Mini Pause #27: Supplements For Performance, Recovery & Brain Health

TL;DR (Too Long; Didn’t Read)

“Question of the Week” takes the top spot this week. I’m sharing my mainstay supplement list! See the “HOW” section for how I divide these up throughout the day.

WHY

I’ve built this Mini Pause issue around consistent questions I get from my Bettys about supplements, such as: What is your daily supplement routine? What are your everyday go-to supplements? What are some non-negotiables?

I wanted to answer these for my regular newsletter subscribers – YOU!

WHAT

In perimenopause, we want to be setting ourselves up for success to recover well from our lifting sessions, help replenish lost minerals, sleep well, and protect our heart. This combination of supplements complements my diet well and isn’t overly intrusive. I bring most of these when I travel, as well.

I’m giving you direct links; some with built-in discounts, others with codes for discounts. Start exploring!

  • AG1 Greens
  • Beam Minerals Humic & Fulvic Complexes
    • Use code DRSTEPHANIE for 20% off
  • BiOptimizers Magnesium Breakthrough, up to 500 mg
  • BodyBio Omega + 2g daily
    • Use code DRSTEPHANIE for 15% off
  • Equip Foods Complete Collagen
    • Use code DRSTEPHANIE for 15% off
  • Equip Foods Colostrum Gummies
    • Use code DRSTEPHANIE for 15% off
  • Equip Foods Prime Protein
    • Use code DRSTEPHANIE for 15% off
  • LMNT electrolytes (Current obsession is watermelon with mint from my garden.)
  • mindbodygreen brain guard+
    • Use code DRSTEPHANIE for 15% off
  • mindbodygreen creatine+ with taurine
    • Use code DRSTEPHANIE for 15% off
  • mindbodygreen grass-fed whey protein isolate+ in chocolate
    • Use code DRSTEPHANIE for 15% off
  • mindbodygreen vitamin D3 potency+ 5000 IU daily
    • Use code DRSTEPHANIE for 15% off
  • Mitopure Urolithin A
    • Use code DRSTEPHANIE for 10% off
  • Qualia NAD+
    • Use code DRSTEPHANIE for 15% off
  • Qualia Night
    • Use code STEPHANIE for 15% off

HOW

First, every Sunday I replenish my supplement organizer. It’s just so efficient and I don’t have to rummage in my supplement cupboard to find what I’m looking for.

Morning (Goal: Replenish lost vitamins & minerals overnight)

  • 1 scoop of AG1 Greens in water
  • Humic & fulvic shots of Beam Minerals

With Coffee (Goal: Collagen benefits & tasty coffee!)

  • 1 scoop of Equip Foods Complete Collagen in Chocolate

Preworkout (Goal: Energy & performance)

  • 1 scoop of Equip Foods Prime Protein + Oatmeal (or any of the protein powders that are a good fit for you in my Health Toolkit)
  • 1g of Body Bio Omega 3
  • 5000 IU of mbg vitamin D3 potency+
  • 5g of mbg creatine + taurine
  • 2 capsules of Qualia NAD+

With Breakfast (Goal: Refuel & prepping my brain for a day of work)

  • 2 capsules of Mitopure Urolithin A
  • 2 capsules of mbg brain guard+
  • 2 Equip Foods Colostrum Gummies

At Night (Goal: Wind down & reduce stress)

  • 3 capsules of Qualia Night
  • 1-2 capsules of BiOptimizers Magnesium Breakthrough, up to 500 mg

I sip on LMNT throughout the day.

NOW

You certainly don’t need to do all of this, but if you’re not already, here is a list of the absolute bare-minimum essentials I feel you should be taking daily:

  • Beam Minerals
  • BiOptimizers Magnesium Breakthrough
  • BodyBio Omega 3
  • Equip Foods Prime Protein & Complete Collagen
  • mbg creatine+ with taurine
  • mbg vitamin D3 potency+

After you get into the habit of taking these regularly, you can decide whether you want to add more.

More Supplement Choices

You’ll also want to visit my online Health Toolkit for descriptions, discounts, and links to other supplements and wellness products I use and recommend. You’ll find essential amino acids, fatty acids, spermidine for anti-aging, energy boosts, and more. Choose from three categories: “I still have a regular cycle.”; “I’m in perimenopause.”; or “I’m in menopause.”

What I Recommend

Eight Sleep

Perimenopause changes often bring big sleep challenges – you may have trouble getting to sleep and staying asleep, and with hot flashes and night sweats, you can be wondering where your precious rest has gone and if you’ll ever get it back.

I used to think I was a good sleeper until I got an Eight Sleep Pod mattress cover. But I didn’t realize how much I was tossing and turning, feeling like I was overheating under my duvet, and then freezing because I had thrown it off. This would repeat throughout the night.

The Eight Sleep Pod 4 Ultra changes everything about midlife sleep and can improve the quality of your sleep dramatically. The pod cools down (up to 20 degrees below room temperature!) or warms up each side of your bed separately. And it elevates your head, which is important for women in peri or meno who tend to develop snoring.

