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Mini Pause #112 | She asked me for my secret to a flat tummy and big booty

Posted on by stephanie-estima

A woman came up to me at the gym this week and asked me what I was doing to get a flat stomach with such a big booty.

(And I was like, hold my beer intraworkout ketone drink¹ and let me tell you!!)

She told me that she had been struggling for years to get rid of her belly and grow her glutes, but was finding it incredibly hard and frustrating.

After channeling my inner Nancy Drew, I solved the case:

She just turned 40, and the strategies she used to rely on for weight management don’t work anymore.

She eats 1100 calories a day.

Her only activity is her hour at the gym.

She sits at her desk for the rest of the day.

The Verdict: Girlfriend is STARVING.

I told her about my lifting program to show her what I do in the gym, but I had to be honest with her… most of the things I swear by to get results are centered around recovery.

Recovery is not a break from the work.
Recovery is the work.

I gave her the rundown on devoting myself to repair as much as (if not more than) my workouts:

I eat carbs! Breads, potatoes, rice, fruit… bring it all on.

I get sufficient protein and supplement²  with protein powders to be extra sure.

I eat ~2000 calories on leg days to build that peach.

I sleep in a haven³ with my cold, dark, silent bedroom.

I walk daily⁴, aiming for 10,000 steps.

 

She really seemed resistant, especially to the idea of eating more carbs and total calories, and I felt for her. Once upon a time, many moons ago in a land far, far away, I was her. 

And even though I’ve been living, breathing, and teaching strength and muscle growth for literal decades, that old programming still pops into my head every now and then.

No matter what you know to be true, it can be tough to completely silence the burn, burn, burn mantra we were taught as young women. Get on that damn elliptical and punish yourself with repetitive, boring, steady-state motion until you’ve earned back the calories you dared to spend on lunch. Push yourself to get smaller.

Now that we’re grown-ass women dedicated to building bodies that will carry us as we age, we need to right the ship.

Repeat after me: Muscle doesn't grow in the gym, it grows when you rest it.

[💧 Start your recovery with my Hydration Recovery Cheat Sheet]

 

Recovery is the ultimate tool for body composition and building a body that feels safe to inhabit… and it’s not just about your muscles. 

There are 4 types of recovery to consider:

Muscular Recovery
Muscle protein synthesis peaks roughly 24 to 48 hours after resistance training.

If you’re new to training or coming back after a long break, it might take longer to reach that peak. For the Barbell Bettys who are training regularly, you’re looking at 1-2 days.

If you train the same tissue intensely every day, you interrupt the repair process that makes muscle grow.

👉 Do this: Strength train with a 4-day split. You give your main working muscle a solid week off between focused training days while you work on the rest of that bod.

 

Connective Tissue Recovery
Tendons and ligaments adapt more slowly than muscle. Collagen turnover is slower. Blood supply is lower.

It’s why your quads feel like they could push more weight, but your knees are the limiting factor in your squat.

It’s why your glutes feel fine, but your gluteal tendinopathy doesn’t. (If you’ve never had the pleasure of experiencing this, I’m thrilled for you – this is one of the most common, chronic, and excruciating tendon injuries in women over 40.)

👉 Do this: Distribute your protein across the day, eat enough carbs to support tissue remodelling, and avoid fasting before a strength training session. Give your body fuel to work with!

 

Nervous System Recovery
High-intensity intervals, heavy lifting, and chronic stress all activate the sympathetic nervous system.

If your resting heart rate is elevated, HRV is chronically low, and you wake up at 3:17 a.m. wide-eyed… Betty, you need a break.

👉 Do this: Add deep breathing, restorative movement (think walks, yoga, stretching), weighted blankets, essential oils, massage therapy, cuddles with someone cute, or a cup of chamomile tea. Not every day is a Norwegian 4×4!

 

Hormonal Recovery

Undereating (1100 calories is definitely undereating) + overtraining = increased cortisol.

Chronically elevated cortisol impairs thyroid conversion, disrupts progesterone, and worsens insulin sensitivity. As women in midlife, we have enough hormonal math to think about. Cortisol is something we can get a hold of.

👉 Do this: Eat. (Ahem… sorry, let me try that again…) EAT! Food is fuel. You can’t make something out of nothing. When you tell your body you’re starving, it will behave accordingly.

[✨ Grab my free Carbs + Protein Cheat Sheet.]

 

Bottom Line: You don’t get a sticker for running yourself into the ground. 

You get your Bounceback Betty status when you prove your devotion to your 80-year-old self by learning how to recover, adapt, and grow.

 

 

¹ Use code BETTER for 25% off clean, caffeine-free ketone drinks at Kenetik.

² Use code BETTER for 20% off your first order of the tastiest Equip protein.

³ Use code BETTER for 20% off your sleep sanctuary at Cozy Earth.

⁴ Use code BETTER for 10% off my favorite barefoot shoes from Saguaro.

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

 

 

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 #111 | Is this insult the best you’ve got?

Posted on by stephanie-estima

Et tu, Bulky?

We need to talk about this word.

Because it gets thrown around like the worst possible insult.

It’s the word that shows up the moment you add load to the bar.
The moment your shoulders look a little stronger.
The moment your jeans fit differently.

Is this too much?
Am I getting too big?

Am I getting… gasp… bulky?

[💪Quick Version: Stay calm and lift heavy.]

 

WHAT

First, let’s start like every great valedictorian speech, and actually look at the definition of the word…

Bulky, according to Oxford Languages, means: taking up much space, typically inconveniently.

Hmm.

Interesting that this is framed as a negative in a culture that has historically preferred women to be small, quiet, and easily handled.

Maybe bulk isn’t a problem as much as it’s an aspirational quality worth building.

Personally? I’m very happy to take up the space meant for me – however inconvenient that might be for those who want to keep me contained.

WARNING → WONDERWOMAN

The word bulky is almost always used as a warning to women:

Don’t lift too heavy.
Don’t build too much muscle.
Don’t take up space.
Don’t get bulky.

Being ‘bulky' is being solid and difficult to move. I like that part.

When a body takes up space, it disrupts systems that benefit from women being compliant and physically minimized.

Muscle changes posture.
Posture changes presence.
Presence changes how you move through a room.
It changes how people respond to you.
It changes how you respond to yourself.

And culturally… a woman who takes up space is a threat.

HOW: THE PHYSIOLOGY OF BULK

For most women, significant muscle gain requires:

Progressive overload
Adequate calories
Sufficient protein [💪My Fave Protein Powder Recipes]
Recovery
Time
And YEARSSSS (with multiple s’s) of intentional hypertrophy training.

Women have a fraction of the testosterone levels of men.

You are not going to accidentally become a bodybuilder because you lifted weights twice this week.

We don’t assume we’re Margaret Atwood because we journal, right?

We don’t worry we’ll outrun Flo-Jo because we sprint occasionally.

[🏃‍♀️Use this Sprint Progression Cheatsheet if you want to try]

I mean, I know how silly this sounds, but it’s no sillier than the belief that muscle will appear overnight or by accident.

What many women label as “bulky” is usually just water flux. Sorry it’s not more dramatic.

The muscle you train is damaged (in a good way) from the work, so it retains more water and blood while it’s healing.

I typically go up about 4 pounds on the scale after a leg day, which earns me a big self-high five. My muscles are healing and my body is adapting to being used.

And adaptation is exactly what protects you as you age.

Those 4 pounds of “bulk” are enough to make women think they’re allergic to the weight room… like this is antithetical to their goals… like lifting just “isn’t for them.”

