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

TL;DR (too long, didn’t read)

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

WHY

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

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

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

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

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

WHAT

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

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

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

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

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

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

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

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

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

AND you’re putting yourself at risk for injury.

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

HOW

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

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

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

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

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

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

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

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

NOW

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

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

Question of the Week

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

IG follower nomad_ad asks a question many women grapple with.

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

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

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

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

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

Does that mean you should never exercise?!

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

Here are some great things cortisol does in the body:

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

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

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

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

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

YOUR TURN!

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

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

What You Can Do About Frozen Shoulder in Perimenopause

TL,DR (too long, didn’t read)

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

WHY

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

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

WHAT

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

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

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

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

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

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

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

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

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

HOW

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

MOBILITY

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

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

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

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

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

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

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

METABOLIC HEALTH

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

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

NOW

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

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

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

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

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

Question of the Week

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

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

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

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

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

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

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

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

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

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

YOUR TURN!

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

What I Recommend: OneSkin

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

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

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

Mini Pause #3: Add ‘Exercise Snacks’ To Your Movement Menu

Exercise Snacks: An Easier (Better?) Way to Stick to Your Goals


TL; DR (too long, didn’t read)

Exercise Snacks (exercising in small 5- to 10-minute increments through the day) yield the same, if not slightly better, results than one big session at the gym.   

And we are not just talking about waistline — exercise snacking demonstrates improvement across fasting insulin, fasting glucose, lipids, and cardiorespiraory fitness. They also show a slightly better outcome in body weight and LDL cholesterol!  

WHY

January is a busy month for gyms. If you’ve just joined a gym, or even if you’re a seasoned muscle mommy like me, you may be feeling some of your original New Year’s goals already falling by the wayside. But have no fear — if you’ve set a goal and are having a hard time keeping up with an aggressive gym schedule you’ve set for yourself — I have a solution for you!

Simple exercise snacks.

Since the pandemic, more and more people work from home either permanently or have a hybrid model working from home and being in an office. What has emerged are new work norms that allow you more freedom to find opportunities in your day for movement.  

I’ve always said moving consistently through the day trumps one big workout followed by sitting for 12 hours. And there’s robust scientific evidence to back this up.

WHAT

This meta-analysis looked at 19 studies with a total of 1080 participants. They were looking for studies that evaluated whether one bout (continuous) of exercise was better, worse, or equal to the same exercise broken into smaller pieces through the day (cumulative or what I am referring to as “exercise snacking”).

They controlled for intensity of the exercise, duration, and type of exercise. Said another way: they were looking for the exact same workout either 1) completed in a single session, or 2) broken up into smaller chunks over the course of the day.

Results showed that the exercise snack group and the single bout group both reduced their total body mass, but the exercise snack group fared slightly better. The exercise snack group and the continuous exercise group both improved their LDL cholesterol, with the snackers faring slightly better here as well.

Both groups improved their total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, and fasting insulin.

Bottom line: both a continuous session at the gym AND exercise snacks can yield comparable results.

There’s mounting evidence that exercise snacks have incredibly positive benefits on your health:

  • like this study looking at exercise snacks on blood glucose levels after a meal
  • or this one on how exercise snacks lower blood lipids after a meal
  • This study showed that 1 minute of all-out sprints (broken down into 3 x 20-second sprints, bookended by 2-minute warmup and cool down) improved cardiometabolic and mitochondrial health AS MUCH AS individuals doing cardio for 45-50 minutes. That’s five times less time and volume!

Pretty compelling, right?

Exercise snacks also alleviate the pressure to get in a big exercise session every day. If you’re able to replicate a 1-hour workout in smaller pieces through the day, the results seem to be equivalent at worst, and superior in terms of body mass and cholesterol levels at best.

HOW

You’ve got two options on how to implement exercise snacks. You can use either option or a combination of both.

  • Option 1: Replace your Gym Session with Exercise Snacks


In order for this to work, you have to think about the intensity and duration of your regular workouts. You’ll want to match your regular, continuous workout by breaking it down into smaller bits.  

So, if you are working out for 60 minutes, your exercise snacks should add up to 60 minutes over the course of the day. That could be 6 x 10-minute sessions, or 12 x 50-minute sessions. And you MUST match the intensity of your regular workout.  

