Mini Pause #21: How Caloric Deficits Impact Your Bones, Muscles & Tendons

TL;DR (too long, didn’t read)

Caloric deficits impact the trajectory of women’s bone density and muscle mass. Caloric deficits also can impact women’s height, ability to build muscle, and menstrual cycle. We must reframe our thinking from being as skinny as possible to being as strong as possible.

WHY

Oh, look! I have more to say about chronic caloric deficits. Hold my beer.

Just kidding. I never drink the stuff. But… I have been thinking about chronic caloric deficits and the impact it has on a woman over her lifetime. Specifically, I want to talk about not getting enough calories in and how seriously it affects your bones, muscles, tendons, and joints, and injury risk.

Last week, I touched on the idea that eating in a caloric deficit can have deleterious effects not only on your gainz, but also on other important areas of female health like menstruation, bone health, brain health, and hormone production.

Let’s tuck into this a bit.

WHAT

One of the things I couldn’t shake after writing last week’s Mini Pause #20 is that most of us have been on some kind of diet for all of our lives. That means that for many women, we have been trying in some form or another to starve ourselves skinny. So at best, we have underestimated our calories thinking we are in a deficit, and at worst, we’ve fostered a real, chronic caloric deficit that impacts organ function and tissue remodeling and maintenance.

I wanted to expand on last week’s newsletter because it has real consequences on our body’s ability to function normally.

Most obviously, chronic caloric restriction is going to affect the regularity and cadence of our menstrual cycle. I write about this extensively in The Betty Body and why women are still getting periods (no matter how irregular they may be).

If your body fat percentage is too low, you run the risk of depriving yourself of ovulation, which is the main point of your menstrual cycle. In doing so, you also deprive your body of progesterone. This sex hormone is only produced when you ovulate.

Progesterone has wide-sweeping effects on the body like promoting good sleep, calming anxiety centers in the brain down, and supporting thyroid function–all three of which perimenopausal women tend to struggle with.

But there are other, perhaps more deleterious effects of prolonged caloric deficits, such as the effects it has on your bones and muscles.

Young women who under-eat and have lost their menstrual cycle as a result of over-dieting are at risk for developing irreversible damage to their skeletal system because 90% of our bone mass peaks at about 18 years of age [*]. This means that without adequate nutrition, a teenager who is undereating will impair her bone strength; change the architecture of the bone itself, causing it to have a higher affinity for bone fractures; and can even change her final height [*]. It puts this young woman at a higher risk of vertebral fractures throughout the rest of her life, even if she resumes normal eating patterns.

Having seen my fair share of vertebral fractures in my clinic, this is something you want to avoid at all costs. It is painful and disruptive, and the rehab is incredibly difficult from both a physical and mental point of view.

Amenorrheic episodes (months without ovulation) also impact your anabolic hormones like estrogen. Without a regular menstrual cycle, you would be considered hypoestrogenic, which is not too dissimilar to what we see in the final stages of perimenopause and menopause.

In both age groups, we see a fraying of the bone architecture, an increased susceptibility to fractures, and reduced bone strength. We want bones that are more “bendable” to withstand the forces on them. The more brittle and less “bendy” a bone is, the more likely it is to snap.

The other deleterious effect chronic caloric deficits have are on our body’s ability to repair and grow new muscle tissue. Muscle is so much more than aesthetic, as you know. Undereating is associated with impaired myofibrillar and sarcoplasmic muscle protein synthesis [*], compared to training with optimum energy availability.

Being on a chronic diet for YEARS is going to measurably impact your muscle mass, bone density, injury risk, and organ health. And it will catch up to you eventually.

HOW

I wish I could snap my fingers and wake us all up from the collective spell of wanting to be skinny, but the truth is, each of us will have our own paths to this awakening. What I can say to the well-intentioned woman (possibly the one reading with a touch of cynicism who gets what I’m saying intellectually but emotionally still desires to be small) is that your worth is not what the scale says.

If you have a lot of muscle mass, you are likely going to be heavier than whatever arbitrary number you have in your head. That number by the way has been subtly implanted from reading Cosmo, Teen Cosmo, and whatever other junk we grew up reading.

Think deeply about the images of thinness growing up. Women in perimenopause know this intimately because if you are around the same age I am, you grew up with Kate Moss and the advent of the grunge and heroin-chic look.

I distinctly remember as a teenager who was studying fashion magazines, that my body was just not built like the girls on these pages. I have thighs that are always going to touch. I have hips made for childbearing. I am just built differently.

Of course, these physical qualities have been in vogue as of late, which also just goes to show you the standards of beauty are always changing. So find the beauty in your own damn self and stop looking for external validation. Love your freckles, your scars, your hair color. Because soon stars will take out their BBLs, strong Roman noses will be the new ideal, and thin eyebrows will be back.

Point is–the house always wins. So be the house. Not the player.

NOW

  • Play India Arie’s “Because I Am a Queen
  • Think about your relationship with food and dieting and what messages your daughters and sons are receiving. Is it good? Bad? Neutral
  • Contrast that with how you would like to show up for yourself, your family, and your community.
  • Can you experiment with eating a little more? What if you started with simply 100 calories more of protein? Could you make that work?

Q: I know I need more calories in my luteal phase. Can I increase fat? Or do I need to add more carbs?

Short and to the point for Divie3 from Instagram today.

Yes, if you are hungrier you definitely need more calories. I usually recommend something like 10 to 15 percent more than you are eating in your follicular phase. The first thing is to make sure your protein intake is adequate. Typically something like 1g of protein/per ideal pound of body weight. After that you can dial up fat or carbs; whatever tickles your fancy!

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: Red Light Therapy

I’ve added another component of light therapy to my recovery practice. (Yes, that’s really me lying on it in the photo).

While my Bettys know how much I rely on science when it comes to all things wellness, I’m going to admit that the PEMF Mat by Bon Charge both soothes and energizes in ways I wasn’t expecting–and I loved it right away.

It’s a pulsed electromagnetic field mat that works with your body’s natural magnetic field and uses bioactive wavelengths combined with red and near-infrared light. An additional far-infrared light component warms your body.

You can use the PEMF Mat during yoga, stretching, or grounding while lying down. You can even read a book or take a nap. The Mat’s programming allows you to choose sleep, grounding, focus, or meditation and relaxation.

And ever searching for ways to be more efficient, I combined my Red Light Face Mask and Red Light Neck & Chest Mask with time on the PEMF Mat. It’s a triple win for wellness. Speaking of triple, the PEMF Mat now comes in three sizes: a sitting pad, a demi size, and the full size.

View the entire Red Light Therapy Collection here and use code DRSTEPHANIE to save 15% off sitewide.

Mini Pause #20: Caloric Deficits Are Ruining Your Gains. There. I Said It.

TL;DR (too long, didn’t read)

Constantly being in a caloric deficit will eventually eat up your muscles, your performance in the gym, and will castrate your happiness. Need I say more?

WHY

I am so tired of this persistent idea that women need to be small and skinny. So many women tell me that they’ve been on one diet or another for most of their lives.

Think about that for a second. Think about how colossally f**ked that is. For women to be on an eternal quest to be small.

I’d like to make a strong (pun intended) case for eating to build muscle as the place to start (and dare I say, stay) so that you can fuel your growth. Not only your body composition growth but your mind as well. Your brain needs good energy. Stable and consistent energy for your metabolic and hormonal production, and just to think.

Strong over skinny.
Resistance training over reduction.
Speed training over starvation.
Anabolic over catabolic.

And if that fails to land, just remember that people don’t write songs about abs. There are, however, numerous songs about big juicy glutes. So there’s that.

WHAT

When embarking on a fitness journey, I’m invariably asked: “Can you build muscle and lose fat?”

There is a long and a short answer to this. Technically you can, but the progress on both goals simultaneously is likely going to be so slow that you might be inclined to erroneously conclude that something is wrong with you, rather than the approach you are taking.

Imagine if you had an important meeting at work and you were about to close the deal of a lifetime. And you brought along your playful dog, your inquisitive child, and decided to scroll on Instagram during this meeting. Could you focus on all of them? Probably. Could you focus on all of them WELL? You know the answer here, friend. And if you are not sure, check out this study [*].

My preference is to separate these two goals, and I prefer to start with muscle building.

Starting with muscle building means typically figuring out what your current maintenance calories are, and looking further at your macronutrient composition (how much protein, fat, carbs) and your hunger patterns.

If you are someone who’s been trying to lose weight forever and restricting calories, this becomes harder the longer you are in a deficit because your total daily energetic expenditure also lowers [*]. Meaning, that you naturally move less, your digestion slows, and your metabolic rate slows, too, as your wily body begins to conserve energy and calories.