The Eight Sleep app monitors your snoring, as well as sleep quality through your sleep stages and your heart rate variability. My HRV has gone up by 30 points since using the Eight Sleep Pod – something that I never thought was possible and now, I’m so well-rested!

P.S.

FREE Super Fertility Summit
I’m pleased to be one of the featured guests on the upcoming Super Fertility Summit hosted by fertility expert Dr. Cleopatra Kamperveen. No matter what age you’re starting or continuing your family, there are ways you can get and keep yourself in optimal health along your reproductive journey. At this summit, you learn science-based and holistic strategies to prepare your body and mind for pre-pregnancy,  pregnancy, and post-partum. Secure your spot now to this FREE event.

Requesting Input from the Bettyverse! We’re midway through the year with this newsletter and I’d love to hear if you find the information valuable and how you’re using it. Also, what topics would you like to know more about, focus on, or have me dig up research on? Send your thoughts and ideas to support@drstephanieestima.com.

Got a Question? 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.

The Secret to Better Sleep Starts With Body Temperature Regulation

As many of you know, regulating body temperature during sleep is crucial for maintaining a restful night. This becomes even more vital for women experiencing hot flashes and night sweats, which are common during perimenopausal and menopausal years. Up to 85% of women [*] face these symptoms, leading to fragmented sleep and daytime irritability. It’s a cycle that can be hard to break.

Keeping Your Cool Starts With What You Sleep On

Innovations in sleep technology keep improving and Eight Sleep has been transforming how women (and their partners!) sleep by focusing on personalized temperature regulation. The secrets lie within a mattress cover called the Pod. Here’s how it works:

Advanced Temperature Control: The Pod 4 Ultra cools and heats each side of your bed independently, with temperatures ranging from 55°F to 110°F. This feature is particularly beneficial for women experiencing hot flashes, as it helps maintain a consistent, comfortable temperature throughout the night.

Improved Sleep Quality: The Pod 4 Ultra is clinically proven to provide up to one more hour of quality sleep each night. For anyone struggling with insomnia or restless nights, this can make a world of difference.

Smart Temp Technology: This feature adjusts the bed’s temperature based on your body’s needs, ensuring you stay at your optimal sleeping temperature all night. This is perfect for those unpredictable hot flashes that disrupt sleep.

Dual Zone Temperature: Couples can enjoy personalized comfort without compromising. Each side of the bed can be set to different temperatures, allowing both partners to sleep peacefully.

Automatic Adjustments: The addition of an adjustable base supports optimal reading and sleeping positions. It even detects snoring and gently elevates your head to improve airflow and reduce snoring.

Comprehensive Sleep Tracking: With integrated sensors that monitor your sleep phases, HRV, and heart rate with 99% accuracy, you can leave your wearables on the nightstand. The Pod provides detailed insights into your sleep patterns, helping you make informed decisions about your health.

Experience the Sleep Difference

Investing in quality sleep is investing in your overall health and well-being. Don’t let temperature fluctuations rob you of the rest you deserve. Discover the transformative power of the Pod 4 Ultra today and regain restful nights and energetic days.

  • Visit eightsleep.com/DRSTEPHANIE and use code DRSTEPHANIE to get a special discount of $350 off the Pod 4 Ultra.
  • Eight Sleep provides a 30-day free trial, so you can experience the benefits without any risk.

This technology also can improve your partner’s sleep so they can better support you during your peri & meno journey. Better sleep means better everything for everyone.

Mini Pause #26: Fasting vs. Caloric Restriction: Which One Really Wins?

TL;DR (Too Long; Didn’t Read)

Fasting, it seems, is a very effective tool for caloric restriction. What it does not appear to be is a goal you should aspire to be able to do, say for 16 hours every day, just because the cool cats are doing it. It needs to be discussed so that you can choose whether fasting is an effective tool for you for the purposes of caloric restriction.

WHY

Fasting has been one of the premier topics in weight loss circles for years now. And there have been some extraordinary claims on its benefits.

Most women come to fasting as a tool for fat loss. But it doesn’t seem to be the fasting in and of itself that is the trick, but rather fasting can provide a tool for you to reduce your overall calories.

A recent randomized control trial [*] concluded that fasting in and of itself did not confer improved blood sugar management when compared to caloric restriction. Meaning–it isn’t the fasting (or the fasting window) that confers benefits to body composition changes–but rather that fasting allows for a reduction in caloric intake in a time-restricted feeding window.

Here is the conclusion of the authors:

“In the setting of isocaloric eating, time restricted eating (TRE) did not decrease weight or improve glucose homeostasis relative to a usual eating pattern (UEP), suggesting that any effects of TRE on weight in prior studies may be due to reductions in caloric intake.”

WHAT

The subjects were 93% women, with an average age of 59 years old.

The researchers split them into two groups: The first group ate throughout the whole day, and the second group consumed 80% of their calories before 1 p.m., with a maximum of a 10-hour eating window (or a 14-hour fast).

It is significant to note that both groups ate the same amount of calories with the same nutrient content. The only difference was when the calories were consumed.

