Mini Pause #6: Your Metabolism & Body Composition

Is Your Metabolism Slowing Down as You Age? The Surprising Answer

TL;DR

Welcome to this part of the internet where we consider how both lifestyle (nutrition, muscle building) AND hormone changes contribute to body composition changes in women in their 40s and 50s.

The online debates have been spicy lately, and I’ll get in the ring with some data and clinical insights to help you better understand your changing physiology. It is not simply calories in, calories out OR just hormones.

Turns out, like most things, the truth lies somewhere in the forgotten middle.

WHY

For decades now, women have been told to “suck it up buttercup” when it comes to body changes as we age:

“This is just part of aging.”

“This is your new normal.”

“Your metabolism isn’t what it used to be.”

Debates continue on the mechanism for excess and unwanted fat deposition for women in perimenopause and menopause. So many women in the Bettyverse have told me that despite dialing in nutrition and exercise they have continued to gain weight (usually through the midsection) DESPITE these efforts.

When we are told to simply eat fewer calories to compensate for the weight gain, or to increase our physical activity — this advice fails to encompass the totality of what is happening. It is part of it, but not all of it.

So is it metabolism? Is it hormones? What’s driving this persistent change in our body composition?

WHAT

Metabolism — Does it Change With Age?

Conventional thinking tells us that as children, our metabolism is elevated and reaches a peak in our mid-20s. This does not seem to be true.

This study set out to investigate the effects of age, sex, and body composition on total body expenditure and other components of metabolism. It was a nice size (6421 participants, with 64% of them female) with geographically diverse backgrounds from 29 different countries. They looked at men and women from 8 days of age to 95 years old.

A few interesting trends emerge from this study.

  • First: In the cohort of 20- to 60-year-olds, metabolism remains virtually unchanged. This remains true even during pregnancy! It is only around the 63-year-old mark that metabolism begins to decline.
  • Second: The single biggest predictor of your metabolism is directly related to your fat-free mass. For an in-depth look at FFMI, listen to my Better! podcast conversation with Dr. Tommy Wood.

Both of these findings are great news for Bettys navigating perimenopause and menopause! Why? Because it gives us a sense of agency, at least partially, over our bodies in our 40s and 50s.

The biggest predictor of your metabolism is how much muscle tissue you have (and by way of extension your bone density). That IS something you can control. Type A personalities rejoice and say it with me, “WE CAN CONTROL SOMETHING!”

However, metabolism is only a part of body composition. How many calories burned is one thing, but fat distribution, type of fat accumulation, insulin resistance, and the loss of anabolic hormones (estradiol and testosterone) contributing to the loss of lean muscle mass is quite another.

During perimenopause and menopause, your tissues become more insulin resistant as a natural consequence of aging. This makes it harder for your cells, tissues, and organs to get the nutrients they need to produce energy.

We know that insulin resistance shows up in skeletal tissue for decades despite euglycemic levels. Said another way: Your muscles can be insulin resistant for YEARS and yet, you can have normal blood sugar because your pancreas can pump out more insulin to counteract the rising blood sugar levels.

The net effect of insulin resistance is ​​fat production and accumulation in the liver (referred to as de novo lipogenesis) — also known as visceral fat. This is often the reason why women see their cholesterol levels skyrocket in perimenopause and menopause despite “doing everything the same.”

But wait, there’s more!

Declining estrogen levels during perimenopause are also part of the reason you see visceral fat distribution favored over subcutaneous fat deposition in your 40s and 50s.

The phenotype of fat literally changes during menopause where your body will preferentially begin to accumulate fat on your organs versus accumulating fat under your skin.

The fat under your skin is largely harmless despite your general disdain for it.

The fat that accumulates around your organs, however, has terrible consequences for your health including skyrocketing the development of cardiovascular disease, Alzheimer’s disease, type 2 Diabetes, cerebrovascular disease, and stroke.

There also is ample evidence that visceral fat is incredibly inflammatory. This leads to premature aging of your cells, tissues, and organs, and generally makes you feel awful.

So, you must consider BOTH lifestyle and hormonal interventions.

HOW

Lifestyle Interventions

 

1. Consider the composition of your calories.

  • In my book, The Betty Body, I detail a female–centric ketogenic diet for women looking to lose weight, and more specifically, lose visceral fat.
  • The ketogenic diet ( high fat, moderate protein, and low carbohydrate) has been shown to improve all measures of body composition including body weight, body mass index, waist circumference, fat mass, fat–free mass, lean body mass, visceral adipose tissue, and body fat percentage

2. Lift heavy weights with the intention of putting on muscle mass.

  • “Heavy” means different things to different people, but as a general guideline, the last few repetitions of a set should be very difficult.
  • You should still be able to rep out good form, but the intensity should be an 8 or 9 out of 10. Forget 3 sets of 15.
  • Work until the muscle is done like dinner.

3. Exercise snack your way through the day.

  • I detailed the utility of exercise snacks and their benefits on lipids, body composition, and overall health here.
  • We are designed to have a lot of low-grade activity throughout the day. If you are someone who sits at a desk for several hours a day, consider investing in an under-desk treadmill and a convertible desktop stand to be able to get some consistent walking through the day. It doesn’t need to be fast: 1.0–1.5 mph is plenty!

Hormone Replacement Therapy

 

  • I’m a big fan of HRT, and think this can and should be started as soon as there is evidence your body is struggling to produce adequate levels of estrogen, progesterone, and testosterone.
  • I always recommend getting blood work every six months to monitor your levels — or sooner if you think something is up.
  • Consider starting HRT in perimenopause when things go awry and plan to be on them for the long haul.
  • Don’t go it alone. Make the HRT decision in tandem with your doctor.