When you want to build muscle, you need to eat. Muscles need substrate (food!) to build and grow, and it becomes difficult to grow muscles in a restricted state. It also compounds for women in perimenopause and menopause because you are naturally–as a function of aging [*]–more resistant to muscle growth.

You also, around the age of 40, begin to see a degradation of your muscle fibers and total loss [*] of volume of muscle fibers.

So when you’re not consuming enough calories because you (and every other woman on the planet) have been told that you need to be as small as possible AND you’re working out, lifting heavy, you’re simply not going to have enough energy to support your physical goals. You won’t have enough energy for your bones, organs, or your hormones either.

AND you’re putting yourself at risk for injury.

So while I completely get the appeal of trying to be “good” and eat under your caloric requirements, it’s simply not serving you in the long run.

HOW

Determining how many calories you are consuming relative to your energy expenditure is going to become important.

Exercise is not just the time you spend in the gym. It’s time spent walking, cleaning up the kitchen, and your general movements like hand gestures and toe-tapping. The first step is always getting a sense of how much energy you’re taking in to support not only the gym but also your life.

If building muscle is the goal, you typically want to set the protein target around 1g of protein (the methionine kind I mention in Mini Pause #19) per ideal pound of body weight.

Then, figure out what your maintenance calories are. I find women fall into two groups: 1) chronic caloric deficit (which is the focus of this issue), or 2) they think they are in a deficit but are eating way more calories than they think.

In either case, getting a sense of your caloric intake is essential.

Calculating how many calories you need at maintenance is the next step. I quite like this calculator [*] to help do this.

Now that you have a sense of your maintenance (and how shocking this number might be for you), this is the springboard from which to develop meal planning for muscle building and, if there is interest down the line, caloric restriction for an event or a transient amount of time.

It’s also an option to eat at maintenance without the need to bulk or cut. Shocker, but it’s true! This is truthfully where I am most of the time. Eating a normal set of calories without looking to cut.

NOW

  • Track your calories as they are now for one week (including weekends).
  • Figure out your calories using this calculator [*] and contrast with the data set from the above action item.
  • Take stock of the difference: are you eating too many calories? Too little? How long has this been going on?

Whether you have been over- or under-consuming calories, there can be a slow calorie shift towards your maintenance calories as you are simultaneously working toward building muscle.

Question of the Week

Q: Is exercising in the morning (cardio) going to affect your cortisol and hormones?

IG follower nomad_ad asks a question many women grapple with.

The short answer here is yes, exercising–irrespective of whether it’s resistance training or cardio–will affect your cortisol levels. Exercise any time of day–not just the morning–will do this.

Cortisol along with other catecholamines are released for your performance during activity, and come back down after the activity is finished.

Cortisol is not the big bad hormone it’s made out to be online with influencers who don’t understand basic physiology. It’s those same people teaching you that glucose spikes should never happen, insulin is the root cause of all your problems (not just one but ALL of them), and the reason you cannot lose weight is you have a “broken” metabolism.

Exercising, in addition to “spiking” cortisol also will cause:

  • a transient decrease in thyroid hormones
  • a downregulation in immune system activity
  • an increase in blood pressure and heart rate
  • transiently raised blood lipids
  • a spike in blood glucose.

Does that mean you should never exercise?!

It’s easy to make something look inherently bad if you don’t fully understand it. Many people who have demonized glucose spikes, cortisol, and insulin are simply scientifically illiterate. Either that or they are peddling some magic supplement to quell said evil glucose spikes, cortisol, or whatever they are demonizing.

Here are some great things cortisol does in the body:

  • Helps provide your muscles with energy by increasing the availability of glucose.
  • Decreases your perceived exertion, which will positively improve your ability to stay with your endurance activity of choice.
  • If you are lifting weights, cortisol decreases the perceived load and allows you to lift heavier weights for longer.
  • Helps to regulate your sleep-wake cycle.
  • In short spurts cortisol is ANTI-INFLAMMATORY. I apologize for the all-caps, but this is worth noting. Sure, long-term chronic stress does the opposite, but in the short term, cortisol decreases inflammation. It is what corticosteroid creams and injections work to mimic.

The kicker of course–with respect to exercise stimulus–is your recovery. The transient stress catalyzes change, but you must allow the body time to adapt to the change before you go at it again.

So should you do HIIT training for 45 minutes 5x/week? Probably not. It’s because of the lack of recovery and runway for adaptations that’s causing the dysregulation. If you were to cut the frequency of the HIIT in half and double your recovery, there wouldn’t be an issue.

Cortisol is your friend–when you balance her with your other bestie: recovery.

Forward this to someone you love, and let’s fall back in love with what cortisol helps us with.

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.

Mini Pause #19: Eating High Protein? Add Collagen to Balance Amino Acids

Keep an Eye on Methionine and Glycine; They Affect Body Composition & Emotional Well-Being

TL;DR

Higher protein consumption is essential as we move through perimenopause and menopause. We should be mindful, however, of balancing the amino acids we take in through a variety of protein sources. Specifically, we want to think about our methionine-to-glycine ratio

Today, I discuss these amino acids, where they are abundant, and the products you can take to keep them in balance. 

WHY

Methionine and glycine are two amino acids that profoundly impact your body composition and emotional well-being. These two changes are inexplicably intertwined and exacerbated in perimenopause. Methionine and glycine are crucial in maintaining your muscles, joints, and connective tissues, and to help you heal when you’re injured. They’ve both been shown to help with type 2 Diabetes, cardiovascular disease, and stroke–all of which are diseases of aging and poor metabolic health.

Striking the right balance will help keep your hair lustrous, build muscle, regulate blood sugar, help quell anxiety, and keep your faculties sharp.

WHAT

Methionine is an abundant amino acid in meat, eggs, chicken, and fish. We typically associate these foods with “high protein.” Methionine also is implicated in several metabolic processes including endogenous creatine synthesis, glutathione synthesis (the master antioxidant in the body), and DNA methylation. 

However, consuming only foods high in methionine can deplete your glycine levels.

Glycine has been shown to stabilize blood sugar levels, keep your hair shiny and thick, and promote collagen and elastin production in the skin. All things we would like to continue to have in our 40s and 50s, thank you very much!

You want adequate levels of BOTH methionine (derived largely from an animal’s muscle) and glycine (derived largely from an animal’s skin, bones, and connective tissue). 

So, how much of each should we be aiming for?

If you want to build muscle and are actively lifting weights in the ways I’ve described in previous newsletters, consume approximately 1g of protein (in this case, methionine-rich foods) per ideal pound of body weight. This is a good place to start. The 1g of protein can be considered your muscle meats (aka the methionine-containing products) and you will most certainly consume adequate amounts of methionine.

The question then becomes: “What about glycine?”

HOW 

We know our ancestors, through nose-to-tail consumption of animals, consumed way more glycine than we do now in modern life. 

The “meat” we consume today is often just the muscle of the meat, and we often discard the bones, the fat, and the organs. I’m guilty of this too. I can make a pretty mean stock from chicken bones and a great bone marrow, but that is the extent of my organ-making skills. I consume liverwurst as my “organ” because I just can’t stomach eating the actual liver, heart, kidneys, and other things that are in liverwurst. 

  • If you are eating an animal-based diet, for every 10 grams of animal (muscle) protein you consume, you can add 1 gram of glycine in the form of collagen protein, bone broth, or glycine supplements. This would be a 10:1 ratio. For example: If you’re eating 150g of animal (muscle)–based protein daily, you want to consume 15g of collagen protein. 
  • If you are eating a plant-based diet, your glycine intake is already naturally higher, as plant-based proteins tend to have more glycine. I recommend adhering to the 10:1 ratio here, as well.

The best sources of glycine are going to be bone broth, hydrolyzed collagen powder, glycine supplements, gelatin, and even edible bones (like in your can of sardines). 

My main source of glycine comes from collagen powder: I use mindbodygreen’s Beauty & Gut Collagen powder or Equip Foods’ Grass-Fed Collagen. The benefit of collagen powder is that it is superior to collagen synthesis than taking a pure glycine supplement. So I always opt for collagen powder or bone broth over taking a glycine supplement. 

NOW

  • Ensure you are balancing your methionine intake with glycine by supplementing with 1g of glycine for every gram of methionine intake
  • Pick up a bag of hydrolyzed collagen powder like Equip Foods or mindbodygreen. Or, you can make or buy bone broth, or glycine powder. (If you try Equip or mbg, click the links and use code DRSTEPHANIE for a discount.
  • I add one scoop of collagen powder to my workout drink–it’s flavorless and dissolves completely in water.

Question of the Week

Q: Do you prefer to work out alone or with your partner? 