Betty, look me in my virtual inbox eyes when I say this: That increase is temporary.

Muscle is a metabolically protective infrastructure – forever. It improves insulin sensitivity, supports bone density, protects joints, and preserves independence into midlife and beyond.

(Though no hate to the way strong shoulders look in a tank top, ya know?)

NOW

Real talk, Betty? I don’t think you’re afraid of being bulky. I think we’ve just been socialized to feel shame when we’re doing anything but shrinking.

That being said, even when you reject the “smaller is better” attitude, it can be unfamiliar to invite strength training to change your body. It’s not wrong – it’s just new, and new can feel vulnerable.

[✨New to weights or seasoned lifter? This 4-day split meets you where you are.]

So here is this week’s reframe on “bulk”:

Train to be harder to move.

Load your skeleton so your bones adapt.

Load your tendons so they stiffen and transmit force.

Load your muscles to help them grow and protect your joints.

Eat enough to support adaptation.

Rest enough to recover.

Repeat for years (not weeks).

The goal is structural presence. The confidence that comes from devoting yourself to your future by doing hard work now. Choosing yourself over a society that tells you to stay small and fragile.

I’ll take a little blip on the scale if it means I will be solid enough to hold the life I want for as long as I want it – no apologies needed.

Remember: A body that is hard to push around physically is harder to push around psychologically.


Lifting you higher than my overhead presses,

Dr. Stephanie

 

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

 

 

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 #89: PEACE & LOVE for your ligaments

Posted on by stephanie-estima

You asked for it: more on ligaments. My heart did a little pitter-patter when the response to my last Mini Pause was a resounding YES.

Most people overlook them, but I love ligaments. They're the unsung heroes that literally hold us together. While muscles are like a bouncy, eager puppy ready to play, your ligaments are more like the loyal family dog: slower to adapt, but dedicated to being there for you 24/7.

WHY

Ligaments connect bone to bone, stabilizing your joints like a seatbelt and giving your body that sixth sense of where it is in space (proprioception).

They don't get much blood flow, which means they heal and adapt slowly. Ligament injuries can take months, even years, to fully remodel. In midlife, with our lower estrogen causing slower collagen turnover, the process can be even longer.

Translation: We need to give these tissues extra care, patience, and respect.

HOW

Here's what the science says about taking care of your ligaments:

Progressive Loading, but Slowly

Deep breath. We need some patience with these ligaments of yours. We want to apply progressive tension over the course of months. Yes, “months” with an S.

Start with isometric holds, then move into heavy-slow resistance, followed by eccentrics, and only later into plyometrics, deceleration, and balance drills.

This stepwise approach tells your fibroblasts (the cells that rebuild collagen) how to lay down stronger fibers along the right lines of stress. Ligaments will remodel along lines of stress of the movement, not necessarily along the original architecture of the ligament, so form and slow progression are key.

Bad movement pattern habits can accelerate injury risk and take years to unlearn and relearn.

Nutrition

Collagen is not the be-all-and-end-all for muscle protein synthesis, but there's good data supporting collagen supplementation for ligament health.

I know, I know. Every online fitfluencer wants to tell you that collagen is garbage, and in the context of muscle, there is an argument to be made that it's not worth your money.

But stay with me. Studies show an increase in circulating markers of collagen synthesis in human ligaments when we ingest ~15 g of gelatin (or collagen peptides) plus vitamin C 30-60 minutes before short bouts of loading. PMC This is undeniably helpful while training, rehabbing an injury, or preventing an injury.

So, its an and/both approach. It's wise to supplement with both protein that will upregulate muscle synthesis AND collagen to support ligaments.

Post-Injury

Okay, so you got injured. You went for a PR right after a PR. Or your coffee hit just right one morning, so you jumped right into track sprints, and now your knee feels wonky. Been there, done that, got the rehab notes to prove it.

First off, let me just exhale a giant ARGUHHGHHHHHH of frustration with you. It is SO annoying to feel like you're being punished for doing something positive for your body. I don't want you to get discouraged. Let's put together a plan to get you back to business.

Remodeling and coming back stronger is going to look something like this:

A few days of inflammation. Then a few weeks of proliferation. Then, a few months to a year (or more) of remodeling and maturation. PMC+1

PEACE & LOVE, not RICE

You've heard about Rest, Ice, Compression, and Elevation for injuries, but the British Journal of Sports Medicine has a new acronym for you:

Protection, Elevation, Avoid Anti-Inflammants, Compression, Education (PEACE) followed by Load, Optimism, Vascularization (cardio), and Exercise (LOVE).

In PEACE, we want to protect the joint and compress it.

To ease discomfort, I'll often wrap the injured joint or compress it to manage swelling. I love the knee compression sleeve from Incrediwear, and I use it pretty regularly post-sprinting as a preventative measure. It'll work well if you're acutely injured as well.

In LOVE, we want to nix old ways of thinking and actually load the ligament as soon as possible. British Journal of Sports Medicine

You can do this by starting with isometrics, then slowly moving to load-bearing exercises and eccentrics, and eventually gently resuming higher-impact activities.

The Midlife Caveat

For women in midlife like us Bettys, estrogen matters and will most certainly impact your healing time.

Higher estrogen can reduce ligament stiffness and alter collagen turnover. Our knee laxity fluctuates across the cycle, and therefore, so does risk. (I wrote about this in The Betty Body.)

In perimenopause and menopause, lower estrogen will impair collagen turnover and healing, making the months monthier and the years yearsier. It just takes longer to heal without the anabolic influence of estrogen.

This is why I will die on the hill of technique. Your ego is your enemy in the gym and on the track. I will absolutely insist that you develop neuromuscular control and year-round strength and balance. Frontiers+1

NOW

The overarching principle of PEACE & LOVE is to protect the ligament, compress it, and return to activity as soon as possible.

The following is an example of how I might structure this for rehabbing a ligamentous injury. This is for demonstrative purposes only on how I might progress through a program:

  • Angle-Specific Isometrics
    30-45 second holds x 3-5 sets x 3-5x/wk initially

    Start these as soon as possible and do them at positions that lightly tension the target ligament. It's good for pain modulation and early load tolerance. If available, I would do these on a vibration plate.

  • Heavy-Slow Resistance (HSR)
    6-8 controlled reps x 3-5 sets x 2-3x/week; ~3-5 seconds down, 1-2 seconds up

    These exercises will build tendon-muscle unit capacity and apply a steady collagen stimulus across joint angles.

  • Eccentrics
    8-12 slow reps x 3-4 sets x 2-3x/week

    Do these exercises to improve strain tolerance and control. I would also incorporate vibration plate training with these eccentrics.

  • Plyometrics & Deceleration

    Once foundational strength and balance are solid, start adding in hops, land-and-stick, and cutting mechanics. Gradually increase the speed and directional variability.

  • Balance and Proprioception

    Start adding in single-leg stance progressions, with eyes open or closed. I'd likely incorporate vibration plate training here, too.

  • Movement Quality

    Focus on tracking knees over toes, hitting soft landings (triple flexion), and maintaining trunk/hip control. Mobility training becomes super important here.

  • Nutrition

    Supplement with gelatin/collagen + vitamin C 30-60 min pre-load, and make sure your total daily protein intake is 1.6-2.2 g/kg of body weight to support remodeling. PMC

I've kind of been itching to talk more about arthritides like osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. How about you? What should we get geeky about next?

 

 

Sending you PEACE & LOVE,

Dr. Stephanie

WHAT I LOVE THIS WEEK

My Secret to Maintaining Skin Health As I Age

Read more about the role of maintaining the skin barrier as we age. 