After 12 weeks, there was no significant differences between the two groups in:

  • Bodyweight
  • Fasting glucose
  • HOMA-IR (a measure for insulin resistance)
  • Response to an Oral Glucose Tolerance Test
  • Glycated Albumin

HOW

Now, while this may seem damaging for fasting, we don’t want to throw the baby out with the bathwater.

Fasting can be an effective tool for some for reducing calories. If that is you, then you do you, boo! But I think it might be time for us to stop pretending that fasting has magical powers other than its ability to help restrict calories.

I also think there is something powerful psychologically about fasting. Many of us mindlessly eat and do not sink into our bodies to really see how we’re feeling. Fasting can certainly help with that, especially when your stomach is gnawing at you.

Now, do I think everyone should be fasting? No.

If you are a woman in perimenopause, your primary physical objective should be to build muscle. That means feeding your body proteins in the morning to stave off the catabolic effects of sleep and to make sure you are getting enough total calories to build strong bones and muscles. So for most women in their 40s and beyond, fasting until noon is a terrible idea.

In your 40s, you need to get AHEAD of the net muscle protein breakdown and the net bone loss that accelerates as we age. So caloric restriction, especially the aggressive kind, is not going to bode well for this kind of body recomposition.

That means you have to eat in the morning and sufficiently through the day to meet your caloric and macro requirements.

NOW

If you have found fasting to be an effective tool for controlling your calories, then keep on doing what works for you. No shame in playing the game that works for you.

Fasting is a boss at helping you reduce your calories, which can give rise to many benefits if you need to reduce your calories.

But, let’s stop pretending fasting is the only way we turn over cells (autophagy) and the magic for clearing up every ailment under the sun.

Question of the Week

Q: What time of day do you typically lift weights?

This question came in from withtanya on IG and it’s one I get pretty frequently.

My personal preference has always been to lift in the morning. A few reasons for this:

  • I feel accomplished first thing in the morning
  • Nothing for the rest of my day is going to be as grueling or as difficult as my workout, so it sets up my work day for better productivity, mood and focus.
  • I can close off the “mental tab” of my workout needing to be completed and doesn’t weigh on me over the course of the day and allows me to work on other aspects of my health that can fall by the wayside (like my steps!)

Now, is this the ideal time to workout? Research seems to agree that the ideal time for a workout is sometime between 12 and 4 p.m. This allows for your core body temperature to rise, and for appropriate lubrication of joints and tendons through natural movement. There’s also the likelihood you’ll have eaten one or two meals by that point, which allows for appropriate substrate to fuel your workouts.

I just make it work when I can make it work, and for me, that is the morning. Is it ideal, according to science? No. But it works for me.

I tried working out one day this past week at 2 p.m. because I wasn’t able to get to the gym in the morning. I had a good workout, but truthfully, I struggled. For no reason other than psychologically, I felt like I was “behind,” and it felt like a break in my cognitive rhythm of the day.

So for me, I have figured out that the morning works best with the commitments I have as a mother, and I have some marginal flexibility to move it if need be.

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

Annmarie Gianni Skincare

I frequently receive requests from my Bettys for natural skincare products that work hard for you and work with all skin types. Now, I’m so pleased to welcome you to Annmarie Gianni skincare!

I rotate through products of several brands depending on the time of year, where I am in my cycle, my skin condition due to stress or tiredness, and a host of other factors that contribute to what’s going on with my skin at any given time. I know you can relate!

Annmarie’s products are clean, organic, and wild-crafted. They nourish skin and are full of supportive activated ingredients. They’re third-party certified through MADE SAFE®, which means their products have none of the more than 6,500 substances prohibited or restricted from use in MADE SAFE® Certified products.

Since summer offers unique skin challenges, Annmarie put together a Clean Beauty Trial Kit for you that includes Aloe Herb Cleanser, Anti-Aging Serum, Anti-Aging Facial Oil, and samples of Sun Love sunscreen and antioxidant lip balm. Click here to try it! You’ll find the ingredient list, botanical infusion process, and videos on how to use each product. Here’s to a summer of great skin!

P.S.

Requesting input from the Bettyverse! We’re midway through the year with this newsletter and I’d love to hear if you find the information valuable and how you’re using it. Also, what topics would you like to know more about, focus on, or have me dig up research on? Send your thoughts and ideas to support@drstephanieestima.com.

Mini Pause #25: Try MyoReps for a Time-Saving Strength Routine

MyoReps: The Answer for Muscle Hypertrophy When You’re Short on Time

TL;DR (Too Long; Didn’t Read)

When you’re in a pinch for time, structuring your workout in MyoReps is an efficient way to build muscle. They are intense! And for the majority of the session, they work the muscle close to muscle fatigue. These were lifesavers for me on a recent trip to Europe where I was pinched for time, jetlagged, and needed to get in a good working session.

WHY

MyoReps add variety to your existing routine and keep you working out when your time constraints don’t allow for luxuriating in the gym.

The theory behind the technique is that it helps athletes to do more effective reps. This method puts the muscles under high metabolic stress to help with hypertrophy and increase muscle growth.