Thanks to Lazgrrl on IG for asking this question. The short answer? I think it depends on what I am working on! 

On leg days, I usually work out by myself simply because my husband doesn’t train glutes in the same way I do. I’m doing large volumes of glute training, and we often are not using the same machines. I also need to dig deep psychologically for leg day, which means I need my music, and I don’t want to talk. 

On back days, I love to train with my hubs because we work the same muscle groups in similar volumes. The same goes for shoulders! 

Cardio is the absolute hardest thing for me to get in consistently and I’m inclined to skip it, so I like to have a cardio partner. My husband is particularly gifted with sprinting! It’s a challenge for me to try and keep up with him (I don’t). 

What I Recommend: CollaGenius

There’s a new collagen product that I tried and I have to say, I’m wholly impressed with CollaGenius. It differs from other formulations because it combines hyper-concentrated forms of Lion’s mane, Chaga, cordyceps, and reishi mushrooms with the collagen. Then, in a brilliant taste move, adds Peruvian cacao!

This formula targets your brain for maximum energy, focus, and performance. It also improves skin elasticity and helps alleviate stress. I like to mix it with my morning cappuccino to transform it into a mochaccino with benefits. It’s also great in smoothies and even just with water.

After each serving of CollaGenius, you’ll feel calm and energized. I noticed a difference right away. You get antioxidants, mood support, and improved brain function. It’s a good fit for my Bettys struggling with peri & meno symptoms like brain fog.

Go to nootopia.com/bettergenius and use code BETTER to get 10% off. (Note: It’s soy-free, gluten-free, lactose-free, and GMO-free.

Mini Pause #18: Deload Weeks & Physical Breaks: Rest=Progress

You Must Squat Before You Jump: Deload, Take a Break, and See Even More Gains

TL,DR (too long, didn’t read)

Deloads are a necessary part of training hard [*] when you are chasing all those gainz. They are often a welcome relief when you have accumulated sufficient stress and fatigue in your training regimen. This happens somewhere between four to eight weeks of intense training and allows for proper recovery.

Deloads can be a drop in weight or volume in your regular program, or you can choose to take a week off altogether. This week I am opting for a reduction in both volume and weight to help with my own (very overdue) deload week.

WHY

I’ve been feeling kind of run down and tired lately, and I’ve been trying to put my finger on what it is. I’ve been sleeping well (better than I ever have, truthfully, consistently hitting new PRs at the gym, and my nutrition is no different than it normally is.

But somehow, I’m exhausted, recovery is taking longer, and I’m even dreading the gym.

Now y’all know something is off when I am not excited about gym time. That’s my happy place!

I took a look at my volume and my progression over the last six months and then it hit me like a 1 Rep Max sumo squat. I’ve accumulated too much physical fatigue, and I failed to schedule a deload week [*].

When I first wrote about training around your cycle in The Betty Body, I naturally built a deload week into Week 4 of the cycle of training with lighter weights than usual. Although it wasn’t intentionally programmed as a deload week in the book, for cycling women it’s a nice anchor to be able to think about a lighter workout in the late luteal phase of your menstrual cycle. This helps to reduce the physical and often psychological stress that accompanies this time of the month.

I find I require a lighter week either on Week 4 or Week 8 of steady training. But for whatever reason, I’ve trained 16 heavy weeks in a row. That explains my current disdain for the gym and poor recovery recently. I’ve been noticing I have been much more sore than normal, taking at least a day longer than I normally do to recover. From leg workouts, specifically.

WHAT

Everyone who’s lifting weights close to failure can and should be thinking about building in regular deload weeks to reduce physical and mental stress and fatigue and to help you push in the next cycle of lifting. For my Type A Boardroom Bettys where I can ALREADY see your brains working (“Maybe I don’t need a deload! I should continue to push despite what she is saying!”), deloads are a necessary part of any intense training regimen. It doesn’t mean you’re broken, failing, or not making gains. By contrast, it’s how you make EPIC gains. In recovery.

Deloading is a crucial part of any well-rounded fitness routine to help reduce overall fatigue, reduce the risk of injury, and help your lifting become stronger in the following weeks. In the same way, you need a break from your diet now and then, the same is true for your physical diet.

When you are training hard, there is a predictable accumulation of stress and fatigue. There is nothing to fear about this, as this is how you get better and improve your energy levels, body composition, and strength.

But when you have accumulated too much stress and fatigue over several weeks or months of training, you can and should actively reduce it so you can facilitate recovery and get back to progress the next week.

Generally speaking, you know you are ready for a deload week when you have had two or three workouts of the same body part where you are either not making any progress, your recovery is longer than normal, or worse, you are regressing in your program.

Let me illustrate with an example.

Let’s assume you train legs on Tuesday and Friday. On both those days, you’d experience substandard workouts in the absence of any other explanation (jet lag, a child was sick, a stressful time at work, etc.).

And even if it were the case where your psychological stress was acutely through the roof, I’m going to gently remind you that psychological or mental stress also accumulates in the physical realm. This would be your cue to lighten up.

HOW

The No. 1 rule about a deload week is KISS: Keep it Simple Smartypants.

Once your strength is not improving by your typical measurements (weight, volume, etc.) for two or three consecutive workouts, it’s time to take a break and amp up recovery.

Here are a couple of ways you can structure a deload:

  • Reduce weights
  • Reduce volume
  • Reduce weight and volume
  • Do absolutely nothing (not a typo and a perfectly reasonable option)

Typically when I deload, I reduce both weight and volume by about 50 percent.

Yes, by that much.
Yes, it seems like a lot.
Yes, these workouts are easy.

So let’s say I am regularly squatting 135 lbs for 10 reps for 3 sets. I might structure a recovery week in the following way:

  • Deload Leg Day 1: 3 sets, 10 reps, but the weight will drop to 67.5lbs (this includes the bar at 45lbs, so using gym math that is 22.5 lbs of weight on the bar, so I usually just round up to 12.5 lbs per side)
  • Deload Leg Day 2: 3 sets, 5 reps, 67.5 lbs (weight and volume drop)

So you can see that I initially just dropped the weight, but kept the volume consistent. On the second leg day of the week, I dropped both the weight and the volume. It feels like an easy workout. And that’s the whole point. You’re training easier this week so you can better recover.

When I structure my deloads so that the workouts are progressively easier for the week, I’m absolutely itching and ready to get back at it the next week. This is because I’ve dropped the stress of the workouts considerably, allowing for my body’s recovery processes to get ahead of the stress I have accumulated. I always find that in the weeks following a deload, I often hit a new personal best.

The important takeaway? When you structure your deload weeks this way, you can still work on your technical skills with the lighter weight.

And in total transparency–about once a year–I simply need a complete break from the gym. A 100% complete drop in volume and weights for at least half a week, and often a full week.

I just get to this place where I don’t want to be in the gym at all, and I honor that. So I will get in a lot of walking, sleep in, spend lots of time in the sauna, and do cold plunges. (I’ve linked my heat and cold recovery tools here for you to explore. Use code DRSTEPHANIE for each to receive an exclusive discount.)

For me, this week I am opting to drop weights and volume on all workouts all week long.

NOW

If you have been noticing your workouts suffering and an inability to progress with at least two workouts feeling like they were crappy, decide to take the next week to amplify recovery. Here are two possible approaches:

  • Reduce your volume, your weights, or both while still training at the same frequency.
  • Take the week off completely. Go for some walks, do some yoga, practice mindfulness, sleep in, and allow your magical body to do its thing.

Prepare your mind for the deload. It isn’t a failure, a setback, or anything of the sort. Think about jumping. Usually, the lower you can go into a squat, the higher you can jump. Think of deloads this way. The squat part of the jump.

Question of the Week

Q: I know rest days are important when working out. I’ve heard women in perimenopause and postmenopausal women should have more than two rest days a week. What are your thoughts?

Thank you to reader Gina G. for asking this question that fits in so well with today’s main topic on deloading!

I am not one for hard rules that apply across the board, so I will say that you should take as much rest as you need. And when you are fully recovered–get back at it!

If you are regularly training legs, let’s say, you can aim to train them twice a week, but if you feel like in between those sessions you are not sore, have the energy, and can easily fit in another workout, you should definitely try it out and see how you respond!

I typically take one full day off and my shoulder days are lighter in terms of energetic output. Sometimes I’ll throw in one or two leg exercises at the end of a shoulder day. Not all the time–just when I have the energy.

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.

Mini Pause #17: Frozen Shoulder-How to Get Your Mobility Back

What You Can Do About Frozen Shoulder in Perimenopause

TL,DR (too long, didn’t read)

Frozen shoulder affects women, especially during perimenopause, by limiting range of motion (ROM). While frozen shoulder often develops without knowing the cause, you can implement prevention strategies focusing on mobility, metobolic health, and musculature to help strengthen and regain ROM.