As I've gotten older, I've noticed my skin becoming more susceptible to dryness and a lot less firm. But I've found a solution that not only improves the appearance of my skin but also supports my overall health. OneSkin's OS-01 BODY has become a staple in my routine, helping to address the root causes of skin aging.

Developed by a team of female longevity scientists, OS-01 BODY uses their powerful OS-01 Peptide™ to target cellular aging. In clinical studies, OS-01 BODY boosted hydration by 38% and improved skin barrier function by over 41%. The results? Smoother, firmer skin that feels nourished and resilient.

I can't recommend this enough. If you're ready for visible results, try OS-01 BODY today. Use code DRSTEPHANIE at checkout for 15% off your first purchase at oneskin.co.¹

References:

01 Zonari, A., et al. Journal of Cosmetic Dermatology, 2025

02 Zonari, A., et al., npj Aging, 2023


Qualia Stem Cell

What if you could do something effortless, just 4 days a month, to gently support your body's natural healing and renewal process that was never possible until now?

Qualia Stem Cell is a breakthrough technology that supports your body's natural healing and repair processes by nourishing the body's own means of healing and renewal: your stem cells.

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It even contains royal jelly from worker honeybees, which contains 10-HDA, as shown in preclinical studies to promote stem cell proliferation and differentiation.

Be among the first to empower your self-care with a simple, science-based ritual that requires just four days a month to nurture your resilience from the inside out.

Experience the renewal of Qualia Stem Cell with up to 50% off using code DRSTEPHANIE. Qualia offers a 100-day money-back guarantee so you can try it risk-free.²

Electrolytes Are Essential for Midlife Women

Electrolyte imbalance is a common but overlooked issue during midlife. As estrogen declines, our bodies struggle to retain sodium, potassium, and magnesium, leaving us depleted despite drinking plenty of water.

If you're experiencing fatigue, brain fog, or trouble sleeping, you might need a boost. LMNT solves this with the precise electrolyte ratios your body needs, and without the sugar and artificial ingredients found in typical sports drinks. Just clean sodium, potassium, and magnesium to support cellular hydration, hormone production, and nervous system function.

Whether you're managing hot flashes, supporting metabolism, or combating afternoon energy crashes, proper electrolyte balance is crucial. LMNT makes it simple with delicious flavors that actually taste good.

Get a free 8-count Sample Pack of LMNT's most popular drink mix flavors with any purchase at drinklmnt.com/drestima. Find your favorite flavor, or share with a friend.

Your midlife body deserves better hydration.

Try LMNT now.³

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 OneSkin ships to all addresses in Canada, Australia, New Zealand, and the United Kingdom. They also ship to Austria, Belgium, Bulgaria, Republic of Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain (unable to ship to the Canary Islands and Balearic Islands) and Sweden. For shipments outside of the US, we ship DDP (with duties paid). Shipping duties and taxes are all included in the final price you see at checkout. Code DRSTEPHANIE works for new and repeat customers on orders over $50. Terms and conditions may apply.

2 Qualia ships to Canada, United Kingdom, Ireland, Australia, and New Zealand. Code DRSTEPHANIE works on all orders except for existing subscriptions. Terms and conditions may apply.

³ LMNT ships to the US only. Free Shipping on all orders. LMNT offers a no-questions-asked refund policy. If you don't like the product for any reason, you can email hello@drinklmnt.com and they'll process a refund in full (you don't even have to send it back!). Terms and conditions may apply.

 

Mini Pause #87: The #1 Way Lifting Heavy Can Cause Injury (and How to Avoid It)

Posted on by stephanie-estima

Muscle sure is having her moment on social media, isn't she!

“Lift heavy, ladies!”
“Be a Muscle Mommy!”
“Build that booty!”

The cheerleading is loud, and I'm not going to pretend it isn't motivating, but something gets lost in the noise:

Strength isn't just about muscle.

When you pick up a weight, whether its a 10-pound dumbbell or a heft of racked plates, your muscles are not alone in carrying the load. Ligaments and tendons are their sisters. Articular cartilage is their cousin. They're all in this together, and they all adapt and recover on their own clocks.

If your training program only takes into account the recovery timeline of muscle, you're most likely going to outpace your connective tissue capacity.

What does this look like? The weakest links tend to complain first. Think of morning tendon stiffness, joint aches, and ligament strains.

Remember that British game show The Weakest Link?

Bad programming is like looking right at your tendons with a sassy British accent and saying, “You are the weakest link. Goodbye!”

So, this is my love letter (my soliloquy, if you will) to the entire network of tissues that keep you strong. Because if we want lasting gainzzzz (yes, with all the zs, like the gym bros say), we have to honor the whole system, not just the muscles in the mirror.

WHY

We have a variety of tissue tolerances to consider when lifting weights to help us go heavy and avoid injury.

Tissue tolerance is a tissue's capacity to absorb, transmit, and recover from load without breaking down. And here's the truth: your tissues don't give a flying F about the number on the weight. They don't see “15 pounds” or “2 plates.” They only know load, mechanical tension, acute damage, and maximum recoverable volume.

So let's look at the recovery timeline for each tissue:

Muscle

Muscle is quick to adapt. Neural gains show up in weeks. Visible hypertrophy (muscle growth) in 6-8 weeks. With rich blood flow and fast protein turnover, she thrives on regular work. Think 2-4 sessions per week for each muscle group. Nature

Tendons

These are slow alchemists. They remodel collagen at a glacial pace. If you've ever injured a tendon, you know it takes a lifetime. Think months, not days. PMCSpringerOpen

With a sparse blood supply and collagen that can be decades old, their improvements come only with steady, patient loading. PMC

Tendons love the “low and slow” approach and punish sudden spikes in effort. True changes in tendon stiffness take at least 12 weeks. SpringerOpen

Ligaments

Ligaments are the baddies that stabilize joints, and they're similar to tendons: dense collagen, slower metabolism, and slower to respond.

Think of ligaments like the introverts at the party. She wants to be there, but she takes a little longer to warm up and get comfy. (Hi, it's me!) PubMed+1

To strengthen a ligament, you want multidirectional movement: jumping, decelerating, sudden changes in direction. These movements sharpen neuromuscular control and protect your joints. ASME Digital Collection

Side Note: I would LOVE to go on a nerd safari on ligaments in a future newsletter. I'm game if you are.

Articular Cartilage

Articular cartilage is the plush cushion between your bones. She's there so your bones don't rub together, because wow that's not nice.

Unlike other tissues I've mentioned, articular cartilage has no direct blood supply of its own and minimal collagen turnover and renewal. PubMed

The only way to keep joint cartilage healthy is through consistent loading. She loves regular, moderate, and cyclic compressions, like walking, cycling, and most steady-state cardio machines. Sedentary is her downfall. PMC

HOW

Okay, Betty, it's time for you to honor all your tissues so they rise together, strong and resilient:

(Want a quick and easy program build to match each tissue's healing clock? LIFT is for you.)

1. Sequence Your Week
Muscle strength sessions can happen often (2-4 times per week per muscle group). Tendon- and ligament-heavy work (slow lifts, plyometrics, change-of-direction) need at least 48-72 hours of rest between exposures.

2. Master Form Before Load
In LIFT, our Master Form videos help you own the movement before you ever load it. Good form isn't just about looking impressive. It's how you protect your tissues and respect their tolerance.

3. Watch for the Signals
Green (Go!): Mild muscle soreness, tendons that warm up and feel fine by the next morning, and joints that feel “used” but not puffy.

