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

Zone 2 Training for Energy Heart Health & Metabolic Flexibility

TL,DR (too long, didn’t read)

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

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

WHY

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

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

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

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

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

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

WHAT

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

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

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

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

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

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

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

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

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

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

HOW

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

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

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

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

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

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

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

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

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

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

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

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

NOW

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

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

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

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

Question of the Week

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

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

MORTALITY

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

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

A part of life is death.

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

EXPLORE YOUR THOUGHTS

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

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

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

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

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

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

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

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

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

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

SHINE YOUR LIGHT

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

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

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

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

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

YOUR TURN!

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

WHAT I RECOMMEND: BEAM Minerals

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

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

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

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

P.S. FREE! Hormone Super Conference

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

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

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Mini Pause #7: Great Skin Health Inside & Out

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

TL,DR (too long, didn’t read)

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

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

WHY

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

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

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

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

WHAT

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

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

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

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

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

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

I think collagen is the heavyweight champ of skin supplements.

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

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

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

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

Electrolytes are involved in:

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

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

Decreased estrogen levels in perimenopause and menopause can look like:

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

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

HOW

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NOW

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

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

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

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

YOUR TURN!

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

Discover Beauty That Fits Your Style

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

  • Equip Foods collagen; use code DRSTEPHANIE
  • mindbodygreen collagen; use code DRSTEPHANIE
  • mindbodygreen vitamin D3/K2; use code DRSTEPHANIE
  • LMNT electrolytes; direct link to free sample pack with purchase
  • OneSkin peptide skincare (cleanser, sunscreen, moisturizer); use code DRSTEPHANIE
  • Timeline Skin Health serum; use code ESTIMASKIN
  • BON CHARGE red light masks; use code DRSTEPHANIE
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Question of the Week

Q: What about fibre?

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

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

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

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

WHAT THE SCIENCE SAYS

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

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

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

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

KEY POINT

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

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

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

SHORT-TERM VS. LONG-TERM BEHAVIOR

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

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

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

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

YOUR TURN!

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