WHY

As we move into perimenopause, joint and bone constitutions begin to change. We begin to see an increase in bursitis, capsulitis, and tendinopathies. Yay us!

Frozen shoulder (or adhesive capsulitis) is a condition that affects women more than men, especially women in perimenopause. Interestingly, hypothyroidism and metabolic derangements like diabetes are strongly correlated with frozen shoulder. These two are also, peculiarly, issues we see pop up in perimenopause, as well.

WHAT

Frozen shoulder is a clinical diagnosis where we see a gradual but deteriorating change in both active and passive range of motion. Active ROM is where the patient initiates the movement, and passive ROM is typically initiated by the clinician doing the exam.

It has been characterized into three phases in its progression to “frozen”:

  • Freezing: This is where we see the onset of shoulder pain, with progressive decline in active and passive ROM.
  • Frozen: This is usually the worst it’s going to get, with a plateauing of loss of motion.
  • Thawing: This is where we see a gradual improvement in pain and range of motion.

Frozen shoulder is often a gradual process spanning six months to as long as two years. When I was in school, we would classify most cases of frozen shoulders in the patient’s chart as “IDK” or idiopathic origin. Or if you’re a smart ass like me, IDK unofficially stood for “I don’t know.”

There is some discussion in manual therapy circles like chiropractic [*] and physical therapy [*] that the spinal accessory nerve (a cranial nerve that winds its way from the neck through to the shoulder) [*][*] may also have an impact on the ability of the patient to lift their arm to the side (called abduction of the shoulder) because of impaired trapezius and scapular innervation.

Even though many cases of frozen shoulder are idiopathic (of unknown origin), there are some clear corollary and potentially causal conditions where we see a greater frequency of frozen shoulder, including diabetes (and prediabetes) [*], thyroid conditions [*], cardiovascular disease, and even post-vaccination [*] called SIRVA (Shoulder Injuries Related to Vaccine Administration), which include frozen shoulder and other conditions of the shoulder.

The vast majority of these are either a metabolic or a mobility problem.

Poor glucose regulation, insulin resistance, dyslipidemia, and body composition changes are implicated in diabetes, CVD, and hypothyroidism, and they all affect women who are over 40 at a much higher rate than women under 40.

Poor mobility implicating neuromechanical integrity of the scapulohumeral rhythm, trapezius, or shoulder girdle activation is also a 40+ female issue if you are not actively working on putting on muscle mass or at the very least maintaining it.

HOW

So at the risk of going dark roast Betty, here are my thoughts on prevention and rehabilitation for frozen shoulder.

MOBILITY

First and foremost, you need to have a plan of action for muscle growth. This will be architected primarily through lifting weights that are heavy enough for you to provide a sufficient stimulus for muscle growth. Meaning, lift as heavy as you can tolerate with good form, coming within one to two reps of failure of that muscle.

Perhaps most importantly, as your strength improves at whatever baseline you start, it needs to progress beyond that. Week over week, you can and should be able to either do a heavier weight or keep the weight the same and do more reps.

I am team full ROM for most exercises. All the way down, stretch, and then all the way up. Finish with some long-length partials and you are golden.

The other thing to consider with lean muscle is the capsular or joint range of motion.

Muscle range of motion is one thing, but we also want to think about a capsular range of motion, too. As a visual, the capsule is the bubble surrounding where the two bones meet. One way to improve capsular range is by making sure you are stretching the muscle at the lengthened portion of the repetition. I talked about long-length partials in Mini Pause #16 as a vehicle for muscle growth. Another benefit to making sure on every rep you stretch at the elongated position is to also induce a capsular stretch as well.

If you are dealing with a shoulder injury, the first thing you want to look at is restoration of the glenohumeral joint range of motion. So, working within your pain-free range of motion is where you start (however limited that may be), AND ALSO we want to think about opportunities to increase supporting and local structures of the glenohumeral joint.

We have a massive opportunity with frozen shoulder to improve the strength and resilience of the scapula, the rib cage, the neck, and even the trunk and pelvis. It’s all related. This probably requires rehab with a chiropractor or bodyworker with a strong understanding of shoulder mechanics.

METABOLIC HEALTH

Related to increasing lean muscle mass, having more muscle is going to directly improve your blood glucose levels, insulin sensitivity, markers of inflammation, and lipid profile.

We can improve our metabolic health in a vast number of ways, but perhaps the simplest way to start is by walking after a meal and forgoing food two hours before bedtime. These two simple, free habits are available to everyone and you will see marked changes in your blood glucose metabolism just by doing these.

NOW

Think about your current exercise program: Have you dedicated enough reps and sets to your shoulders and back?

A lot of the rear deltoid and some of the medial deltoid muscle is engaged and working with most back exercises.

If you are working your chest, you’ll also engage with the deltoid’s front head.

When you are training your shoulders specifically, most of your focus should be on the lateral deltoid because it is precisely that movement (raising your arm out to the side) that is impacted with frozen shoulder.

  • Are you progressing week over week in terms of both reps and/or volume? Begin to keep a journal of your progress or use an app.
  • When performing each shoulder repetition, think about not only elongating the arm all the way down, but also think about stretching the joint capsule as well
  • Pick one of the following: walking after a meal or cutting food off two hours before bedtime and do it every day this week! Note your digestion, mood, and sleep patterns changing, if at all.

Question of the Week

Q: Can you talk about self-sabotage? Why it happens and how to shift mindsets around it?

Thank you to consciouswithkirth on IG who sent in this question. There are many ways to answer it, and truthfully, I feel it needs its own podcast episode!

I will say that self-sabotage stems from a past where we were told that somehow we were not allowed to make a mistake, that we had to be perfect, or that we were conditionally loved. That somehow we were not good enough or worthy enough unless we lived up to others’ expectations and standards.

While as adults we certainly know that the behaviors around self-sabotage do not serve us, in a way, it’s a familiar feeling to us as we somehow experienced letting someone down when we were younger. And even though the familiarity and the behaviors associated with it are toxic, we just cannot help ourselves.

  • The first reframe in our quest for success – be it health, career, finances, or our personal relationships – we must allow ourselves to feel our feelings. If we feel sad, guilty, or down, acknowledge what we are feeling and be able to name it.

So often self-sabotage comes at us almost out of nowhere, largely because we are trying to run away from a feeling or cannot recognize we are feeling a certain way. Old coping mechanisms resurface, and we fall off our path.

  • The second piece to it is recognizing that failure is an essential part of your success. The individuals who have achieved what you are seeking have failed more times than they have succeeded. They became comfortable with failure, learned the lesson that failure was meant to teach them, and did not give up.

So let’s use weight loss as an example. You are absolutely going to mess up. A LOT. But it is in the mess-ups where the lessons for expansion and growth are. Welcome the failure, welcome the self-sabotage as much as it feels uncomfortable or like you’re “letting yourself off the hook.”

Speak to yourself as if you were a wide-eyed 6-year-old looking to adult you for advice and comfort. What would you say to that 6-year-old version of you who was scared, frightened, and maybe tired and overwhelmed?

Those are the words you can begin to direct to yourself when you fall off the wagon. And you can begin to look for the lessons embedded in each situation.

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: OneSkin

When it comes to skincare, I want products that address how my skin is changing as I age. I looked to OneSkin, a skin longevity company, for solutions. The founders, four women scientists, researched and identified more than 800 novel peptides. They discovered that OS-01 targets cellular senescence, which is a root cause of aging. These topical supplement formulas are clinically proven to strengthen the skin barrier and improve key skin health markers.

My absolute favorite is OS-01 SHIELD Protect + Repair SPF 30+. This mineral-based sunscreen comes in both tinted and clear. Visit oneskin.co and use code DRSTEPHANIE to save 15%.

As if we didn’t have enough to deal with managing low energy, mood swings, and brain fog, within the first five years after menopause, we can expect to lose 30% of our skin’s collagen — and collagen production continues to drop another 2% every year for the next two decades! In this feature article, learn “How Peptides Combat Collagen Loss.”

How Peptides Combat Collagen Loss

As if we didn’t have enough to deal with managing low energy, mood swings, and brain fog, within the first five years after menopause, we can expect to lose 30% of our skin’s collagen — and collagen production continues to drop another 2% every year for the next two decades!

Even if you aren’t concerned about the aesthetic impact of collagen loss (namely lines, wrinkles, and sagging skin), there’s a health component involved, which I explain in more detail below.

But what triggers these changes? Just like other symptoms common in perimenopause and menopause, it’s due to shifts in estrogen and progesterone.