WHAT

MyoReps are designed to be high in intensity and short on time. Here’s the way they are typically structured:

  • Pick a heavy weight for your working set sufficient enough to approximate muscle failure. This means that by the end of your set, you might be able to–if asked–execute 1-3 more reps.
  • Wait 5-10 seconds.
  • Then start your second set. Do as many reps as you can until you’re approximately 1-3 reps from failure.
  • Wait another 5-10 seconds.
  • Begin set 3, again, aiming to do as many repetitions as you can until you fail.
  • Continue until you have executed your desired number of sets.

You can see with this shortened rest period that the accumulation of metabolites does not have sufficient time to clear, and the muscle does not have much time to recharge before starting up again. Beginning subsequent sets when the muscle is already fatigued provides a big stimulus for hypertrophy.

HOW & NOW

For your next upper body day (I do not recommend trying this with legs initially because of the sheer intensity of the workout!), try the following:

  • SET 1: Heavy weights for a set of 8-12 until failure
  • Rest 5-10 seconds
  • SET 2: Same weights as set 1, trying to get as many reps as you can before muscle failure. Aim for 8-12.
  • Rest 5-10 seconds.
  • SET 3: Repeat Set 2
  • Rest 5-10 seconds.
  • SET 4: Repeat Set 3

And voilà! That exercise is now complete. Move on to the next exercise in your program and repeat this pattern.

Question of the Week

Q: When you say ‘lift heavy,’ what does that mean exactly?

This came in from heyrachelej on IG and echoes a sentiment I get asked a lot.

Heavy means choosing a weight that, for your given repetitions in a set, you approximate muscle failure.

So let’s break this down a little bit further because most of us are not training to failure or even close to it.

You know you are approximating failure when one or both of the following happen:

  • Your velocity of the reps starts to slow down significantly.
  • The perceived weight starts to exponentially increase.

This is how you should be selecting a weight that is “heavy” and one that is appropriately heavy for you so that it approximates muscle failure.

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 Red Light Therapy

As I’m experiencing perimenopause like many of my Bettys, recovery, healing, and skin health have become non-negotiables. I discovered the Australian company BON CHARGE last year and have found numerous products that are useful within my daily routines and support my health goals.

If you’ve read my mentions before and been curious, now’s the time to learn even more and invest in devices that offer you so much direct benefit. And if you’ve already tried one product, consider adding another to your routine.

Simply click the links below and the discount will be automatically applied. There are a variety of price points for all budgets. And for those of you who have health insurance HSA or FSA accounts, BON CHARGE products are all HSA/FSA eligible. Follow a few easy steps to obtain these tax-free savings.

Whether you’re still cycling, in peri or meno, a competitive athlete, or at any point in your health and fitness journey–these are my go-to’s I hope you’ll consider:

  • Infrared PEMF Mat Max: I underestimated just how much I’d love this product. The Pulsed Electromagnetic Field (PEMF) harnesses electromagnetic wavelengths and red light therapy. I find it hard to relax–no shocker there–and this mat grounds my body and calms my mind every time. (It’s also low EMF and flicker-free.)
  • Red Light Face Mask: Red light and near-infrared light combine for powerful skin benefits. It’s now my 10- to 20-minute morning habit!
  • Red Light Neck & Chest Mask: If you’re playing catch-up with taking care of the skin on your neck and chest, this mask pairs well with the face mask to heal, firm, and smooth.
  • Infrared Sauna Blanket:  For my Bettys who want to experience all the benefits of a sauna without the monetary or space investment, the sauna blanket offers a great alternative. This one soothes my muscles after a hard lift day and helps me get to sleep.
  • Cold & Heat Therapy Massage Gun: This “hurts so good” device targets muscle soreness in the usual (and most unlikely!) areas of your body after an especially intense workout. The cold and heat combination gives you the flexibility to customize your recovery practice–genius! It’s portable, too, so you can pack it in your gym bag and use it right after working out instead of waiting until you get home.

Mini Pause #23: Meals, Muscle, Mindset & (Peri)Menopause

Hello my Bettys!

For the past 22 weeks, I’ve delivered this weekly newsletter to you filled with educational content and actionable strategies for your meals, muscle, and mindset. I’ve also included recommendations for items that put the focus on your energy, body and brain with new ways to reach your health goals. And it’s been my absolute pleasure to answer your direct questions. Keep them coming!

This weekend, I’m speaking on two stages at Europe’s Health Optimisation Summit about Cycle Syncing and Menopause. So instead of my usual article, I’m giving you a bevy of resources to dive into.

  • Missed any of the first 22 issues of Mini Pause? Read past issues here.
  • Need to catch up on the Better! podcast episodes? Listen here.
    • The June podcast lineup is all about mindset (just as essential as your meals & muscle) with four amazing guests: Dr. Emma Seppälä on personal sovereignty; Africa Brooke on self-expression; Danielle Bayard Jackson on women’s relationships; and Stephanie Harrison on finding happiness.
  • Want a customized podcast playlist based on your health goals? Take a short quiz here.
  • Prefer your Better! podcasts on video? Watch here (and please subscribe!).
  • Intrigued by the supplements, devices, and products I use in my daily routine? Explore the Health Toolkit here.
  • Check out what I’m doing day to day on Instagram here.