Bonus! Take a listen to my in-depth discussion about the Women’s Health Initiative and why it was a colossal failure for our beautiful menopausal women — check it out here.

NOW

  • Pick up a copy of The Betty Body to learn how to apply the ketogenic diet as a mechanism to reduce body weight, body mass index, waist circumference, fat mass, visceral adipose tissue, body fat percentage, and increase fat–free mass and lean body mass.
  • Book an appointment with your doctor to discuss HRT. At the very least, get some blood work done!
  • Start lifting weights intending to increase muscle mass. Intensity is key here. Work the muscle close to (but not at) muscle failure. For most women, rate your set intensity between 8 or 9 out of 10.

QUESTION OF THE WEEK

Q: Post-workout soreness: How much is considered normal? (If any?)

This is a great question! I’m going to nerd out and break this down into the different components that might be contributing to your soreness. Let’s also look at whether or not they are “common” or “normal.” Much of it has to do with different fatigue types related to recovery.

Muscular Fatigue / Soreness

This is the soreness in the muscle/muscle groups you’ve trained.

There are many reasons for muscle soreness and fatigue. The most common one being a novel stimulus. If you went to the gym on Monday, found your groove, felt like Woman Woman, and decided to either change up some exercises in your routine and/or add weight to the exercises, this can elicit soreness in your muscles.

DOMS (delayed onset of muscle soreness) can occur up to 72 hours after the stimulus as the muscle tissue repairs and remodels itself.

This type of soreness is not required each time you train, but out of the different types I’m going to describe it is the most desirable one. If you trained your glutes on Monday, and on Tuesday your glutes are sore, it’s an indication that the novel stimulus has been directed at the target muscle group. If you’re sore in your biceps after training glutes, that’s a problem.

To develop strength (hypertrophy), you don’t always need to be sore. It is not an indication that you had a successful lifting session.

Said another way: If you’re NOT sore in your glutes on Tuesday when you trained them on Monday, it doesn’t necessarily mean nothing happened.

This is normal to feel or not to feel. I love it when I can feel some muscle soreness, but I don’t hinge the success of my lifting session based on it.

Joint, Tendon, Connective Tissue Fatigue / Soreness

This is soreness originating from the joints, connective tissues, or tendons.

We really want to minimize this type of soreness both during the workout and in the recovery period afterward. Feeling pain or soreness in these elements can indicate that there may be a technique issue with compensatory movement patterns present.

For example,  you really shouldn’t feel pain in your shoulder joint when doing a side lateral raise, or pain in your knee when doing a squat. If you are, it is a possible indication of aberrant mechanics during the move itself. This partially translates the force to the non-contractile tissue. This could be muscle movement patterning, a lack of mobility at the joints themselves, or both. It could also be that for your biomechanics, that particular movement isn’t optimal for YOU. There are many other ways to shred your legs and grow your shoulders.

You want this type of fatigue and soreness to be as close to zero as possible. It is certainly not normal to be feeling this kind of soreness all the time.

Axial Fatigue / Soreness

This is the fatigue and soreness through the spine and back from spinal loading.

It’s anything that loads weight on your spine top to bottom (e.g., putting a barbell on your back) or from hinge movements like a deadlift where a lot of the lower, mid, and upper back muscles, as well as the deep muscles of the back, are involved in stabilizing and executing the movement.

While not inherently good or bad, we want to be mindful of excessive axial loading being the limiting factor in lower limb progression.

For example, when I’m training my legs, I have to be mindful in between sets that both legs are sufficiently recovered AS WELL AS my lower back before I start again. My glutes can be ready, but if my lower back still needs a minute I wait until any secondary mover (in this example my lower back) is ready again. Otherwise, it’s going to be my back that limits my execution, energy, and form on the next set.

Your back is designed to carry heavy loads and with training, you will necessarily experience some axial loading. Fatigue is normal.

Ensure you’re 1) giving yourself sufficient rest in between sets, and 2) giving yourself adequate time between leg days.

Overall or Systemic Fatigue

This is the fatigue that occurs after too many days of poor recovery. It can be many weeks or months before you feel the effects.

You might notice that you begin to experience brain fog after workouts, or you’re generally less excited about training in general.

Other markers like poor sleep, excess or prolonged soreness, or any other types of fatigue above are beyond what you would consider normal.

This lack of desire when you have been able to demonstrate a consistent training schedule in the past is usually a gentle reminder to take a break.

A lot of women dealing with autoimmune conditions might experience systemic fatigue when they have pushed it too far in the gym. Learning how to stimulate — not annihilate — your muscles when dealing with an autoimmune condition might be tricky, but it’s fundamental to train at 40–50% less capacity so you don’t overwhelm an already overwhelmed immune system.

When you experience overall fatigue like this, it might be time for a deload week (another topic I will be exploring), or taking a few days off altogether.

What I Recommend: LMNT

Because you lose water and sodium when you sweat, you have to replace it. The water? Pretty easy. The sodium? It’s got to be the right kind of electrolyte mix. LMNT combines sodium, potassium, and magnesium. This trio helps prevent muscle cramps, headaches, and energy dips.

For my Bettys in a cold climate, your hydration needs go up in winter. And while I’m truly a fan of LMNT’s limited-edition Chocolate Medley for hot drinks, the Chocolate Mint was a surprise. (I actually don’t like chocolate mint anything.) I wanted give it a fair shot, though, and ended up loving the taste. I mixed it with hot water. Super simple and the perfect complement to a snowy day at home this past week.

For my Bettys in a hotter climate, you’ll want to try the Watermelon for some refreshingly fruity, zero-sugar hydration.

When you go to drinklmnt.com/drestima, you’ll get a free LMNT Sample Pack of flavors with your order. I know you all love recipes, so be sure to visit LMNT’s “Recipes” section for some salty inspo.

P.S.

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 #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.