The Role of Estrogen and Progesterone on Skin

  • Skin Barrier: Estrogen stimulates the production of several key proteins in the skin, keeping your skin barrier healthy and strong. However, as estrogen levels decrease, your skin can become thinner over time [*], which puts you at greater risk for moisture loss, infections, and UV damage.
  • Oil Production: Declining levels of progesterone can lead to skin that’s drier and more sensitive since this hormone is involved in the skin’s oil production.
  • Free Radicals: As estrogen levels drop, the body’s natural defense [*] against free radicals becomes less effective, leading to accelerated skin aging.
  • Hyaluronic Acid: Estrogen also stimulates the production of hyaluronic acid. Without a strong skin barrier and the estrogen-stimulated production of hyaluronic acid, the skin will feel more dehydrated [*].
  • Sun Sensitivity: When estrogen levels decrease, so does melanin, the pigment that helps protect skin from UV rays. This means, you might notice that your skin becomes lighter and that you’re more sensitive to sun damage [*].

How I Keep My Skin Healthy After 40

In addition to eating foods rich in antioxidants, using broad spectrum sunscreen, and getting quality sleep — which can all affect the health of your skin — I recently found a skincare line developed by a team of female scientists.

The company is called OneSkin. And their products, called “topical supplements,” are powered by their proprietary OS-01 peptide which is scientifically proven to counteract some of the factors caused by estrogen decline during menopause.

In lab studies, they found that OS-01 increased collagen and hyaluronic acid production in skin (1), improving firmness, elasticity, and hydration and strengthening the skin barrier (2). Not only that, their peptide is proven to reduce cellular senescence (3), one of the hallmarks of skin aging, so your skin stays younger and healthier as you age

I’ve shared with my Bettys that I’m completely up-leveling my skin this year. I’d love for you to consider how you can do the same. My absolute go-to product from the OneSkin line is OS-01 SHIELD Protect + Repair SPF 30+. This mineral-based sunscreen comes in both tinted and clear. If the science of peptide skin care intrigues you, visit oneskin.co. (Use code DRSTEPHANIE at checkout to save 15%.)

1) Shown in lab studies on human skin samples by measuring collagen production biomarker, COL1A1, and hyaluronic acid production biomarker, HAS2. Treatment with the OS-01 peptide displayed a significant increase compared to no treatment. (Zonari, A., et al. npj Aging, 2023)

2) Shown in a clinical study performed by a third party research organization. Skin barrier and hydration measured by a vapometer. Elasticity and firmness analyzed via double-blind expert clinical grader evaluation. Significant improvements were observed on skin treated with OS-01 FACE for 12 weeks versus baseline. (Zonari, A., et al. Journal of Cosmetic Dermatology, 2024)

3) Shown in lab studies on human skin samples and/or cells by measuring the number of senescent cells via SA-Bgal staining, senescence biomarkers (CDKN2A/P16, CDKN1A, H2A.J), and SASP biomarkers (CXCL8 and IL-6).  Treatment with the OS-01 peptide displayed a significant decrease in all mentioned markers compared to no treatment. (Zonari, A., et al. npj Aging, 2023)

***

Disclaimer: The information included in a newsletter, email, or on drstephanieestima.com is intended solely for educational purposes. It does not replace a direct relationship with your licensed medical provider and is not intended to diagnose, treat, cure, or prevent any disease.

Affiliate Disclosure: Products mentioned in a newsletter, email, or on drstephanieestima.com, may be part of an affiliate agreement in which Dr. Stephanie Estima receives a small commission on the sale of an item you purchase.

Mini Pause #16: Smart Changes to Increase Your Muscle Mass

Try Long-Length Partial Repetitions for Muscle Gains

TL,DR (too long, didn’t read)

Long-length partials are a great addition to your already established weightlifting routine. The literature seems to agree that long-length partials–when the goal is muscle hypertrophy (increase in muscle mass)–seem to be at least equivalent to a full range of motion.

They are great to use if you are injured (and cannot perform full range of motion exercises), or as a finisher to a set, or for variety to combat boredom.

Oh, and I have never been so sore. It hurts so good!

WHY

Recently at the gym, as I was peeling myself off of a leg machine, my husband was looking at me, somewhat amused, and I knew what he was thinking so I answered the question before he asked it.

“I’d rather endure the pain of this exercise than the pain of staying the same.”

It was one of those “damn I need to remember that line and tell more people” moments.

There are many reasons why I like to push beyond my comfort zone in the gym. To the point where I am riding the line of pain and excruciating pain. If we ever get to train together, you will find me often shaking my head no as I descend into yet another squat, mentally overriding my desire to stop.

Because staying the same, never growing, and never challenging myself feels like death to me.
Maybe I was a huntress in a previous life, but I find extreme satisfaction in the hunt. In this case, the hunt for hypertrophy.

So on a recent Friday night, I was nose deep down a muscle hypertrophy rabbit hole on PubMed (as one does on a Friday) and came across some interesting meta-analysis on long-length partials compared to full range of motion and their effect on muscle hypertrophy. I was so excited I started rabidly consuming several studies, and have now incorporated them into my training routine and have noticed some exciting preliminary changes in my strength.

WHAT

Long-length partials are essentially a half rep focusing on the lengthened portion of the movement.

For an easy visual, think of a bicep curl. Where the bicep muscle is most lengthened is when the elbow is straight. A half rep would be bending the elbow to about 90 degrees of flexion, rather than bringing the weight to your shoulder.

  • For a pull-up: It would be when the arms are straight, and you pull up halfway.
  • For a squat: It would be at the bottom of the squat and lifting up halfway before going right back down again.
  • For a chest press: It would be when the bar or weight is closest to your chest, with the pec muscles stretched out.

The literature agrees that long-length partials, when the goal is muscle hypertrophy, seem to be at least equivalent to a full range of motion (ROM).

This study [*] looked at women performing knee extension exercises at various ranges of motion varying from full ROM to long-length partial extension to shortened-length partial extensions. They found partial ROM training in the lengthened phase of the knee extension promoted greater relative hypertrophy in certain muscle regions than training in other ROM configurations.

It holds true for the entire body. This study [*] looked at muscle hypertrophy in the bicep muscle, again in women, and found an identical result.
This meta-analysis [*] concluded full range of motion or long ROM enhanced results for most outcomes (strength, speed, power, muscle size, and body composition).

HOW

So, should you swap out all your full ROMs for partials? No! They’re a useful tool in the proverbial tool belt but by no means a total replacement for full ROM.

Where you can, proper form and full range of motion should be performed. This preserves muscle movement at all angles and is conducive to range of motion and proprioception at the level of the joint as well.

Where I think long-length partials (LLPs) may be handy:

  • When you are injured and cannot perform a full ROM. This can be useful as a rehab tool for getting back to full ROM and preserving muscle tissue.
  • When you have a condition like rheumatoid arthritis, adhesive capsulitis/ frozen shoulder, or bursitis and cannot perform full ROM without pain. Again, LLPs can preserve tissue, and act as a stepping stone to full ROM.
  • When you are close to completing a set but can no longer move the weight through the full range of motion, you can begin using long-length partials. I have found I can punch out five or six more reps this way.
  • When you want variety and are combating boredom. I have been playing with alternating a full ROM repetition with a LLPl rep in many of my leg and upper body days.

NOW

For your next workout, choose to incorporate LLPs in one of the following:

  • All sets and all reps are LLPs
  • Full ROM reps until you cannot anymore, then switch to LLPs to really finish the muscle you are working
  • Alternating between a full ROM and a LLP

Which one are you going to try?

Also a word of warning–it might be the novelty, but I have never had such an amazing pump and ensuing soreness the next day! Have your favorite recovery tool at the ready.

A few of my go-to recovery tools include: Coldture cold plunge, Sunlighten sauna, Bon Charge sauna blanket, and Bon Charge massage gun. (Curious? You can use code DRSTEPHANIE to get special discounts.)

Question of the Week

Q: I’ve noticed on Dr. Stephanie’s IG that she tends to use machines rather than free weights/barbells during her strength workouts. I’m very interested to learn her recommendations for women around this—the difference between using free weights vs. machines.

Thank you to April who sent in this question that I get asked a lot! I use a combination of all of the above.

For legs, I often use a Smith machine (which is a barbell with a fixed range of motion), a barbell for deadlifts or squats, walking lunges with dumbbells, Bulgarian split squats, and then machines like abduction and hamstring curls or leg extension.

Same goes for back days and shoulder days–it’s usually a combination of free weights, some type of axial loading with a barbell, and machines.

There is no right way or wrong way to train.