DID YOU KNOW?

In addition to speaking engagements, I’m invited to share my expertise with other podcast audiences. I love being able to do this and reach even more women! Here are a few of the conversations I’ve had recently about women’s health.

Biohacking Bestie with Aggie Lal: Cycle Syncing for Weight Loss, Boosting Your Metabolism, and the Dangers of Calorie Restriction (What Every Woman Should Know) Listen

Ancient Health Podcast by Dr. Josh Axe (hosted by Courtney Bursich): Empower Your Hormones: Dr. Estima’s Guide to Female Health Listen

Passion Struck with John R. Miles: Deciphering the Language of Symptoms Listen

The Optimal Body with Dr. Jen Fraboni & Dr. Dom Fraboni: Improve Your Metabolism; Body Composition; and Pain During Menopause and Beyond Listen

Coming Soon! A Premium Membership Subscription

It’s my mission to remove information overwhelm for you. So, I’m carefully curating resources designed with actionable steps that help you achieve real and lasting results in the new Premium Membership Subscription. For example:

  • Private “Ask Me Anything” episodes based on your most important and pressing questions.
  • Early and ad-free access to the weekly Better! podcasts. I go deep into my own process for living my best geeky goddess life in my mid-40’s and how you can, too!
  • A downloadable action guide for each podcast episode in either “light,” “medium,” or “dark” roast versions, including key topic points, conversation takeaways, helpful links, and more.
  • My insights from the guest discussion coupled with recommendations you can use to build habits and routines that support your goals.
  • Surprise guests and solo shows only for members.
  • Exclusive content beyond the podcast episodes.

Since you’re already getting the Mini Pause newsletter, you’ll be the first to know when the membership opens. I can’t wait to bring this new option into the Bettyverse for you!

WHAT’S ON YOUR MIND?

Send your topic ideas, feedback, and suggestions to support@drstephanieestima.com.

What I Recommend

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.

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.

You can read about how the Apollo delivers gentle, soothing vibrations that help the body switch from “fight or flight” to a more “rest and digest” parasympathetic state in this article.

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.

Mini Pause #22: Why Up Your Calories? More Muscle Growth & Less Fat Gain

TL;DR (too long, didn’t read)

Eat more calories to build muscle. At any weight. At any size. At any fitness level.

WHY

I’ve been writing over the last few weeks (Mini Pause #21 & Mini Pause #20) about why women need to stop punishing ourselves with overly aggressive caloric restriction. Bottom line: you need to eat more food to provide the building blocks to assemble new muscles.

But… just how much? And what kind? Are we talking a tub of Häagen-Dazs or is it extra steaks? How many calories above maintenance are we talking about here

WHAT

If muscle hypertrophy is the goal, you need to provide the muscle (and the bones, tendons, and ligaments that support it) extra calories to assimilate and build said muscle.

The best evidence [*] suggests that if you are a beginner, you can profit off the newbie gainz to utilize more food for muscle accumulation. If you have been training for less than a year consistently, progressing slowly in your muscle growth journey, it seems like a caloric surplus of 20-40%of your maintenance calories is ideal. This works out to somewhere between 500-1000 extra calories daily.

Remember, as a new lifter, your rate of muscle turnover is much higher than a seasoned lifter, and as such, will require more calories (hurray!)

If you are an experienced lifter, where your progress and strength gains are near maxed out, you still require a caloric surplus, but it’s much lower. Something around 10-20% caloric surplus, or somewhere between 250-500 extra calories daily.

When you are close to your natural potential in muscle size, unfortunately, your fat gain potential is higher, and so fewer calories are recommended here.

HOW

For the record–I totally get how shocking these numbers might be. Especially if you’re someone who has been under-fueling and on some sort of “diet” for weight loss for a long time. Couple this with the cultural norms of women needing to be small, skinny, petite, and delicate, and it is a mind f*ckery at its finest.

I write about periodization of, well, your period, in The Betty Body where we increase calories every month in week 4 of your cycle by about 10-15%. I get 40% caloric surplus can feel like just too much too soon, so let’s start off nice and easy shall we?

There are so many benefits to nourishing your body in the way it requires and expects of you. You can gradually increase your metabolic rate, and your NEAT output (Non-Exercise Activity Thermogenesis), and give your organs, bones, and muscles the energy they need to operate properly.

Are you with me?

NOW

  • Pick up a copy of The Betty Body.
  • Start tracking your food intake to determine what you’re currently eating.
  • You can keep these calories consistent in the follicular phase of your menstrual cycle.
  • In your luteal phase, you’re going to pinky promise me you’re going to TRY and increase your calories a little bit. Deal?
  • If you are menopausal, congratulations. You don’t have to worry about a cycle any more so you can just jump right into a caloric surplus of 10-15% today.

Question of the Week

Q: Should we be sore after a workout?

This question came in through my recent Ask Me Anything on IG. And there’s A LOT of debate around this. Here is where I stand on it:

Whenever you change up your routine (which you should be doing regularly) because it is a novel stimulus, having some soreness is normal for the first or second time you do it.

