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

Fasted or Fed Exercise?

TL,DR (too long, didn’t read)

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

WHY

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

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

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

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

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

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

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

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

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

WHAT

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

Fasted Workouts

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

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

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

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

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

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

Fed State

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

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

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

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

HOW

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

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

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

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

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

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

NOW

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

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

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

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

Question of the Week

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

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

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

EVALUATING

Menstrual Cycle:  

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

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

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

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

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

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

TESTING & NEXT STEPS

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

YOUR TURN!

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

WHAT I RECOMMEND: Living Libations

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

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

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

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

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

P.S.

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

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

Mini Pause #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.