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.

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.

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

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

The Links Between Air Quality, Sleep, and Hormonal Balance

Air Quality and Sleep

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

Impact on Hormonal Health

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

Specific Concerns for Women Over 40

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

Strategies for Improving Indoor Air Quality

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

My Home Experience

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

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

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

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

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

Warmly,

Dr. Stephanie

Mini Pause #2: How Cold Plunge Benefits Women

Welcome to the The Mini Pause!

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

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

Cold Plunge: Is It The Same for Women?

TL,DR (too long, didn’t read)

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

WHY

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

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

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

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

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

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

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

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

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

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

WHAT

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

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

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

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

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

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

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

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

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

HOW

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

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

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

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

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

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

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

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

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

NOW

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

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

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

Question of the Week

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

 

Excellent question!  Let’s tuck into it.

EVALUATING

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

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

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

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

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

NEXT STEPS

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

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

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

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

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

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

YOUR TURN!

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

What I Recommend: LMNT

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

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

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