The absence of soreness doesn’t mean you didn’t work hard enough.

That being said, if you are never sore (even from a workout you are familiar with) I find this problematic. Workouts should be a sufficient stimulus that induce soreness from time to time.

For me, I am gunning for soreness in weeks two and three of my cycle. I just have the most energy, motor coordination, mental stamina, and hormonal landscape to go for it. So I’ll increase volume, weights, or both during this time.

So… I guess what I’m saying is… it depends. You know yourself best, and you know when you’re ready for a stellar workout. When you feel well-rested, mentally sharp, and prepared to work–see what you’re made of. Intermittent soreness is a good thing.

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: A Health Toolkit

I get a lot of questions from my Bettys about what they can do, take, or try to look, feel, and perform better in their lives. That’s why I compiled and launched a Health Toolkit for you this year.

I’ve curated numerous resources on my new website for my Bettys who are still cycling, experiencing symptoms of perimenopause, or going through the menopause transition. You’ll find solutions for sleep, skin, longevity, protein, energy, red light therapy, cooling hot flashes and more! Everything I recommend, I use myself. That’s my rule.

I invite you to get curious about the ways you can uplevel your health. Check out the Health Toolkit here.

And to answer the Betty question that came in regarding why I don’t use a sauna blanket anymore–I still do! (And now I interchange it with time in my Sunlighten sauna.) I love the sauna blanket for recovery after especially heavy lifting days. My preference is the BON CHARGE model. Use code DRSTEPHANIE for an exclusive discount on either sauna style you prefer.

Mini Pause #21: How Caloric Deficits Impact Your Bones, Muscles & Tendons

TL;DR (too long, didn’t read)

Caloric deficits impact the trajectory of women’s bone density and muscle mass. Caloric deficits also can impact women’s height, ability to build muscle, and menstrual cycle. We must reframe our thinking from being as skinny as possible to being as strong as possible.

WHY

Oh, look! I have more to say about chronic caloric deficits. Hold my beer.

Just kidding. I never drink the stuff. But… I have been thinking about chronic caloric deficits and the impact it has on a woman over her lifetime. Specifically, I want to talk about not getting enough calories in and how seriously it affects your bones, muscles, tendons, and joints, and injury risk.

Last week, I touched on the idea that eating in a caloric deficit can have deleterious effects not only on your gainz, but also on other important areas of female health like menstruation, bone health, brain health, and hormone production.

Let’s tuck into this a bit.

WHAT

One of the things I couldn’t shake after writing last week’s Mini Pause #20 is that most of us have been on some kind of diet for all of our lives. That means that for many women, we have been trying in some form or another to starve ourselves skinny. So at best, we have underestimated our calories thinking we are in a deficit, and at worst, we’ve fostered a real, chronic caloric deficit that impacts organ function and tissue remodeling and maintenance.

I wanted to expand on last week’s newsletter because it has real consequences on our body’s ability to function normally.

Most obviously, chronic caloric restriction is going to affect the regularity and cadence of our menstrual cycle. I write about this extensively in The Betty Body and why women are still getting periods (no matter how irregular they may be).

If your body fat percentage is too low, you run the risk of depriving yourself of ovulation, which is the main point of your menstrual cycle. In doing so, you also deprive your body of progesterone. This sex hormone is only produced when you ovulate.

Progesterone has wide-sweeping effects on the body like promoting good sleep, calming anxiety centers in the brain down, and supporting thyroid function–all three of which perimenopausal women tend to struggle with.

But there are other, perhaps more deleterious effects of prolonged caloric deficits, such as the effects it has on your bones and muscles.

Young women who under-eat and have lost their menstrual cycle as a result of over-dieting are at risk for developing irreversible damage to their skeletal system because 90% of our bone mass peaks at about 18 years of age [*]. This means that without adequate nutrition, a teenager who is undereating will impair her bone strength; change the architecture of the bone itself, causing it to have a higher affinity for bone fractures; and can even change her final height [*]. It puts this young woman at a higher risk of vertebral fractures throughout the rest of her life, even if she resumes normal eating patterns.

Having seen my fair share of vertebral fractures in my clinic, this is something you want to avoid at all costs. It is painful and disruptive, and the rehab is incredibly difficult from both a physical and mental point of view.

Amenorrheic episodes (months without ovulation) also impact your anabolic hormones like estrogen. Without a regular menstrual cycle, you would be considered hypoestrogenic, which is not too dissimilar to what we see in the final stages of perimenopause and menopause.

In both age groups, we see a fraying of the bone architecture, an increased susceptibility to fractures, and reduced bone strength. We want bones that are more “bendable” to withstand the forces on them. The more brittle and less “bendy” a bone is, the more likely it is to snap.

The other deleterious effect chronic caloric deficits have are on our body’s ability to repair and grow new muscle tissue. Muscle is so much more than aesthetic, as you know. Undereating is associated with impaired myofibrillar and sarcoplasmic muscle protein synthesis [*], compared to training with optimum energy availability.