Machines have a predetermined line of drive, so in a sense, they are more stable because you do not need to create the stability yourself. There is an inherent trade-off to this. We want stability when we’re focusing on strength because the less stable the surface, the less strength you generate. But we also want to endogenously generate stability with accessory muscles and joints. So, I often use certain machines for six to eight weeks and then switch it up.

As long as you are going close to failure (making ugly faces, grunting noises, and getting to a place where you can no longer perform a full range of motion rep and drop down to long-length partials)–truthfully do whatever you love to do.

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: Tips for nutrition, hydration, sleep & stress

I love hearing from my Bettys! When you write in, DM me, or comment on my socials, consistent themes emerge, like: Ways to keep your nutrition on point, how to stay hydrated, what to do to get good sleep, and how to handle stress. Here are some simple choices I make that you may find useful.

GREENSAG1 is convenient, comprehensive, foundational nutrition. Use this link to order and receive a FREE One Year Supply of Vitamin D3+K2 and 5 Travel Packs!

ELECTROLYTESLMNT prevents muscle cramps, headaches, and energy dips. Visit drinklmnt.com/drestima to receive a free LMNT Sample Pack with any order.

SLEEP:

  • Hello NED: A unique combination of CBN plus full-spectrum hemp and botanicals (non-addictive). Check out the Sleep Blends. On April 29 & 30, all Sleep Blend tincture + capsules will be buy one, get one free with code DRSTEPHANIEBOGO.
  • Qualia Night. Help your nervous system naturally wind down, starting after dinner. Learn more about how this supplement works differently here. If you try it, use code ESTIMA15 to save 15%.

STRESS: The Apollo wearable uses the gentle vibrations of touch therapy to promote stress resilience. (My kids use it, too.) Explore its features and use code DRSTEPHANIE to save $50.

***

Disclaimer: The information included in a newsletter, email, or on drstephanieestima.com is intended solely for educational purposes. It does not replace a direct relationship with your licensed medical provider and is not intended to diagnose, treat, cure, or prevent any disease.

Affiliate Disclosure: Products mentioned in a newsletter, email, or on drstephanieestima.com, may be part of an affiliate agreement in which Dr. Stephanie Estima receives a small commission on the sale of an item you purchase.

Mini Pause #15: Creatine Essentials for Women

Why You Need Creatine, Especially in Perimenopause & Menopause

TL,DR (too long, didn’t read)

Creatine is one of my absolute favorite supplements for women over 40. It helps with brain fog, cognition, and performance in the gym and makes your muscles look full and beautiful.

WHY

Creatine can offer several benefits like augmenting performance, slowing down your fatigue in the gym, and amping up muscle mass and recovery. It has also been shown to help with cognitive capacity. Yet, perhaps perplexingly, myths around creatine persist. I want to address some of these in kind, with some actionable items for you to try in your own life.

WHAT

Myth 1: Creatine Causes Water Retention

Of all the myths surrounding creatine, this is the most common one I encounter from women. Most of us have likely already experienced the annoyance and inevitability of water retention in the luteal phase of the cycle, with rings not fitting, and our pants feeling just a little too snug for our liking.

So it comes as no surprise that if a woman is presented with the slightest inkling of water retention, she will avoid it.

The only issue is… creatine does not cause water retention in the extracellular matrix, but it does so in the intracellular one. There’s debate in the literature as to whether that is short-lived.

Creatine is an osmotically active substance and is taken up into muscle from circulation by a sodium-dependent creatine transporter. [*] Since the transport involves sodium, water also will be taken up into muscle to help maintain intracellular osmolality.

What does that actually mean? The water retention is not outside the muscle, which would lead to more puffiness and inflammation. The water retention is inside the muscle, which only makes the muscle look fuller and more defined.

And even if that is not your jam (full defined muscles), there are several studies that suggest long-term supplementation of creatine does not affect increases in either total body water volume, extracellular water volume, or even intracellular water volume! [*][*]

Although there is some disagreement about this in the literature, [*][*][*] the take-home point is that creatine is not going to make you puffy.

At worst, there is no change in water volume after long-term supplementation, and at best, you increase the water and sodium in the muscle cell which is important for muscle transcription and hypertrophy.

Myth 2: Creatine Is Just For Gym Bros

Much like lifting weights and eating meat has often been ascribed as phenotypical male behavior, creatine is not just for guys. There is ample evidence to suggest creatine supplementation is incredibly useful for women.

Hormone-driven fluctuations can alter your ability to synthesize and transport creatine effectively because creatine synthesis is affected by both estrogen and progesterone levels [*]. And so your ability to make and use creatine will be particularly affected during bleed week, perimenopause, and menopause [*] where we see drastic changes in concentrations of these hormones.

Creatine in the female frontal lobe has also been shown to be lower [*] than our male counterparts. So supplementing with creatine, particularly for women [*], can also help to reduce depression and anxiety.

And ladies in perimenopause and menopause, creatine has been shown to help with almost all measures of improving muscle mass and bone density [*] and reducing inflammation. Inflammaging, as the cool cats call it, is the epicenter of all chronic disease and accelerated aging.

HOW

Grab yourself a bag of creatine monohydrate. It MUST say creatine monohydrate in the ingredient list. No proprietary blend BS. I am asked all the time for recommendations and I absolutely love the Creatine with Taurine from mindbodygreen. (Visit mbg and use code DRSTEPHANIE for 15% off.)

The simplest way to start on creatine is to add 3-5g to your morning smoothie, your water for your workout, or even your coffee. It is flavorless so it will dissolve in just about any liquid and you won’t notice it.

Do this daily and just make it a part of your habit stack. No need to cycle on and off it, just take it consistently. Forever.

Although I find many things wrong with the fitness industry (unrealistic beauty standards, women getting so lean they don’t menstruate, filtered photos, etc.) one thing we can learn from them is their behaviors and habits toward tissue preservation. When fitness competitors are getting stage lean they undergo extreme caloric deficits, but their main goal is to preserve as much muscle as they can. So their protein intake never changes and they never stop taking creatine.

I think that’s more than telling in terms of the value creatine plays in muscle appearance and function.

NOW

  • Order your first bag of Creatine with Taurine here. (Use code DRSTEPHANIE to save 15%.)
  • Add one scoop to your morning smoothie, workout water, or cup of coffee daily
  • After a few weeks, ask yourself if you are noticing changes in your endurance and performance at the gym. Can you go harder for longer? What about your mood? Sleep? Recovery? If this is the only change you make over the next few weeks, you will likely notice several of these markers improving for the better.

Q: Do I take creatine before or after working out? Or does it even really matter when you take it?

Ahhhh, this is SUCH a good question with the possibility of going down several rabbit holes of nerdom. Thank you bltaillon who sent this in via IG. Let’s tuck into this without going TOO overboard, and give you a tangible answer.

So the TL;DR version of this answer is, based on the literature, it doesn’t seem to matter whether you take it before or after exercise. It seems strength gains and hypertrophy gains are all comparable.

For my medium- and dark-roast Bettys who want a little more detail, the largest study to date [*] on the topic of creatine timing involved a 32-week resistance exercise training program. They also had a placebo group so they could monitor the effects of strength training alone.

Thirty-nine healthy, older adults completed the double-blind placebo-controlled design, and were randomized into three groups: “Cr-Before”, “Cr-After”; or placebo (corn starch maltodextrin immediately before and immediately after resistance training).

Following the 32-week intervention, both creatine groups exhibited similar strength gains, with changes greater than the placebo control group.

The best answer here is: just take it when you can easily do it consistently!

I typically take it before training, but that’s because I make my proats (protein powder + oatmeal) and the creatine bag is right beside my protein powder. So they are stacked together for me. I scoop out of one and then just scoop out of the other.

Suggested for You: Another creatine option comes from Equip Foods. Take a look here at the PureWOD Pre-Workout. It includes creatine monohydrate.

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.

In these newsletters, I often share the products, devices, and equipment that I use in my own life regularly. I ONLY mention items I feel are worth highlighting and that I believe may provide health and wellness benefits to my Bettys. I encourage you – pressure-free! – to explore and then determine if any of the items fit YOUR health needs, fitness goals, lifestyle, or budget.

You’ll find more resources in my online HEALTH TOOLKIT. I’ve compiled these for my Bettys who are still cycling, experiencing symptoms of perimenopause, or managing the transition to the other side of menopause. Take a look!

***

Disclaimer: The information included in a newsletter, email, or on drstephanieestima.com is intended solely for educational purposes. It does not replace a direct relationship with your licensed medical provider and is not intended to diagnose, treat, cure, or prevent any disease.

Affiliate Disclosure: Products mentioned in a newsletter, email, or on drstephanieestima.com, may be part of an affiliate agreement in which Dr. Stephanie Estima receives a small commission on the sale of an item you purchase.

