes, your exercise snacks should add up to 60 minutes over the course of the day. That could be 6 x 10-minute sessions, or 12 x 50-minute sessions. And you MUST match the intensity of your regular workout.  

Intensity is subjective, but you can think about it on a scale of one to 10: One being pretty low intensity, and 10 being all out. If your continuous workout was an eight, the exercise snacks also have to be an eight.

This is a GREAT option if you struggle with the time commitment for a bigger gym session, if you travel frequently, or if you’re the family chauffeur driving kids to after-school activities.

  • Option 2: Keep Your Gym Session and Incorporate Exercise Snacks


In full transparency, this option is what I like to do. I’m one of those people who actually enjoys going to the gym. But after researching this topic for this week’s newsletter, I’m going to incorporate more exercise snacks into my day — even on days I get in a workout.   

Exercise snacks are a blessing on travel days, when I’ve slept in and don’t make it to the gym, or for hectic days when I’m just not getting to the gym that day. It’s reassuring to know that these days aren’t a regression, but a progression.

And frankly, these exercise snacks are one of the few reasons I get my sprint training in on my CAROL Bike. I can pop on it and in 5 minutes, I’ve done 3 x 20 second all-out sprints — and haven’t broken a sweat! (If you find you’re interested in a CAROL Bike, you’ll get a discount using code DRSTEPHANIE.)

NOW

Here are some of my favourite exercise snacks. I encourage you to try these and be creative with your own based on how you like to exercise.

  • While I’m making dinner: 20 pushups, 20 air squats, 20 switch lunges
  • While I’m waiting for a plane: walking lunges back and forth near the boarding gate; wall sits; decline pushups at the gate chair
  • When I have 10 minutes before a meeting starts: CAROL Bike sprints (30-second sprint, 90-second recovery, then repeat 3x), or 30 box jumps on plyo boxes I have at home.
  • When I can opt for walking meetings : I’ll take a call and go for a walk around the block. Pro tip: if you have an iPhone, put the “Voice Isolation” mode on. This prioritizes your voice over background noise. I have taken calls at loud airports and at my kids’ soccer games where people are screaming. The lucky caller on the other end of the line cannot hear anything but me.
  • When I’m on soccer mom dutyI alternate lunges on the side of the pitch while my boys practice, and in the summer I sprint around the track (if there is one). This helps me feel less like an Uber driver.

Submit Your Exercise Snacks!

Let us know if you already have some great exercise snacks. Or, if you’re inspired to create new ones, share those, too. Reply to this email and we’ll compile some of the best ideas from you in a downloadable PDF!

Question of the Week

Q: What do you eat after one of your workouts?

I’m preparing a bigger newsletter for you on peri-exercise fuel, but here are some guidelines following a workout.

RESISTANCE TRAINING & CARDIO

I always follow any lift session or cardio with a combination of protein and carbohydrates.  On mornings when I exercise early, this will be breakfast. One recent morning I had five egg whites + one whole egg omelette on a piece of sourdough toast. On the side was 1/4 avocado and some fruit. I also treat myself to a cappuccino with whole fat milk. Not a Starbucks triple grande venti purple long short with sprinkles and foam (or whatever the cool cats are drinking these days) but a regular 3/4 cup-sized cappuccino cup.

If I am about to get my period, I’ll also add in one scoop of protein in water as my “drink” instead of water. I do this because I know I’m going to be hungrier in week four of my cycle, and I preempt that with more calories and specifically more protein.

(If you want to learn more about eating around your cycle, check out my book, The Betty Body.)

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: BON CHARGE

Sometimes all the “steps” for skin care can feel overwhelming. I like efficiency, and I prefer a simple daily routine that doesn’t take a lot of time. I also want great skin.

When I found the Bon Charge Red Light Face Mask, it checked all the boxes and more. It combines red and near-infrared light to diminish fine lines, scars, and blemishes. No matter what your skin type, you can experience a brighter, healthier complexion and firmer, more youthful skin using this mask. I love the results I’ve gotten.

I keep this mask beside my desk and work with it on because it molds comfortably and easily to my face. I can choose the intensity and wear it for as little as 10 minutes and still get all the benefits.

I invite you to visit Bon Charge to learn more about the Red Light Face Mask. Use code DRSTEPHANIE to save 15% sitewide.

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.

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Dr. Stephanie