Intensity is subjective, but you can think about it on a scale of one to 10: One being pretty low intensity, and 10 being all out. If your continuous workout was an eight, the exercise snacks also have to be an eight.

This is a GREAT option if you struggle with the time commitment for a bigger gym session, if you travel frequently, or if you’re the family chauffeur driving kids to after-school activities.

  • Option 2: Keep Your Gym Session and Incorporate Exercise Snacks


In full transparency, this option is what I like to do. I’m one of those people who actually enjoys going to the gym. But after researching this topic for this week’s newsletter, I’m going to incorporate more exercise snacks into my day — even on days I get in a workout.   

Exercise snacks are a blessing on travel days, when I’ve slept in and don’t make it to the gym, or for hectic days when I’m just not getting to the gym that day. It’s reassuring to know that these days aren’t a regression, but a progression.

And frankly, these exercise snacks are one of the few reasons I get my sprint training in on my CAROL Bike. I can pop on it and in 5 minutes, I’ve done 3 x 20 second all-out sprints — and haven’t broken a sweat! (If you find you’re interested in a CAROL Bike, you’ll get a discount using code DRSTEPHANIE.)

NOW

Here are some of my favourite exercise snacks. I encourage you to try these and be creative with your own based on how you like to exercise.

  • While I’m making dinner: 20 pushups, 20 air squats, 20 switch lunges
  • While I’m waiting for a plane: walking lunges back and forth near the boarding gate; wall sits; decline pushups at the gate chair
  • When I have 10 minutes before a meeting starts: CAROL Bike sprints (30-second sprint, 90-second recovery, then repeat 3x), or 30 box jumps on plyo boxes I have at home.
  • When I can opt for walking meetings : I’ll take a call and go for a walk around the block. Pro tip: if you have an iPhone, put the “Voice Isolation” mode on. This prioritizes your voice over background noise. I have taken calls at loud airports and at my kids’ soccer games where people are screaming. The lucky caller on the other end of the line cannot hear anything but me.
  • When I’m on soccer mom dutyI alternate lunges on the side of the pitch while my boys practice, and in the summer I sprint around the track (if there is one). This helps me feel less like an Uber driver.

Submit Your Exercise Snacks!

Let us know if you already have some great exercise snacks. Or, if you’re inspired to create new ones, share those, too. Reply to this email and we’ll compile some of the best ideas from you in a downloadable PDF!

Question of the Week

Q: What do you eat after one of your workouts?

I’m preparing a bigger newsletter for you on peri-exercise fuel, but here are some guidelines following a workout.

RESISTANCE TRAINING & CARDIO

I always follow any lift session or cardio with a combination of protein and carbohydrates.  On mornings when I exercise early, this will be breakfast. One recent morning I had five egg whites + one whole egg omelette on a piece of sourdough toast. On the side was 1/4 avocado and some fruit. I also treat myself to a cappuccino with whole fat milk. Not a Starbucks triple grande venti purple long short with sprinkles and foam (or whatever the cool cats are drinking these days) but a regular 3/4 cup-sized cappuccino cup.

If I am about to get my period, I’ll also add in one scoop of protein in water as my “drink” instead of water. I do this because I know I’m going to be hungrier in week four of my cycle, and I preempt that with more calories and specifically more protein.

(If you want to learn more about eating around your cycle, check out my book, The Betty Body.)

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: BON CHARGE

Sometimes all the “steps” for skin care can feel overwhelming. I like efficiency, and I prefer a simple daily routine that doesn’t take a lot of time. I also want great skin.

When I found the Bon Charge Red Light Face Mask, it checked all the boxes and more. It combines red and near-infrared light to diminish fine lines, scars, and blemishes. No matter what your skin type, you can experience a brighter, healthier complexion and firmer, more youthful skin using this mask. I love the results I’ve gotten.

I keep this mask beside my desk and work with it on because it molds comfortably and easily to my face. I can choose the intensity and wear it for as little as 10 minutes and still get all the benefits.

I invite you to visit Bon Charge to learn more about the Red Light Face Mask. Use code DRSTEPHANIE to save 15% sitewide.