Yellow (Yield): Morning tendon stiffness for more than 24 hours, lingering joint aches, or from breaking down under fatigue.

Red (Stop and Deload): Swollen or locking joints, sharp instability, night pain, tendon pain that worsens as you warm up are all signs to rest and see a professional.

NOW

Here's what you can expect when you play the long game:

  • Muscle: You'll feel fitter within 2-3 weeks with visible changes in 6-8.
  • Tendons and Ligaments: Real, durable change happens over 8-16+ weeks, with tendon stiffness improving best at >12 weeks.
  • Cartilage: Healthy cartilage loves consistency. Regular walking and rhythmic, cyclical movement keep it nourished and thriving.

Think of your body like a financial portfolio. You wouldn't put all your money in one stock and hope for the best. In the same way, your tissues thrive with a diverse portfolio of movements. Strength, cardio, recovery, and multidirectional play… it all matters.

So yes, lift heavy, Betty. Build muscle. But train like the queen you are: with wisdom, patience, and respect for the whole kingdom (or queendom) of tissues that carry you forward.

 

Selected sources for further reading for my dark roast Bettys:

  • Bohm et al., human tendon adaptation;
  • Heinemeier et al., minimal collagen turnover in adult tendon/cartilage;
  • Bontemps et al., early neural vs later hypertrophic gains;
  • Bader/Eckstein, cartilage thrives on moderate cyclic load;
  • Rio et al. & Holden et al., isometrics for tendinopathy
  • SprinterOpenPMC+3PMC+3PMC+3PubMed+2PubMed+2VBN

WHAT I LOVE THIS WEEK

BIOptimizers

You can nail your diet and workouts, but if your sleep is suffering, your results will stall.

A compelling study recently found that poor sleep slashed fat loss by 55% and increased muscle loss by 60%, even when calories stayed the same.

Think about these two women on the same plan. The rested one loses fat and keeps muscle while the sleep-deprived one loses the muscle she worked so hard to build (while living exhausted!).

Here's why: Poor sleep spikes hunger hormones, slows fat burning, and makes your body more likely to store fat.

That's why you need Magnesium Breakthrough from BIOptimizers. It combines all 7 essential form of magnesium to help you fall asleep faster, sleep deeper, and wake up calm, clear, and ready to kick butt.

Try Magnesium Breakthrough and use code ESTIMA for 15% off.¹


Apollo

When stress, anxiety, or poor sleep creep in, my go-to is Apollo Neuro. It's a wearable device that feels like cheating on a test for your nervous system.

Apollo uses gentle, rhythmic vibrations (vibroacoustic stimulation, for the nerds among us) to activate your parasympathetic nervous system, which is your body's natural calm mode.

The results are powerful. It helps boost heart rate variability (your body's stress-resilience score), lowers cortisol, and supports the release of serotonin and dopamine (your feel-good neurotransmitters).

Translation? You feel calmer, sleep more deeply, and bounce back from stress with strength.

The best part is it's risk-free to try with a 30-day guarantee. Strap it to your wrist, ankle, or clip it to your shirt and let Apollo guide your body back into calm.

Try Apollo Neuro now and get $60 off with code BETTER.²

Create

I used to think creatine was just for gym bros, but after 40, the rules change. We lose muscle mass faster, recovery slows, and even our mental sharpness can feel inconsistent.

Creatine directly addresses all of this, and the research for women is nothing short of incredible.

That's why I love Create's creatine gummies.

No messy powders, no chalky taste, and no “forgetting” because it's unpleasant.

These taste good and they're portable. I just throw them in my purse and I never miss a day.

Since making them part of my routine, I've noticed better strength in my workouts, faster recovery between sessions, and, honestly, clearer thinking and steadier energy throughout the day.

If you want to maintain muscle, brain power, and energy as you age, creatine isn't optional. It's foundational.

Try Create here and use code DRSTEPHANIE for 20% off.³

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 Here's the list of countries BIOptimizers currently ships to. Code can be used multiple times. Terms and conditions may apply.

2 Applies $60 off the Apollo wearable (no one-time limit). Valid on the device only. Cannot be stacked with other coupons, bundles, or site-wide promos. Terms and conditions may apply. Currently, Apollo is accepting orders and shipping within the United States, as well as to Canada, Europe, and Australia. Terms and conditions may apply.

³ Create only ships in the USA. The 20% discount is for new customers only. All subscription orders get free shipping. A $100 order is the free shipping threshold for one-time purchases.

 

Mini Pause #82: Bloated? Tired? Stressed? Start Here

Posted on by stephanie-estima

TL;DR

Your gut is ground zero for mood, hormones, energy, immunity… basically everything.
In perimenopause and menopause, gut health takes a hit, and it shows up as bloat, fatigue, anxiety, skin changes, weight gain, and even acne.

The key to improving digestion in midlife is multifold – there are supplements you can take before you eat, and even exercise can improve gut health!

Think of your gut like a garden — and get the right gardener (probiotics), fertilizer (prebiotics), and soil conditions (diverse food, less stress) to keep it thriving.

WHY (Our Gut Changes In Perimenopause)

In midlife, your hormones dip, your stress rises, and your digestive system gets a little… sluggish.

Estrogen, progesterone, and testosterone all rely on your gut microbiome to break down and excrete them properly. When your gut is leaky or inflamed, it can reabsorb “used” hormones (hello, estrogen dominance), leading to mood swings, tender breasts, cravings, and brain fog.

Even just the regular foods we eat on a daily basis can start causing a lot of distention, bloating and gas.

WHAT You Can Do for a Better Belly

✔ ️ Start with a Spore-Based Probiotic: Unlike most probiotics that die in your stomach acid, spores are dormant in the capsule, wake up in your intestines, and actually change the gut landscape. Using a gardener analogy, they like to pull weeds (bad bacteria), and feed the good bacteria to bring balance back to your microbiome

✔️ Add Prebiotics (The Fertilizer): These feed your good bacteria — but only if they’re targeted. Some prebiotics feed the bad guys too, so choose carefully or go with a supplement like Just Thrive’s Prebiotic that only nourishes the good flora

✔️ Eat the Rainbow: Diversity of plant foods = diversity of microbes. More color, more fiber, more phytonutrients, more microbial magic. Here I tend to follow Dr. Terry Wahls advice where she recommends 9 servings of vegetables and fruit: 3 servings of green leaves, 3 servings of sulfur rich and 3 servings of bright colors.

✔ ️ Love Your Ferments (But Don’t Rely On Them): Sauerkraut, kimchi, kefir are all amazing. They support gut health, but keep in mind most bacteria in fermented foods die before reaching your colon.

✔️ Reduce Gut Stressors:

  • Skip antibacterial sprays (they kill good bacteria too) and quit it with the hand sanitizers!!! Remember in the good ol’days when we used soap? That is the ideal way to clean your hands.
  • Go organic when you can (to avoid glyphosate)
  • Take walks, breathe, meditate — your stress hormones mess with your gut lining

Supplements That Support a Happy Gut

Once you’ve got your gut gardener (spore-based probiotic1) and your fertilizer (prebiotic) in place, there are other MVPs that can really help your gut thrive — especially if you’re in perimenopause or menopause and noticing more bloating, sluggish digestion, and food sensitivity.

1. Apple Cider Vinegar (ACV) Before Meals
A splash of raw, unfiltered ACV in water 15–20 minutes before meals can help:

  • Stimulate stomach acid (which declines with age/hormone shifts)
  • Improve protein digestion
  • Reduce post-meal bloating
  • Support blood sugar balance

➡️ Tip: Start with 1 tsp in warm water before meals, work up to 1 Tbsp if tolerated.