Mini Pause #14: Common Cardio Mistakes & How to Fix Them

What You’re Getting Wrong About Cardio and How to Make Simple Changes for Big Results

TL,DR (too long, didn’t read)

Cardio is a good thing. But you don’t need it to lose weight. And doing too much of it and to the exclusion of other forms of beneficial fitness just doesn’t serve you. Choose the type, intensity, and duration of your cardio wisely and based on your goals. Timing matters, too. If you’re strength training (and I know you are), you’ll want to save cardio until after your lifting. Cardiopulmonary health is especially important in perimenopause and menopause, so you’ll want to do cardio smarter, not harder, and definitely not longer.

WHY

I am a fan of cardio work, but not for the reasons you might think. One of the biggest misnomers for integrating cardio into routines is that it’s required for fat loss. Spoiler–it isn’t!

Cardio is important for cardiovascular health (this is especially true as we age and lose estrogen). Just as importantly, cardio facilitates work capacity for your resistance training workouts and for your recovery because of a better ability to deliver nutrients to repairing muscles.

When your cardiorespiratory fitness is good, you will be able to work hard during leg day and recover in between sets.

The other thing to note is that individuals who engage in some type of regular cardio are also generally setting up good habits so that when they lose weight (through diet and weight lifting) they are more likely to keep it off. You are more active, so your caloric balance has a better chance of staying balanced.

As important as cardio is in a balanced exercise regimen, I want to explore some common mistakes with cardio, with the assumption that you are looking to build muscle and lose fat.

WHAT

Mistake 1: Cardio As Effective As Diet

In a word, no. Cardio is not at all required for fat loss. Not even one bit! The biggest determinant of whether you will lose weight is your balance of calories in versus your calories out. If you are in even a mild caloric deficit, you will lose weight. This can be achieved without cardio entirely.

If you’ve ever looked at calories burned on your typical cardio equipment (even when they are likely overestimating it), it’s pretty discouraging. I clock in somewhere between 400-600 calories when I’m on the bike for an hour. An hour!!

By contrast, I can easily pack away 700 or 800 calories of food in a few minutes.

When we’re thinking about caloric deficits, it’s way easier to eat your calories than it is to burn them! It’s unfair, cruel, and unfortunately true. So a better strategy is to think about the calories you’re eating (and often the hidden calories from dressings, the bit here and there, and the mindless snacking) that is leading to a caloric surplus.

Now, don’t get me wrong, if muscle building is your goal, a caloric surplus is a great idea, as long as you’re putting the energy to work by lifting weights.

Relying on cardio for fat loss is a losing scenario, because it’s far easier to eat your calories than it is to burn them.

The other thing to remember is that if you’re overdoing it on the cardio, your body is a wily minx and will compensate by driving up hunger cues and metabolically adapting by decreasing your overall caloric expenditure. That means you will likely start moving less, your digestion will slow down, and even the calories you burn during subsequent cardio sessions will decrease.

The more you rely on cardio as a fat-loss tool, the more the returns diminish as you burn fewer calories overall and reduce non-exercise activity thermogenesis (NEAT).

Cardio should supplement your fat loss goals, not be the main event.

Mistake 2: The Timing Of Your Cardio

If fat loss and muscle gain are the goals, you also want to think about when you engage in cardio relative to when you lift weights.

There’s a well-established interference [*][*][*] between developing the aerobic endurance pathway and the muscle hypertrophy pathway.

This means, your muscle goals may be impaired if you do your cardio before your training. Some studies suggest that strength is compromised for 6 to 8 [*] hours after an intense cardio session.

This is especially true for high-intensity interval training (HIIT) [*]. HIIT may be less of a time commitment and it can be more fun than a Zone 2 workout, but putting your HIIT workout ahead of your weight session is likely going to catabolize your performance because you’re already going to be pretty gassed.

And HIIT and weight training have a lot of physical features in common anyway: the explosive power and recruitment of type 2 fibers. By combining these two, the activity that comes second likely will suffer.

Also keep in mind that the recovery demand for a HIIT session is much higher than a Zone 2 workout. You’ll need more time to recover from a HIIT workout before you should do it again.

HOW

Think about your cardio as a way to keep your overall fitness level high:

  • The cardioprotective benefits it extends in perimenopause and menopause.
  • The way it augments your performance on heavy lift days.
  • How it helps establish healthy lifelong habits.

Cardio isn’t required at all for fat loss. It should never be used as your primary fat loss tool. Fat loss happens in the kitchen, not on the treadmill.

If your goal is fat loss and muscle gain, the timing of your cardio can be after a training session, or even on separate days altogether.

I typically lift weights in the morning, and if I have trained my upper body, I’ll jump on my stationary bike in the evening for a Zone 2 ride. If I have trained legs in the morning, I’m doing no cardio that day. Instead, I’m sitting on the couch, going for a sauna, or going to bed early.

Zone 2 training can be a great way to train your base level of cardiopulmonary health. Aim for a 30-45 minute session, several times a week. Remember, there are a lot of ways to get into your Zone 2! Rucking, cycling, walking, and swimming are wonderful, low-impact options.

HIIT training can be done once or twice a week, and probably shouldn’t be longer than 15 to 30 minutes.

For more ideas, I wrote about different ways to train the top end of your cardiopulmonary fitness in Mini Pause #11 and Mini Pause #12.

NOW

  • Reframe your thinking around cardio to be an adjunct for living well (and helping with leg day!)
  • Ensure your weightlifting is done first. If you want to do Zone 2 that day, it can go immediately after weights, or later that day.
  • Limit your HIIT workouts to 30 minutes or less one to two times per week following weight workouts. (And probably not on leg day unless you are a maniac.)

Question of the Week

Q: How to navigate perimenopause with a low budget? The must-dos!

This is such a great question from vykteran on IG! There are many  low- and no-cost items that make a major difference in our experience with perimenopause.

Here are the top 30 things I feel measurably move the needle when it comes to feeling great in perimenopause. Take your pick!

  • Watch the sunrise / early morning sunlight: Get outdoors (rain or shine) for 10 minutes every morning.
  • Watch the sunset.
  • Snack on exercise: for every 1 hour of sitting, get up and move for 10 minutes. (Read more about exercise snacks in Mini Pause #3.)
  • Mouth tape at night (can be a piece of surgical tape on the mouth).
  • Clean your house with vinegar, water, and a few drops of essential oils (I use orange or lemon).
  • Keep your phone and all electronics out of your bedroom.
  • Keep your room cool, dark, and serene.
  • Use only floor lights or candles after sunset, no overhead lights.
  • Lift heavy at least 3x/week. This can be weights at the gym or odd-shaped rocks and objects you find in nature.
  • Sprint 1-2x/week. Grab your trainers and hit the road! Run as fast as you can for one minute, then walk until your heart rate recovers. Do this cycle 5x.
  • Aim to get at least 7,000 steps a day. Your phone likely has a pedometer built into it.
  • Drink 3L of water daily. Add in sea salt or electrolytes.
  • Moisturize your skin after a shower or bath with olive oil.
  • Absolutely no alcohol.
  • Set boundaries and stick to a consistent bedtime and waketime every day (including weekends).
  • Aim to get a minimum of 30g of protein at each meal.
  • Chew your food 20 times on each side of your mouth.
  • Stop eating 2-3 hours before bedtime.
  • Open your windows!
  • Practice gratitude for people, things, and events in your daily life.
  • Tell people why you love them: send a voice note or a written note about what you are grateful for and what you notice about them that you admire.
  • Watch comedy and let yourself laugh!
  • Sing or hum along to music (opens the throat chakra; the humming is calming for the nervous system).
  • Oil pull for oral health.
  • “Close and clean” your work and personal spaces daily. Have a proper work shutdown: tidy up your desk, and shut down your computer. Put dishes in the dishwasher, and wipe down countertops so you can walk into your kitchen the next day without seeing clutter.
  • Celebrate your efforts, not only the outcome.
  • At the end of the day, reflect on how awesome you were with at least one specific example.
  • Make a desire list and dream about what lights you up. A desire list can be anything: from material items you want, experiences, relationships, properties, lifestyle, etc. Just allow yourself to dream again.
  • Practice forgiveness. For your parents, for ex-partners, coworkers, friends, or anyone who has wronged you. It is not that you are letting them off the hook for what they did, but that you are setting yourself free.
  • Sit on the grass, on the sand, or anywhere in nature. Gaze off into the distance. Let your mind wander.

Ok, that’s just a preliminary list! What did I miss?

YOUR TURN!

Let me know what you’d add to this list of low-budget perimenopause must-dos. Send in your favorites to support@drstephanieestima.com.

WHAT I RECOMMEND: BodyBio

You know I’m a big proponent of optimizing my nutrition and lifestyle to promote healthy aging, and I love a product that achieves multiple health goals at once.