Being on a chronic diet for YEARS is going to measurably impact your muscle mass, bone density, injury risk, and organ health. And it will catch up to you eventually.

HOW

I wish I could snap my fingers and wake us all up from the collective spell of wanting to be skinny, but the truth is, each of us will have our own paths to this awakening. What I can say to the well-intentioned woman (possibly the one reading with a touch of cynicism who gets what I’m saying intellectually but emotionally still desires to be small) is that your worth is not what the scale says.

If you have a lot of muscle mass, you are likely going to be heavier than whatever arbitrary number you have in your head. That number by the way has been subtly implanted from reading Cosmo, Teen Cosmo, and whatever other junk we grew up reading.

Think deeply about the images of thinness growing up. Women in perimenopause know this intimately because if you are around the same age I am, you grew up with Kate Moss and the advent of the grunge and heroin-chic look.

I distinctly remember as a teenager who was studying fashion magazines, that my body was just not built like the girls on these pages. I have thighs that are always going to touch. I have hips made for childbearing. I am just built differently.

Of course, these physical qualities have been in vogue as of late, which also just goes to show you the standards of beauty are always changing. So find the beauty in your own damn self and stop looking for external validation. Love your freckles, your scars, your hair color. Because soon stars will take out their BBLs, strong Roman noses will be the new ideal, and thin eyebrows will be back.

Point is–the house always wins. So be the house. Not the player.

NOW

  • Play India Arie’s “Because I Am a Queen
  • Think about your relationship with food and dieting and what messages your daughters and sons are receiving. Is it good? Bad? Neutral
  • Contrast that with how you would like to show up for yourself, your family, and your community.
  • Can you experiment with eating a little more? What if you started with simply 100 calories more of protein? Could you make that work?

Q: I know I need more calories in my luteal phase. Can I increase fat? Or do I need to add more carbs?

Short and to the point for Divie3 from Instagram today.

Yes, if you are hungrier you definitely need more calories. I usually recommend something like 10 to 15 percent more than you are eating in your follicular phase. The first thing is to make sure your protein intake is adequate. Typically something like 1g of protein/per ideal pound of body weight. After that you can dial up fat or carbs; whatever tickles your fancy!

YOUR TURN!

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

What I Recommend: Red Light Therapy

I’ve added another component of light therapy to my recovery practice. (Yes, that’s really me lying on it in the photo).

While my Bettys know how much I rely on science when it comes to all things wellness, I’m going to admit that the PEMF Mat by Bon Charge both soothes and energizes in ways I wasn’t expecting–and I loved it right away.

It’s a pulsed electromagnetic field mat that works with your body’s natural magnetic field and uses bioactive wavelengths combined with red and near-infrared light. An additional far-infrared light component warms your body.

You can use the PEMF Mat during yoga, stretching, or grounding while lying down. You can even read a book or take a nap. The Mat’s programming allows you to choose sleep, grounding, focus, or meditation and relaxation.

And ever searching for ways to be more efficient, I combined my Red Light Face Mask and Red Light Neck & Chest Mask with time on the PEMF Mat. It’s a triple win for wellness. Speaking of triple, the PEMF Mat now comes in three sizes: a sitting pad, a demi size, and the full size.

View the entire Red Light Therapy Collection here and use code DRSTEPHANIE to save 15% off sitewide.

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 #18: Deload Weeks & Physical Breaks: Rest=Progress

You Must Squat Before You Jump: Deload, Take a Break, and See Even More Gains

TL,DR (too long, didn’t read)

Deloads are a necessary part of training hard [*] when you are chasing all those gainz. They are often a welcome relief when you have accumulated sufficient stress and fatigue in your training regimen. This happens somewhere between four to eight weeks of intense training and allows for proper recovery.

Deloads can be a drop in weight or volume in your regular program, or you can choose to take a week off altogether. This week I am opting for a reduction in both volume and weight to help with my own (very overdue) deload week.

WHY

I’ve been feeling kind of run down and tired lately, and I’ve been trying to put my finger on what it is. I’ve been sleeping well (better than I ever have, truthfully, consistently hitting new PRs at the gym, and my nutrition is no different than it normally is.

But somehow, I’m exhausted, recovery is taking longer, and I’m even dreading the gym.

Now y’all know something is off when I am not excited about gym time. That’s my happy place!

I took a look at my volume and my progression over the last six months and then it hit me like a 1 Rep Max sumo squat. I’ve accumulated too much physical fatigue, and I failed to schedule a deload week [*].

When I first wrote about training around your cycle in The Betty Body, I naturally built a deload week into Week 4 of the cycle of training with lighter weights than usual. Although it wasn’t intentionally programmed as a deload week in the book, for cycling women it’s a nice anchor to be able to think about a lighter workout in the late luteal phase of your menstrual cycle. This helps to reduce the physical and often psychological stress that accompanies this time of the month.

I find I require a lighter week either on Week 4 or Week 8 of steady training. But for whatever reason, I’ve trained 16 heavy weeks in a row. That explains my current disdain for the gym and poor recovery recently. I’ve been noticing I have been much more sore than normal, taking at least a day longer than I normally do to recover. From leg workouts, specifically.