2. Digestive Enzymes
As we age (especially in midlife), we make less stomach acid and digestive enzymes which means even healthy meals can sit heavier than they once did.

Digestive enzyme blends help break down:

  • Protein (protease)
  • Fat (lipase)
  • Carbs (amylase)
  • Fiber (cellulase)

Look for broad-spectrum enzyme blends2, and take them before your first bite of food, if you can around 20 minutes prior to eating.

3. L-Glutamine
This amino acid is gut lining gold. It helps:

  • Repair a “leaky gut”
  • Calm inflammation
  • Support regularity

➡️ Tip: Powdered glutamine is tasteless and easy to stir into water or smoothies. Dose: ~5g/day.

4. Collagen or Bone Broth
Both contain:

  • Glycine and proline: key for gut lining integrity
  • Gelatin: helpful for soothing inflammation
  • Bonus: glowy skin + joint love

Choose grass-fed, unflavored options3, or sip on bone broth between meals.

5. Zinc + Vitamin A
Both support the regeneration of the gut lining and immune system. A deficiency in either can delay gut healing.

  • Zinc carnosine is especially studied for gut lining repair
  • Retinol (the active form of vitamin A) is gut-protective

6. Magnesium
Constipated? Magnesium can help “move things along” (gently).

➡️ Tip: Start low, go slow. Aim for 400mg daily to start. Especially if you have been under chronic stress for a long time.

🌾 Prebiotics: The Fertilizer for Your Gut Garden

If spore-based probiotics are the gardeners of your gut, then prebiotics are the fertilizer because they help feed and grow the good bugs that keep your digestion, mood, and hormones in balance.

Unlike probiotics (which are live bacteria), prebiotics are fibers and plant compounds your body doesn’t digest, but your good gut microbes love to munch on. When those good microbes eat, they produce short-chain fatty acids like butyrate, which help reduce inflammation, improve gut lining integrity, and even impact brain health.

Food Prebiotic Fiber Type Benefits
Jerusalem Artichokes Inulin, FOS High in potassium + iron
Asparagus Inulin Supports detox + estrogen clearance
Garlic & Onions Inulin, FOS Antibacterial + anti-inflammatory
Leeks Inulin Great for digestion and estrogen metabolism
Bananas (especially green) Resistant starch Helps feed bifidobacteria
Oats (cooled overnight) Beta-glucans + RS3 Great for cholesterol + gut lining
Apples (with skin) Pectin Supports gut lining and regularity
Chicory Root Inulin Found in many fiber supplements
Dandelion Greens Inulin Liver and gut support
Flaxseeds & Chia Seeds Mucilage + soluble fiber Helps with elimination + estrogen excretion
Cooked + cooled potatoes Resistant starch (RS3) Enhances microbial diversity

 

Supplement Alternative To Fibre

You can also add targeted prebiotic blends like Just Thrive’s Prebiotic, which uses precision oligosaccharides that only feed beneficial bacteria (not the “weeds”). This is especially useful if you're sensitive to FODMAPs or fiber-rich foods.

🏋️‍♀️ HOW Fitness Fits In

Movement is magic for your microbiome and especially in perimenopause, when digestion slows, hormones fluctuate, and stress can take over.

Here’s exactly how the right types of exercise improve gut health:

💩 1. Improves Motility (A.K.A. Helps You Poop)
Regular movement helps “massage” your intestines and keep things moving through your digestive tract. This means:

  • Less bloating
  • Fewer backup toxins
  • More regular and satisfying BMs (💃)

Even just 15–20 minutes of walking after a meal can significantly reduce post-meal bloating and gas by helping move food through the system.

🌬️ 2. Lowers Gut-Damaging Stress Hormones
Chronic cortisol messes with your gut lining, leading to:

  • Leaky gut
  • Sluggish digestion
  • Mood and sleep issues

Gentle movement like:

  • Strength training
  • Pilates
  • Walking in nature
  • Yoga or breathwork

…helps calm the nervous system, reduce cortisol, and support the gut-brain axis.

🦠 3. Increases Microbial Diversity
Moderate exercise has been shown to increase the number and diversity of good gut bugs, especially those that produce butyrate, a powerful anti-inflammatory short-chain fatty acid.

This is key for:

  • Reducing belly fat
  • Improving insulin sensitivity
  • Calming gut-related inflammation

Too much cardio, though, especially when paired with under-eating or chronic stress, can have the opposite effect causing inflammation and damaging the gut lining.

💪 4. Enhances Nutrient Absorption
Muscle contractions improve blood flow to the gut which means your body can:

  • Digest food more efficiently
  • Absorb more nutrients
  • Detox more effectively

It also improves lymphatic drainage, which helps remove waste and toxins from the body faster.

✅ NOW: 3 Easy Gut-Loving Steps Today

  • Start a spore-based probiotic: Look for something like Just Thrive Probiotic (I love their gummies!)
  • Eat 30+ plants a week: Aim for fruits, veggies, legumes, spices, herbs. More diversity = better microbial diversity.
  • Ditch your chemical cleaners: Swap antibacterial sprays for vinegar + essential oil blends to protect your good gut flora.

WHAT I LOVE THIS WEEK

The Midlife Muscle Secret We've Been Ignoring Too Long

Can we talk about something that might surprise you? Creatine isn't just for gym bros – it's actually one of the most important supplements we midlife women should be considering.

Here's why you should start taking creatine NOW: after 40, we lose muscle mass rapidly, our brain energy tanks, and recovery becomes painfully slow. Creatine directly addresses all three. It fuels our muscles, supports cognitive function (hello, brain fog!), and helps us bounce back faster from workouts.

Create's creatine gummies make this so much easier than choking down chalky powders. Finally, a form that doesn't make you feel like you're drinking sand! The research is crystal clear – creatine helps preserve lean muscle, improves strength, and even supports mood stability during hormonal fluctuations.

Ladies, we've been missing out on one of the most researched, effective supplements available. Our muscles, our brains, and our energy levels deserve this support.

Get 20% off Create's Creatine Gummies with code DRSTEPHANIE at https://trycreate.co/DRSTEPHANIE.4

 

Why Your Achy Joints Aren't Just “Part of Getting Older”

Let me tell you about something that's quietly revolutionizing my recovery routine – and it's not another supplement or gadget. It's Incrediwear's bamboo charcoal-infused fabric that actually increases blood flow and reduces inflammation.

Here's why this matters for us: midlife brings achy joints, slower recovery, and that persistent stiffness we pretend isn't happening. Whether it's my knees protesting after workouts, my elbows aching from too much tennis, or my feet screaming after long days, these aren't just “getting older” issues – they're circulation and inflammation problems.

Incrediwear's socks, knee sleeves, and elbow supports work by increasing blood flow at the cellular level. No compression, no weird sensations – just better circulation that helps reduce pain and speed recovery. I wear their socks during travel and sleep, and honestly? The difference in how I feel the next day is remarkable.

Get 20% off Incrediwear with code DrSteph20 at https://incrediwear.com/.

 

The Real Reason You're Tired (And It's Not What You Think)

Ever wonder why that afternoon energy crash hits harder now, or why your skin looks tired despite expensive serums? The answer might be happening at the cellular level – specifically, in your mitochondria.

New research reveals that after 40, our cellular powerhouses start accumulating damage faster than our bodies can clear it out. This mitochondrial decline affects everything from energy and muscle strength to skin health and recovery time. But here's the fascinating part: there's a compound called urolithin A that can actually help activate our cells' natural cleanup process.