That’s why I’ve incorporated BodyBio PC, a phospholipid complex, into my daily routine. Not only are phospholipids essential for cellular health, especially as we age, they also:

  • Promote mental clarity and memory*
  • Support a healthy gut lining (no more leaks!)*
  • Encourage liver detoxification*
  • Support bile flow and fat digestion*

Visit BodyBio.com to learn why PC is considered  “the foundation of your cells.” Use code DRSTEPHANIE to save 15% sitewide.

Bonus! If you missed my April 8 BETTER! podcast with Jessica Berman, you may want to take a listen this weekend. We talked about seed oils (misunderstood), omega 6s & 3s (essential) and how they impact your body’s composition and overall health. As an executive leader at BodyBio, Jess is continuing the legacy of the membrane medicine work her grandfather, scientist Ed Kane, spent over four decades researching.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Benefits for My Bettys

In these newsletters, I often share the products, devices, and equipment that I use in my own life regularly. I only mention items I feel are worth highlighting and that I believe may provide health and wellness benefits to my Bettys. I encourage you – pressure-free! – to explore and then determine if any of the items fit YOUR health needs, fitness goals, lifestyle, or budget.

Today’s issue includes the following items. Use code DRSTEPHANIE with the links below to receive a special discount.

You’ll find more resources in my online HEALTH TOOLKIT. I’ve compiled these for my Bettys who are still cycling, experiencing symptoms of perimenopause, or managing the transition to the other side of menopause. Take a look!

Mini Pause #13: Adopt Recovery Practices to Manage Your Energy

Ways You Can Better Manage Fatigue and Recovery During Perimenopause and Menopause

TL,DR (too long, didn’t read)

You deserve to recover. Not half-assed recovery. Full ass recovery. Using techniques like walking, thermal manipulation, and sleeping are mostly low-cost or no-cost ways to upregulate your capacity to recover. I’ve included some options I personally use, as well.

WHY

Recovery and fatigue management become essential pillars to master in perimenopause and menopause.

Truthfully, I don’t think women were ever meant to work themselves into the ground and burn out, but words like hustle and hack have made their way into common language. Women are told they are just as good as the guys are… and then oops, here we are, pulling all-nighters, saying yes when we should be saying no, and living off of a To-Do list with a bad attitude and angry at the world.

Now don’t misunderstand me – I DO want women to seek out and achieve all they desire and dream about.

Just not at the expense of health, joy, and pleasure.

Life humbles you as you age. Gone are the days of forgoing sleep for partying (or in my case studying), and you begin to cherish sleep, time alone, and a nourishing diet of food, people, and sacred spaces in your home.

Mastering recovery is key for body composition, mental grit, progression in the gym, and, dare I say… happiness at large.

You deserve to recover.
Fully.

There’s no half-assed recovery here, Bettys. We only recover with our full ass. Let’s dive in.

WHAT

SLEEP

There is no better glute builder, waist trainer, or happiness serum than a good night’s rest. It is the panacea of recovery. For perimenopausal women, sleep can evade us like the patriarchal moving target of beauty.

Our society is notoriously bad when considering our diurnal rhythms. We avoid sunlight like vampires, we eat late at night, and we bathe in artificial lights. The knock-on effects pervade our sleep quality and quantity.

Sleep affects every aspect of our lives. Mood, emotional regulation, physical repair, metabolism, glute gains, and wrinkles. For example, what happens when you only sleep for four hours for six days in a row during a particularly busy week? Your blood glucose spikes, your cells stop responding to insulin, and your glycation levels skyrocket.

Here in the Bettyverse, we want to sleep (and recover) like the goddesses we are. So, here are a few general guidelines, many low or no cost.

Go to Bed and Wake Up at the Same Time. I know this is glaringly obvious and potentially reduced to the ridiculous, but you would be AMAZED at what this does for sleep. Set your alarm clock. Do a wind-down routine an hour before bedtime. Dim the lights.

Go Outside. Rain or Shine. Again, at the risk of sounding ridiculous, going to a window is not being outside. Being in a car is not being outside. Going outside is going outside. No matter the weather, inclement or sunny. Buy some fun slip-ons and go out onto your balcony, terrace, or stoop. It doesn’t matter as long as you can see the sun.

Make Your Bedroom a Sanctuary. I talk about this in The Betty Body: invest in dark curtains, pick your laundry up off the floor, and sleep on beautiful linens. Do whatever it takes to make your bedroom feel like a resting place fit for a queen.

TEMPERATURE MANIPULATION

In our efforts at modernity, we have forgotten that humans have never existed eternally in environments that were constantly 72F / 22 C. We have baked-in mechanisms to help uplevel our capacities based on whether we are cold or hot.

Cold Plunges. Sanctioned by biohackers and optimizers alike, there’s quite a bit of literature to support getting cold regularly to uplevel mitochondrial function and augment recovery. While women do not need to get into temperatures as cold as men, we can still reap many benefits from cold water immersion. This has become one of my favorite recovery tools that I use each morning.

I outlined a few low-cost ways to cold plunge in Mini Pause #2. I also invested in a portable cold plunge tub in my home but did so only after several months of cold water immersion in my home bathtub.

I am very happy to report that this winter I never used my winter jacket once! I would go to the store, to and from the gym, and everywhere else without my winter coat. My cold tolerance has steadily improved and I am super proud of it.

Heat Exposure. Heat is another way we can augment recovery via activating heat shock proteins. I recorded a BETTER! podcast #357 on heat science for my dark roast Bettys, but here are the high-level takeaways. Heat exposure:

    • helps promote cardiovascular health
    • activates your natural endorphin system
    • helps with muscle repair and soreness
    • helps to grow muscles (useful if you are training or to preserve tissue while injured)

Many gyms offer saunas as part of their service packages. If you have room in your home, you can invest in a home sauna. If you don’t have room in your home, there are portable sauna blankets. I love this as an option because, like a blanket, it just folds up after use so it doesn’t require a dedicated space in your home.

ZONE 1 AKA WALKING

Maybe the most underrated recovery tool of all time is walking. Besides the metabolic and mood benefits, this is a great way to recover from a grueling leg day at the gym, an argument with your partner, or a bad night’s sleep.

Walking delivers oxygen and nutrients to your legs, replenishes glycogen stores in the legs, and helps to remove the build-up of metabolites like lactate that cause soreness in the first place.

I always try to go for a walk in the evening with my family in the warmer months of the year after dinner. And I always walk on the days following leg day to help reduce DOMS (delayed onset of muscle soreness). The first few minutes are uncomfortable, especially if I’m really sore, but as the blood starts moving and my legs get warmer, it becomes much more pleasant. My recovery from leg day is always better when I walk the same day or the day after that workout.

For all the Type A Bettys who need to ‘feel it,” you can certainly dial up the intensity with pace, hills, or rucking with a weighted vest or backpack.

HOW & NOW

Decide that you are worthy of recovery, rejuvenation, and rest! This may be the hardest task of them all. But trust me, you are worth it. Even if you don’t always believe that to be true. You are.

Build on sleep habits. Once you establish regular sleep/wake times (including weekends!, prioritize getting early morning light, and jeuge up your bedroom, you also can think about supplementation. I like to use magnesium supplements about an hour or so before bedtime.

Get your progesterone levels tested. This is one of the more common hormonal reasons we see sleep evade us in our 40s and 50s. Micronized oral progesterone is often the standard of care. Talk with your physician to determine if this might be an option for you, especially if you’ve mastered basic sleep hygiene and you’re still having difficulty sleeping.

WHAT I RECOMMEND: Recovery Tools

I’ve mentioned several recovery tools in today’s main article. Feel free to explore these options and determine if any may be a good fit for your lifestyle and budget. Use code DRSTEPHANIE with the links below to receive a special discount.

Question of the Week

Q: What is a solid alternative to birth control for my daughter?

I am a big fan of FAM, the Fertility Awareness Method. FAM works by tracking your basal body temperature and possibly cervical fluid secretions to determine ovulation. You can do this manually, or with modern apps. By doing a simple web search, you’ll find a plethora of information on FAM.

I often recommend a Daysy fertility tracker because it’s easy, and the app does all of the calculations for you. You take your oral temperature every morning on waking, enter menstruation days (if applicable) into the app, and it does the work for you.I love this because it’s a blend of modern science and natural cycles. You’re not taking anything exogenously that alters your natural hormone production, and it allows you or your daughter to get in touch with her unique rhythms. She will learn the length of her cycle, and eventually how her mood, sleep, and desire change throughout her menstrual cycle.

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. Everything I recommend, I use myself. That’s my rule. I invite you to look around!