WHAT

Everyone who’s lifting weights close to failure can and should be thinking about building in regular deload weeks to reduce physical and mental stress and fatigue and to help you push in the next cycle of lifting. For my Type A Boardroom Bettys where I can ALREADY see your brains working (“Maybe I don’t need a deload! I should continue to push despite what she is saying!”), deloads are a necessary part of any intense training regimen. It doesn’t mean you’re broken, failing, or not making gains. By contrast, it’s how you make EPIC gains. In recovery.

Deloading is a crucial part of any well-rounded fitness routine to help reduce overall fatigue, reduce the risk of injury, and help your lifting become stronger in the following weeks. In the same way, you need a break from your diet now and then, the same is true for your physical diet.

When you are training hard, there is a predictable accumulation of stress and fatigue. There is nothing to fear about this, as this is how you get better and improve your energy levels, body composition, and strength.

But when you have accumulated too much stress and fatigue over several weeks or months of training, you can and should actively reduce it so you can facilitate recovery and get back to progress the next week.

Generally speaking, you know you are ready for a deload week when you have had two or three workouts of the same body part where you are either not making any progress, your recovery is longer than normal, or worse, you are regressing in your program.

Let me illustrate with an example.

Let’s assume you train legs on Tuesday and Friday. On both those days, you’d experience substandard workouts in the absence of any other explanation (jet lag, a child was sick, a stressful time at work, etc.).

And even if it were the case where your psychological stress was acutely through the roof, I’m going to gently remind you that psychological or mental stress also accumulates in the physical realm. This would be your cue to lighten up.

HOW

The No. 1 rule about a deload week is KISS: Keep it Simple Smartypants.

Once your strength is not improving by your typical measurements (weight, volume, etc.) for two or three consecutive workouts, it’s time to take a break and amp up recovery.

Here are a couple of ways you can structure a deload:

  • Reduce weights
  • Reduce volume
  • Reduce weight and volume
  • Do absolutely nothing (not a typo and a perfectly reasonable option)

Typically when I deload, I reduce both weight and volume by about 50 percent.

Yes, by that much.
Yes, it seems like a lot.
Yes, these workouts are easy.

So let’s say I am regularly squatting 135 lbs for 10 reps for 3 sets. I might structure a recovery week in the following way:

  • Deload Leg Day 1: 3 sets, 10 reps, but the weight will drop to 67.5lbs (this includes the bar at 45lbs, so using gym math that is 22.5 lbs of weight on the bar, so I usually just round up to 12.5 lbs per side)
  • Deload Leg Day 2: 3 sets, 5 reps, 67.5 lbs (weight and volume drop)

So you can see that I initially just dropped the weight, but kept the volume consistent. On the second leg day of the week, I dropped both the weight and the volume. It feels like an easy workout. And that’s the whole point. You’re training easier this week so you can better recover.

When I structure my deloads so that the workouts are progressively easier for the week, I’m absolutely itching and ready to get back at it the next week. This is because I’ve dropped the stress of the workouts considerably, allowing for my body’s recovery processes to get ahead of the stress I have accumulated. I always find that in the weeks following a deload, I often hit a new personal best.

The important takeaway? When you structure your deload weeks this way, you can still work on your technical skills with the lighter weight.

And in total transparency–about once a year–I simply need a complete break from the gym. A 100% complete drop in volume and weights for at least half a week, and often a full week.

I just get to this place where I don’t want to be in the gym at all, and I honor that. So I will get in a lot of walking, sleep in, spend lots of time in the sauna, and do cold plunges. (I’ve linked my heat and cold recovery tools here for you to explore. Use code DRSTEPHANIE for each to receive an exclusive discount.)

For me, this week I am opting to drop weights and volume on all workouts all week long.

NOW

If you have been noticing your workouts suffering and an inability to progress with at least two workouts feeling like they were crappy, decide to take the next week to amplify recovery. Here are two possible approaches:

  • Reduce your volume, your weights, or both while still training at the same frequency.
  • Take the week off completely. Go for some walks, do some yoga, practice mindfulness, sleep in, and allow your magical body to do its thing.

Prepare your mind for the deload. It isn’t a failure, a setback, or anything of the sort. Think about jumping. Usually, the lower you can go into a squat, the higher you can jump. Think of deloads this way. The squat part of the jump.

Question of the Week

Q: I know rest days are important when working out. I’ve heard women in perimenopause and postmenopausal women should have more than two rest days a week. What are your thoughts?

Thank you to reader Gina G. for asking this question that fits in so well with today’s main topic on deloading!

I am not one for hard rules that apply across the board, so I will say that you should take as much rest as you need. And when you are fully recovered–get back at it!

If you are regularly training legs, let’s say, you can aim to train them twice a week, but if you feel like in between those sessions you are not sore, have the energy, and can easily fit in another workout, you should definitely try it out and see how you respond!

I typically take one full day off and my shoulder days are lighter in terms of energetic output. Sometimes I’ll throw in one or two leg exercises at the end of a shoulder day. Not all the time–just when I have the energy.

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.”