Most of us can't produce meaningful amounts of this compound naturally, even if we're eating pomegranates daily. The science behind why this happens – and what we can actually do about it – is pretty eye-opening.

Read the full article to discover how supporting your mitochondria could change how you age from the inside out.

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 Ships worldwide. Offer available for all orders, however only on first time subscriptions.

2 Code can be used multiple times, does not ship to Canada.

3 One use per customer, on first time orders or first time subscriptions. Ships everywhere, however shipping times variable based on location.

4 Create only ships in the USA. Offer available to new customers only. Exclusively for new customers only. All subscription orders are free shipping, $100 order is free shipping threshold for one-time purchases.

Mini Pause #76: Ketones – Your New Metabolic BFF?

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Ketones are a clean energy source that mimic fasting or keto without cutting carbs.

They fuel your brain and body directly (unlike caffeine, which just blocks sleepiness) and can boost workout performance, mental focus, and appetite control.

They’re ideal if you want steady energy without the crash, care about long-term health, but don’t want to commit to a full keto lifestyle. Start small, use them strategically, and treat them as a tool (not a magic fix).

WHY

Why Should You Care About Ketones?

Ketones are drinks that rapidly elevate your ketone levels, mimicking a mild fasting or ketogenic state all without the need to fast or restrict your carbohydrates for extended periods of time. They are an effective way to fuel early morning workouts without sacrificing performance and not having to eat.

WHAT 

What do Ketones actually do in the body?

Ketones are small molecules we produce in our liver when fat is broken down. Higher ketone levels indicate that your body is using fat for energy rather than glucose (sugar), which is the primary goal of ketosis or a ketogenic diet.

When you supplement with ketones they provide an immediate source of energy for both your brain and your body.

This is in stark contrast to coffee (or the active ingredient – caffeine).

Caffeine works by blocking the receptors that make you feel sleepy. When we have caffeine, we often “feel” the jittery effects of it, but that is because it is ramping up our cortisol and adrenaline. Caffeine is not a source of energy that our cells can make energy from.

So while I’m never giving up my morning cappuccino, we have to recognize that the caffeine itself is not making energy.

Only molecules like glucose, amino acids or ketones (that we get from our diet or as we break down fat) that can be used to actually make energy inside the cell.

In my discussion this week with Dr. Brianna Stubbs, she outlined some of the benefits they provide:

  • Boost pre-workout energy without food, helping spare muscle glycogen and reduce fatigue during the actual workout.
  • Act as a natural appetite suppressant, lowering hunger hormones during and after workouts.
  • Enhance mental clarity and focus without caffeine's jittery side effects.
  • Possibly support longevity, improving mitochondrial function, reducing inflammation, protecting the brain, and positively influencing gene expression linked to healthy aging.

HOW

How do you know which option is right for you?

  • Vs. Natural Ketosis: Natural ketosis (via strict diets or fasting) is great if you can fast and restrict carbs for several weeks. The issue here is it often requires significant dedication and a longer term lifestyle change. Which is GREAT, but it is just not meant for everyone.
    • Supplementing with ketones instantly and temporarily mimic ketosis without carb restrictions. This is ideal if you prefer flexibility or occasional use without long-term commitment.
    • I also no longer follow a ketogenic diet, nor do I fast for longer periods of time, so supplementing with ketones is a nice work around for me.
  • Vs. Caffeine: Caffeine boosts alertness rapidly but can cause anxiety, jitters, and energy crashes. Ketones offer steadier, jitter-free energy, beneficial if caffeine leaves you wired or disrupts sleep.
  • Vs. Traditional Pre-workouts: Typical pre-workouts rely on stimulants (caffeine, beta-alanine, etc.) for a sharp energy spike. Ketones provide a subtle, sustained energy that may enhance endurance rather than immediate explosive power

Consider ketones if you:

  • Workout early and don't want to eat breakfast beforehand.
  • Struggle with hunger when fasting or caloric restriction.
  • Need stable, calm mental energy or you want to reduce your caffeine intake.
  • Are interested in metabolic, brain health, and longevity benefits but don't want to maintain strict dietary ketosis forever.

Avoid Ketones if you:

  • Prefer significant immediate stimulation (like strong pre-workouts).
  • Have sensitive digestion (ketones can initially cause GI upset in some people).
  • Are strictly following natural keto diets for long-term metabolic goals (you may not need them because you are likely already producing ketones).

NOW

What are your immediate next steps?

Start Small: Begin with half a serving to see how your body responds. I use Ketone IQ and take 1 bottle before working out, or before podcasting.

Timing Matters: Use strategically: early morning pre-workout, during fasting windows, or mid-afternoon when focus and willpower fades.

Consistency over Magic: Remember, ketones are a useful tool, not a cure-all. Combine them with healthy eating, regular exercise, and quality sleep to maximize benefits.

 

WHAT I RECOMMEND

Ketone-IQ 

I have personally been using this product for years and I love it. It tastes great, I down a 10mL bottle and head out to the gym in the morning. No sugar. No artificial ingredients, just pure ketones in a convenient bottle. Visit https://ketone.com/STEPHANIE and 30% off your first subscription order

My Latest Article: Pique Life's Drinkable Skincare

Feeling like your skin has lost its “glow” in midlife? Myself and my Bettys can relate!

Hormonal shifts during perimenopause and menopause can leave your skin thinner, drier, and more prone to irritation. Yes, gut health, strength training, and sleep are all essential, but your skin deserves just as much attention.

And while I love my cream and serums, there’s something else I’m loving that’s super simple… It’s “drinkable skincare” from Pique Life that helps your skin from the inside out.

Click here to read more and grab an exclusive discount on USA subscriptions while it lasts.

LvlUp Health’s Ultimate GI Repair:

If you’re feeling bloated, foggy, or just off after nearly every meal there’s a reason for it.

As estrogen declines in midlife, your digestion takes a hit and your body simply doesn’t process food like it used to. But there’s an easy solution, and you can support your gut naturally and effectively.

I’ve been using a gut-healing formula called Ultimate GI Repair from LvlUp Health, and it’s completely transformed how I feel after meals. It uses clinically-backed peptides to repair the gut lining, reduce inflammation, and improve nutrient absorption—no need to change what you eat or make drastic lifestyle changes. Most women see results in just two months, and LvlUp’s products are third-party tested for purity and transparency.

Want to feel lighter, clearer, and more energized after meals? Try Ultimate GI Repair for just 60 days and get back that confidence that you can eat without fear! Visit lvluphealth.com/DRSTEPHANIE and use the code DRSTEPHANIE for 15% off.

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

Mini Pause #71: Why Are Women So Afraid to Build Muscle?

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Women often shy away from muscle building due to misconceptions around bulkiness and outdated beauty standards.

We unpack where this came from, why being skinny is not a good look in midlife (and beyond), and why this can be detrimental to our health as we age.

Strong>>>Skinny!

WHY

The pursuit of being “small”—primarily through excessive cardio—can lead to detrimental long-term health effects, especially as we age.

Being small in midlife—if I may be so frank—is just not a good look.

But prioritizing muscle isn't just about aesthetics; it's essential for your health, longevity, and overall quality of life.

The bulking myth continues to persist, and I see it taking many different shapes: even in the new wave of women embracing weights, we still see women eating small quantities of food, doing too much cardio, and shying away from lifting heavier weights or muscle growth.

I had a woman on Instagram tell me recently that building muscle means we have to eat soooooo much food!! If we just focus on strength, then you can have strong muscles, but they won’t be big!

😳 I found this incredibly bizarre and alarming. What is wrong with full, round, juicy muscles on a woman?

What is wrong with eating to give your muscles a reason to grow?

And then I realized it's the fear of being too big / too bulky / too much, but it has presented now as a different form.

WHAT 

1. Misguided Beauty Standards: Today's mainstream beauty ideals, heavily influenced by media and celebrity portrayals, rarely showcase women with pronounced muscle definition.

Popular culture often celebrates being skinny with minimal muscle visibility, reinforcing the idea that muscles detract from femininity. We see it on trashy magazine covers, the “before” and “afters,” or when medications like GLP-1s are intentionally mismanaged.

This widespread portrayal of skinny over strong contributes significantly to misunderstandings about what a truly healthy, strong female body can and should look like, leading many women to undervalue strength training and muscle development.

I personally want my glute-sized shoulders and a quad sweep that makes grown men weep. I LOVE it when I can see my muscles. I have a few goals in life: be a better mother to my kids, learn to perfect a winged eyeliner, and to be jacked and tanned.

All still a work in progress. 😉

2. The Bulk Myth: Many women fear becoming bulky from strength training.

The irony, of course, is that this is so very unlikely for 98% of the female population. Building significant muscle mass is extremely challenging for women.

Women naturally produce significantly lower levels of testosterone, the primary hormone responsible for muscle growth, compared to men.

Additionally, while essential for health, female hormones like progesterone don't significantly contribute to muscle hypertrophy.

Muscle building in women typically results in improved shape, enhanced strength, and vital protection for bones and joints—not bulkiness. I have been trying to get jacked naturally for years now—and it hasn’t happened yet… although a gal can continue to dream!

3. The Language Trap: Common phrases like “long and lean” or “toned” misrepresent how muscles actually function and adapt.

Muscle length is genetically predetermined, with specific origin and attachment points on the skeleton that remain constant throughout life.

Training can and will certainly influence muscle strength, overall size, and visible definition by affecting muscle fiber thickness and body fat levels.

However, NO exercise or stretching can physically elongate muscle beyond its genetically set parameters. Understanding this helps dispel myths that often discourage women from engaging in effective strength training.

And don’t even get me started when I hear “long, lean, and toned” all together in one sentence!

4. Muscle as a Long-Term Investment: Unlike rapid fat-loss strategies, building muscle is a gradual and strategic process that requires:

  • consistent strength training;

  • proper nutrition, including sufficient protein for muscle repair and growth;

  • balanced carbohydrate intake for energy;

  • adequate healthy fats for hormone production;

  • quality sleep for optimal recovery’

  • targeted supplementation to address specific nutrient gaps;

  • and diligent stress management practices;

… all sustained consistently over years. Building muscle is a game of centimetres. It is energetically expensive to build more muscle, and we must have the proper environment to maximize this.

5. The Consequences of Muscle Loss: Ignoring muscle strength leads to numerous health risks, including:

  • Decreased bone density: Muscles stimulate bone growth and strength through load-bearing activities, helping to prevent osteoporosis and reducing fracture risks as we age.

  • Poor glucose regulation: Muscle tissue plays a crucial role in glucose uptake and metabolism. Losing muscle mass can significantly elevate the risk of insulin resistance and type 2 diabetes.

  • Loss of proprioception: Reduced muscle strength and joint mobility impair proprioception (the body’s ability to sense its position and movement in space), heightening the chance of falls and related injuries.

  • Weakened immune function: Adequate muscle mass and regular resistance training support immune health by promoting anti-inflammatory responses and enhancing overall resilience.

  • Compromised mental health: Muscle strength is closely linked to cognitive function and mental well-being. A decline in muscle mass and strength can negatively impact mood, cognitive clarity, and overall mental health.

6. Cardio's Impact on Muscle: Excessive cardio elevates cortisol, adrenaline, and norepinephrine levels, creating a prolonged catabolic state.

Cortisol, a stress hormone, signals the body to break down muscle protein for energy, particularly during extended periods of physical stress or calorie deficits.

Additionally, elevated adrenaline and norepinephrine can further amplify this catabolic effect by promoting the mobilization of muscle glycogen and amino acids, ultimately leading to decreased muscle mass and compromised muscle preservation.

HOW

💪 Prioritize Resistance Training: 

  • Include regular strength workouts focusing on progressive overload, so you’re gradually increasing the weight, sets, or repetitions to challenge your muscles and stimulate growth continuously.
  • Emphasize compound movements like squats, deadlifts, presses, and rows to maximize muscle recruitment and efficiency.
  • Think of resistance training as the kind of person you want to marry and have a long-term relationship with. You’re in it for the long haul, through it all, through thick and thin.

🚴🏻‍♀️ Do Strategic Cardio: 

  • Opt for brief, intense cardio sessions (e.g., sprints or high-intensity interval training) 1–2 times weekly to support muscle growth rather than hinder it. Short, intense cardio sessions help improve cardiovascular fitness and metabolic function without creating prolonged stress that can lead to muscle breakdown.
  • For the fun step or Zumba classes, bike rides, or other Zone 2/3/4 activities: date them. They are super fun and novel, and you can switch them up to your heart’s delight.

💋 Rethink Beauty Ideals: 

  • Embrace strength as beauty, and being strong over skinny.
  • The benefits of muscle long-term include improved bone density, joint health, metabolic rate, and functional independence, ultimately contributing to a higher quality of life and better aging outcomes.

NOW

➡️ Audit Your Routine: Replace excessive cardio with balanced strength training and targeted cardio sessions.

➡️ Nutrition Adjustments: Ensure adequate protein and carbohydrate intake to support muscle growth.

➡️ Consistency: Adopt a long-term mindset, understanding that muscle growth is a slow and steady process. It is more important to be consistent than it is to have the “perfect” routine.

What I Recommend

MIDLIFE WEIGHT CHANGES? CORRECT THIS HIDDEN MINERAL GAP NOW.

Do you struggle to lose weight, despite following a healthy diet?  It's because our food has changed a lot over the past 70 years! Fruits, veggies, and other whole foods aren’t as nutritious as they used to be and are deficient in essential minerals, directly related to pesticide use and farming practices. And when you’re short on minerals, weight loss gets a lot harder. There are two reasons: metabolism and hormone balance.

  • To learn more about minerals and how they can support weight loss in midlife, read my new article here.
  • BONUS! BEAM Minerals is offering 25% off site-wide, through May 26. Go to beamminerals.com/BETTER and use code MEMORIAL25 at checkout.

💥 KICK OFF SUMMER WITH SPECIAL DISCOUNTS

BiOptimizers: Maximize every meal—digest better, absorb more, and feel the power of next-level enzymes and magnesium.

  • 20% off site-wide through May 27; use code ESTIMA at checkout

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BodyBio: Midlife game-changer: balance your omegas, fight inflammaging, and feel the relief.

  • 20% off unlimited use sitewide through May 27; discount auto-applied at checkout

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BON CHARGE: From effortless beauty boost to recovery tool, explore red light therapy options that fit into your morning scroll or post-workout stretch.

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OneSkin: One powerhouse peptide, discovered by women and backed by science—this is skincare and haircare that actually works in midlife.

  • 15% off through May 26; use code DRSTEPHANIE at checkout. PLUS, choose your free travel-size gift:

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  • Link HERE

Qualia: From energy-boosting NAD to inflammation-fighting senolytics for longevity to helping you get the sleep your body needs—these smart supplements do it all.

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Sunlighten: Sweat smarter—glow, recover, and recharge in an infrared sauna. It's the best health investment I’ve ever made.

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  • Link HERE

‼️ Want these discounts all in one place for the holiday weekend? Download the PDF!

SUMMER HYDRATION FLAVOR BURST

🍋 Lemonade that checks ALL the electrolyte boxes? Yes, please! I’m loving the new Lemonade Salt flavor from LMNT. It just debuted and is available for a limited time. Grab this new flavor at drinklmnt.com/drestima and get a free Sample Pack with your purchase!

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

Stress Speeds Up Skin Aging–These 4 Tips Slow It Down

Posted on by stephanie-estima

You can’t out-moisturize a stressed-out system.

All those fancy serums and creams won’t save your skin if stress is running the show. When hormones shift and life keeps moving at 100mph, you must tackle the problem from the inside out.

Stress is a full-body biochemical reaction. When you’re constantly on the go, juggling work, family, and life, your body releases cortisol, the primary stress hormone. In small doses, cortisol is helpful. But when it stays elevated (hello, modern life), it breaks down collagen, slows down skin repair, and ramps up inflammation.

And if you’re in perimenopause or menopause? Estrogen is declining, too, which means your skin is already losing hydration, elasticity, and the ability to bounce back. Add chronic stress into the mix, and suddenly, your skin is thinner, duller, and more prone to fine lines, sagging, and sensitivity.

Beyond the signs you see on the surface, stress is working overtime at the cellular level to accelerate the process. Chronic stress leads to an accumulation of senescent cells—also known as “zombie cells.” These dysfunctional cells stop dividing, but instead of dying off as they should, they linger, pumping out inflammatory signals that weaken the skin’s structure and speed up aging.

Translation? The more stressed your system is, the harder it is for your skin to repair, renew, and stay strong.

You can’t avoid stress completely, but you can change how it impacts your skin. Here’s what works:

  • Regulate cortisol with movement. Strength training, walking, and breathwork can help reduce stress hormones.
  • Fuel skin from the inside. Protein, healthy fats, and micronutrients like vitamin C and omega-3s support collagen production and fight inflammation.
  • Prioritize deep, quality sleep. Your skin repairs itself overnight, but only if you’re getting actual sleep. Aim for 7-9 hours and avoid blue light before bed to keep melatonin levels in check.
  • Target skin stress at the cellular level. I’ve been using OneSkin’s line of peptide moisturizers and sunscreens. Their proprietary OS-01 peptide combats the effects of stress-induced aging by switching off dysfunctional, senescent cells, helping to boost your skin’s natural repair process. [**]

Your skin doesn’t have to be a casualty of stress. The sooner you take action, the better your skin will hold up—through perimenopause, menopause, and beyond. Support your body, regulate your stress, and give your skin the tools it needs to stay strong.

Because aging is inevitable, but how you age? That’s up to you.

I'm offering an exclusive discount to make it easier for you to take that first step. Visit oneskin.co and use my code DRSTEPHANIE to get 15% off your first order.

Unlocking the Secrets of Nervous System Regulation for Women in Midlife

Posted on by stephanie-estima

As women transition into their perimenopausal and menopausal years, they often experience myriad symptoms that can disrupt daily life and make them feel unlike themselves. It can be a turbulent time — physically and emotionally. These symptoms are frequently rooted in hormone imbalances, from stress and weight gain to brain fog and sleep disturbances.

And while hormones tend to take center stage, another important player often overlooked is the nervous system. Understanding and regulating your nervous system can help you unlock better health, energy, and overall vitality.

Understanding the Nervous System

The nervous system is your body's command center. It regulates everything from your heartbeat to your ability to handle stress. During menopause, hormonal fluctuations upend this delicate balance.

An overactive sympathetic nervous system causes a chronic release of stress hormones like adrenaline and cortisol, making your breathing shallow and fast, sending your heart rate up, and diverting all available resources like blood and oxygen to your heart, lungs, skeletal muscle systems, and amygdala (the fear center of your brain) to get you out of harm's way.

Since you only have so much blood and oxygen to go around, all the systems that aren’t responsible for survival in those moments–like digestion, reproduction, immunity, and even emotional regulation–get deprioritized to ensure you get to safety.

This is how humans survived over time; our nervous system evolved to prevent us from falling asleep or thinking about reproduction when a threat is nearby (bear! lion!).

Nervous System and Hormone Imbalance

Estrogen, a key hormone that declines during menopause, significantly impacts the nervous system. This decline can lead to heightened stress responses and disrupted sleep patterns. It's not just about feeling stressed or tired; these changes can exacerbate other menopausal symptoms like weight gain and brain fog.

Regulating Your Nervous System

Fortunately, there are several strategies to help regulate your nervous system:

  • Mindfulness & Meditation: Regular mindfulness practices can reduce stress and improve your body's response to hormonal changes. Simple techniques like deep breathing or guided meditation can be powerful tools.
  • Exercise: Physical activity, especially yoga and aerobic exercises, can help regulate the nervous system. They not only improve muscle mass and energy levels but also enhance your mood and sleep quality.
  • Nutrition: Foods rich in omega-3 fatty acids, magnesium, and B vitamins support nervous system health. Incorporating these into your diet can aid in managing stress and improving overall well-being.
  • Sleep Hygiene: Prioritizing sleep is crucial. Establish a regular sleep routine (also known as sleep hygiene), limit screen time before bed, and create a calming bedtime environment.
  • Supplementation: Certain supplements, under the guidance of a healthcare professional, can support nervous system health. These might include adaptogens, magnesium, or omega-3 fatty acids.

Products That Support Nervous System Health

When considering products, look for those that support the strategies mentioned above. Whether it's a meditation app, a yoga mat, or a high-quality supplement, each product should align with the goal of nervous system regulation and overall well-being.

I started doing yoga regularly at the start of 2024 and it’s been wildly beneficial for me. I now attend yoga classes regularly several times a week. Try what works for you–perhaps you’d like to explore the serenity of meditation or supplements that can guide you into a calmer state.

One of my favorite products that helps to regulate the nervous system is the Apollo wearable, especially because it was created by neuroscientists and physicians. It delivers gentle, soothing vibrations that help the body switch from “fight or flight” to a more “rest and digest” parasympathetic state.

Apollo is designed to offer the benefits of mindful practices like meditation and breathwork through your body’s natural response to touch. It also can improve your deep sleep, REM sleep, and total sleep time. (And I’ll keep saying this: Getting better quality sleep is absolutely essential to managing your peri and meno symptoms!)

Navigating the perimenopausal and menopausal years doesn't have to be such a struggle. By understanding and caring for your nervous system, you can significantly impact your health, vitality, and quality of life. Remember, small, consistent steps can lead to big changes.

I’m always looking for affordable items for my Bettys who want to uplevel their health.  If you choose to invest in an Apollo wearable to help manage your nervous system, click HERE. A DRSTEPHANIE 15% discount will be automatically applied at checkout for you.

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

Posted on by stephanie-estima

Fasted or Fed Exercise?

TL,DR (too long, didn't read)

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

WHY

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

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

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

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

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

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

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

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

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

WHAT

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

Fasted Workouts

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

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

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

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

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

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

Fed State

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

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

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

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

HOW

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

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

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

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

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

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

NOW

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

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

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

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

Question of the Week

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

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

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

EVALUATING

Menstrual Cycle:  

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

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

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

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

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

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

TESTING & NEXT STEPS

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

YOUR TURN!

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

WHAT I RECOMMEND: Living Libations

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

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

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

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

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

P.S.

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

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